Evaluating the role of smoking abstinence expectancies in the relation between perceived ethnic discrimination and cigarette dependence among Latinx individuals who smoke.

The experience of perceived ethnic discrimination is prevalent and has harmful effects across various behavioral health processes among Latinx persons. Yet, there is limited work on the association between perceived ethnic discrimination and smoking among this health disparities group. Building from initial work that has demonstrated a relationship between perceived ethnic discrimination and smoking abstinence expectancies, the present study sought to explore mechanisms by which perceived ethnic discrimination may be related to cigarette dependence. Specifically, we tested the indirect effect of perceived ethnic discrimination on cigarette dependence through smoking abstinence expectancies (i.e., negative mood, somatic symptoms, harmful consequences, and positive consequences) among Latinx persons who smoke (N = 338; Mage = 35.53 years; SD = 8.65; age range 18-61; 37.3% female). Results indicated that abstinence expectancies related to harmful consequences was a statistically significant underlying factor between the experience of perceived discrimination and cigarette dependence (b = 0.39, SE = 0.16, CI95% = 0.08, 0.71, CSE = 0.14). Overall, the present study suggests that smoking abstinence expectancies pertaining to harmful consequences may be a point of intervention for Latinx persons seeking to reduce or quit smoking. Future research is needed to extend the generalizability of these findings by corroborating the mediational role of abstinence expectancies related to harmful consequences across Latinx persons of varying cigarette use severity levels over time.

The Need for Responsive Workforce Development During the Pandemic and Beyond: A Case Study of the Regional Public Health Training Centers.

CONTEXT: The COVID-19 pandemic underscored the importance of a strong public health infrastructure for protecting and supporting the health of communities. This includes ensuring an adaptive workforce capable of leading through rapidly changing circumstances, communicating effectively, and applying systems thinking to leverage cross-sector partnerships that help promote health equity. The 10 Regional Public Health Training Centers (PHTCs) advance the capacity of the current and future public health workforce through skill development and technical assistance in these and other strategic areas. PROGRAM: This study examines activities through which the Regional PHTCs and their partners supported the public health workforce during the pandemic. Representatives of the 10 Regional PHTCs completed a survey in the spring of 2022. The survey included (1) pulling trends in training usage from 2018-2021 annual performance reports and (2) questions assessing the type, content, and reach of training needs assessments, training and technical assistance, student placements, and PHTC Network collaborative activities that occurred from January 1, 2020, to December 31, 2021. Respondents also reflected on trends in use, challenges, lessons learned, stories of impact, and future PHTC practice. EVALUATION: During the pandemic, the Regional PHTCs engaged in numerous efforts to assess needs, provide training and technical assistance to the practice community, facilitate projects that built student competency to support public health agency efforts, and collaborate as the PHTC Network on national-level initiatives. Across these activities, the Regional PHTCs adjusted their approaches and learned from each other in order to meet regional needs. DISCUSSION: The Regional PHTCs provided student and professional development in foundational public health knowledge and skills within their regions and nationally while being flexible and responsive to the changing needs of the field during the pandemic. Our study highlights opportunities for collaboration and adaptive approaches to public health workforce development in a postpandemic environment.

A comprehensive analysis of neuroblastoma incidence, survival, and racial and ethnic disparities from 2001 to 2019.

BACKGROUND: We characterize the incidence and 5-year survival of children and adolescents with neuroblastoma stratified by demographic and clinical factors based on the comprehensive data from United States Cancer Statistics (USCS) and the National Program of Cancer Registries (NPCR). METHODS: We analyzed the incidence of neuroblastoma from USCS (2003-2019) and survival data from NPCR (2001-2018) for patients less than 20 years old. Incidence trends were calculated by average annual percent change (AAPC) using joinpoint regression. Differences in relative survival were estimated comparing non-overlapping confidence intervals (CI). RESULTS: We identified 11,543 primary neuroblastoma cases in USCS. Age-adjusted incidence was 8.3 per million persons [95% CI: 8.2, 8.5], with an AAPC of 0.4% [95% CI: -0.1, 0.9]. Five-year relative survival from the NPCR dataset (n = 10,676) was 79.7% [95% CI: 78.9, 80.5]. Patients aged less than 1 year had the highest 5-year relative survival (92.5%). Five-year relative survival was higher for non-Hispanic White patients (80.7%) or Hispanic patients (80.8%) compared to non-Hispanic Black patients (72.6%). CONCLUSION: Neuroblastoma incidence was stable during 2003-2019. Differences in relative survival exist by sex, age, race/ethnicity, and stage; patients who were male, older, non-Hispanic Black, or with distant disease had worse survival. Future studies could seek to assess the upstream factors driving disparities in survival, and evaluate interventions to address inequities and improve survival across all groups.

