International Journal for Equity in Health最新文献

{"title":"Examining pathways between structural stigma and tobacco use: a comparison among young adults living in the United States by sexual orientation and gender identity.","authors":"Wilson Figueroa, Srinivasan Sridhar, Emma Jankowski, Alysha Ennis, Anne Trinh, Eric Seiber, Joanne G Patterson","doi":"10.1186/s12939-025-02487-2","DOIUrl":"https://doi.org/10.1186/s12939-025-02487-2","url":null,"abstract":"<p><strong>Background: </strong>Sexual and gender minority young adult (SGM YA) populations use tobacco at higher rates than their non-SGM YA peers. Prior studies have identified significant correlations between interpersonal stigma and tobacco use, yet structural stigma may also influence tobacco use among SGM YA. This study aimed to assess the indirect effects of structural stigma on current tobacco use among SGM YA and non-SGM YA via depletion of economic resources, interpersonal discrimination, and perceived psychological stress.</p><p><strong>Methods: </strong>Structural Equation Modeling was used to conduct a secondary data analysis from a cross-sectional parent study. Eligible participants were 18-35 years old and currently residing in the U.S. (N = 2,649). Current use of combustible cigarettes and nicotine vapes was our dependent variable. Our independent variable of interest, structural stigma, was a latent variable comprised of three state-level indicator items: Attitudes toward SGM people, SGM protective policies (absence of), and SGM discriminatory policies (introduced or passed in 2022). We assessed three mediators of interest: Depletion of economic resources was a latent variable, which included two indicator items: food insecurity and financial strain. Interpersonal discrimination and perceptions of psychological stress were also assessed. Covariates included race/ethnicity, age, and educational attainment.</p><p><strong>Results: </strong>Structural stigma was indirectly associated with current tobacco use via depletion of economic resources for SGM YA, but not non-SGM YA. Structural stigma was not indirectly associated with current tobacco use via interpersonal discrimination or psychological stress for either group.</p><p><strong>Conclusions: </strong>Future tobacco intervention research should consider the role of structural stigma when working with SGM YA; specifically, how interventions promoting economic stability may influence tobacco use and cessation in this population.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"128"},"PeriodicalIF":4.5,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On equal footing? The impact of patient companions on Lifeworld integration and patient-centeredness in linguistically diverse emergency consultations.","authors":"Antoon Cox, Marianne Couillard Larocque, Nicolas Dauby, Yvan Leanza","doi":"10.1186/s12939-025-02425-2","DOIUrl":"https://doi.org/10.1186/s12939-025-02425-2","url":null,"abstract":"<p><strong>Introduction: </strong>Patient companions (PCs) can have an ambiguous impact on the quality of communication during multilingual medical consultations and therefore on health outcomes. Studies of multilingual medical consultations have focused mainly on PCs' role as interpreters, with less regard to other roles they may take up. This paper uses mixed methods to investigate PC role dynamics in multilingual PC-mediated consultations and how they affect the management of a patient's Lifeworld, a crucial element for history taking and rapport building.</p><p><strong>Methods: </strong>Nine recordings of multilingual PC-mediated consultations from a Brussels emergency department, complemented with ethnographic notes and clinician interviews, were subjected to linguistic-ethnographic analysis and a codification of communication patterns and PC roles to explore the link between PC roles and Lifeworld management. PC roles were grouped into four stances (Linguistic agent, Lifeworld agent, System agent, and Principal). The communication patterns were grouped into three categories (\"strictly medicine\", \"Lifeworld heard/included\", and \"Lifeworld interrupted\").</p><p><strong>Results: </strong>In ED consultations, patients' Lifeworld frequently remains inadequately addressed, primarily due to physician interruptions. Significant associations are observed between roles taken up by PCs and the way patients' Lifeworld is managed. Successful integration of Lifeworld aspects is best supported by PCs taking up the role of System agent, possibly because it allows them to link the Lifeworld directly to medical issues. Linguistic-ethnographic analysis reveals how language barriers, PC role changes and Lifeworld management strategies are taking shape organically (often implicitly) determined by a wide range of situational factors, such as the complexity of the topic, the available (non)verbal linguistic repertoire, the level of meta-communication, explicit role negotiation and timing.</p><p><strong>Conclusion: </strong>Since poor Lifeworld management negatively impacts care, clinicians should be trained to detect and manage role dynamics and relevant situational factors in PC-mediated multilingual consultations to protect patients' right to high-quality communication and healthcare.