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Underserved communities face persistent challenges due to limited access to healthcare services. Digital volunteering offers opportunities for healthcare professionals to support these populations remotely. This study examined factors associated with healthcare workers’ intentions to participate in digital healthcare volunteering in Algeria. An extended technology acceptance model was used, incorporating perceived organizational support (OS), altruism, and social responsibility. A convenience sample of 142 healthcare workers completed a survey, and hierarchical regression analysis was conducted. Results indicated that perceived ease of use, social responsibility, altruism, perceived OS, and perceived usefulness were each significantly associated with intentions to engage in digital volunteering. The extended model explained 75.6% of the variance in intention, highlighting the relevance of psychological, organizational, and ethical factors. These findings provide insights for policymakers, healthcare organizations, and developers seeking to support digital volunteering initiatives. Limitations include the cross-sectional design and the use of convenience sampling, which may affect generalizability. Future research should consider longitudinal designs, larger and more diverse samples, and cross-cultural comparisons to validate and extend these findings. © 2026 by Author/s and Licensed by Modestum.

Objective: To determine the association of sleep duration and disturbances with physical and mental health-related quality of life (HRQoL) in stroke survivors. Design: Cross-sectional analysis of the REasons for Geographic And Racial Differences in Stroke second in-home visit (May 2013-Dec 2016). Setting: Population-based national study in US. Participants: Individuals with adjudicated incident stroke (N=368). Interventions: Not applicable. Main Outcome Measures: Physical and mental HRQoL based on the 12-item Short Form. Sleep measures included sleep duration, difficulty initiating sleep, difficulty maintaining sleep, nonrestorative sleep, and a combined measure based on the latent class model. Logistic regression models were used to investigate the association between sleep variables and HRQoL, adjusting for demographic factors, socioeconomic factors, behavioral factors, and comorbidities. Results: This study included 368 non-Hispanic Black and White stroke survivors. The mean age was 76.0 years (SD=7.9), and 52.7% were men. Stroke survivors with short sleep duration were more likely to have poor physical HRQoL (OR, 2.87; 95% CI, 1.46-5.62) compared with stroke survivors with adequate sleep duration after adjusting for confounding. Similarly, stroke survivors with nonrestorative sleep were 3 times more likely to have poor physical HRQoL (OR, 3.11; 95% CI, 1.28-7.55) compared with stroke survivors with restorative sleep. Conclusions: Non-optimal sleep duration and nonrestorative sleep were associated with higher odds of poor physical HRQoL in stroke survivors. These findings highlight the importance of considering sleep health in post-stroke care. © 2025 American Congress of Rehabilitation Medicine

There has been a decline in the age at which girls experience menarche worldwide. Research suggests that exposure to endocrine-disrupting chemicals is linked to negative health consequences, including early onset of menarche. This systematic review examined the association between exposure to endocrine-disrupting chemicals (EDCs) and the early onset of menarche. Comprehensive searches of the PubMed, Embase, Web of Science, and Scopus databases were conducted to find relevant studies published from inception to November 2024. Exposure to certain EDCs, such as particulate matter and phthalates, showed significant associations with earlier menarche onset, while exposure to other EDCs (e.g., pyrethroids) was linked to delayed menarche timing. Overall, there were mixed findings in the relationships between various EDC exposures and menarche onset. Few studies investigated how exposure to EDCs and early menarche differed by race and ethnicity. This underscores the need for more studies that examine the relationship between early menarche onset and exposure to endocrine-disrupting substances. Education and policy approaches are also warranted to address this issue. © 2025 by the authors.

Stroke is a leading cause of death and disability worldwide. It is a serious disease caused by a disruption of blood flow in the brain resulting from either blockage of blood flow to the brain (ischemic stroke) or sudden bleeding in the brain (hemorrhagic stroke). Stroke survivors experience more sleep disorders than the general population. Sleep disorders could also increase the risk of stroke even in individuals who have no history of stroke. Obstructive sleep apnea and insomnia are the most common sleep disorders associated with increased risk of stroke. Long sleep duration (≥9 h/day) and circadian rhythm changes have also been linked to an increased risk of stroke. This chapter summarizes the current evidence on the relationship between sleep disorders and stroke. © 2025 Springer Nature Switzerland AG.

