Social Science & Medicine

Violence against women is sustained not only by individual behavior but also by social norms that legitimize coercion and control. While attitudes justifying intimate-partner violence have been extensively documented in large-scale household surveys, they are rarely analyzed as structured, predictable population-level phenomena. Here, we model the continuous prevalence of violence-justifying attitudes across 70 countries and demographic subgroups using country-resolved supervised machine learning with strict out-of-sample evaluation. Drawing on harmonized estimates derived from the Demographic and Health Surveys, we quantify how much cross-subgroup variation in normative acceptance is explainable from survey structure alone. By comparing full models that incorporate attitudinal scenario framing with demographics-only baselines, we show that high predictability arises from fundamentally different sources across countries: in some contexts, demographic stratification--particularly education--structures normative acceptance, whereas in others, conditional justification narratives dominate. Integrating independent country-level indicators of gender inequality, human development, and democratic quality reveals that violence-justifying norms are most predictable in structurally polarized settings rather than within a single cultural regime. Together, these findings demonstrate that normative acceptance of violence is not uniformly diffuse but can form coherent, structurally embedded patterns. This cross-scale framework provides a quantitative basis for identifying where prevention strategies may benefit most from demographic targeting versus direct challenges to context-specific justifications of violence. Significance statementNormative acceptance of intimate-partner violence is a measurable societal risk factor, yet it is rarely analyzed as a structured population-level phenomenon. Most quantitative studies remain descriptive, and machinelearning analyses using large-scale household surveys typically focus on individual-level classification of victimization or vulnerability. Here, we model the continuous prevalence of violence-justifying attitudes across 70 countries and demographic subgroups using country-resolved supervised regression with rigorous out-of-sample evaluation. By contrasting demographics-only models with those incorporating attitudinal scenario framing, we show that cross-national differences in predictability arise from distinct sources--demographic stratification in some contexts and conditional justification narratives in others. Linking these patterns to independent indicators of gender inequality, human development, and democratic quality reveals that highly structured norms emerge in structurally polarized settings, highlighting where targeted prevention strategies are most likely to be effective.

BackgroundUnderstanding the associations among biopsychosocial factors is essential for improving research and treatment of chronic low back pain (CLBP). Here we characterized interrelations among biopsychosocial domains using network analysis and identified the most influential features in CLBP. MethodsData came from Quebec Low Back Pain Study, comprising 4,489 CLBP participants. We modeled relationships among baseline biopsychosocial features as networks, where nodes represent features and edges encode statistical or causal dependencies among them. Undirected network was inferred using distance correlation. Directed network was constructed using the Linear Non-Gaussian Acyclic Model, which estimates plausible causal directions. Influence maximization was performed using the Independent Cascade (IC) model to identify the most influential features in each network. ResultsIn the undirected network, physical function and pain interference were the most central nodes, followed by depression. In the directed network, fear of movement, catastrophizing, and widespread pain emerged as key downstream hubs receiving multiple causal inputs, whereas pain interference, physical function, and depression acted as major upstream drivers exerting broad causal influence. IC diffusion simulations further identified pain interference and physical function as the most influential features in the undirected and directed networks, respectively. ConclusionsPain interference, physical function, and depression consistently emerged as key components of the CLBP biopsychosocial network. These features exert causal effects on fear of movement, catastrophizing, and widespread pain, with diffusion analyses confirming their roles as system-wide drivers. Interventions targeting functionality and pain interference, rather than pain intensity alone, may yield broader benefits across psychological and functional domains.