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"126"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Universal health coverage in fragile and conflict-affected States: insights from Somalia.","authors":"Zlatko Nikoloski, Mubarik M Mohamoud, Elias Mossialos","doi":"10.1186/s12939-025-02486-3","DOIUrl":"https://doi.org/10.1186/s12939-025-02486-3","url":null,"abstract":"<p><strong>Introduction: </strong>Achieving Sustainable Development Goal (SDG) 3, which focuses on health, and more specifically SDG 3.8-universal health coverage (UHC)-by 2030 remains a critical objective for all nations. This paper presents an updated evaluation of Somalia's progress toward UHC. Additionally, by identifying key barriers to achieving UHC in Somalia, this study offers insights that may be valuable for other conflict-affected and post-conflict countries striving to improve healthcare access and financial protection.</p><p><strong>Methodology: </strong>To assess Somalia's progress at various levels, we developed a UHC index incorporating access to essential healthcare services and financial risk protection. Furthermore, we employed standard analytical methods, including equity analysis and logit modelling, to examine the key factors influencing both healthcare access and the financial burden associated with seeking medical care.</p><p><strong>Results: </strong>With an overall UHC index score of 33.5, Somalia ranks lowest among the countries previously analysed. While there is some regional variation in UHC scores, these differences are not as pronounced as the disparities in poverty rates, resulting in a weak correlation between regional socio-economic development (measured by poverty levels) and overall UHC performance. Equity analysis highlights that socio-economic status, educational attainment, and, to a lesser extent, healthcare infrastructure significantly contribute to disparities in access to essential health services, favouring wealthier populations. Additionally, financial risk protection analysis indicates that the most economically disadvantaged groups are at a higher risk of experiencing catastrophic healthcare expenditures.</p><p><strong>Implications: </strong>Given Somalia's ongoing security challenges, achieving SDG 3.8 by 2030 remains a formidable task. However, targeted interventions that address key determinants-such as household income, education levels, and healthcare infrastructure-could help improve access to essential health services and reduce financial barriers to care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"125"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender equity and COVID-19 vaccine policies for pregnant people: a global analysis.","authors":"Eleonor Zavala, Elizabeth Doggett, Andrew Nicklin, Ruth A Karron, Ruth R Faden","doi":"10.1186/s12939-025-02497-0","DOIUrl":"10.1186/s12939-025-02497-0","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing vaccine availability and evidence and expert recommendations to support administration, some countries maintained restrictive policies regarding COVID-19 vaccination in pregnancy throughout the pandemic. This global analysis explores the role of gender equity, country income level, and vaccine availability in predicting national policies on COVID-19 vaccine administration in pregnancy.</p><p><strong>Methods: </strong>Policies were collected from May 2021 to January 2023 from 224 countries/territories using publicly available information posted on national public health authority web pages. Policies were categorized into 6 types, representing different levels of permissiveness, from recommended for some or all to not recommended, and changes in national policies were captured over time. Outcomes were defined as: 1) prevalence of restrictive policies at a specific time point; 2) country-level change from restrictive policy/no position at an earlier time point to a permissive policy at a later timepoint. Simple and multivariable logistic regressions were performed to explore the association between the outcomes and potential policy predictors, including income level, mRNA vaccine availability, and the Global Gender Gap Index (GGGI).</p><p><strong>Results: </strong>Complete cross-sectional data were available for 114 countries as of June 2021, 137 countries as of October 2021, and 142 countries as of March 2022. The number of maternal immunization policies increased and became steadily more permissive between 2021 and 2022. Availability of mRNA vaccines and higher income level were associated with reduced odds of a restrictive policy at the 2021 timepoints, and higher GGGI scores were associated with reduced odds of restrictive policies at all timepoints. After adjusting for income level and mRNA vaccine availability, higher GGGI scores reduced the relative odds of a restrictive COVID-19 vaccine policy by 10% (aOR: 0.90, 95CI: 0.81, 0.99) in October 2021 and 14% (aOR: 0.86, 95%CI: 0.76, 0.97) in March 2021. Higher GGGI scores were also associated with increased odds of a policy switch from restrictive/no position in June 2021 to permissive in October 2021 (aOR: 1.12, 95%CI: 1.00, 1.24).</p><p><strong>Conclusions: </strong>Gender inequity was associated with greater odds of a restrictive policy for use of COVID-19 vaccines in pregnancy, suggesting that gender biases may influence fair policymaking for pregnant people in pandemic preparedness and response.