{"title":"Health Worker Burnout and Moral Injury: Drivers, Effects, and Remedies.","authors":"Kevin Grumbach, Rachel Willard-Grace","doi":"10.1146/annurev-publhealth-071823-122832","DOIUrl":"10.1146/annurev-publhealth-071823-122832","url":null,"abstract":"<p><p>The prevalence of burnout among health workers is alarmingly high and worsening. Many factors across the domains of culture of wellness, efficiency of practice and work demands, and personal resilience place workers at risk for burnout. Intervention research has disproportionately studied individually focused interventions to strengthen personal resilience, demonstrating small benefit from such interventions. While coping strategies may have value, we stress the need to focus interventions on mitigating work conditions that breed burnout, such as inadequate levels of staffing, and to rigorously evaluate such interventions. A conceptual framework on burnout must include critical theory interrogating the broader economic, political, and structural forces shaping health care and the relative power of workers. The concept of moral injury may be more apt than burnout for describing the effects on workers' well-being of accelerating health care consolidation by investor-owned organizations, government austerity policies, and the disempowered position of labor.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":"46 1","pages":"447-465"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"From <i>Roe</i> to <i>Dobbs</i>: 50 Years of Cause and Effect of US State Abortion Regulations.","authors":"Caitlin Myers","doi":"10.1146/annurev-publhealth-071823-122011","DOIUrl":"10.1146/annurev-publhealth-071823-122011","url":null,"abstract":"<p><p>The <i>Roe</i> era was hardly a monolith. For more than 50 years-beginning with abortion reforms in the 1960s and continuing through the <i>Dobbs</i> decision in 2022-state regulations of abortion were neither uniform nor consistent. States reformed and repealed abortion bans leading up to the <i>Roe</i> decision in 1973. Following <i>Roe</i>, they enacted both demand-side regulations of people seeking abortions and supply-side regulations of people providing abortions. The resulting laboratory of state policies affords natural experiments that have yielded evidence on the effects of abortion regulations on demographic, health, economic, and other social outcomes. I present a brief history of state policy variation from 1967 through 2016 and review the empirical scholarship studying its effects. This literature demonstrates that the liberalization of abortion access in the 1960s and 1970s allowed women greater control over their fertility, resulting in increased educational attainment and earnings. Subsequent state restrictions in the 1980s through 2010s had the opposite effect, particularly when they increased the financial and logistical costs of obtaining an abortion. I conclude with a discussion of implications for the post-<i>Dobbs</i> era, considering to what extent evidence from the past foretells the future.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"433-446"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Breaking Barriers with Data Equity: The Essential Role of Data Disaggregation in Achieving Health Equity.","authors":"Ninez A Ponce, Tara Becker, Riti Shimkhada","doi":"10.1146/annurev-publhealth-072523-093838","DOIUrl":"10.1146/annurev-publhealth-072523-093838","url":null,"abstract":"<p><p>Achieving health equity necessitates high-quality data to address disparities that have remained stagnant or even worsened over time despite public health interventions. Data disaggregation, the breakdown of data into detailed subcategories, is crucial in health equity research. It reveals and contextualizes hidden trends and patterns about marginalized populations and guides resource allocation and program development for specific needs in these populations. Data disaggregation underpins data equity, which uses community engagement to democratize data and develop better solutions for communities. Years of research on disaggregation show that researchers must collaborate closely with communities for adequate representation. However, despite generally positive support for this approach in health disparities research, data disaggregation faces methodological and political challenges. This review offers a framework for understanding data disaggregation in the context of data equity and highlights critical aspects of implementation, including challenges, opportunities, and recent policy and community-based efforts to address hurdles.