Assessing Impacts of "Anti-Equity" Legislation on Health Care and Public Health Services.

A deluge of state "anti-equity" legislative bills seek to reverse prevailing trends in diversity, equity, and inclusion; withdraw protections of LGBTQ+ communities; and deny access to gender-based care for trans minors and adults. While the political and constitutional fate of these acts is undetermined, profound impacts on patients and their providers are already affecting the delivery of health care and public health services.

Supreme Court Impacts in Public Health Law: 2022-2023.

In another tumultuous term of the United States Supreme Court in 2022-2023 a series of critical cases implicate instant and forthcoming changes in multiple fronts that collectively shift the national public health law and policy environment.

Conceptualizing socially-assistive robots as a digital therapeutic tool in healthcare.

Artificial Intelligence (AI)-driven Digital Health (DH) systems are poised to play a critical role in the future of healthcare. In 2021, $57.2 billion was invested in DH systems around the world, recognizing the promise this concept holds for aiding in delivery and care management. DH systems traditionally include a blend of various technologies, AI, and physiological biomarkers and have shown a potential to provide support for individuals with various health conditions. Digital therapeutics (DTx) is a more specific set of technology-enabled interventions within the broader DH sphere intended to produce a measurable therapeutic effect. DTx tools can empower both patients and healthcare providers, informing the course of treatment through data-driven interventions while collecting data in real-time and potentially reducing the number of patient office visits needed. In particular, socially assistive robots (SARs), as a DTx tool, can be a beneficial asset to DH systems since data gathered from sensors onboard the robot can help identify in-home behaviors, activity patterns, and health status of patients remotely. Furthermore, linking the robotic sensor data to other DH system components, and enabling SAR to function as part of an Internet of Things (IoT) ecosystem, can create a broader picture of patient health outcomes. The main challenge with DTx, and DH systems in general, is that the sheer volume and limited oversight of different DH systems and DTxs is hindering validation efforts (from technical, clinical, system, and privacy standpoints) and consequently slowing widespread adoption of these treatment tools.

Increasing Opportunities for Healthy Sexual Socialization in LGBTQ+ People with IDD: The Role of LGBTQ+ Organizations and Community.

In the current intersectionality-focused discourse within sexuality research, individuals existing at the convergence of intellectual and developmental disabilities (IDD) and lesbian, gay, bisexual, transgender, and queer+ (LGBTQ+) are often overlooked. Individuals with IDD face difficulties acquiring sexual knowledge and skills due to limited opportunities for sexual socialization, misconceptions concerning sexuality and IDD, lack of comprehensive sexual education, restricted support from staff and caregivers, and a lack of community experiences that facilitate the development of healthy sexuality. When an individual with IDD identifies as LGBTQ+, these disability-related barriers can exacerbate the stigma and discrimination some LGBTQ+ people experience. Using the intimate justice framework, we explore avenues to support and foster inclusivity within the LGBTQ+ community for members with IDD. Several recommendations were identified from the literature search, including logistical considerations and using accessible language for outreach events, presentations, workshops, training, and other activities and opportunities for sexuality education while challenging disability-related stigma in LGBTQ+ spaces.

Midterm Maelstrom: Public Health Legal Impacts of Election 2022.

Among the morass of critical issues impacting the results of the midterm elections in 2022 were core public health issues related to health care access, justice, and reforms. Collectively, voters' communal health and safety concerns dominated outcomes in key races which may shape national, state, and local legal approaches to protecting the public's health in the modern era.

BARRIERS TO REPORTING AND LACK OF EQUITABLE SUPPORT: ABORTION ACCESS FOR ADULTS WITH AUTISM EXPERIENCING RAPE-RELATED PREGNANCY POST-ROE.

Following the overturning of Roe v. Wade, individuals with autism experience unique barriers to accessing abortion for rape-related pregnancies in states restricting reproductive health care. Barriers to reporting rape include inadequate sex education which contributes to a lack of information about sexual violence (SV), difficulties labeling and recognizing SV, and potential difficulties navigating the role of a caregiver or conservator when reporting SV. Individuals with autism often experience a lack of equitable support from formal SV support services. Both barriers to reporting and lack of equitable support from formal SV support services reflect that individuals with autism are marginalized and often overlooked when receiving sexual and reproductive health care. Suggestions are provided for sexuality educators, SV support services, police, healthcare providers and policymakers, for better supporting individuals with autism experiencing rape-related pregnancy in states with abortion restrictions.