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"127"},"PeriodicalIF":4.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12060400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Forgone and delayed care in Germany- inequalities and perceived health risk of unmet need.","authors":"Jens Klein, Daniel Lüdecke, Olaf von dem Knesebeck","doi":"10.1186/s12939-025-02483-6","DOIUrl":"https://doi.org/10.1186/s12939-025-02483-6","url":null,"abstract":"<p><strong>Background: </strong>Subjective unmet need is an established indicator of unequal access to medical care and is often measured by delaying and forgoing medically necessary treatment. Research on delayed and forgone care among the general population in Germany including different reasons, social deprivation measures, and the perceived health risk of unmet need is sparse. This study aims to examine reasons, inequalities, and health-related consequences of unmet need in terms of delayed and forgone care.</p><p><strong>Methods: </strong>A cross-sectional online survey was carried out based on a randomly drawn sample of the German adult population in December 2022 (N = 2,201). Respondents were asked whether medical treatments were delayed or forgone in the past 12 months due to different reasons (waiting time, travel distance, financial costs). If unmet need was indicated, the respondents were subsequently asked about their perception of related health risks. Associations with individual social (sex, age, migration history, education, income) and regional factors (social deprivation) as well as insurance status were examined using multilevel logistic regressions analyses.</p><p><strong>Results: </strong>Among N = 1,955 respondents who indicated need for medical care, 30% reported at least one reason for forgone care (waiting time 23%, financial costs 11%, travel distance 9%). In terms of delayed care, highest rate was found for waiting time (34%). Multilevel analyses revealed significant associations of unmet need with female sex, younger age, lower education, lower income, and statutory health insurance. Associations varied depending on the reason for unmet need. Differences in regional social deprivation were particularly found for forgone care due to distance. Between half and nearly two-thirds of the participants reported worsening of symptoms in case of unmet need. Associations with social characteristics were inconsistent.</p><p><strong>Discussion: </strong>Unmet need is a prevailing issue in Germany and associated with perceived worsening of health, various indicators of social inequality, and health insurance. Reducing waiting times (e.g. through the further development of appointment service centres) and private co-payments as well as ensuring health care provision in deprived areas can contribute to a decrease of barrier-related unmet need and health risks. However, more in-depth studies are required to account for the complex nature of health care access.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"122"},"PeriodicalIF":4.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Equity, power and resources in primary health care reform: insights from Aotearoa New Zealand.","authors":"Johanna Reidy, Nina Bevin, Don Matheson, Ngaire Rae, Rawiri Keenan, Peter Crampton, Max Harris","doi":"10.1186/s12939-025-02463-w","DOIUrl":"https://doi.org/10.1186/s12939-025-02463-w","url":null,"abstract":"<p><strong>Background: </strong>New Zealand's District Health Board reform (2000-2022) was underpinned by the goal of reducing inequities in health outcomes between population groups and improving health overall. A key policy vehicle for achieving the goal was a system-wide shift to population health with increased strategic focus on and investment in primary health care.</p><p><strong>Methods: </strong>This research explored shifts in power and resource to understand how equity as a policy goal for primary health care fared over the District Health Board era, and examined how the distribution of power and resources in the health sector changed for PHC over the period 2000-2020. The study used an exploratory case study methodology based on insights from key informant interviews.</p><p><strong>Results: </strong>The study found that despite policy intent, actors holding political power shaped health outcomes under the reforms, curtailing the mechanisms that could have made a significant impact on equitable health outcomes between population groups.</p><p><strong>Conclusion: </strong>It concludes that exploring power and resource shifts sheds light on power dynamics within a reform. Since power shapes how resources are deployed, attention to power and resource complements technical elements of health system reform, by helping to understand where and how to intervene so that reforms achieve their desired goals.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"124"},"PeriodicalIF":4.