The consumption of sugar-sweetened beverages (SSBs) has risen significantly in both developing and developed economies, despite well-documented evidence of their adverse health consequences. Although price-based regulations, primarily through SSB taxation, are widely recognized as a policy instrument to reduce consumption and improve public health outcomes, interventions targeting SSBs have received relatively limited attention in Bangladesh. Using the 2022 Household Income and Expenditure Survey (HIES) data and the Quadratic Almost Ideal Demand System (QUAIDS) model, we quantify own- and cross-price elasticities of SSBs to assess the responsiveness of SSB consumption to price changes. We document a substantial escalation of SSB consumption, rising from 13.2% of households in 2016 to 36.7% in 2022. The estimated uncompensated own-price elasticities are -1.060, -1.103, and -0.880 for soft drinks (liters), tea consumed outside the home (cups), and tea consumed inside the home (kilograms), respectively, suggesting pronounced price responsiveness, particularly for soft drinks and tea outside the home. Own-price elasticities for soft drinks and tea outside the home are higher among rural and low-income households compared to urban and high-income households, indicating greater sensitivity among the marginalized groups. In contrast, the elasticity estimates for tea consumed inside are higher in urban areas. The cross-price elasticity estimates suggest that soft drinks and tea consumed at home are complementary goods in the uncompensated case, while most SSB categories are found to be substitute goods across both uncompensated and compensated specifications. The findings highlight the potential effectiveness of targeted taxation policies in curbing SSB consumption, particularly soft drinks, and promoting public health in Bangladesh.

Large-scale epidemics are consistently associated with increased psychological distress and substantial changes in human mobility, yet the relationship between mental health responses and effective population mobility remains overlooked. During the COVID-19 pandemic, non-pharmaceutical interventions (NPIs) such as lockdowns and travel restrictions altered daily movement patterns while simultaneously affecting psychological well-being. Importantly, formal policy stringency alone does not fully capture realized mobility behavior, which also reflects spontaneous adaptation and adherence fatigue over time. In this study, we examine the association between self-reported mental distress and mobility recovery across the United States during the first wave of the COVID-19 pandemic. We combine state-level human mobility data derived from anonymized mobile phone records with large-scale survey data on self-reported anxiety and depression. Our analysis focuses on the U.S. states and territories from April 1 to September 1, 2020. Using fixed-effects regression models, we assess how variations in mental distress relate to deviations from pre-pandemic mobility levels, while controlling for reported COVID-19 mortality and the stringency of NPIs. We find a negative and statistically significant association between mental distress and mobility recovery: higher levels of self-reported anxiety and depression are associated with lower recovery of pre-pandemic mobility. These results indicate that psychological distress is associated with population mobility beyond what is explained by formal restrictions alone. Our findings highlight the relevance of mental health as a factor linked to behavioral responses during public health crises. Incorporating psychological well-being into the evaluation of mobility dynamics may inform more balanced public health strategies in future emergencies. Author summaryDuring the COVID-19 pandemic, governments introduced restrictions on movement, such as stay-at-home orders and travel limits, to slow the spread of the virus. At the same time, many people experienced increased anxiety and depression. In this study, we ask whether changes in mental well-being were linked to how quickly people returned to their usual patterns of movement. Here, we focus on the first wave of the pandemic in the United States and combine mobility data and large-scale digital survey data to study the association between self-reported mental health indicators and effective mobility at the population level. By comparing states over time, we explore whether changes in mental distress were associated with changes in mobility, beyond what can be explained by public restrictions or reported deaths alone. We find that states with higher levels of reported anxiety and depression tended to show slower recovery toward normal mobility levels. This suggests that psychological well-being played an important role in shaping individual and collective responses to the pandemic, with implications for the design of future public health interventions.

IntroductionAge-group specific disparities for dentalcare use persist in the United States. The COVID-19 led to delays in non-urgent dentalcare. We provide national estimates on dentalcare use and influencing factors for the U.S. population before and during the COVID-19. MethodsWe used nationally representative Medical Expenditure Panel Survey for over pre-COVID-19 years (2018-2019) and COVID-19 years (2020-2021) We estimated yearly survey-weighted trends in mean non-zero dental visits by age followed Poisson regression, controlling for a comprehensive set of confounders across five domains of influence. Dentalcare visits were defined as visits to any dentalcare provider. ResultsOverall analytic sample included non-institutionalized community living persons (unweighted n=6518, weighted N[~]320 million) grouped as ages 0-17, 18-44, 45-64, 65-74 and 75+ present in all four years The prevalence ratio (PR) for dental visits was slightly higher for ages 75+ in comparison to ages 65-74 across years 2018-2021 and increased from 1.73 (95% CI: 1.4, 2.1) to 1.84 (95% CI: 1.5, 2.3) to 2.13 (95% CI: 1.7, 2.7) from 2018 to 2020 but rebounding to near pre-pandemic level in 2021 to 1.66 (95% CI, 1.3, 2.0). Consistent factors during COVID-19 pandemic years 2020-2021 that increased dental visits included dental insurance, high income, and having a usual source of care (p<0.01). ConclusionsDentalcare use rebounded for older adults in 2021 but remained below pre-pandemic levels. Practical ImplicationsIncreasing dentalcare visits across ages remains a key policy priority. Continued monitoring of dentalcare use trends beyond COVID-19 among older adults is critical to improve their oral health.