Sexual Health and Women Living With Spinal Cord Injury: The Unheard Voice.

Women's sexual health within the context of sexual function and psychosocial dimensions while living with a spinal cord injury (SCI) has rarely been discussed separately from men living with a SCI or from a collective with other chronic conditions. To date, over 64,000 women in the U.S. are currently living with SCI, with total numbers increasing each year, as well as the demographics shifting to include more diversity in race and incidences occurring later in life. On average, SCI tends to be acquired during the childbearing years (~30-50 years old), as well as when women experience other health concerns associated with aging, including perimenopause and menopause. Additionally, women's sexual health is often conceptualized from the position of the absence of disease and dysfunction. However, consistent with definitions furthered by the World Health Organization (WHO) and World Association of Sexual Health (WAS), we believe women's sexual health is multifaceted, moving beyond a focus on reproduction to also encompass sexual function and the psychosocial dimensions of sexual health both living with and without disabling conditions and diseases. Within this lens, we present prior research that has been conducted, conclusions from these studies, implications for practice, and recommendations for future research. Thus, the paper will expand the understanding of both sexual function and psychosocial dimensions for women living with SCI.

Regressive Federalism, Rights Reversals, and the Public's Health.

As the United States emerges from the worst public health threat it has ever experienced, the Supreme Court is poised to reconsider constitutional principles from bygone eras. Judicial proposals to roll back rights under a federalism infrastructure grounded in states' interests threaten the nation's legal fabric at a precarious time. This column explores judicial shifts in 3 key public health contexts - reproductive rights, vaccinations, and national security - and their repercussions.

Legal Challenges Underlying COVID-19 Vaccinations.

Immunizing hundreds of millions against COVID- 19 through the most extensive national vaccine campaign ever undertaken in the United States has generated significant law and policy challenges.

Effect of a mentoring program for adolescents with physical disabilities attending a therapeutic camp.

PURPOSE: Youth with physical disabilities are at an elevated risk for poor psychosocial health. Pediatric medical camps are one common intervention utilized to provide short-term psychosocial support. However, there is a growing criticism that the effects of such programs diminish as participants return to home and school settings post residential camp experience. A post camp support intervention, the first known in the literature, was tested for perceptions of mattering and self-esteem. Specifically, this study examined the psychosocial effect of a year-round mentoring and online support program as an adjunct to residential camp (intervention) as compared to peers that attended only the summer residential experience (comparison group). METHODS: A quasi-experimental design using an intervention and comparison group was implemented. Data were analyzed using a repeated measures analysis of variance to test for within group and between group effect. RESULTS: A small effect (partial η2= 0.096) between groups (p< 0.17) and a moderate effect (partial η2= 0.133) within groups (p< 0.10) was detected for the mattering construct. A positive effect for self-esteem was not detected between or within groups. CONCLUSIONS: The online and mentoring support program appeared to improve perceptions of mattering three months into implementation. Future implications center on the refinement of the support program and suggestions for further longitudinal research.

Different Levels of Physical Activity, Physical Health, Happiness, and Depression among Older Adults with Diabetes.

The purpose of this study was to investigate the relationship between different levels of physical activity (light, moderate, and vigorous), physical health, happiness, and depression among older adults with diabetes. Using data from the National Social Life, Health and Aging Project (NSHAP) Wave 3, the results indicate that moderate and/or vigorous physical activity is more effective than light physical activity for promoting physical health and happiness and lowering depression of older adults with diabetes. This study suggests that activity professionals and therapists working with older adults with diabetes need to encourage their participation in physical activity as well as adjust a level of physical activity intensity that is tailored to participants' needs and expectations.

Legal Interventions to Counter COVID-19 Denialism.

A series of denialist state laws thwart efficacious public health emergency response efforts despite escalating impacts of the spread of the Delta variant during the COVID-19 pandemic.

