Vulnerability and Resilience: Use and Misuse of These Terms in the Public Health Discourse

"I Don't Think a Broken Spirit Can Be Quantified": Perceptions of College Victimization and Its Consequences Among Students at a Hispanic-Serving Institution

This study investigated students' perceptions of victimization among college students (e.g., extent, location, consequences) through eight focus groups at a large, urban Hispanic-serving institution. Understanding students' perceptions of crime sheds light on the consequences of victimization as well as the cognitive, emotional, and behavioral impacts of the possibility of experiencing victimization. Our results yielded several key findings that warrant further discussion: (1) victimization-particularly sexual and property victimization-is an issue that many students thought about extensively and viewed as important; (2) the psychological impact of victimization and threatened sense of safety were perceived to be enduring consequences of victimization that can impact the college experience; (3) there was nuance to perceptions of "on-" versus "off-" campus victimization, with consequences carrying over to campus life even when incidents occur off campus; and (4) participants expressed both moral and conceptual issues with assigning a dollar amount to consequences of victimization. These results inform how perceptions of victimization risk and anticipated consequences shape student fears and behavior, while also highlighting key areas that universities may consider for prevention and intervention efforts.

Improving Health and Reducing Chronic Disease Disparities with Latinx Communities: Evaluating the Role of Documented Community-Based Intervention Participation

PURPOSE

Limited evidence exists on the impact of participation in community-based chronic disease self-management and prevention programs on health disparities. The purpose of this research was to determine the effects of participation in the Healthy Here Wellness Referral System on existing disparities in glycated hemoglobin (HbA1c), systolic blood pressure (BP), and diastolic BP among Hispanic/Latinx adults compared with non-Hispanic White adults.

METHODS

We merged administrative clinical and referral data from 2018 through 2022 for adult patients in six focus ZIP codes in New Mexico resulting in a sample of 1331 patients and used regression models to examine predictors of intervention participation as well as propensity-adjusted impacts of participation on HbA1c and BP outcomes.

RESULTS

Non-Hispanic White patients who were referred to community-based programming but did not participate saw statistically significant increases in HbA1c. Hispanic/Latinx patients saw statistically significant decreases in HbA1c with referral alone, with no added benefit from program participation. The impact of participation differed statistically significantly (t(683) = 3.55, p < .001) between these two groups for HbA1c levels, as well as for systolic (t(958) = 2.11, p = .04) and diastolic BP outcomes (t(958) = 2.96, p = .003).

CONCLUSIONS

Results of this study support the promise of using centralized referral systems to co-produce health improvement in community settings. Mixed findings highlight the need for further uptake of theory-informed measurement in evaluations seeking to understand heterogeneous program impacts by race and ethnicity.

Current perspectives on perinatal mental health and neurobehavioral development: focus on regulation, coregulation and self-regulation

PURPOSE OF REVIEW

Perinatal mental health research provides an important perspective on neurobehavioral development. Here, we aim to review the association of maternal perinatal health with offspring neurodevelopment, providing an update on (self-)regulation problems, hypothesized mechanistic pathways, progress and challenges, and implications for mental health.

RECENT FINDINGS

(1) Meta-analyses confirm that maternal perinatal mental distress is associated with (self-)regulation problems which constitute cognitive, behavioral, and affective social-emotional problems, while exposure to positive parental mental health has a positive impact. However, effect sizes are small. (2) Hypothesized mechanistic pathways underlying this association are complex. Interactive and compensatory mechanisms across developmental time are neglected topics. (3) Progress has been made in multiexposure studies. However, challenges remain and these are shared by clinical, translational and public health sciences. (4) From a mental healthcare perspective, a multidisciplinary and system level approach employing developmentally-sensitive measures and timely treatment of (self-)regulation and coregulation problems in a dyadic caregiver-child and family level approach seems needed. The existing evidence-base is sparse.

SUMMARY

During the perinatal period, addressing vulnerable contexts and building resilient systems may promote neurobehavioral development. A pluralistic approach to research, taking a multidisciplinary approach to theoretical models and empirical investigation needs to be fostered.

