This study evaluated whether food insecurity (US Adult Food Security Survey) was associated with chronic pain (≥ 3 months) and high-impact chronic pain (i.e. pain that limits work and life) among US adults.

Cross-sectional analysis.

Nationally representative sample of non-institutionalised adults in the USA.

79 686 adults from the National Health Interview Survey (2019–2021).

Marginal, low and very low food security were associated with increased prevalence odds of chronic pain (OR: 1·58 (95 % CI 1·44, 1·72), 2·28 (95 % CI 2·06, 2·52) and 3·37 (95 % CI 3·01, 3·78), respectively) and high-impact chronic pain (OR: 1·28 (95 % CI 1·14, 1·42), 1·55 (95 % CI 1·37, 1·75) and 1·90 (95 % CI 1·65, 2·18), respectively) in a dose–response fashion (P-trend < 0·0001 for both), adjusted for sociodemographic, socio-economic and clinically relevant factors. Participation in Supplemental Nutrition Assistance Program (SNAP) and age modified the association between food insecurity and chronic pain.

These findings illustrate the impact of socio-economic factors on chronic pain and suggest that food insecurity may be a social determinant of chronic pain. Further research is needed to better understand the complex relationship between food insecurity and chronic pain and to identify targets for interventions. Moreover, the consideration of food insecurity in the clinical assessment of pain and pain-related conditions among socio-economically disadvantaged adults may be warranted.

This study examined how the multidimensional negative coronavirus disease (COVID-19) impacts contextualized the age differences in psychological distress following exposures to tornadoes and the COVID-19 pandemic.

Data were from a 2-wave panel study conducted at T1 (October 2020–August 2021) and T2 (May–August 2022). Latent class analysis was conducted to explore the patterns of negative COVID-19 impacts based on a sample of 1134 at T1. Negative binomial regressions were performed to examine the age differences in psychological distress at T2, based on the working sample (N = 554), as well as the moderating effect of identified class membership, with baseline psychological distress controlled.

Three latent classes were identified: class 1 “low overall impacts,” class 2 “moderate overall impacts with high emotional distress,” and class 3 “severe overall impacts.” Individuals ages 65 and over reported lower psychological distress at T2 relative to those ages 18–34 and 35–49. However, compared to people ages 18–34, 35–49, and 50–64, those ages 65 and over reported the greatest increases in T2 psychological distress if they had experienced moderate or severe overall COVID-19 impacts at T1.

There is a pressing need for mental health interventions that are tailored to multi-disaster scenarios and age-related differences in long-term disaster recovery.

This study explored community supervision officers’ perceptions of the individual, community, and organizational challenges confronted by program participants after Hurricane María and their recommendations for future emergency management.

A qualitative content analysis was conducted for nine focus group with community supervision officers in Puerto Rico. Participants were asked about their perceptions of how the mental health and drug abuse of persons on parole or probation were affected and the measures taken to address these concerns in disaster response.

Narratives expose vulnerabilities experienced by those supervised and the aggregated challenges that impact retention in health and rehabilitative services, all of which can detract from successful sentence completion. The disaster response categories call for a more adaptable approach to overseeing procedures in light of the difficulties involved and recognizing the support of the supervised population who have contributed to community initiatives.

Findings will contribute to informing planning, preparedness, and responses that mitigate the adverse consequences this vulnerable population may experience when exposed to future disaster hazards. Addressing emergency preparedness in this setting provides an opportunity to enact reforms in community supervision and improve access to services needed to enable the successful reintegration of individuals into their communities.

To promote equity for intersectionally disaster-vulnerable individuals and address three literature gaps: (1) incremental effects of collective and self-efficacy as preparedness predictors, (2) differentiation of fear and perceived severity of a disaster, and (3) clarification of the relationship between fear and preparedness.

Due to infection risks associated with communal housing, early in the coronavirus disease (COVID-19) pandemic, many universities permitted students to remain in campus housing only if they were housing insecure, including many international students. We surveyed intersectionally-vulnerable students and their partners at a southeast US university, N = 54, who were international (77.8%), Asian (55.6%), and/or housing insecure at baseline (79.6%). In 14 waves from May–October 2020, we assessed pandemic preparedness/response behaviors (PPRBs) and potential PPRB predictors.

We examined within- and between-person effects of fear, perceived severity, collective efficacy, and self-efficacy on PPRBs. Within-person perceived severity and collective efficacy both significantly, positively predicted greater PPRBs. All effects of fear and self-efficacy were not significant.

