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Objectives The public health sector has long recognized the role of the social determinants of health in health disparities and the importance of achieving health equity. We now appear to be at an inflection point, as we hear increasing demands to dismantle structures that have perpetuated inequalities. Assessing prevailing mindsets about what causes health inequalities and the value of health equity is critical to addressing larger issues of inequity, including racial inequity and other dimensions. Using data from a nationally representative sample of adults in the United States, we examined the factors that Americans think drive health outcomes and their beliefs about the importance of health equity. Methods Using data from the 2018 National Survey of Health Attitudes, we conducted factor analyses of 21 survey items and identified three factors from items relating to health drivers—traditional health influencers (THI), social determinants of health (SDoH), and sense of community health (SoC). Health equity beliefs were measured with three questions about opportunities to be healthy. Latent class analysis identified four groups with similar patterns of response. Factor mixture modeling combined factor structure and latent class analysis into one model. We conducted three logistic regressions using latent classes and demographics as predictors and the three equity beliefs as dependent variables. Results Nearly 90% of respondents comprised one class that was characterized by high endorsement (i.e., rating the driver as having strong effect on health) of THI, but lower endorsement of SDoH and SoC. Logistic regressions showed that respondents endorsing (i.e., rated it as a top priority) all three health equity beliefs tended to be female, older, Black or Hispanic, more educated, and have lower incomes. The class of respondents that endorsed SDoH the most was more likely to endorse all three equity beliefs. Conclusions Results suggested that people historically impacted by inequity, e.g., people of color and people with low incomes, had the most comprehensive understanding of the drivers of health and the value of equity. However, dominant beliefs about SDoH and health equity are still generally not aligned with scientific consensus and the prevailing narrative in the public health community.

Health mindset is a group of beliefs or assumptions that individuals hold about the causes of health and well-being. Strengthening our understanding of factors that shape mindset and how mindset shapes expectations for who can and should be responsible for health can inform the success and sustainability of solutions to current health crises including the COVID-19 pandemic, ongoing disparities in health outcomes, and gun violence. We first examined associations between personal characteristics and experiences with health mindset. Next, we examined the association between mindset and the belief that government involvement can help address pressing health questions, using obesity as an example of a health outcome that is shaped both by personal choices and factors outside one’s control. Going forward, it will be important to consider health mindset in broader transformations of the health system and population approaches to improving health.

Drawing on national, state, and local data, the Urban Child Institute partnered with RAND to explore the social and emotional well-being of children in Memphis and Shelby County, Tenn. The book highlights the importance of factors in the home, child care setting, and community that contribute to social and emotional development.

INTRODUCTION Low health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is largely unaddressed in public health and clinical practice. To help overcome these limitations, we developed two models to estimate health literacy. METHODS We analyzed data from the 2003 National Assessment of Adult Literacy (NAAL), using linear regression to predict mean health literacy scores and probit regression to predict the probability of an individual having ‘above basic’ proficiency. Predictors included gender, age, race/ethnicity, educational attainment, poverty status, marital status, language spoken in the home, metropolitan statistical area (MSA) and length of time in U.S. RESULTS All variables except MSA were statistically significant, with lower educational attainment being the strongest predictor. Our linear regression model and the probit model accounted for about 30% and 21% of the variance in health literacy scores, respectively, nearly twice as much as the variance accounted for by either education or poverty alone. CONCLUSIONS Multivariable models permit a more accurate estimation of health literacy than single predictors. Further, such models can be applied to readily available administrative or census data to produce estimates of average health literacy and identify communities that would benefit most from appropriate, targeted interventions in the clinical setting to address poor quality care and outcomes related to LHL.

Emerging health care research paradigms such as comparative effectiveness research (CER), patient-centered outcome research (PCOR), and precision medicine (PM) share one ultimate goal: constructing evidence to provide the right treatment to the right patient at the right time. We argue that to succeed at this goal, it is crucial to have both timely access to individual-level data and fine geographic granularity in the data. Existing data will continue to be an important resource for observational studies as new data sources are developed. We examined widely used publicly funded health databases and population-based survey systems and found four ways they could be improved to better support the new research paradigms: (1) finer and more consistent geographic granularity, (2) more complete geographic coverage of the US population, (3) shorter time from data collection to data release, and (4) improved environments for restricted data access. We believe that existing data sources, if utilized optimally, and newly developed data infrastructures will both play a key role in expanding our insight into what treatments, at what time, work for each patient.

Given the ongoing debate over whether giftedness is associated with mental health disorders, there is a great need to highlight and compare results from the most methodologically rigorous studies. Surprisingly, the vast majority of literature reviews and background sections of research articles include studies that do not directly compare gifted and nongifted youth. Furthermore, almost no attention has been paid to how differences in the definitions of giftedness or mental health outcomes of interest affect the interpretation and comparison of studies. The authors apply an epidemiologic perspective for thinking about these issues, highlight many of the challenges of studying this population, and present results from meta-analyses that include the most methodologically rigorous studies comparing rates of depression, bipolar disorder, anxiety, suicide ideation, and attention deficit hyperactivity disorder (ADHD) between gifted and nongifted youth. They conclude with recommendations to strengthen research in this area. Putting the research to use Through this review we sought to provide concrete recommendations to strengthen future research on the mental health of gifted children. Most notably, future studies should assess large, population-based cohorts that include both gifted and nongifted individuals. Researchers should also move toward describing their study population according to their specific aptitudes, talents, skills or abilities, rather than using the general term ‘gifted’. Thinking more specifically about these relationships will not only help us to understand the association between giftedness and mental health, but will also increase the potential to effectively shape programs and policies for gifted youth, focusing resources on the most vulnerable.