The emergence of young children's tolerance for inequality: With age, children stop showing numerically sensitive fairness.

One persistent and pernicious feature of outstanding social inequality is that even relatively extreme forms of inequality can be justified with reference to merit-based considerations. One key feature of fairness with respect to resource allocation is that it is numerically sensitive; greater (more extreme) inequalities are generally seen as less fair than less extreme ones. This work sought to document the emergence of numerically sensitive fairness in children aged 4 to 8 years. A total of 81 4- to 8-year-olds completed a series of within-participants fairness judgment trials in which they observed two characters receive either equitable or inequitable shares of resources-ranging from 50/50 (completely fair) to 0/100 (completely unfair)-in two contexts: one in which the two characters were described as working the same amount (equality context) and one in which one character was described as working harder than the other character (merit context). Children of all ages showed numerically sensitive fairness in the equality context. However, whereas younger children continued to show numerically sensitive fairness in the merit context, older children approved even relatively extreme inequalities when one person was described as working harder. This effect emerged with age, suggesting a double-edged sword to acquiring beliefs in merit-based fairness; as children get older, they may begin to accept even relatively extreme forms of inequality when presented in a merit context. Results are discussed with respect to the acquisition of meritocracy as a normative belief of fairness.

Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping.

INTRODUCTION: Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face. AIMS AND METHODS: Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified. RESULTS: Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity. CONCLUSION: Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.

Income-Related Inequalities in Physical and Cognitive Health Domains Over the Later Life Course: Longitudinal Evidence From the U.S. (1992-2016).

This study aims to investigate changes in the income-health gradient over the later life course. We test the age-as-leveler, the cumulative advantage/disadvantage, and the persistent inequality pattern for physical and cognitive health domains, and analyze whether these patterns are gendered. We used HRS data (1992-2016) and Poisson growth curve models to predict multimorbidity (33,860 participants) as an indicator of physical health and memory (25,291 participants) as an indicator of cognitive health. We disentangled the within-participant from the between-participant effects. For multimorbidity, the income-health gradient weakened as individuals aged; whereas for memory, the income-health gradient strengthened as individuals aged. The cumulative advantage/disadvantage of higher/lower income on memory may be more pronounced among women than men. Findings were confirmed by sensitivity analyses. Findings suggest that the support for the age-as-leveler or cumulative advantage/disadvantage pattern may depend on health domains and the effect strength may depend on gender.

Women in Surgical Residency Programs in Brazil: A Trend Analysis.

INTRODUCTION: There is a gender gap in the surgical field worldwide. Brazil and low- and middle-income countries generally tend to have a more profound gap. Therefore, we aim to assess the gender distribution in Brazilian surgical residencies. METHODS: From a national residencies' database, we collected residency entering years, names, and surgical subspecialties. We classified gender from the names using Gender API software and performed linear regression, binomial, and chi-square tests. RESULTS: From 81,979 doctors (1931-2020), 36.6% were women (P < 0.001). Of 13 subspecialties, regarding the absolute numbers of women, only neurosurgery and plastic surgery did not significantly differ between gender per year. There was a statistically significant growth in the proportional rates of female representation among most of the surgical residencies analyzed. Overall, the least women's representation was in urology (3.8%). From all subspecialties analyzed, both genders had a significant linear absolute increase over the years (P < 0.05), except for obstetrics-gynecology and pediatric surgery for men. Until 1990, all surgical programs had at least one woman resident, except for colorectal surgery. CONCLUSIONS: Although there is an overall lack of women surgeons in Brazil, we observed an increase in women in surgical residencies. Therefore, the study may demonstrate a future change in the Brazilian gender equity scenario and reflect the growing representation of women in medicine in Brazil, except for some surgical specialties.

Socioeconomic Factors Associated With Thymoma Survival in the United States.