Adopting a child perspective for exposome research on mental health and cognitive development - Conceptualisation and opportunities

Mental disorders among children and adolescents pose a significant global challenge. The exposome framework covering the totality of internal, social and physical exposures over a lifetime provides opportunities to better understand the causes of and processes related to mental health, and cognitive functioning. The paper presents a conceptual framework on exposome, mental health, and cognitive development in children and adolescents, with potential mediating pathways, providing a possibility for interventions along the life course. The paper underscores the significance of adopting a child perspective to the exposome, acknowledging children's specific vulnerability, including differential exposures, susceptibility of effects and capacity to respond; their susceptibility during development and growth, highlighting neurodevelopmental processes from conception to young adulthood that are highly sensitive to external exposures. Further, critical periods when exposures may have significant effects on a child's development and future health are addressed. The paper stresses that children's behaviour, physiology, activity pattern and place for activities make them differently vulnerable to environmental pollutants, and calls for child-specific assessment methods, currently lacking within today's health frameworks. The importance of understanding the interplay between structure and agency is emphasized, where agency is guided by social structures and practices and vice-versa. An intersectional approach that acknowledges the interplay of social and physical exposures as well as a global and rural perspective on exposome is further pointed out. To advance the exposome field, interdisciplinary efforts that involve multiple scientific disciplines are crucial. By adopting a child perspective and incorporating an exposome approach, we can gain a comprehensive understanding of how exposures impact children's mental health and cognitive development leading to better outcomes.

Resilience of Older Latinos and Mexicans Before and During the Pandemic

This article introduces the special issue on Aging and Resilience in the Americas: Mexico and the United States. The article overviews the role that the annual International Conference on Aging in the Americas (ICAA) has played in the development of scholarship on aging of Latinos in the United States and older persons in Latin America and the Caribbean. A brief overview of the aging literature reveals a growing interest on the resiliency of older Latino and Latin American populations in the United States and more broadly the Americas. The article provides a short description of each of the five articles included in this special issue.

Nurse-led approaches to address social determinants of health and advance health equity: A new framework and its implications

BACKGROUND

The U.S. health care system is burdened by inefficiencies, longstanding health inequities, and unstainable costs. Within the nursing profession and the broader health care sector, there is growing recognition of the need for a paradigm shift that addresses persistent structural problems and advances health equity.

PURPOSE

Despite evidence of the importance of the social determinants of health (SDOH) in shaping inequitable health outcomes, practical tools for applying SDOH theory in the development of effective nurse-led programs to mitigate harmful SDOH remain scarce.

METHODS

We synthesize extant SDOH literature into a heuristic framework for conceptualizing core SDOH mechanisms, constructs, and principles.

FINDINGS

To illustrate how nurse scientists can use the framework to guide the development of programs for SDOH mitigation, we outline a three-step exemplar application to the U.S. Latino HIV epidemic.

DISCUSSION

Our framework can inform a paradigm shift toward nurse-led, multi-level SDOH mitigation across practice, education, and research.

Social Vulnerability, COVID-19, Racial Violence, and Depressive Symptoms: a Cross-sectional Study in the Southern United States

BACKGROUND

In March 2020, the novel 2019 coronavirus disease (COVID-19) was declared a pandemic. In May 2020, George Floyd was murdered, catalyzing a national racial reckoning. In the Southern United States, these events occurred in the context of a history of racism and high rates of poverty and discrimination, especially among racially and ethnically minoritized populations.

OBJECTIVES

In this study, we examine social vulnerabilities, the perceived impacts of COVID-19 and the national racial reckoning, and how these are associated with depression symptoms in the South.

METHODS

Data were collected from 961 adults between June and November 2020 as part of an online survey study on family well-being during COVID-19. The sample was majority female (87.2%) and consisted of 661 White participants, 143 Black participants, and 157 other racial and ethnic minoritized participants. Existing social vulnerability, perceived impact of COVID-19 and racial violence and protests on families, and depressive symptoms were assessed. Hierarchical regression analysis was used to predict variance in depressive symptoms.

RESULTS

Half of the sample (52%) reported a negative impact of COVID-19, and 66% reported a negative impact of national racial violence/protests. Depressive symptoms were common with 49.8% meeting the cutoff for significant depressive symptoms; Black participants had lower levels of depressive symptoms. Results from the hierarchical regression analysis indicate social vulnerabilities and the perceived negative impact of COVID-19 and racial violence/protests each contribute to variance in depressive symptoms. Race-specific sensitivity analysis clarified distinct patterns in predictors of depressive symptoms.

CONCLUSION

People in the South report being negatively impacted by the confluence of the COVID-19 pandemic and the emergence of racial violence/protests in 2020, though patterns differ by racial group. These events, on top of pre-existing social vulnerabilities, help explain depressive symptoms in the South during 2020.

Implementing barbershop-based health-promotion interventions for Black men: A systematic scoping review

OBJECTIVE

Health-promotion efforts among Black men in the United States have been limited in their ability to recruit, retain, and produce meaningful health-related changes. These difficulties have led to Black men being referred to as a "hard-to-reach" population-a designation that places undue blame on these men as opposed to the dissemination and implementation strategies being used by health-promotion specialists. Gender- and race-based strategies that align with the lived experiences of these men are likely to circumvent these challenges. Barbershops are cultural institutions that are uniquely positioned to promote health among Black men. There is little guidance on how to develop, implement, and evaluate barbershop-based efforts. This scoping review seeks to provide this guidance by applying the RE-AIM framework to analyze existing interventions.