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic inequities, dignity, and trust in the context of HIV care: a qualitative analysis.","authors":"Amanda L Sanchez, Chynna Mills, DeAuj'Zhane Coley, Katelin Hoskins, Florence Momplaisir, Robert Gross, Kathleen A Brady, Rinad S Beidas","doi":"10.1186/s12939-025-02481-8","DOIUrl":"https://doi.org/10.1186/s12939-025-02481-8","url":null,"abstract":"<p><p>Adherence and retention in care are key targets to achieve favorable health outcomes for people with HIV. Challenges with adherence and retention are pronounced for marginalized communities facing intersectional structural oppression. Community health worker delivery of Managed Problem Solving (MAPS+), an evidence-based behavioral intervention, has the potential to improve adherence and retention, yet understanding structural inequities affecting people with HIV is necessary to increase the likelihood of equitable implementation. The current study explores systemic inequities influencing HIV care adherence and retention, and approaches to address these challenges. We conducted semi-structured interviews with 13 clinics and 4 constituent groups: prescribing clinicians, non-prescribing clinical team members (e.g., medical case managers), clinic administrators, and policymakers. Through reflexive thematic analysis within a constructionist paradigm, we identified two key themes. The first elucidated experiences of systemic inequities such as access to resources, healthcare system navigation difficulties, power differentials, medical mistrust, intersectional stigma and potential patient burden associated with MAPS+. The second theme highlighted the ways in which staff and clinicians shoulder the burden of addressing inequities by approaching people with HIV with dignity and developing trusting relationships and how MAPS + can bolster this approach by partnering with and centering patient needs. While these individual and organizational efforts are valuable, ending the HIV epidemic requires structural changes to address systemic inequities directly. This research underscores the complex interplay between structural oppression and HIV care, calling for comprehensive approaches to achieve health equity.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"123"},"PeriodicalIF":4.5,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12057254/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding African American/Black and Latine young and emerging adults living with HIV: a sequential explanatory mixed methods study focused on self-regulatory resources.","authors":"Leo Wilton, Marya Gwadz, Charles M Cleland, Stephanie Campos, Michelle R Munson, Caroline Dorsen, Samantha Serrano, Dawa Sherpa, Shaddy K Saba, Corey Rosmarin-DeStefano, Prema Filippone","doi":"10.1186/s12939-025-02492-5","DOIUrl":"https://doi.org/10.1186/s12939-025-02492-5","url":null,"abstract":"<p><strong>Background: </strong>HIV care continuum engagement is inadequate among African American/Black and Latine (AABL) young/emerging adults living with HIV in the United States. Within this population, some subgroups face barriers to research and are under-studied. Grounded in social action theory, the present study focuses on a diverse community-recruited cohort including those with non-suppressed HIV viral load. Using a sequential explanatory mixed methods design, we describe contextual self-regulatory resources (e.g., substance use, mental health), and their relationships to HIV management.</p><p><strong>Methods: </strong>Participants (N = 271) engaged in structured baseline assessments and biomarker testing (HIV viral load, drug screening). Being well-engaged in HIV care and HIV viral suppression were the primary outcomes. We purposively sampled a subset for maximum variability for in-depth interviews (N = 41). Quantitative data were analyzed via descriptive statistics and logistic regression, and results were used to develop qualitative research questions. Then, qualitative data were analyzed via directed content analysis. The joint display method was used to integrate results.</p><p><strong>Results: </strong>Participants' mean age was 25 years (SD = 2). The majority (59%) were Latine/Hispanic and 41% were African American/Black. Nearly all were assigned male sex at birth (96%) and identified as gay/bisexual/queer (93%). The average HIV diagnosis was 4 years prior (SD = 3). The majority were well-engaged in HIV care (72%) and evidenced viral suppression (81%). Substance use (tobacco, marijuana, alcohol) was prevalent, mainly at low- and moderate-risk levels. Drug screening indicated marijuana, methamphetamine, and MDMA were the most common recent substances. Symptoms of depression and PTSD were associated with decreased odds of engagement in care. High-risk cannabis use was associated with decreased odds of HIV viral suppression. Qualitative results highlighted the prevalence of substance use in social networks and venues, and the importance of substances as a coping strategy, including for mental health distress. Tobacco and methamphetamine (but not marijuana) were described as problematic, and marijuana was used as harm reduction. Substance use was more common among those with non-suppressed versus suppressed HIV viral load. However, overall, substance use did not commonly interfere substantially with HIV management.</p><p><strong>Conclusions: </strong>The present study advances knowledge on AABL young/emerging adults living with HIV and highlights ways to improve screening and services.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"120"},"PeriodicalIF":4.