Borderline personality disorder (BPD) is a common and serious mental health condition characterized by emotional instability, impulsive behavior, and difficulties in interpersonal relationships. This review aimed to comprehensively summarize the current stage of knowledge on the association between social determinants of health (SDoH) and BPD. MEDLINE (PubMed), Embase, and PsycINFO databases were searched from inception to May 2025. We included peer-reviewed studies written in English that assess the association between SDoH and BPD. Each article was screened by two reviewers, and disagreements were resolved by a third reviewer. A narrative synthesis was used to summarize the studies, grouped by the domain of SDoH. Of the 3983 articles screened, 29 were included in this review. The majority of the studies (59.3%) were conducted in the United States, with the social and community context emerging as the most frequently represented domain. A bidirectional relationship was observed between SDoH and BPD, where unfavorable SDoH triggers or worsen BPD symptoms, and BPD can limit access to favorable SDoH. There is a significant and bidirectional relationship between SDoH and BPD. Addressing SDoH is essential for prevention, recovery, and long-term well-being among individuals with borderline personality disorder. © 2025 John Wiley & Sons Ltd.

PURPOSE: This formative research study describes the development and preliminary evaluation of a theory-guided, online multimedia psycho-educational program (PROGRESS) designed to facilitate adaptive coping among prostate cancer patients transitioning from treatment into long-term survivorship. METHODS: Guided by the Cognitive-Social Health Information Processing Model (C-SHIP) and using health communications best practices, we conducted a two-phase, qualitative formative research study with early stage prostate cancer patients (n = 29) to inform the Web program development. Phase 1 included individual (n = 5) and group (n = 12) interviews to help determine intervention content and interface. Phase 2 employed iterative user/usability testing (n = 12) to finalize the intervention. Interview data were independently coded and collectively analyzed to achieve consensus. RESULTS: Survivors expressed interest in action-oriented content on (1) managing treatment side effects, (2) handling body image and comorbidities related to overweight/obesity, (3) coping with emotional and communication issues, (4) tips to reduce disruptions of daily living activities, and (5) health skills training tools. Patients also desired the use of realistic and diverse survivor images. CONCLUSIONS: Incorporation of an established theoretical framework, application of multimedia intervention development best practices, and an evidence-based approach to content and format resulted in a psycho-educational tool that comprehensively addresses survivors' needs in a tailored fashion. IMPLICATIONS FOR CANCER SURVIVORS: The results suggest that an interactive Web-based multimedia program is useful for survivors if it covers the key topics of symptom control, emotional well-being, and coping skills training; this tool has the potential to be disseminated and implemented as an adjunct to routine clinical care.

Rural communities, compared with their urban counterparts, have higher rates of disease and adverse health conditions, fueling disparities in health outcomes. This encourages the need for effective curricula to engage students and enable them to address such disparate health outcomes as imminent health professionals. Incorporating learner-centered teaching strategies, such as collaboration and power-sharing, into public health (PH) courses can enhance student learning and help faculty enable future health professionals to address needs of rural, underserved populations. Successfully engaging students to explore issues related to rural health disparities in their education, research, and training can thereby advance PH practice. This paper describes the collaborative efforts of five PH faculty, an instructional designer, and administrators to develop a learner-centered curriculum for a newly launched PH program in a rural Midwestern United States (US) university.