BackgroundSocioeconomic status (SES) strongly shapes oral health, yet the magnitude of these gradients, their pathways and the influence of US Medicaid policies remain uncertain. We quantified SES gradients in adult oral health, examined potential mechanisms and assessed whether state Medicaid expansion and adult dental benefit generosity were associated with aggregate oral health indicators. MethodsWe analysed adults aged [&ge;]20 years in NHANES 1999-2019 and state adult populations in BRFSS 2011-2025, supplemented with international oral health and Medicaid policy data. Individual outcomes were DMFT and self-rated oral health (good vs fair/poor). State-level outcomes were past-year dental visit rates, any permanent tooth loss and complete edentulism among adults [&ge;]65 years. SES measures included poverty-income ratio (PIR) and education; mediators included annual dental visits, unmet dental need and sleep duration. Analytic methods comprised survey-weighted regression, concentration and slope indices of inequality, Oaxaca-Blinder decomposition and state-level difference-in-differences models with state and year fixed effects and state-clustered standard errors. ResultsHigher PIR and education were independently associated with lower DMFT and higher odds of good self-rated oral health in all age groups. PIR coefficients for DMFT were {approx}-0.25 (ages 20-44), -0.79 (45-64) and -1.07 ([&ge;] 65); corresponding odds ratios for good oral health were {approx}1.48, 1.46 and 1.33. Predicted probabilities of good oral health increased monotonically across PIR quartiles. Concentration indices indicated that DMFT burden was concentrated among low-income adults (CI {approx} -0.105), whereas good oral health was concentrated among high-income adults (CI {approx} 0.094). The Slope Index suggested that moving from the lowest to highest income rank corresponded to {approx}2.48 fewer affected teeth; the Relative Index indicated {approx}eight-fold higher odds of reporting good oral health. Oaxaca-Blinder decomposition showed a Q4-Q1 DMFT gap of 1.31 teeth, with roughly one quarter explained by observed variables, mainly differences in dental access. State-level difference-in-differences models did not identify large, precisely estimated changes in dental visit rates, tooth loss or edentulism associated with Medicaid expansion or adult dental benefit generosity. ConclusionMarked SES-related oral health inequalities persist among US adults, particularly in midlife, and are strongly linked to differential dental access and socially patterned behaviours. Medicaid expansion and adult dental benefit generosity, as implemented, did not produce substantial detectable shifts in state-level oral health indicators. Reducing inequalities will require improved financial protection for dental care and broader action on income, education and other social determinants of health.

ObjectiveExplore self-reported racial discrimination in healthcare. MethodsRepresentative population sample, Switzerland, repeated cross-sectional data 2016 to 2024 (N=15,525). ResultsContrary to expectation, respondents from the migration-related population (foreign citizens, foreign born, migration background, first/second generation) report less racial discrimination than members of the majority population. Over time, we see an increase in the non migration-related population reporting (racial) discrimination in healthcare, while the share for the migration-related population is constant. The validity of the instrument is demonstrated with reported discrimination at work and in housing and the results are reliable across specifications and statistical controls. ConclusionWe speculate that in some cases, reported racial discrimination may express unmet expectations in healthcare more generally.