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"21-42"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adapting Public Health and Health Services Interventions in Diverse, Real-World Settings: Documentation and Iterative Guidance of Adaptations.","authors":"Borsika A Rabin, Kelli L Cain, Russell E Glasgow","doi":"10.1146/annurev-publhealth-071321-041652","DOIUrl":"10.1146/annurev-publhealth-071321-041652","url":null,"abstract":"<p><p>When complex public health and health services interventions are implemented in real-world settings, adaptations should be expected, embraced, and studied rather than suppressed and ignored. A substantial amount of recent research has been conducted on the assessment of some types of adaptations, and interest in guiding adaptations to both interventions and implementation strategies is growing. However, there is still a need to investigate the optimal ways to systematically and pragmatically document, analyze, and iteratively guide adaptations as well as to measure the impact of those adaptations on implementation and effectiveness outcomes. This article reviews key findings from the adaptations assessment literature, frameworks to guide classification of adaptations, and methodologies to study adaptations and their impact. We summarize research from diverse settings and populations from public health and health services research on the use of these methodologies and make recommendations for research and practice.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"111-131"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12629590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christine Till, Philippe Grandjean, E Angeles Martinez-Mier, Howard Hu, Bruce Lanphear
{"title":"Health Risks and Benefits of Fluoride Exposure During Pregnancy and Infancy.","authors":"Christine Till, Philippe Grandjean, E Angeles Martinez-Mier, Howard Hu, Bruce Lanphear","doi":"10.1146/annurev-publhealth-060722-023526","DOIUrl":"10.1146/annurev-publhealth-060722-023526","url":null,"abstract":"<p><p>Health authorities have promoted community water fluoridation (CWF) to prevent dental caries for more than 75 years. However, growing evidence has raised questions about the safety of this public health intervention, particularly for young children who are at risk of excess fluoride intake. Divergent opinions about the risk-benefit ratio of CWF have ignited a global debate. The efficacy of topical fluoride in preventing dental caries is strong, whereas contemporary evidence for systemic administration of fluoride is weaker. Inequalities in access to dental care and topical fluorides introduce an additional layer of complexity. This review discusses evidence showing that fluoride ingestion is not essential for caries prevention, offers little benefit to the fetus and young infant, and can cause dental fluorosis and cognitive deficits. In an environment where fluoride is available from multiple sources, community-based administration of systemic fluoride may pose an unfavorable risk-benefit ratio for pregnant women and young children.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":"46 1","pages":"253-274"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aaron R Lyon, Tricia Aung, Kathryn E Bruzios, Sean Munson
{"title":"Human-Centered Design to Enhance Implementation and Impact in Health.","authors":"Aaron R Lyon, Tricia Aung, Kathryn E Bruzios, Sean Munson","doi":"10.1146/annurev-publhealth-071823-122337","DOIUrl":"10.1146/annurev-publhealth-071823-122337","url":null,"abstract":"<p><p>Human-centered design (HCD) is an approach that aligns innovation development with the needs of the people and the settings where those innovations will be used. HCD is increasingly being applied across a variety of health domains, most often with the goals of translating research into real-world settings and expanding innovation adoption. This review introduces key HCD concepts, reviews the growth of HCD in public health and its alignment with the complementary field of implementation science, and details four prominent proximal outcomes of design processes: (<i>a</i>) usability, (<i>b</i>) user burden, (<i>c</i>) contextual appropriateness, and (<i>d</i>) engagement. For each outcome, we provide a definition and background, measurement options, and critiques and future directions. We conclude with a series of opportunities and challenges, including an inclusive big tent spanning different design traditions, pathways for enhancing HCD's scientific legitimacy, and explicit promotion of equitable design processes to improve individual, community, and population health.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"467-485"},"PeriodicalIF":20.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142830708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coady Wing, Madeline Yozwiak, Alex Hollingsworth, Seth Freedman, Kosali Simon
{"title":"Designing Difference-in-Difference Studies with Staggered Treatment Adoption: Key Concepts and Practical Guidelines.","authors":"Coady Wing, Madeline Yozwiak, Alex Hollingsworth, Seth Freedman, Kosali Simon","doi":"10.1146/annurev-publhealth-061022-050825","DOIUrl":"10.1146/annurev-publhealth-061022-050825","url":null,"abstract":"<p><p>Difference-in-difference (DID) estimators are a valuable method for identifying causal effects in the public health researcher's toolkit. A growing methods literature points out potential problems with DID estimators when treatment is staggered in adoption and varies with time. Despite this, no practical guide exists for addressing these new critiques in public health research. We illustrate these new DID concepts with step-by-step examples, code, and a checklist. We draw insights by comparing the simple 2 × 2 DID design (single treatment group, single control group, two time periods) with more complex cases: additional treated groups, additional time periods of treatment, and treatment effects possibly varying over time. We outline newly uncovered threats to causal interpretation of DID estimates and the solutions the literature has proposed, relying on a decomposition that shows how the more complex DIDs are an average of simpler 2 × 2 DID subexperiments.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"485-505"},"PeriodicalIF":20.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139567347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lan N Ðoàn, Michelle M Chau, Naheed Ahmed, Jiepin Cao, Sze Wan Celine Chan, Stella S Yi
