Links between obesity, weight stigma and learning in adolescence: a qualitative study

Background Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap. Methods We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically. Results We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the ‘right’ friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them. Conclusions Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Job Satisfaction and Alcohol Consumption: Empirical Evidence from China

Despite growing attention to job satisfaction as a social determinant of alcohol-related behaviors, few studies focus on its diverse impacts on alcohol consumption. Using data from the China Family Panel Study in 2018, this study uses logistic regression analysis to examine how job satisfaction affects alcohol consumption in China, finding that people who were satisfied with their jobs were more likely to be regularly drinking. Employed people who were satisfied with their working environment and working hours were more likely to regularly drink, but those who were satisfied with their wages and working security were less likely to be regularly drinking. Findings suggest that the link between job satisfaction and alcohol consumption is dynamic. Employment policies, working wellbeing improvement programs, and alcohol policy improvement should, therefore, be designed on the basis of a comprehensive account of entire job-related attitudes.

Racism and Older Black Americans’ Health: a Systematic Review

We reviewed research that examines racism as an independent variable and one or more health outcomes as dependent variables in Black American adults aged 50 years and older in the USA. Of the 43 studies we reviewed, most measured perceived interpersonal racism, perceived institutional racism, or residential segregation. The only two measures of structural racism were birth and residence in a “Jim Crow state.” Fourteen studies found associations between racism and mental health outcomes, five with cardiovascular outcomes, seven with cognition, two with physical function, two with telomere length, and five with general health/other health outcomes. Ten studies found no significant associations in older Black adults. All but six of the studies were cross-sectional. Research to understand the extent of structural and multilevel racism as a social determinant of health and the impact on older adults specifically is needed. Improved measurement tools could help address this gap in science.

Psychological well-being among college students: A study from Central India

Background: Psychological well-being (PWB) is affected by age, physical health, personality, life experiences, socioeconomic status, and culture. Age is an important social determinant of health and age-based analysis is necessary to rectify one’s health and health care. Aims and Objectives: This study aims to assess the PWB of college students and to determine the correlation between age and PWB aspects. Materials and Methods: This cross-sectional study was conducted among 210 college students selected by simple random sampling. Ryff’s PWB scale, a 42-item version used for the assessment of PWB, and data were collected by self-administering questionnaires. Statistical Analysis: Internal consistency of the scale was estimated and descriptive statistics, independent samples t-test, and regression analysis were applied. Results: The mean age of the participants was 19.41±1.69 years and 61% were male. Cronbach’s alpha coefficient for internal consistency of Ryff’s PWB scale was 0.814 in this study. The mean of PWB was 205.42±11.04 and ≥20 years scored higher in all the parameters of PWB than <20 years, differences were (t=3.62, P=0.001) significant. Simple linear regression showed that age was a highly significant (P=0.002) predictor of PWB. Conclusion: The study illustrated that students of 20 years or more had better PWB in terms of all dimensions than <20 years-, and also suggested the need for future research, like, to deepen on the conceptual and relations between age and PWB, and to analyze the impact that social changes have toward age group on PWB.

A Researcher–Practitioner Collaboration to Enable Replication of an Evidence-Based Financial Education and Coaching Program That Improves Health in Low-Income Single Mothers

Financial strain is a social determinant of health (SDOH). Although public financial education helps individuals improve financial well-being, specifics are lacking on how and why effective programs work, potentially limiting their successful replication in other practice settings. In this study, researchers and practitioners cocreated the core components and theory of change of a novel financial education and coaching program, which a randomized controlled trial found was effective in significantly improving participants’ financial and health-related behaviors. A Cocreating Knowledge Translation Framework within a case study design was used at a university-affiliated nonprofit in Omaha, Nebraska, from August to December 2020. Twelve practitioner and alumni participants were purposefully sampled. An administrative records review, semi-structured interviews (n =3), survey (n = 10), and facilitated backward mapping session (n = 5) were conducted. Transcripts were coded to identify themes. Thirty-one core components were identified within program principles, design, tools, activities, and expectations of participants and coaches. Ten theory of change outcomes described participants’ pathway to change. Interventions occurred at individual, relationship, and community levels from initial engagement, through behavioral changes, to improved health-related quality of life. Activities and indicators were mapped to each outcome. The program’s intersecting and reinforcing design was key to enabling participants’ outcomes. Its theory of change described how and why the model improved financial and health behaviors. Findings suggest that other SDOH-focused organizations may benefit from researcher–practitioner collaboration to investigate their interventions’ core components and theories of change. This may enable replication, promoting downstream health benefits in new community settings.

A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers

Background: Smoking rates among low-income patients are double those of the general population. Access to health care is an essential social determinant of health. Federally qualified health care centers (FQHC) are government-supported and community-based centers to increase access to health care for non-insured and underinsured patients. However, barriers to implementation impact adherence and sustainability of evidence-based smoking cessation within FQHC settings. To address this implementation barrier, our multi-disciplinary team proposes Mi QUIT CARE (Mile Square QUITCommunity-Access-Referral-Expansion) to establish the acceptability, feasibility, and capacity of an FQHC system to deliver an evidence-based and multi-level intervention to increase patient engagement with a state tobacco quitline.Methods: A mixed-method approach, rooted in an implementation science framework of RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance), will be used in this hybrid effectiveness-implementation design. We aim to evaluate the efficacy of a novel delivery system (patient portal) for increasing access to smoking cessation treatment. In preparation for a future randomized clinical trial of Mi QUIT CARE, we will conduct the following developmental research: (1) Examine the burden of tobacco among patient populations served by our partner FQHC, (2) Evaluate among FQHC patients and health care providers, knowledge, attitudes, barriers, and facilitators related to smoking cessation and our intervention components, (3) Evaluate the use of tailored communication strategies and patient navigation to increase patient portal uptake among patients, and (4) To test the acceptability, feasibility, and capacity of the partner FQHC to deliver Mi QUIT CARE.Discussion: This study provides a model for developing and implementing smoking and other health promotion interventions for low-income patients delivered via patient health portals. If successful, the intervention has important implications for addressing a critical social determinant of cancer and other tobacco-related morbidities.Trial Registration: U.S. National Institutes of Health Clinical Trials, NCT04827420, https://clinicaltrials.gov/ct2/show/NCT04827420.