BackgroundHealth literacy (HL) influences communication quality, treatment adherence, and equity in care. However, how general practitioners (GPs) recognize and respond to patients HL in everyday clinical reasoning remains insufficiently understood. ObjectiveTo investigate how Danish GPs incorporate patients health literacy into decisions about prescribing pain medication for chronic musculoskeletal pain, using insights from surveys, interviews, and a literature review. MethodsA mixed-methods design combined survey data from 39 Danish GPs, seven qualitative interviews, and a synthesis of 14 studies on HL in general practice. The literature was used to contextualize and contrast the empirical findings. Quantitative data were analyzed descriptively, while qualitative data underwent thematic analysis. All three datasets were integrated through mixed-methods comparison to assess convergence, divergence, and complementarity. ResultsAcross the integrated survey, interview, and literature findings, HL emerged as a largely implicit but consistent element of GP decision-making. In the Danish survey and interview data, some GPs explicitly reported considering HL in prescribing decisions, yet interviews showed that HL more often influenced clinical reasoning indirectly through intuition and conversation. GPs adapted communication, explanations, and treatment planning to their perceptions of patient understanding, but these adjustments were rarely guided by structured tools or frameworks. Conversation appeared as the main approach for assessing comprehension, echoing patterns observed in the literature. Many Danish GPs perceived most patients as competent and self-managing, a perception the literature cautions may mask hidden comprehension challenges. Finally, both local interviews and existing studies highlighted digital HL as an emerging theme, with GPs commonly managing patients online health information through conversational reframing rather than formal strategies. ConclusionsHL is tacitly integrated into GP reasoning but remains under-recognized as a professional skill. Making HL an explicit component of communication training, reflective practice, and prescribing guidelines could improve patient understanding, shared decision-making, and treatment equity.

Why some surgical participants experience pain that extends beyond the original site of injury while others do not remains poorly understood. Both pain intensity and widespread pain contribute to recovery and quality of life, yet their psychosocial correlates are often examined separately. Using data from two large pre-surgical cohorts--participants preparing for knee replacement or thoracic surgery--we examined associations between sociodemographic and psychosocial factors, pain intensity at surgical and non-surgical sites, and widespread chronic pain. Across cohorts and outcomes, fatigue showed the strongest and most consistent associations with pain intensity and widespread pain, independent of other measured factors. Fatigue also occupied a central position in statistical association networks and accounted for substantial shared variance among multiple psychosocial variables, including sleep disturbance, depression, stress, and socioeconomic disadvantage. Pain at non-surgical sites was strongly associated with widespread pain and frequently accounted for observed associations between surgical-site pain and widespread pain. Together, these findings highlight robust patterns of association linking fatigue, pain intensity, and widespread pain in pre-surgical populations. One Sentence SummaryFatigue is the strongest and most consistent factor linked to how pain intensifies and spreads before surgery.

Background and AimIndividuals with non-binary gender commonly face minority stress such as invisibility, identity invalidation or even hostility within various social contexts. The COVID-19 pandemic represented an exceptional form of societal stress that presented mental health challenges in the population and probably even more so for vulnerable groups including non-binary gender individuals. We investigated whether there are gender differences in the impact of the COVID-19 pandemic on functional ability. MethodUniversity students and personnel (n=1998) responded to an online survey in May 2021, when the measures for preventing COVID-19 infections had sustained about a year and a half. Based on the gender option responses, groups of non-binary and binary (male or female) gender identity were formed. Current functioning (FUNCT), and subjective assessment of the effect of COVID-19 on functioning (COFUNCT) were recorded. Psychosocial and mental health characteristics were included in the statistical models. ResultsThe non-binary group represented 3,6 % of all study participants. The gender option "Male" was selected by 23.8% and the gender option "Female" by 72.7% of respondents. Compared to the binary group, those in the non-binary group exhibited poorer socioeconomic living situation and less favourable previous psychosocial development. Non-binary participants reported lower FUNCT and more negative COFUNCT than binary participants. In non-binary participants, a poor work situation was directly associated with poor FUNCT, while multiple adverse childhood experiences and loneliness were indirectly associated with lower FUNCT via depressive symptoms. Conversely, high family support and previous mental health care were directly associated with more negative COFUNCT, and loneliness was indirectly associated with low COFUNCT via depression. In binary participants, family support, good economy, resilience and active physical exercise associated with good FUNCT, while age, family support, good economy, resilience, active physical exercise and adverse childhood experiences associated with good COFUNCT. ConclusionsIndividuals with non-binary gender are more vulnerable for functional deficits in a period of serious societal stress such as COVID-19 pandemic. The related psychosocial and mental health factors should be taken into account when planning tailored interventions for vulnerable groups during periods of exceptional societal circumstances. Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/25343131v1_ufig1.gif" ALT="Figure 1"> View larger version (45K): org.highwire.dtl.DTLVardef@1bd9d76org.highwire.dtl.DTLVardef@1acee78org.highwire.dtl.DTLVardef@5c1eaeorg.highwire.dtl.DTLVardef@1e26602_HPS_FORMAT_FIGEXP M_FIG C_FIG