Objective Preterm birth (PTB) is one of the leading causes of infant and neonatal mortality. Prepregnancy body mass index (BMI; kg/m2) has been linked to PTB but the evidence of this association by weight gain during pregnancy, race, and ethnicity is limited. This study aimed to assess the association between maternal prepregnancy BMI and PTB stratified by weight gain during pregnancy, race, and ethnicity. Study Design The U.S. natality data from 2017 to 2021 were used. In this analysis, we included mothers who had a live singleton birth and available data for prepregnancy BMI, gestational age at birth, weight gain during pregnancy, race, and ethnicity. Logistic regression models were used to assess the association between prepregnancy BMI categories and PTB stratified by weight gain during pregnancy, race, and ethnicity. Results A total of 17,311,509 singleton live births were included of which 1,393,889 (8.05 %) were PTBs. After adjusting for confounders, compared with normal prepregnancy BMI mothers (18.5–24.9), those with underweight BMI (<18.5) were at increased odds of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, for mothers with a prepregnancy BMI above the normal weight (≥25), the association between prepregnancy BMI and PTB differs by weight gain during pregnancy, race, and ethnicity. Asian mothers with obesity II (35.0–39.9) had 93% (odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.62–2.30) increased odds of PTB for weight gain during pregnancy of 31 to 40 pounds. Their White, Hispanic, and Black counterparts experienced lower odds of PTB for similar weight gain during pregnancy (White: OR = 1.56, 95% CI: 1.51–1.60; Hispanic: OR = 1.48, 95% CI: 1.41, 1.54; and Black: OR = 1.22, 95% CI: 1.17–1.27). Conclusion Mothers with underweight BMI were at increased risk of PTB regardless of weight gain during pregnancy, race, and ethnicity. However, the association between high prepregnancy BMI and PTB varied by weight gain during pregnancy, race, and ethnicity. Key Points

Despite the persistence of breastfeeding racial and ethnic disparities in the United States, little is known about Black fathers' perceptions of breastfeeding and breastfeeding support services (e.g., maternity hospital-based care and lactation management care). This qualitative, community-based participatory research study reports Black fathers' perceptions of barriers and facilitators to breastfeeding, including the provision of breastfeeding support services in Connecticut. A focus group guide was co-developed with community partners and adapted from the Barrier Analysis Tool to identify breastfeeding facilitators, barriers, and service improvement areas. Four focus groups were conducted with 30 Black fathers who were Connecticut residents with a child under 3 years old. Qualitative data were analyzed using rapid template analysis involving deductive and inductive coding. We identified factors influencing breastfeeding and fathers' ability to support breastfeeding across all levels of the Socio-Ecological Model. Facilitators included high paternal breastfeeding knowledge, paternal breastfeeding involvement, parents' shared decision-making, extensive maternity hospital discharge support, ongoing breastfeeding support into the postnatal period, availability of community breastfeeding resources, and designated spaces for public breastfeeding. Barriers included low paternal breastfeeding knowledge, familial discouragement, insufficient prenatal breastfeeding education, exclusion of the father from breastfeeding support services, and stigma against breastfeeding in public. Understanding breastfeeding perceptions among members of a mother's support network, including their partners, is key for developing effective person- and family-centered breastfeeding education and counseling services that are well coordinated from the prenatal to postnatal periods with strong direct engagement from fathers.

BackgroundCancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas.ObjectiveWe conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States.MethodsA systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus.ResultsAfter reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts.ConclusionUnderrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.

Electronic waste (e-waste) or discarded electronic devices that are unwanted, not working, or have reached their end of life pose significant threats to human and environmental health. This is a major concern in Africa, where the majority of e-waste is discarded. In the year 2021, an estimated 57.4 million metric tons of e-waste were generated worldwide. Globally, COVID-19 lockdowns have contributed to increased e-waste generation. Although Africa generates the least of this waste, the continent has been the dumping ground for e-waste from the developed world. The flow of hazardous waste from the prosperous ‘Global North’ to the impoverished ‘Global South’ is termed “toxic colonialism”. Agbogbloshie, Ghana, an e-waste hub where about 39% of e-waste was treated, was listed among the top 10 most polluted places in the world. The discard of e-waste in Ghana presents an issue of environmental injustice, defined as the disproportionate exposure of communities of color and low-income communities to pollution, its associated health and environmental effects, and the unequal environmental protection provided through policies. Despite the economic benefits of e-waste, many civilians (low-income earners, settlers, children, and people with minimal education) are exposed to negative health effects due to poverty, lack of education, and weak regulations. We critically examine the existing literature to gather empirical information on e-waste and environmental injustice. Comprehensive policies and regulations are needed to manage e-waste locally and globally.