Investigating relationships among coping, personal growth, and life satisfaction among individuals with physical disabilities.

Background: It is well-documented that active coping strategies can lead to better positive adjustment and psycho-social outcomes among individuals with disabilities and illnesses. However, little information exists related to exploring how coping is related to health benefits such as personal growth and life satisfaction in an international context. Thus, this study examined how the use of coping strategies is associated with personal growth and life satisfaction among individuals with physical disabilities in non-Western settings. Methods: In this cross-sectional study, we employed a nonprobability methodology, purposivesampling, to recruit 351 participants who adults over the age of 18 living with a physicaldisability and currently enrolled in the Korean Disability Association. A hierarchical linearregression analysis was conducted to determine which types of coping strategies predictedpersonal growth and life satisfaction, while controlling for the effects of the demographicvariables (i.e., gender and age). Results: With regard to personal growth, problem-solving coping strategy (ß = 0.663, P < 0.001,95% CI [0.51, 0.70]) was the strongest predictor, followed by avoidance coping strategy(ß = -0.263, P < 0.001, 95% CI [-0.37, -0.20]). As for life satisfaction, problem-solving copingstrategy (ß = 0.268, P < 0.001, 95% CI [0.18, 0.70]) was the strongest predictor, followed bysocial support seeking coping strategy (ß = 0.264, P < 0.001, 95% CI [-0.19, 0.10]). Conclusion: Our study suggests that problem-focused and social support coping strategies playimportant roles in improving the personal growth and life satisfaction among Korean individualswith physical disabilities. This study provides implications for health professionals seeking waysto facilitate the personal growth and enhance the life satisfaction of individuals with physicaldisabilities.

Leisure behavior and sense of coherence in the context of depression.

AIMS: Improved sense of coherence (SOC) can protect health among individuals with depression. Literature suggests that leisure behavior can improve SOC, yet empirical studies are lacking. The current study aimed to examine whether leisure behavior was associated with SOC and depression. METHODS: A cross-sectional online survey method was used with a sample of community-living adults (62% female, age 18-75 years) with a self-reported current or historical diagnosis of depression recruited from four different depression-related populations. RESULTS: The results of structural equation modeling found that leisure behavior predicted greater SOC as well as lower depressive symptoms. Greater SOC was associated with lower perceived stress and lower depressive symptoms. The total effect size, including both direct and indirect association between leisure behavior and depressive symptoms was 0.452. CONCLUSION: The findings suggested the potential benefits of leisure behavior on SOC and depressive symptoms.

Relationship Between Substance Use and the Onset of Spinal Cord Injuries: A Medical Chart Review.

Background: Opioid misuse is a leading health care concern within the United States. In many cases, opioid misuse and opioid use disorder are associated with pain, a secondary health condition affecting individuals with spinal cord injury (SCI). Further, substance use is a known risk factor for SCI, resulting in the potential for a substance-related risk trajectory running from pre- to post-SCI. However, little research has examined substance use prior to SCI since the opioid epidemic began, and so the relative risk of opioids to patients with SCI is unclear. Objective: To determine whether individuals with SCI tested positive for substance use at the time of injury and identify the primary substances used at the time of injury. Methods: This study retrospectively reviewed all medical charts of individuals ages 18 and older who had sustained an SCI during an identified 18-month period and received medical care at a selected level 1 trauma center in the Midwest. Results: Data revealed an 80% combined positive toxicology and/or self-report of substance use immediately prior to the onset of the SCI. Twenty-five percent of males were positive for more than one substance at time of injury. Substances used prior to injury, listed most to least prevalent, were opioids (37.5%), alcohol (25%), marijuana (25%), methamphetamines (12.5%), benzodiazepines (12.5%), followed by cocaine (6.25%) and synthetic cathinone (6.25%). Conclusion: Although opioids were the most common substance used prior to SCI, none of the individuals positive for opioids at the time of injury were identified by the reviewing medical professional as having pain as a secondary health condition either prior to or after injury. However, pain is commonly listed as the primary health concern among individuals living with SCI, and the possibility of opioid use prior to injury likely warrants pain management planning that includes careful pharmacological and nonpharmacological interventions.