Transportation and other social needs as markers of mental health conditions

Type of trauma exposure and subsequent mental health Symptoms: Examining the role of social needs in TX-YDSRN youth

Many youth experience potentially traumatic events and may go on to develop post-traumatic stress disorder (PTSD). For youth who develop PTSD, little research has examined the role of health-related social needs, like housing instability or food insecurity, on its development. The present study aimed to explore the types of traumatic experiences reported at baseline by youth and sought to explore the relationship between post-traumatic stress symptoms and reported health-related social needs. Specifically, it aimed to determine if the effects of health-related social needs differed across demographic variables (e.g., sex assigned at birth, gender, race, ethnicity) and trauma types (i.e., interpersonal and other trauma). Findings demonstrated interpersonal trauma was a significant predictor of PTSD symptoms. While lower interpersonal safety was associated with a greater likelihood of participants reporting interpersonal trauma, it was not related to PTSD symptoms. Our findings highlight the need for clinicians to utilize interventions that specifically target the psychological effects of interpersonal trauma. Furthermore, interventions should consider the wider social context to address factors like interpersonal safety which may play a part in the increased risk of trauma exposure among youth.

National analysis of health-related social needs among adult injury survivors

BACKGROUND

Despite advances in trauma care, the effects of social determinants of health continue to be a barrier to optimal health outcomes. Health-related social needs (HRSNs), now the basis of a Centers for Medicare and Medicaid Services national screening program, may contribute to poor health outcomes, inequities, and low-value care, but the impact of HRSNs among injured patients remains poorly understood at the national level.

METHODS

Using data from the nationally representative 2021 Medical Expenditure Panel Survey, injured patients were matched with uninjured controls via coarsened exact matching on age and sex. We then determined the prevalence of HRSNs based on core needs identified by Centers for Medicare and Medicaid Services: food, utilities, living situation, transportation, and personal safety. We used multivariable regression models to evaluate the association between HRSNs and health, delays in care, and emergency department visits.

RESULTS

Overall, 43% of injured patients reported one or more HRSNs. Compared with uninjured controls, injured patients were more likely to have unmet needs in all five HRSN domains (adjusted odds ratio, 1.44-2.00; p < 0.05 for all). In stratified analyses, HRSNs were highest among patients with lower income (65.1%), those who identified as Non-Hispanic Black patients (61.3%), and patients with Medicaid (66.1%). Increasing number of HRSNs was associated with worse physical and mental health ( p < 0.05). Injured patients with three or more HRSNs were also more likely to delay care because of cost (adjusted odds ratio, 3.79; 95% confidence interval, 2.29-6.27) and had greater emergency department utilization (adjusted incidence rate ratio, 1.47; 95% confidence interval, 1.16-1.87).

CONCLUSION

In this nationally representative study, nearly half of injured patients had one or more HRSNs. Greater numbers of HRSNs were associated with worse health outcomes, delayed care, and low-value care. As national screening for HRSNs is implemented, strategies to address these factors are needed and may serve to optimize health and health care utilization among injury survivors.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.

Understanding Barriers and Facilitators of Primary Care Use Among Assertive Community Treatment Teams Via Qualitative Analysis of Clients and Clinicians

Individuals with severe mental illness and substance use disorders face complex barriers to achieving physical health. This study aims to explore the barriers and facilitators of primary care access among an Assertive Community Treatment (ACT) team. Semi-structured qualitative interviews were conducted with 14 clients and 7 clinicians from an ACT team at a community mental health center in Connecticut. Data analysis followed a grounded theory approach, with codes and themes emerging iteratively during the interview process. The study identified multifaceted barriers to accessing primary care, including economic challenges, homelessness, and the prioritization of mental health and substance use symptoms over healthcare. The conceptual framework consists of nine dominant themes: clients' attitudes, knowledge, mental health, and motivations ("Client-Level Barriers and Facilitators"); ACT team-directed care coordination and relationship-building as well as primary care provider communication ("Provider-Level Barriers and Facilitators"); and clients' experiences with medical care and socioeconomic status ("Systemic-Level Barriers and Facilitators"). This research provides valuable insights into the various barriers faced by ACT clients in accessing primary care. Improving primary care access for individuals with severe mental illness and substance use disorders is crucial for reducing health disparities in this vulnerable population.

Effects of public transportation use on non-exercise activity thermogenesis and health promotion: a mini-review

PURPOSE

Public transportation (PT) systems significantly shape urban mobility and have garnered attention owing to their potential impact on public health, particularly the promotion of physical activity. Beyond their transportation functions, PT systems also affect daily energy expenditure through non-exercise activity thermogenesis (NEAT). This mini-review surveys the existing literature to explore the effects of PT use on NEAT levels and subsequent health outcomes.

METHODS

A comprehensive literature search was conducted using the electronic databases PubMed, Google Scholar, and Web of Science. Keywords including "public transportation," "non-exercise activity thermogenesis," "physical activity," "health promotion," and related terms were used to identify relevant studies.

RESULTS

This review highlights the multifaceted relationship between PT use and health promotion, emphasizing the potential benefits and challenges of increasing NEAT through public transit utilization. Overall, the findings suggest that PT use contributes positively to NEAT levels, and thus improves health outcomes. However, the extent of this impact may vary depending on individual and contextual factors.

CONCLUSION

Interventions promoting active transportation modes, including public transit, hold promise for addressing sedentary behavior and fostering healthier lifestyles at the population level.

Nowhere to go? A study of marginalization, social connection, and mental health outcomes among young adults experiencing the COVID-19 pandemic

Background

The COVID-19 pandemic onset necessitated large-scale closures of third places, potentially exacerbating social barriers experienced by young adults in the United States. To better understand the role of urban form in facilitating socialization, we examine the effects of pandemic-based third place closures on mental health outcomes as mediated by changes in social connection. Because identifying as a racial, gender, or sexual minority can compound baseline disadvantages rooted in systemic inequities, we investigate outcome differences for non-white, woman/nonbinary, and LGBTQ+ young adults to disentangle identity-based nuances of the pandemic experience.

Methods

In February 2021, we administered a web-based survey with retrospective name and place generators to 313 18-to-34-year-olds in California, Illinois, and Texas. A structural equation model is estimated showing the direct and indirect effects of physical and virtual mobility constraints on mental health.

Results

Both the closure of third places and dissatisfaction with alternative social spaces are associated with the deterioration of social connections and mental health. The strongest direct predictor of mental health decline is dissatisfaction with virtual socialization (more significant for women and nonbinary respondents). Surprisingly, two distinct categories of third places (i.e., 'civic' and 'commercial') reveal different relationships with social connections and mental health outcomes. Asian, other non-white, and non-heterosexual young adults experienced greater 'civic' visit reduction, while those with intersecting identities of low income and woman/nonbinary or Black experienced greater 'commercial' visit reduction.

Conclusions

Physical and virtual mobility reductions contributed to the inequitable mental health outcomes experienced by young adults during the pandemic. This highlights the potential for a careful redesign of physical and virtual social spaces to support feelings of belonging/safety and spontaneous 'weak tie' interactions, encourages further investigation of social infrastructure's role in facilitating the maintenance of social connections and mental health, and reveals the value of examining differences in mobility-related experiences across social identities.