METHOD

Information was identified by searching the following bibliographic databases: PubMed, EMBASE PsycINFO, CINAHL, and Web of Science. A grey literature search was conducted using Web of Science and ClinicalTrials.gov. Results were uploaded to Rayyan. Each article was independently and blindly assessed by two reviewers. A third reviewer blindly resolved any discrepancies. Data were then independently extracted by the two reviewers. Discrepancies were flagged and resolved collaboratively.

RESULTS

Results indicate that barbershop-based health-promotion efforts that prioritize community engagement and intentional alignment to the gender- and race-based lived experiences of Black men are likely to result in satisfactory recruitment, retention, and health-related changes among these men.

CONCLUSIONS

More intervention efforts are needed that target young Black adults, rural Black men, mental health outcomes, and which implement peer-to-peer models. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Conceptualizing the Mechanisms of Social Determinants of Health: A Heuristic Framework to Inform Future Directions for Mitigation

Policy Points A large body of scientific work examines the mechanisms through which social determinants of health (SDOH) shape health inequities. However, the nuances described in the literature are infrequently reflected in the applied frameworks that inform health policy and programming. We synthesize extant SDOH research into a heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing key mechanisms that represent intervention opportunities for mitigating the impact of harmful SDOH. In light of scarce existing SDOH mitigation strategies, the framework addresses an important research-to-practice translation gap and missed opportunity for advancing health equity.

CONTEXT

The reduction of health inequities is a broad and interdisciplinary endeavor with implications for policy, research, and practice. Health inequities are most often understood as associated with the social determinants of health (SDOH). However, policy and programmatic frameworks for mitigation often rely on broad SDOH domains, without sufficient attention to the operating mechanisms, and effective SDOH mitigation strategies remain scarce. To expand the cadre of effective SDOH mitigation strategies, a practical, heuristic framework for policymakers, practitioners, and researchers is needed that serves as a roadmap for conceptualizing and targeting the key mechanisms of SDOH influence.

METHODS

We conduct a critical review of the extant conceptual and empirical SDOH literature to identify unifying principles of SDOH mechanisms and to synthesize an integrated framework for conceptualizing such mechanisms.

FINDINGS

We highlight eight unifying principles of SDOH mechanisms that emerge from landmark SDOH research. Building on these principles, we introduce and apply a conceptual model that synthesizes key SDOH mechanisms into one organizing, heuristic framework that provides policymakers, practitioners, and researchers with a customizable template for conceptualizing and operationalizing the key SDOH mechanisms that represent intervention opportunities to maximize potential impact for mitigating a given health inequity.

CONCLUSIONS

Our synthesis of the extant SDOH research into a heuristic framework addresses a scarcity of peer-reviewed organizing frameworks of SDOH mechanisms designed to inform practice. The framework represents a practical tool to facilitate the translation of scholarly SDOH work into evidence-based and targeted policy and programming. Such tools designed to close the research-to-practice translation gap for effective SDOH mitigation are sorely needed, given that health inequities in the United States and in many other parts of the world have widened over the past two decades.

The role of sense of community in improving the health-related quality of life among Black Americans

Black Americans have the lowest life expectancy and health-related quality of life (HRQoL; a strong predictor of premature mortality) of any racial/ethnic group in the United States. Low rates of physical activity and engagement in healthy eating are two known contributors to low HRQoL. Black Americans are more likely to live in environments that inhibit engagement in these two contributors. The present study examined sense of community as a buffer against the adverse effects of low physical activity and healthy eating on HRQoL among Black Americans. A sample of 290 Black American adults were recruited for the present study. Results indicate that sense of community buffers against the adverse effects of low physical activity on HRQoL. The results of the present study can be used by health promotion interventionists and policy-makers to improve HRQoL and reduce premature mortality among Black Americans.

Restoring trust in research among historically underrepresented communities: A call to action for antiracism research in nursing

BACKGROUND

Health disparities and inequities among historically underrepresented populations represent a public health crisis.

PURPOSE

This manuscript describes how use of an antiracism framework, an evidence-based approach to addressing systemic barriers, can assist with restoring trust in historically underrepresented communities that have experienced harm by researchers.

METHODS

We also discuss the necessity of inclusive research teams and provide exemplars of how antiracism research principles and inclusive research teams can be used to mitigate harm and restore trust in historically underrepresented communities.

DISCUSSION

Historical trauma and research misconduct have resulted in the mistrust of healthcare providers and health care systems among historically underrepresented individuals and communities.

CONCLUSION

Nurse scientists are positioned to appreciate historical inequities and trauma and to intervene by developing culturally relevant interventions. This work, however, will only happen if communities that have suffered harm trust nurse scientists.