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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.

Background: Maternal mortality in Brazil remains a critical indicator of social and racial inequalities, reflecting structural failures in access to and quality of obstetric care. Black women, particularly those categorized as black or brown, are at a higher risk of dying during pregnancy, childbirth, or the postpartum period. This is the result of the intersection of institutional racism, poverty, and social vulnerabilities. This study aimed to analyze trends and associated factors of maternal mortality among black women in Brazil from 2000 to 2020. Methods: This is a retrospective cohort analytical study using data from the Brazilian Mortality Information System. The sample included women aged 10 to 49 years whose underlying cause of death was classified under ICD-10 codes O00–O99. Descriptive and bivariate analyses were conducted, as well as Poisson and multinomial logistic regressions to estimate adjusted risk ratios according to skin color, education, region, type, and place of death. Results: A total of 40,907 maternal deaths were identified, with 59.2% occurring among black women. The maternal mortality ratio was 39% higher among black women compared to white women and more than double among Indigenous women. Low education, residence in the North and Northeast regions, deaths outside hospital settings, and lack of formal investigation were independently associated with increased risk. Direct obstetric causes accounted for most deaths, with hypertensive disorders and puerperal complications being the leading conditions. Conclusions: Maternal mortality among black women in Brazil reveals deep structural inequalities. Urgent public policies that incorporate an intersectional perspective, addressing race, gender, and class, are necessary to reduce disparities and ensure equitable and dignified maternal healthcare.

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.

Objective To examine the association between the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation during pregnancy and birth weight by race and ethnicity on a national level. Design Retrospective cohort of US natality from 2014 to 2022. Setting All US states and Washington, DC. Participants First-time mothers of a live singleton birth covered by Medicaid with available data on WIC participation and birth weight. Exposure WIC participation during pregnancy (yes/no) Main Outcome Measure Low (< 2,500 g) and very low (< 1,500 g) birth weight. Analysis Multivariable logistic regression Results A total of 3,778,400 mothers covered by Medicaid were included in this analysis, of which 69.6% were WIC participants during pregnancy. The association between WIC participation and birth weight outcomes differed by race and ethnicity. After adjusting, WIC participants during pregnancy were 25%, 20%, 17%, and 10% less likely to give birth to low-weight infants compared with non-WIC participants for Native Hawaiian or Other Pacific Islanders, Black, American Indian or Alaskan Native, and White, respectively. Conclusion and Implications Special Supplemental Nutrition Program for Women, Infants, and Children participation during pregnancy was associated with reduced low birth weight in all races and ethnicities. Improving WIC access and participation during pregnancy may support health equity in birth weight outcomes.

Sexual minority (SM) adults are at increased risk for adverse health outcomes and face unique barriers to engagement and retention in healthcare, including stigma and discrimination. Given known barriers to care, SM adults may prefer online platforms due to limited access to in-person clinical care and fear of discrimination. To date, there is limited knowledge of these behaviors among subgroups of SM adults. This study was a cross-sectional, secondary data analysis of the United States National Health Interview Survey (NHIS) Adult Sample Data Set, 2018. Utilizing descriptive statistics and multivariable logistic regressions, we found that bisexual females had significantly greater odds (AOR = 1.58, CI: 1.04–2.39) of seeking health information online compared to straight females. Similarly, when compared to their straight male counterparts, gay males had significantly higher odds of seeking health information online in the past 12 months (AOR = 2.96, 95% CI: 2.00–4.37). These findings indicate the need for targeting messaging and interventions to address the health concerns of these populations. It also suggests that virtual platforms are viable and perhaps preferred for these subgroups of SM adults. Through continued efforts and research, the field can target relevant health information to populations who need it most by leveraging where they seek it.