Perceived severity and confidence that one’s actions positively impact one’s community fluctuated throughout the pandemic and are linked to greater PPRB engagement. Public health messages and interventions to improve PPRB may benefit from emphasizing collective efficacy and accuracy over fear.

To explore the health impacts of Hurricane Maria (HM) on HIV care outcomes among people living with HIV who use drugs.

Using data from an ongoing cohort study in San Juan, Puerto Rico (Proyecto PACTo), we measured differences in HIV care outcomes (viral load, viral suppression, and CD4 counts) before and after HM using assessments conducted at 6-month intervals. Generalized estimating equations were used to assess factors associated with HIV care outcomes.

All HIV care outcomes showed a deterioration from pre-HM values to post-HM values (mean viral load increased, CD4 counts decreased, and rate of viral suppression decreased) after controlling for pre-HM sociodemographic and health characteristics. In addition to HM, age (aIRR = 1·01), being homeless (aIRR = 0·78) and having health insurance (aIRR = 1·6) were independently associated with viral suppression.

219 participants completed follow-up visits between April 2017 and January 2018, before and after HM.

People living with HIV who use drugs in Puerto Rico experienced poorer HIV outcomes following HM. Socio-environmental factors contributing to these outcomes is discussed in the context of disaster response, recovery, and program planning.

Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity.

Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey.

Washington State, USA.

Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more.

The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not.

Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.

Typhoon Hagibis struck Japan on October 12, 2019. This study documents and characterizes deaths caused by Hagibis and helps identify strategies to reduce mortality in future disasters.

Japanese residents, who were killed by Typhoon Hagibis, as reported by Japan’s Fire and Disaster Management Agency, were considered for the study. Details were collected from mainstream Japanese media, and flooding data from hazard maps published by local municipalities.

Out of the 99 total fatalities, 65 (73.0%) were aged 65 years or above. Among those who drowned indoors (20), 18 (90.0%) lived in high-risk areas of flooding, and their bodies were found on the first floor of their residences. A total of 10 (55.6%) out of the 18 fatalities lived in homes with 2 or more floors, indicating that they could have moved upstairs to avoid the floodwater. However, 6 (33.3%) could not do so due to existing health issues.

Relatively elderly people, particularly those in areas at high risk of flooding, were most affected. Seeking higher ground is a standard safety measure in times of flooding, but this may not be possible for everyone depending on their health status, structure of their residence, and the depth of floodwaters.

Shared decision-making (SDM) is a critical component of delivering patient-centered care. Members of vulnerable populations may play a passive role in clinical decision-making; therefore, understanding their prior decision-making experiences is a key step to engaging them in SDM.

To understand the previous healthcare experiences and current expectations of vulnerable populations on clinical decision-making regarding therapeutic options.

Clients of a local food bank were recruited to participate in focus groups. Participants were asked to share prior health decision experiences, explain difficulties they faced when making a therapeutic decision, describe features of previous satisfactory decision-making processes, share factors under consideration when choosing between treatment options, and suggest tools that would help them to communicate with healthcare providers. We used the inductive content analysis to interpret data gathered from the focus groups.

Twenty-six food bank clients participated in four focus groups. All participants lived in areas of socioeconomic disadvantage. Four themes emerged: prior negative clinical decision-making experience with providers, patients preparing to engage in SDM, challenges encountered during the decision-making process, and patients’ expectations of decision aids. Participants also reported they were unable to discuss therapeutic options at the time of decision-making. They also expressed financial concerns and the need for sufficiently detailed information to evaluate risks.

Our findings suggest the necessity of developing decision aids that would improve the engagement of vulnerable populations in the SDM process, including consideration of affordability, use of patient-friendly language, and incorporation of drug–drug and drug–food interactions information.

The aim of this study was to quantify immediate bed availability (IBA) in a United States children’s hospital and treatment needs of hospitalized patients whose needs could be met outside a traditional hospital setting.

Using a novel tool to capture census, scheduled discharges, and resource needs for hospitalized patients, we surveyed our hospital’s 5 non-neonatal inpatient pediatric units on 4 d over 1 y.

Median ward occupancy was 81% (range, 58-79), median intensive care unit occupancy was 80% (range, 7-19), and median IBA was 42% (range, 34-59). A median of 14 patients per day (13% of total capacity) had treatment needs that could be met by providing limited support in a nontraditional setting; the most common reason for requiring ongoing hospitalization in this group of patients was a safe discharge plan.

Our median IBA of 42% exceeds federal recommendations, but varies widely between days surveyed. Even on days when IBA percentage is high, our total number of available beds is unlikely to meet pediatric population needs in a large-scale public health emergency.