INTRODUCTION: The effects of socioeconomic factors on patients diagnosed with thymomas have not been previously studied. We propose these factors have an important association with survival. Thymoma is the most common tumor of the anterior mediastinum. Compared to other neoplasms which can integrate different therapeutic approaches for treatment, the most effective therapy for local and locally advanced thymoma is complete surgical resection. This study aimed to elaborate on socioeconomic variables and their potential effects on the survival outcomes in patients diagnosed with thymoma. METHODS: Clinical data from the Surveillance, Epidemiology, and End Results 22 registry from 1975-2019 was used to define overall and cancer-specific survival of thymoma. The unadjusted analysis was followed by fitting a Cox proportional hazards model that included all variables assessed with Kaplan-Meier curves. An unadjusted Kaplan-Meier analysis was performed first comparing time to death by decade, age, race, ethnicity, sex, income, and region separately. The primary outcome was survival measured in months. RESULTS: We identified 1821 patients aged 18 y or over from the Surveillance, Epidemiology, and End Results database with a thymoma diagnosis between the years 1975 and 2019. The demographic variables considered were age, race, ethnicity (Hispanic/non-Hispanic), sex (male/female), inflation-adjusted income in 2019 dollars, and community size. We observed a decrease in mortality from thymic neoplasm across the decades. For each subsequent year, mortality risk decreased by 3.5% (P <0.001). The mortality risk of older patients was significantly higher. Compared to the youngest group, the mortality risk was 52.8% higher in the 50-year-old to 65-year-old category (P = 0.021). The mortality risk was 339% times higher in the 65 + age group (P <0.001). Income may be associated with risk reduction. Patients making greater than $75,000 had a 40.1% lower mortality risk than those making less than $50,000 (P = 0.029). The survival rate categorized by race was similar between Blacks and Whites but tended to be higher for the Asian and Pacific Islander groups without reaching statistical significance (P = 0.12). CONCLUSIONS: Medical advancements have improved the overall thymoma survival in the past four decades. Yet, demographic, and socioeconomic factors such as age, income, and race may also play a role.

Disparities in Gender and Diversity Representation Among Surgical Subspecialties: Are we Losing Momentum?

INTRODUCTION: Recruitment efforts have demonstrated small increases in female and under-represented applicants in recent years; however, the majority of surgical programs remain predominantly Caucasian and male. With increased national emphasis on Diversity, Equity, and Inclusion initiatives and mentoring programs, applicants to surgical specialties have continued to increase. While strategies to improve gender and racial diversity are now openly discussed, it is unclear if we have seen significant improvement. We sought to analyze the gender and diversity trends between surgical specialties. METHODS: Publicly available data from the Association of American Medical Colleges, National Board of Medical Examiners, and Accreditation Council for Graduate Medical Education were extracted to determine total number, gender, and diversity of surgery applicants and active residents from the years 2018 to 2021. Surgical specialties within the main match were compared through an analysis completed through Microsoft Excel. RESULTS: Between the years from 2018 to 2021, there was a rise in diversity representation among all surgical residents except for orthopedics which remained less than 30%. Orthopedics, Neurosurgery, and Thoracic Integrated training programs have the lowest rates of female representation among current residents at 16.72%, 20.37%, and 30.05%, respectively. General surgery demonstrates the greatest increase of female residents with a positive 6% change over this recent four-year time period. CONCLUSIONS: There has been minimal positive progress in gender and diversity representation in surgical subspecialties overall in recent years. Continued advocacy through mentorship and scholarship programs is recommended to achieve greater gender and diversity representation in general surgery and surgical subspecialties.

Navigating Promotion in Thoracic Surgery.

The academic promotion process in thoracic surgery can appear nebulous to many young surgeons. However, at most institutions, clear promotion criteria exist for specific academic tracks, and they are based on factors such as clinical excellence, research/investigation, funding, education/teaching, service, health policy, diversity, equity, and inclusion (DEI), ethics, quality and safety, and health care delivery. A thorough understanding of the promotion process is the key to successful advancement in academia.

Racial and Ethnic Disparities in the Physical Health Outcomes of Children in Foster Care: A Systematic Review.