Objective: We aim to determine the association between insomnia symptoms and mental health in females and males and compare mental health care utilization and perceived barriers between females and males with insomnia symptoms. Methods: This is a cross-sectional study using the National Health Interview Survey. Insomnia symptoms included self-reported “trouble falling asleep”, ‘trouble staying asleep”, and “waking up feeling not well rested”. Mental health included self-reported anxiety and depression. Multivariable logistic regression was used to assess the association between insomnia symptoms and mental health in females and males. Results: A total of 26,691 adults were included. The mean age was 48.2 years; 51.4% were females, and 48.6% were males. Insomnia symptoms were associated with anxiety and depression for both females and males. These associations were stronger in younger adults (<50 years) than older adults (≥50 years). Females with insomnia symptoms were more likely to receive mental health care (OR = 1.7; 95% CI = 1.53, 1.87) but also to delay mental health care because of its cost (OR = 1.96; 95% CI: 1.67, 2.30) or needed mental health care but did not get it because of the cost (OR = 2.14; 95% CI: 1.82, 2.50) than their males counterpart. Conclusions: Insomnia symptoms were associated with mental health in females and males, being stronger in younger adults than older adults, with gender differences in mental health care utilization and financial barriers to mental health care. Holistic approaches involving prevention and better access to mental health care are warranted.

Background Patients presenting to the emergency department (ED) following nonfatal opioid overdose represent a high-risk population with 5 % of patients dying within a year of the index visit. Objective To evaluate subsequent overdose and death before and after the implementation of an ED discharge naloxone program. Methods This was a retrospective cohort study of ED patients who presented at the Virginia Commonwealth University Health ED with an Opioid Use Disorder (OUD) chief complaint before and after a discharge naloxone program. The pre-naloxone cohort was consecutive ED OUD patients from August 15, 2021, to August 14, 2022, and the post-naloxone cohort from August 15, 2022, to August 14, 2023. The outcomes were subsequent overdose, ED visit to same hospital (VCU), and death within six months of the index visit. Results In total, 1,053 patients were included, of which 529 were in the pre-naloxone cohort and 524 patients in the post-naloxone cohort. The mean age was 44.2 years (SD = 14.0) and 69 % were males. There was a reduction in overdose requiring ED visiting (subsequent ED overdose) and death (4.6 % vs 9.2 % p = 0.03 and 2.0 % vs 5.6 % p = 0.02 respectively) in the post-naloxone cohort compared to the pre-naloxone cohort. After adjusting for sociodemographic and clinical factors, there was a 48 % reduction in the risk of subsequent ED overdose (RR = 0.52, 95 % CI: 0.27, 1.02) and a 63 % reduction in the risk of death (RR = 0.37, 95 % CI: 0.14, 0.95). Conclusion Implementing an ED take-home naloxone program was associated with a reduction in subsequent overdose and death at six months.

Background: Social determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities.Methods: Using longitudinal data from the Black Women’s Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status.Results: Breastfeeding initiation (n = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile (p < 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration (n = 2,172), women residing in NSES quartiles 1–3 were significantly less likely (p < 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1–3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively (p = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region (Pinteraction = >0.05).Conclusion: Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.

Introduction: Intimate partner violence (IPV) is an important determinant of poor sexual and reproductive health. One’s sense of sexual autonomy may be an important concept in the context of IPV and sexual and reproductive health outcomes. Compromised sexual autonomy may explain the risk of poor sexual and reproductive health among individuals who experienced IPV; yet few studies have examined the role of sexual autonomy. The current study examined the mediating effects of sexual autonomy on the association between recent IPV, sexual risk and HIV-related worry. Methods: One hundred ninety-eight sexually active women and men involved in past-year romantic partnerships completed an online survey in 2016. Path analysis was used to test the direct and indirect effects of sexual autonomy. Results: Recent IPV predicted lower sexual autonomy (B = −.29, SE =.15, p <.05), unwanted condomless sex (aOR = 3.38, 95% CI 1.63–7.02), coercive sexual risk (aOR = 25.91, 95% CI 5.02–133.75), and HIV-related worry (aOR = 5.44, 95% CI 1.44–20.57). Lower sexual autonomy predicted unwanted condomless sex (aOR =.98, 95% CI.96–.99), coercive sexual risk (aOR =.95, 95% CI.90–.99), and HIV-related worry (aOR =.92, 95% CI.90–.97). Sexual autonomy mediated the association between IPV and HIV-related worry (indirect effect OR = 1.39, 95% CI 1.01–3.63). Conclusions: Recent IPV experiences can weaken one’s sexual autonomy, which in turn creates concerns about acquiring HIV. HIV prevention programming should address the implications of IPV, promote sexual safety strategies, and develop tailored support to increase sexual autonomy among individuals navigating violence. Policy Implications: Findings can inform the integration of trauma-informed policies and IPV screening practices in comprehensive sexual health programmatic initiatives. © The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2025.