BackgroundEarly life social determinants of health, such as childhood trauma, have implication on adverse health outcomes later in the life course. Our objective was to develop a childhood trauma measure within the Health and Retirement Study (HRS) - a large, diverse, U.S.-based aging cohort. MethodsData from the HRS Psychosocial and Lifestyle Questionnaire [2006-2016] and Life History Survey [2015-2017]) surveys collected thirteen binary items measuring self-reported exposure to early life adversity across the two study questionnaires. Participants who completed both questionnaires and had exposure items available were included in the analyses. Frequencies and percentages for self-reported trauma items are presented for the study sample and by gender and race/ethnicity. Using complete cases, exploratory factor analyses followed by Mokken scale analyses were performed to evaluate the scalability of the childhood trauma items. Predictive criterion validity of the final domains was evaluated with general health and socioeconomic indicators at participant baseline. ResultsAmong the sample with complete childhood trauma data available (n=9,340), most were women (60.7%), White/Non-Hispanic (73.2%), and had a high school/general education degree (54.0%). The most reported childhood traumas were paternal separation [&ge;]6-months (22.8%), parental death (21.4%), sibling death (18.1%), and problematic parental substance use (17.5%). Two scales were formed based on factor analysis and scalability coefficients. The domain measuring disruption of family structure had strong scalability (HT = 0.55) and included living in an orphanage, foster care, parents divorced/separated, [&ge;]6-month from mother and/or father, and grandparents as primary caretakers. A second domain measuring adverse experiences of parent and/or sibling death had moderate scalability (HT = 0.41). Parental substance abuse and physical abuse clustered together in a third domain with weak scalability (HT = 0.39). ConclusionsThe early adversity items available in the HRS offer meaningful domains for which researchers can evaluate childhood trauma exposure in the context of aging outcomes in older adults. In particular, the family structure domain and parental/sibling death demonstrated moderate-to-strong scalability and may have important implications for health trajectories later in life.

ObjectivesThere is a deficit of information available to guide longer-term healthcare planning in meeting health needs and ensuring financial sustainability. This study attempts to address this gap through projecting future population health state and demographics and associated healthcare resources required to satisfy expected demands over the next two decades. MethodsA mathematical model is developed for projecting a populations future age and health state, subject to births, deaths, immigration and emigration. These modelled outputs are combined with healthcare resource utilisation profiles to provide future cost estimates at a total level and for constituent healthcare settings. The model is calibrated to linked longitudinal patient-level data from a one-million-resident NHS healthcare system in England covering a mixture of urban, rural and coastal locations. ResultsCost growth is projected to exceed population growth over the period from 2025 to 2047, with costs growing by 15-22%, depending on the scale of international migration, and the population growing by 4-16%. This is being driven by a projected 15-30% growth in the size of all but the healthiest population health states. If budgets were constrained to population growth, then either a 4% productivity improvement would be required or a 10% reduction in those transitioning to worse health states. ConclusionsAn ageing and unhealthier population is leading to a 5-11% rise in average per-person healthcare costs. To avert this, healthcare administrators may need to prioritise the quicker-acting cash-releasing productivity schemes to fund the prevention measures that may ultimately be required to secure longer-term financial sustainability.