{"title":"Turning the Health Equity Lens to Diversity in Asian American Health Profiles.","authors":"Lan N Ðoàn, Michelle M Chau, Naheed Ahmed, Jiepin Cao, Sze Wan Celine Chan, Stella S Yi","doi":"10.1146/annurev-publhealth-060222-023852","DOIUrl":"10.1146/annurev-publhealth-060222-023852","url":null,"abstract":"<p><p>The monolithic misrepresentation of Asian American (AsAm) populations has maintained assumptions that AsAm people are not burdened by health disparities and social and economic inequities. However, the story is more nuanced. We critically review AsAm health research to present knowledge of AsAm health profiles from the past two decades and present findings and opportunities across three topical domains: (<i>a</i>) general descriptive knowledge, (<i>b</i>) factors affecting health care uptake, and (<i>c</i>) effective interventions. Much of the literature emphasized underutilization of health care services; low knowledge and awareness among AsAms about health-related risk factors, prevention, diagnosis, and treatment; inadequate efforts by health systems to improve language access, provider-patient communication, and trust; and the critical roles of community- and faith-based organizations and leaders in health promotion initiatives. Future opportunities for AsAm health research will require adoption of and significant investment in community-engaged research infrastructure to increase representation, funding, and research innovation for AsAm communities.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"169-193"},"PeriodicalIF":20.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advancing the Science and Application of Implementation Science to Promote Health Equity: Commentary on the Symposium.","authors":"Rachel C Shelton, Ross C Brownson","doi":"10.1146/annurev-publhealth-062723-055935","DOIUrl":"10.1146/annurev-publhealth-062723-055935","url":null,"abstract":"<p><p>There has been an increasing focus on making health equity a more explicit and foundational aspect of the research being conducted in public health and implementation science. This commentary provides an overview of five reviews in this <i>Annual Review of Public Health</i> symposium on Implementation Science and Health Equity. These articles reflect on and advance the application of core implementation science principles and concepts, with a focus on promoting health equity across a diverse range of public health and health care settings. Taken together, the symposium articles highlight critical conceptual, methodological, and empirical advances in the study designs, frameworks, and approaches that can help address equity considerations in the use of implementation science in both domestic and global contexts. Finally, this commentary highlights how work featured in this symposium can help inform future directions for rapidly taking public health to scale, particularly among systemically marginalized populations and communities.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"1-5"},"PeriodicalIF":20.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138886542","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Health Promotion and Chronic Disease Prevention at the Workplace.","authors":"Lars Louis Andersen","doi":"10.1146/annurev-publhealth-060222-035619","DOIUrl":"10.1146/annurev-publhealth-060222-035619","url":null,"abstract":"<p><p>The concept of workplace safety and health has focused largely on preventing accidents and on minimizing hazardous exposures. However, because workers spend a substantial part of their waking hours at the workplace, the potential to influence the health of a large proportion of the world's population through the workplace is enormous. The opportunities to carry out health promotion and chronic disease prevention activities at the workplace are countless, including (<i>a</i>) health screening; (<i>b</i>) tobacco cessation activities; (<i>c</i>) the promotion of healthy food choices and weight loss; (<i>d</i>) active breaks with physical exercise in terms of microexercise, enhancement of infrastructure to stimulate physical activity, and organization of work tasks to facilitate incidental physical activity; and (<i>e</i>) routine vaccinations. This review discusses the key factors necessary to implement health promotion and chronic disease prevention programs at the workplace (SWOLE model) and discusses the different foci and possibilities with respect to the differing nature of work for the blue- versus white-collar workforce.</p>","PeriodicalId":50752,"journal":{"name":"Annual Review of Public Health","volume":" ","pages":"337-357"},"PeriodicalIF":20.7,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41170042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}