New care delivery models that hold providers more accountable for coordinated, high-quality care and the overall health of their patients have appeared in the US health care system, spurred by recent legislation such as the Affordable Care Act. These models support the integration of health care systems, but maximizing health and well-being for all individuals will require a broader conceptualization of health and more explicit connections between diverse partners. Integration of health services and systems constitutes the fourth Action Area in the Robert Wood Johnson Foundation's Culture of Health Action Framework, which is the subject of this article. This Action Area conceives of a strengthened health care system as one in which medical care, public health, and social services interact to produce a more effective, equitable, higher-value whole that maximizes the production of health and well-being for all individuals. Three critical drivers help define and advance this Action Area and identify gaps and needs that must be addressed to move forward. These drivers are access, balance and integration, and consumer experience and quality. This article discusses each driver and summarizes practice gaps that, if addressed, will help move the nation toward a stronger and more integrated health system.

To examine whether women whose partners are involved in their pregnancy are more likely to receive early prenatal care and reduce cigarette consumption over the course of the pregnancy. This study also examines sociodemographic predictors of father involvement during pregnancy. Data on 5,404 women and their partners from the first wave of the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B) were used to examine the association between father involvement during pregnancy and maternal behaviors during pregnancy. Multivariate linear and logistic regression analyses were used and data were weighted to account for the complex survey design of the ECLS-B. Women whose partners were involved in their pregnancy were 1.5 times more likely to receive prenatal care in the first trimester and, among those who smoked at conception, to reduce their cigarette consumption 36% more than women whose partners were not involved in the pregnancy (p = .09). Fathers with less than a high school education were significantly less likely to be involved in their partner's pregnancy, while first-time fathers and fathers who reported wanting the pregnancy were significantly more likely to be involved. The positive benefits of father involvement often reported in the literature on child health and development can be extended into the prenatal period. Father involvement is an important, but understudied, predictor of maternal behaviors during the prenatal period, and improving father involvement may have important consequences for the health of his partner, her pregnancy, and their child.

Objective. Education is inversely associated with coronary heart disease (CHD) risk; however the mechanisms are poorly understood. The study objectives were to evaluate the extent to which rarely measured factors (literacy, time preference, sense of control) and more commonly measured factors (income, depressive symptomatology, body mass index) in the education-CHD literature explain the associations between education and CHD risk. Method. The study sample included 346 participants, aged 38 to 47 years (59.5% women), of the New England Family Study birth cohort. Ten-year CHD risk was calculated using the validated Framingham risk algorithm that utilizes diabetes, smoking, blood pressure, total cholesterol, high-density lipoprotein cholesterol, age, and gender. Multivariable regression and mediation analyses were performed. Results. Regression analyses adjusting for age, race/ethnicity, and childhood confounders (e.g., parental socioeconomic status, intelligence) demonstrated that relative to those with greater than or equal to college education, men and women with less than high school had 73.7% (95% confidence interval [CI; 29.5, 133.0]) and 48.2% (95% CI [17.5, 86.8]) higher 10-year CHD risk, respectively. Mediation analyses demonstrated significant indirect effects for reading comprehension in women (7.2%; 95% CI [0.7, 19.4]) and men (7.2%; 95% CI [0.8, 19.1]), and depressive symptoms (11.8%; 95% CI [2.5, 26.6]) and perceived constraint (6.7%, 95% CI [0.7, 19.1]) in women. Conclusions. Evidence suggested that reading comprehension in women and men, and depressive symptoms and perceived constraint in women, may mediate some of the association between education and CHD risk. If these mediated effects are interpreted causally, interventions targeting reading, depressive symptoms, and perceived constraint could reduce educational inequalities in CHD.

BackgroundResearch has demonstrated associations between smoking and reading skills, but other literacy skills such as speaking, listening and numeracy are less studied despite our dependence on the use of numbers and the oral exchange to deliver information on the risks of smoking.MethodsThe authors used multivariable logistic regression to examine the effects of reading, numeracy, speaking and listening skills on: (1) becoming a regular smoker and (2) smoking cessation. Further, multivariable linear regression was used to examine the relation between literacy skills and amount smoked among current smokers. Models controlled for education, gender, age, race/ethnicity, income and, when relevant, age at which they became a regular smoker.ResultsFor each grade equivalent increase in reading skills, the odds of quitting smoking increased by about 8% (OR=1.08, 95% CI 1.01 to 1.15). For every point increase in numeracy skills, the odds of quitting increased by about 24% (OR=1.24, 95% CI 1.06 to 1.46). No literacy skills were associated with becoming a regular smoker or current amount smoked.ConclusionThe ability to locate, understand and use information related to the risks of smoking may impact one's decision to quit. Messaging should be designed with the goal of being easily understood by all individuals regardless of literacy level.