Children of color-especially Black and Indigenous children-are disproportionately overrepresented in foster care and experience barriers in accessing services and receiving physical and behavioral healthcare compared to their White counterparts. Although racial disparities in mental health outcomes of children in foster care have been examined systematically, less is known about racial disparities in their physical health outcomes. This systematic review aimed to examine disparities in physical health outcomes (i.e., general health, developmental delays and disability, chronic illness, health-compromising behaviors, all-cause mortality) of children in foster care by their race and ethnicity (PROSPERO ID: CRD42021272072). Systematic literature searches were conducted in PubMed, EMBASE, PsycINFO, CINAHL, Cochrane Library, and Psychology and Behavioral Sciences Collection. Of the 6,102 unique studies identified, 24 met inclusion criteria: peer-reviewed journal article; published from 1991 to 2021; written in English; involved children in the U.S. foster care system; children were primarily in family-based placements; included health outcomes; included children's race and ethnicity; conducted quantitative analyses; and had an observational study design. There was limited evidence to suggest racial disparities among physical health domains examined, in part, due to the small number of studies, variability across study measures and designs, how race and ethnicity were categorized, and how related results were reported. Research that disaggregates results by more nuanced race and ethnicity categories, goes beyond including race and ethnicity as control variables, and uses more robust study designs to understand where racial disparities lie is necessary to inform practice and policy efforts to attain race and health equity in child welfare.

Dietary shifts drive the slowdown of declining methylmercury related health risk in China.

Chinese population suffers severe health risk from dietary methylmercury (MeHg) exposure. However, the temporal change of such risk and socioeconomic driving factors remain unknown. This study investigates this issue by compiling time-series inventory of China's MeHg-related health risk at the provincial scale and revealing critical socioeconomic influencing factors through structural decomposition analysis. Results show that the per-fetus IQ decrements from dietary MeHg exposure have declined by 60% nationally during 2004-2019. Such decline results from the joint effects of dietary shifts (contributing 44%) and the decrease of MeHg concentrations in foods consumed (contributing 56%). However, the declining trend has slowed down since 2014 and even leveled off after 2016, which is mainly affected by dietary pattern changes. Especially, the increased intake level and proportion of fishes in underdeveloped provinces of China have dominated the slowdown of declining trend after 2016. Moreover, the affluence and education levels have significantly negative associations with per-fetus IQ decrements. Rich and well-educated people have higher ability of risk perception, which indicates the importance of rational consumption patterns. Our findings can help develop socioeconomic regulatory policies on reducing per-fetus IQ decrements from dietary MeHg exposure in China.

Multi-scale spatiotemporal trends and corresponding disparities of PM2.5 exposure in China.

Despite the effectiveness of targeted measures to mitigate air pollution, China-a developing country with high PM2.5 concentration and dense population, faces a high risk of PM2.5-related mortality. However, existing studies on long-term PM2.5 exposure in China have not reached a consensus as to which year it peaked during the "initially pollution, then mitigation" process. Furthermore, analyses in these studies were rarely undertaken from multi-spatial scales. In this study, a piecewise linear regression model was employed to detect the turning point of population-weighted exposure (PWE) to PM2.5 for the period 2000-2020. Multi-scale spatiotemporal patterns of PM2.5 exposure were evaluated during upward and downward periods at the province, city and county levels, and their corresponding disparities were estimated using the Gini index. The results showed that 2013 was the breakpoint year for PM2.5 PWE across China from 2000 to 2020. Cities and counties where PM2.5 PWE displayed increasing trends during the mitigation stage (2013-2020) basically became the heaviest PM2.5 exposure regions in 2020. High PM2.5 exposure was observed in Beijing-Tianjin-Hebei, Central China, and the Tarim Basin in Xinjiang, whereas lower PM2.5 exposure regions were mainly concentrated in Hainan Province, the Hengduan Mountains, and northern Xinjiang. These cross-provincial patterns might have been overlooked when conducting macro-scale analyses. Province-level PM2.5 exposure inequality was less than the city- and county-levels estimations, and regional inequalities were high in eastern and western China. In this study, multi-scale PM2.5 exposure trends and their disparities over a prolonged period were investigated, and the findings provide a reference for pollution mitigation and regional inequality reduction.

Workforce Diversity, Equity, and Inclusion: A Crucial Component of Professionalism in Psychiatry.

Documented disparities have profoundly impacted the training and careers of physicians from socially and historically marginalized groups, including women, people with disabilities, people who identify with racial and ethnic minority groups, and the lesbian, gay, bisexual, transgender, and queer or questioning+ community. Professionalism is a core component of medical training and practice, yet a focus on workforce diversity, equity, and inclusion is often absent. This report aims to encourage the adoption of workforce diversity, equity, and inclusion as a crucial component of professionalism, with an emphasis on the field of psychiatry.