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12051309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How inclusive were strategies to prevent the spread of COVID-19 for people with disabilities? Evidence from qualitative research in eight low- and middle-income countries.","authors":"Xanthe Hunt, Sarah Marks, Shaffa Hameed, Donruedee Srisuppaphon, Francisco Diez-Canseco, Wachara Riewpaiboon, Shaheda Viriyathorn, Viroj Tangcharoensathien, Divya Goyal, Tracey Smythe, Rifat Shahpar Khan, Luong Anh Ngoc, John Ganle, Shailaja Tetali, Lopita Huq, Tom Shakespeare, Zeynep Ilkkursun, Ceren Acarturk, Vu Quynh Mai, Lena Morgon Banks","doi":"10.1186/s12939-025-02482-7","DOIUrl":"https://doi.org/10.1186/s12939-025-02482-7","url":null,"abstract":"<p><strong>Background: </strong>From the outset of the pandemic there were calls to ensure people with disabilities were included in prevention and response measures, given their increased risk of health consequences from COVID-19 infection. This study sought to explore people with disabilities' experiences of inclusion in the response to the COVID-19 pandemic, to understand how such responses can be more inclusive in the future.</p><p><strong>Methods: </strong>Qualitative interviews were conducted with 372 people with disabilities and their caregivers in Bangladesh, Ghana, India, Peru, Thailand, Türkiye (with Syrian refugees), Viet Nam, and Zimbabwe between 1 December 2020 and 28 February 2023, and analysed using thematic analysis.</p><p><strong>Results: </strong>The study found that people with disabilities demonstrated high levels of knowledge about COVID-19 and were willing to adhere to prevention measures. However, participants noted that countries' COVID-19 responses were largely not inclusive of people with disabilities; that pandemic information was seldom available in accessible formats; and that adhering to social distancing and other mandates was challenging and incurred personal and economic costs.</p><p><strong>Conclusions: </strong>Consequently, the pandemic compounded existing barriers and inaccessibility experienced by people with disabilities and contributed to inequality.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"121"},"PeriodicalIF":4.5,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12054281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sectional study of individual- and poly-bullying victimization and suicidal ideation among Chinese university and high school students: the roles of hopelessness and interpersonal relationships.","authors":"Zixuan Cao, Li Lu, Zi-Wei Li, Sha Lai, Zhongliang Zhou, Qing Shen, Shou Liu","doi":"10.1186/s12939-025-02472-9","DOIUrl":"https://doi.org/10.1186/s12939-025-02472-9","url":null,"abstract":"<p><strong>Background: </strong>We aim to examine the associations between poly-bullying victimization (i.e., school-, family- and cyber-bullying ever and only) and suicidal ideation (SI) among Chinese university and high school students, and the roles of interpersonal relationships and hopelessness in the interested relationships.</p><p><strong>Methods: </strong>We included 17633 participants integrating data from the 2019 mental health survey in university students in Qinghai, China (N = 5700), and the Chinese Database of Youth Health in high school students (N = 11933) in Shandong. We applied multivariate logistic regression models to explore the associations between poly-bullying victimization and SI, by gender and level of schools. Stratification analyses were conducted by levels of hopelessness and interpersonal relationships. The role of hopelessness in the relationships between poly-bullying victimization and SI in university students was evaluated by fitting mediation analyses.</p><p><strong>Results: </strong>Exposure to specific forms of bullying victimization was positively associated with SI in students from both school levels. Cyberbullying victimization only was not significantly associated with SI in university students, but with significance in both female (OR: 1.70, 95% CI: 1.26-2.30) and male (OR: 2.69, 95% CI: 2.04-3.55) high school students. In university students, the association between school bullying only and SI was greater in female (OR: 2.38, 95% CI: 1.71-3.34) than males (OR: 1.33, 95% CI: 0.85-2.09); the strongest association was exhibited between the co-occurrence of family and school bullying victimization, and SI; a dose-response relationship was observed between number of victimization and SI, particularly among males. Interpersonal relationships did not significantly moderate the relationships between poly-bullying victimization and SI among university students. Hopelessness played significant mediating role in the relationships between Family + School bullying victimization and SI (14.80% mediated) in female university students, and Family + School + Cyberbullying victimization and SI (29.40%) in males.</p><p><strong>Conclusion: </strong>The exploration-oriented study provided an intricate mechanism of gender-specific differences in SI related to poly-bullying victimization. Tailored, gender-sensitive interventions and support systems for adolescents and young adults should be designed and implemented.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"24 1","pages":"117"},"PeriodicalIF":4.5,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12042594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144015037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}