IntroductionThe wellbeing of university undergraduates is a pressing area of concern, with one in five students reporting serious psychological distress. In previous semesters of a course on mental wellbeing, we asked undergraduates to engage with a standardized wellness program for the general population and provide feedback through weekly surveys and a final reflection paper. Based on these responses, we developed the 30-day, course-embedded Spaces program to more specifically address college student needs. MethodsThe Spaces program incorporates intrinsically pleasurable activities and short presence practices. We piloted the program in a cohort of 30 students during the Fall 2024 semester. Students completed weekly surveys measuring anxiety, depression, and wellbeing, pre-post surveys on present-moment awareness, and a post-program engagement scale. ResultsOver the five program weeks, students in the Spaces semester experienced significantly less anxiety (F(1,4)=38.40, P=0.003) and depression (F(1,4)=32.87, P=0.005) and more wellbeing (F(1,4)=65.86, P=0.001) than those in semesters with the standardized program, and increased present-moment awareness compared to baseline (t(27)=3.859, P=0.0006). Engagement with specific components predicted improvements in mood and attention. DiscussionThese findings highlight the potential of an iterative approach that incorporates input from the target population in enhancing the ability of a wellness program to meet its goals.

Young people are increasingly remaining in the parental home for longer - a trend associated with poorer mental health. There is little evidence on this transition for young people with disability. We used three waves of the Australian Census Longitudinal Dataset, a 5% sample of linked Census records. Two analyses compared transitions between 2011-2016 and 2016-2021 among people 15-34y living with parents at baseline with complete data on disability and housing. The proportion of people no longer living with parents at follow-up was calculated, comparing people with and without disability, along with absolute and relative inequalities. Young people with disability were half as likely to leave the parental home as their peers without disability. Inequalities were greatest for people 25-29y (relative difference 0.41 (95%CI 0.36-0.45), living outside major cities (0.48, 0.44-0.52), or with higher income (0.53 (0.47-0.59). Patterns were consistent over time. Targeted supports are needed to enable independent living. Points of interestO_LIWe found that less people with disability leave the parental home than people without disability C_LIO_LIWe also found the gap between people with and without disability was biggest outside major cities. C_LIO_LIThis may mean people with disability in rural, regional and remote areas find it more difficult to move out of home C_LIO_LIBetter housing and income supports are needed to help young people with disability live in the way they choose C_LI

ObjectiveYouth mental health is shaped by interacting individual, relational, and structural factors that vary across communities, yet few tools integrate these drivers into youth-specific, geographically granular measures for decision-making. This study describes the development and preliminary validation of ThriveAtlasTM, a geographically granular index designed to identify factors that prevent youth from thriving. MethodsThriveAtlas was developed through a multi-step process to identify, operationalize, and validate contextual determinants of youth mental health and well-being. This process included a literature review; selection and construction of indicators from public and proprietary data; aggregation into thematic domains and a composite index; and preliminary validation using county-level mental health outcomes in two U.S. states. Principal components analyses using California and Washington data were used to derive dimensions of youth mental health, which were correlated with ThriveAtlas index and subthemes. ResultsThe review identified key gaps in existing tools: youth-focused indices often emphasize general well-being rather than mental health, while structurally-focused indices lack youth specificity or sub-state granularity. ThriveAtlas revealed geographic variability in vulnerability, including regional clusters and isolated high-risk counties. Validation analyses showed expected patterns in California, where higher vulnerability aligned with greater distress and lower well-being. In Washington, correlations varied by outcome, with stronger correlations observed for crisis-related mental health indicators than overall distress. ConclusionThriveAtlas addresses a critical measurement gap by providing a youth-centered, multidimensional, and geographically granular index of vulnerability. Early validation supports its utility as a decision-relevant signal to identify communities with elevated youth mental health challenges and inform targeted intervention strategies.

