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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.