In 2019, there was no entity specifically dedicated to health promotion and education practitioners in Connecticut or New England. This made it difficult for health promotion practitioners and students to network, collaborate, and engage in professional development. The purpose of this article is to share our experiences developing the new Connecticut Chapter of the Society for Public Health Education (CT SOPHE), including how we leveraged student interns during the first two years to promote organizational growth. To build our membership, it was important to determine who would be interested in joining CT SOPHE and so we focused on three groups: the current workforce/professionals, future workforce/students, and future leaders/interns. Over the course of these two years, three interns were recruited to help with creating a needs assessment (MPH student) and program development (two BS students); the organization was established by an MPH student as her internship project. Three former interns share how their experience working with the CT SOPHE board has helped them develop crucial leadership skills early in their careers. Embedding student interns into the framework and operations of CT SOPHE demonstrates an intentional and strategic commitment to the sustainability of both the organization and the workforce.

Context: Authors of previous research at a public university in New England, where the current study takes place, showed that approximately one-third of undergraduate students have experienced some aspect of food insecurity. More recent investigators at this university revealed that students who were members of a sport team were 4 times more likely to be food insecure than their peers who were not on a sport team. The estimated prevalence of student-athlete food insecurity from other previous research studies ranged from 14% to 32%. Objective: To understand the contributing factors to food insecurity among collegiate athletes. Design: Qualitative study. Setting: A public university in New England. Patients or Other Participants: Data are presented for 10 collegiate athletes who experienced some level of food insecurity according to the United States Department of Agriculture Six-Item Short Form. Data Collection and Analysis: Data were collected using a brief demographic questionnaire and semistructured interviews. Results: Contributing factors were a lack of time, special dietary needs, limited campus dining options, and limited access to transportation or kitchens. Coping strategies were managing time and resources, buying cheaper foods, and skipping meals. Food insecurity negatively affected students' athletic performance. The athletes struggled to balance their athletic and academic schedules and obtain a diet that allowed them to meet their performance goals. Conclusions: Additional and innovative programming is needed to support food-insecure student-athletes. © by the National Athletic Trainers' Association, Inc.

Background: Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine. Methods: This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs). Results: Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities. Conclusions: Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults. © 2024 Lippincott Williams and Wilkins. All rights reserved.

Drug waste poses a real threat to human health and the environment. Therefore, recycling and sustainability scholars have recently sought practical solutions to the drug waste problem. Furthermore, several governments have made significant efforts to reduce the negative effects of waste, such as establishing programs to take back unwanted drugs (expired and unused) for recycling (i.e., drug reuse or drug redispersing). However, many of these programs have failed to achieve their goals. In this context, it is expected that creating green start-ups to collect unwanted drugs will contribute to solving this problem. Accordingly, this study aims to investigate the antecedents of intentions to create green start-ups for collecting unwanted drugs. To this end, the authors integrate start-up self-efficacy and drug waste collection-related knowledge constructs into the theory of planned behavior (TPB). Using a self-administered paper questionnaire and relying on a convenience sample, data were collected from 328 students in six Algerian universities. A hierarchical multiple regression was conducted to test the proposed study model. Theresults revealed that perceived behavioral control (PBC) (β = 0.187, p < 0.001), attitudes (β = 0.182, p = 0.002), start-up self-efficacy (β = 0.169, p = 0.001), drug waste collection-related knowledge (β = 0.161, p < 0.001), and subjective norms (β = 0.088, p < 0.05) have a positive significant effect on the intention to create a start-up to collect unwanted drugs. In conclusion, this paper contributes to reducing drug waste by investigating the drivers of intention to create green start-ups for collecting unwanted drugs. Therefore, our study is expected to provide valuable insights for hospitals, pharmacies, pharmaceutical manufacturers, environmental protection associations, and stakeholders interested in reverse logistics. © 2024 by the authors.