BackgroundIn Colombia, internal violence, displacement, COVID-19, suicide, and climate crises threaten the survival of younger adults, many of whom are parents. Such premature mortality increases orphanhood risks. Evidence-based psychosocial support for surviving caregivers has potential to mitigate adverse impacts of orphanhood for bereaved children in crisis settings. Here, we adapted the Hope Group program from war-affected Ukraine to post-COVID-19 Colombia Parenting with Hope, and evaluated the effectiveness of psychosocial and parenting support delivered via home visits on improvements in caregiver mental health, violence against children, parenting practices, and child behavioral issues. MethodsParticipants (n=220) included surviving caregivers co-residing with children experiencing death of a parent or caregiver in the previous 12-36 months. Next-of-kin caregivers were identified through vital statistics data, death certificate annexes, radio/social media, schools, COVID-19 laboratories, and referrals. We used pre-post and quasi-experimental approaches to evaluate the effectiveness of Parenting with Hope. For both analysis types, we constructed Bayesian models to estimate mean change and percent change following completion of the 8-session program. ResultsBoth pre-post and quasi-experimental findings showed significant improvements across all mental health, violence prevention, parenting, and child outcomes. Pre-post results showed caregiver depression/anxiety ratings decreased by 91.2% (95% posterior credible interval (CrI) - 93.7, -87.6), and hopefulness increased by 43.8% (95% CrI 34.5, 54.8) and self-care, by 139.5% (95% CrI 107.5, 178.1). Each component measure of parenting practises (nonviolent discipline, positive parenting, parental monitoring, and parental involvement) improved significantly. By endline, violence against children had decreased by 63.9% (95% CrI -71.1, -54.4), and child externalizing and internalizing behaviors, by 74.4% (95% CrI, -78.0%, -70.3%). Pre-post and quasi-experimental findings showed equivalence. ConclusionThis study generalizes evidence for effectiveness of Parenting with Hope in crisis settings to surviving Colombian caregivers, on improved mental health, parenting practices, and reduced violence against children and child behavioral issues. Article Summary Parenting with Hope for families in crisis settings significantly improved mental health and parenting strategies in post-COVID-19 Colombia, generalizing effectiveness previously measured in war-affected Ukraine. Whats Known on This SubjectCaregiver death harms children long-term. Colombia experiences both community violence affecting caregivers and substantial COVID-19-related parental death burden. A Ukrainian program improved caregiver mental health, parenting, and reduced child violence, offering a model for Colombias prevention efforts. What This Study AddsWe report pre-post evidence of the Parenting with Hopes effectiveness in Colombian families experiencing bereavement. Adapted from Ukraine Hope Groups, the intervention shows consistent benefits and is a promising, transferable and scalable strategy to prevent violence against children in communities globally.

BackgroundViolence across the life course is a persistent global problem with well-documented health and social consequences. Less is known about its relationship with labour market outcomes in high-income countries with strong social protections, such as Canada. This study examines whether lifetime exposure to physical or sexual violence is associated with labour force participation (LFP), reasons for economic inactivity, sectoral and occupational sorting, and income. MethodsWe analyzed data from the 2018 Canadian Survey on Safety in Public and Private Spaces (SSPPS), a nationally representative cross-sectional survey linked to 2018 administrative tax records. The analytic sample included working-age adults (18-64) with complete data on violence exposure and labour market outcomes. Lifetime violence exposure captured childhood abuse, adulthood non-partner violence, and intimate partner violence. Outcomes included past-year LFP, part- versus full-time work, employment sector and occupation, and annual personal income. We described labour market patterns by gender and exposure and used inverse probability weighted regression adjustment (IPWRA) to estimate average treatment effects (ATEs) on economic inactivity, using unexposed men as the reference group. ResultsNearly 62 percent of respondents reported lifetime violence exposure (64.5 percent of women, 59.1 percent of men). Past-year labour force participation was high (85.9 percent overall) and showed minimal differences by exposure status: 82.0 percent of exposed women versus 80.3 percent of unexposed women, and 90.7 percent of exposed men versus 90.1 percent of unexposed men. IPWRA models indicated that, relative to unexposed men, exposed women had small but statistically significant increases in the probability of health-related inactivity (ATE: 0.009; 95%CI: 0.000-0.017) and early retirement (ATE: 0.015; 95%CI: 0.000 to 0.031), whereas ATEs for exposed men were small and non-significant across all outcomes. Sectoral and occupational distributions differed chiefly by gender; within-gender differences by exposure were limited. Income patterns were inconsistent by exposure status. For example, among women with secondary education or less, exposed women earned markedly less than unexposed women ($34,604 vs. $39,913), while differences among men were smaller and uniformly negative (exposed $74,981 vs. unexposed $75,208). ConclusionsIn Canadas welfare-state context, lifetime violence exposure shows limited association with labour force participation but may influence specific pathways into inactivity and sectoral sorting. Longitudinal analyses are needed to clarify longer-term economic impacts.