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.

Insomnia is more frequently reported in stroke survivors but its independent role in mortality in stroke survivors is unknown. The purpose of this study was to investigate the association of insomnia symptoms with all-cause mortality among stroke survivors.

As the population of Aotearoa New Zealand ages, informal family carers will play an increasingly important role in caring for older adults at home. Multi-generational living arrangements are a growing trend, particularly among Māori communities, where caring for older relatives within the family home is widespread. This article uses in-depth, semi-structured interviews with Māori whānau (extended family members) caring for kaumātua (older family members) at home to explore how carers experienced care coordination in the broader care collective. The findings centred on three interconnected factors that described the collective organisation of care: (1) whānau care as normal; (2) whānau care as collective coordination; and (3) whānau carer knowledge and needs as unseen. The findings show that although whānau care of kaumātua is highly valued, ‘structural holes’ within care systems contribute to challenges in care coordination. Despite extensive whānau support for kaumātua, primary carers often felt that their knowledge, preferences and self-care needs remained unseen and not translatable to those outside the everyday care situation. Rather than assuming an artificial binary difference between ‘collective’ and ‘individually oriented’ care contexts and cultures, analysing the cultural norms surrounding whānau care-giving confirms that collective care system members face similar and different challenges to carers with smaller caring capacities. © The Author(s), 2024.

Study Objectives: Prior research suggests that insomnia may increase the risk of death. However, the potential influence of age and sex is unclear. This study aimed to investigate the association of insomnia symptoms with all-cause mortality by age and sex. Methods: This prospective cohort was drawn from the Health and Retirement Study, a survey of Americans older than 50 years and their spouses of any age from 2002–2018. Insomnia symptom scores were based on difficulties initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Cox proportional-hazards regression models were employed to investigate the association between insomnia symptoms and all-cause mortality stratified by age and sex. Results: A total of 33,004 participants were included with a mean age of 61.7 years and 56.8% females. Over a mean follow-up of 8.4 years, 8,935 (27.1%) deaths were recorded. After adjusting for confounding, males with insomnia symptom scores ranging from 5–8 had a 71% increased risk of death (hazard ratio = 1.71; 95% confidence interval: 1.27, 2.30) compared with their counterparts without insomnia symptoms. Similarly, males aged ≥ 60 years and females aged < 60 years with insomnia symptoms ranging from 5–8 had an increased risk of death compared with their counterparts without insomnia symptoms (hazard ratio = 1.15; 95% confidence interval: 1.02, 1.31 and hazard ratio = 1.38; 95% confidence interval: 1.00, 1.90, respectively). However, there was no increased risk of death for females aged ≥ 60 years (hazard ratio = 0.94; 95% confidence interval: 0.84, 1.06). Conclusions: These findings suggest that insomnia symptoms may serve as predictors of low life expectancy. © 2024 American Academy of Sleep Medicine. All rights reserved.

Food insecurity is a detriment to the health and academic success of college students nationwide, increasing the need for innovative interventions. This cross-sectional study administered an online survey to 140 students attending a Northeastern public university to understand student interest in a student-sustained grocery program. The majority of students (53.6%) were food insecure (FI), measured with the USDA 6-item survey, as well as upperclassmen. Results identified that FI students may be most interested in a food pickup program that provides them with cooking classes, snack foods, and ingredients for 2–6 meals at a cost between $24.50 and $26.90 per week. © 2024 Taylor & Francis Group, LLC.

The aim of this qualitative research paper was to identify how social isolation policies implemented during the COVID-19 pandemic impacted the lives of pregnant women and mothers with opioid use disorder. Between 2020 and 2022, in-depth interviews were conducted with 37 mothers and pregnant women living in the suburbs of Newark, NJ, and New Haven, CT. Participants had to be at least 18 years old, misused or abused opioids in the last 12 months while residing in a suburban location, and pregnant or caring for children aged 12 and younger. We used syndemics theory to guide our grounded theory analysis to identify relationships between social situations, health conditions, and opioid use disorder. Five major themes emerged that were either directly or indirectly impacted by social isolation caused by policies implemented during the COVID-19 pandemic: Relationships, Environment, Services, Drug Use, and Health. Findings from this study reveal new insights into how mothers and their health were impacted by prolonged social isolation policies and offer suggestions for policymakers and service providers to better address future crisis.

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.