Background: Limited research has been done on nursing students’ awareness of racial disparities and their readiness to address bias and racism in clinical practice. Purpose: This study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States. Methods: Interpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants’ perceptions surrounding racism and health disparities. Discussion: Nurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities. Conclusion: The most critical finding was the lack of participants’ understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism. © 2024

Objective: To describe faculty efforts to deliver and evaluate health disparities–related education in US online undergraduate and graduate public health courses. Design: A pre- and post-survey was given to a cohort of 46 US college students in three public health courses taught asynchronously online over an 8-week period in 2017. This study took place at a mid-sized, public, rural, midwestern US university. Method: Faculty received professional development and online training and were assigned to develop courses for a new public health programme. Following the receipt of ethical approval, students completed anonymous, online pre- and post-surveys to assess effect of intentional instructional approaches on their knowledge and attitudes about health disparities. Curricula incorporated various assessment methods and teaching strategies. Descriptive statistics were used to compare pre- and post-survey scores and analyse demographic data. Paired t-tests and one-way analysis of variance were used to analyse pre- and post-survey test scores. Results: At post-survey, students demonstrated a positive change in mean scores for several items, including for ability to discuss the role of theory in understanding health behaviour and disparities in health status (3.20 vs 4.06; p < .001) and ability to discuss strategies health promotion programmes can use to reduce health disparities (3.47 vs 4.40; p < .001). Post-survey response rate was 87%. Conclusion: Results suggest an effective way to increase health disparities knowledge among online college students. Additional research is encouraged to expand upon these findings.

Preventable differences in health outcomes between U.S. population subgroups, related to factors such as race or ethnicity, income, and geographic location, are troubling. Geographically, rural American communities experience higher rates of adverse health conditions when compared with urban areas, further widening disparities in health outcomes. Such disparities necessitate the creation of effective curricula to enable students to address the health needs of underserved populations. By intentionally incorporating health disparities awareness content into the curricula, undergraduate and graduate public health programs can play an integral role in developing conscious health practitioners to help close gaps in health outcomes. Moreover, rural health courses may increase students’ interest in rural health careers. This article presents the process and results of faculty efforts to design and deliver health disparities–related education in undergraduate and graduate public health courses at a rural Midwestern U.S. university. Various teaching development programs inspired faculty to use intentional instructional approaches to teach students about health disparities. Consequently, faculty incorporated a variety of assessment methods and teaching styles to infuse health disparities awareness content into public health courses. Results from students’ course evaluations and reflections are discussed along with lessons learned and implications for future pedagogical directions.

There are emerging concerns about the preparedness of rural communities in the United States in the face of the 2019 novel coronavirus (called SARS-CoV-2, causing the disease COVID-19) considering the existing disparities across the social determinants of health between rural and urban Americans. Taking into account the current exponential rate of spread of the coronavirus, this article critically examines the risk facing the 60 million Americans living in rural areas, discusses possible solutions pertaining to rural COVID-19 prevention, and examines measures to consider to prepare for this epidemic before it reaches rural areas.

Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety and depression within the African context. There is a gap in the research literature from Africa, particularly Ghana, with few studies focusing on depression among patients undergoing radiation treatment. The purpose of the study was to find various interventions for depression and anxiety among breast cancer patients in Ghana. A mixed method study examined breast cancer patients undergoing radiotherapy and their responses through a concurrent triangulation involving an interview with selected professional and a detailed patient survey. In all, 100 patients between the ages of 20-89 completed a questionnaire and individual interviews were held with 6 professionals with a minimum of 5 years of work experience. Themes were generated through open coding of the interview data, while multiple regression was performed to determine the relationship between depression and anxiety with the independent variables. In all, 89% had no family history of breast cancer, and the majority (55%) had the disease duration of one to three years. Almost 95% of patients with breast cancer had anxiety and depression in different categories. This included hair loss, discolored finger nails, cost of treatment, and fear of the unknown. Age and monthly income of patients were statistically significant in predicting the anxiety and depression among the patients. Coping mechanisms are essential for all patients undergoing treatment. This study’s implications will lead to positive change when all stakeholders assist in implementing measures to promote coping strategies for breast cancer patients in Ghana.