Abstract/SummaryFinancial exploitation of older adults is an increasingly prevalent public health concern, yet few have characterized fraud prevalence longitudinally or evaluated whether financial exploitation vulnerability measures prospectively predict fraud outcomes. Using data from the Health and Retirement Study, we examined fraud prevalence across a 14-year period and tested whether the Perceived Financial Vulnerability Scale (PFVS) predicts subsequent fraud victimization among older adults. Fraud prevalence increased steadily over time, rising from 5.0% in 2008 (347 of N=6,920) to a peak of 10.2% in 2022 (448 of N=4,380). Higher PFVS scores measured in 2018 were associated with greater odds of fraud victimization reported in 2022 (OR=1.62, 95% CI [1.25-2.15], p<.001). Most individuals who later reported fraud fell within the highest group of PFVS scores up to five years earlier. Together, these findings highlight financial exploitation as an emerging aging-related vulnerability and support the PFVS as a brief indicator of future fraud risk.

BackgroundThis study argues that the crisis in South Korean essential medicine stems from "allocation failure" driven by economic and legal disincentives, rather than an absolute shortage. We evaluate the efficacy of the medical school quota expansion policy by analyzing workforce mismatch in the "Vital 5" specialties. (Internal Medicine, General Surgery, Obstetrics & Gynecology, Pediatrics, and Cardiothoracic Surgery). MethodsWe developed two quantitative models: (1) a Social Sunk Cost model to estimate the wasted resources when specialists work in fields unrelated to their training, and (2) an Expected Value (E(V)) model to analyze the decision-making process of physicians entering essential fields. The E(V) model incorporates variables such as Net Return (Rnet), Probability of Lawsuit (Psuit), and Cost of Risk (Crisk). Two real-life scenarios were coined to estimate the economic impact of workforce mismatch: (1) an Individual Sunk Cost model based on hypothetical profiles of a cardiothoracic surgeon and a pediatrician working in non-vital fields, calculating the loss of 11-year training investments; and (2) a National Sunk Cost model utilizing a "Shadow Price" valuation derived from the 2024 medical crisis data (3.4 trillion KRW government injection), to estimate the aggregate social replacement cost of mismatched specialists in essential fields. ResultsAnalysis of national data reveals a significant proportion of cardiothoracic surgeons working in non-major fields, indicating high social sunk costs. Simulations show that a rapid expansion of 2,000 medical students, without accompanying structural reforms, would dilute the net return (Rnet) for individual doctors and increase the probability of malpractice suits (Psuit) due to potential undertraining. Consequently, the expected value of entering essential medicine would drop to a negative value, exacerbating the avoidance of vital specialties. ConclusionExpanding quotas without addressing low compensation and high legal risks will likely accelerate the collapse of essential medicine--a phenomenon we term the "Paradox of Expansion." Policy must prioritize "Restoring Expected Value" through legal immunity and fee adjustments over mere headcount increases.

BackgroundMental well-being encompasses positive psychological functioning, life satisfaction, and engagement with daily activities. It is influenced by multiple interrelated factors, including symptoms of stress, anxiety, depression, and psychological inflexibility. Network analysis provides a data-driven framework for examining the complex interconnections between these components and for identifying elements that may play a central role in the mental well-being system. The present study aimed to identify key elements related to stress, anxiety, depression, and psychological inflexibility associated with mental well-being in individuals seeking online psychological support. MethodsThis cross-sectional study analyzed data drawn from the Online Well-being intervention. A total of 967 Mexican participants were included. A psychological network comprising seventy-four items was estimated, and centrality indices (strength, closeness, and betweenness) were computed to determine the relative importance of individual elements within the network. Network comparisons by gender were conducted to evaluate global and local differences. ResultsThe network revealed multiple inter-domain associations, particularly negative relationships between mental well-being and symptoms of depression, anxiety, negative stress, and psychological inflexibility. Items reflecting self-evaluation and emotional well-being consistently emerged as the most central elements in the network across centrality metrics. Gender-based comparisons indicated overall structural similarity between networks, although differences were observed in the strength of specific connections. ConclusionsNetwork analysis identified central elements linking mental well-being with psychological distress and inflexibility in a population seeking online psychological support. These findings contribute to a systems-level understanding of mental well-being and highlight potential targets for psychological interventions to enhance well-being and reduce distress.