Measuring the 3-30-300 rule to help cities meet nature access thresholds.

The 3-30-300 rule offers benchmarks for cities to promote equitable nature access. It dictates that individuals should see three trees from their dwelling, have 30 % tree canopy in their neighborhood, and live within 300 m of a high-quality green space. Implementing this demands thorough measurement, monitoring, and evaluation methods, yet little guidance is currently available to pursue these actions. To overcome this gap, we employed an expert-based consensus approach to review the available ways to measure 3-30-300 as well as each measure's strengths and weaknesses. We described seven relevant data and processes: vegetation indices, street level analyses, tree inventories, questionnaires, window view analyses, land cover maps, and green space maps. Based on the reviewed strengths and weaknesses of each measure, we presented a suitability matrix to link recommended measures with each component of the rule. These recommendations included surveys and window-view analyses for the '3 component', high-resolution land cover maps for the '30 component', and green space maps with network analyses for the '300 component'. These methods, responsive to local situations and resources, not only implement the 3-30-300 rule but foster broader dialogue on local desires and requirements. Consequently, these techniques can guide strategic investments in urban greening for health, equity, biodiversity, and climate adaptation.

Practice Perspectives on Care Coordination in Rural Settings.

PURPOSE: Social needs and nonmedical health determinants are increasingly incorporated into care coordination models. However, little is known about the practice of operationalizing enhanced care coordination, particularly in rural settings. The objective of this study was to determine care coordination practices in rural settings that integrate social services with health care. PRIMARY PRACTICE SETTINGS: Staff and administrators in rural Missouri health and health care settings were interviewed about their organization's implementation of enhanced care coordination practices. METHODOLOGY AND SAMPLE: This is a mixed-methods study; 16 key informant structured interviews were conducted across 14 organizations. RESULTS: Organizations reported a median care coordination population of 800 (range: 50-21,500) across a median of 11 case managers (range: 3-375). The percentage of organizations reporting social determinants of health services included the following: 100% transportation, 86% mental health, 79% food, 71% housing, and 50% dental. Implementation of the essential indicators of care coordination quality ranged from 41.7% to 100%. We report organizations' innovative solutions to care coordination barriers. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: This study contributes to a very limited literature on the practice of rural care coordination by assessing the quality of care provided compared with a recommended standard. This study also contributes an in-depth reporting on the variety of service models being implemented. Finally, this study uniquely contributes innovative interprofessional examples of enhanced care coordination initiatives. These examples may provide inspiration for rural health care organizations. As the care coordination landscape evolves to include social determinants of health, there remain important fundamental barriers to ensuring quality of care.

Understanding the Public Health Role, Motivations, and Perceptions of Community Health Workers Deployed to Low-Income Housing in Richmond, Virginia.

BACKGROUND: For the US health indicators to improve to the level of other developed countries, the use of Community Health Workers (CHWs) in vulnerable populations has been indicated as a possible long-term intervention. There are few models of long-term deployment of CHWs as part of the district level public health system in the US. METHOD: In this study we interviewed CHWs who served as neighborhood-integrated health district staff assigned to low-income housing in Richmond, Virginia for 10 years. Qualitative analyses of their taped and transcribed interviews resulted in 5 themes from the interviews. The themes were Activities, Satisfaction, Strengths, Facilitation/Resources and Challenges. We highlighted quotes from the CHWs interviews for themes and summarized the findings from each theme. RESULTS: CHWs carried out a variety of activities daily and these were described. The CHWs were generally satisfied with their job because it enabled them to assist others. The strength of their communities was resilience, and the resources they needed more included physical resources, human resources, political support, and more comprehensive programming. Their client's challenges include transportation, mental health, and physical safety and the CHWs challenge to effectively carrying out their work with clients was trust by community members. CONCLUSION: The information garnered from the CHWs would be useful in designing CHW programs at other health districts.

The Impact of Climate Change on Global Oncology.

Climate change is the greatest threat to human health of our time, with significant implications for global cancer control efforts. The changing frequency and behavior of climate-driven extreme weather events results in more frequent and increasingly unanticipated disruptions in access to cancer care. Given the significant threat that climate change poses to cancer control efforts, oncology professionals should champion initiatives that help protect the health and safety of patients with cancer, such as enhancing emergency preparedness and response efforts and reducing emissions from our own professional activities, which has health cobenefits for the entire population.