Background: Oral cavity cancer remains a major public health challenge because many cases are diagnosed at advanced stages, when treatment is more complex and outcomes are poorer. Although oral cancer screening involves a simple, non-invasive examination, its implementation remains inconsistent across settings. This review examines barriers to oral cancer screening through a biosocial lens, with attention being paid to clinical, social, and policy factors shaping access. Materials and Methods: This study was conducted as a structured narrative review of peer-reviewed literature and policy documents. Targeted searches of PubMed and Google Scholar were taken from database from 2000 to May 2024 using MeSH terms and free-text terms related to oral cancer screening, disparities, social determinants, access, guidelines, and policy. Eligible sources included English-language studies and guidance documents addressing oral cancer screening practices, barriers, disparities, or recommendations. Findings were synthesized thematically and interpreted using a biosocial framework informed by social medicine theory. Results: The review finds that oral cancer screening is limited by variation in guideline recommendations, uneven integration across healthcare settings, and persistent disparities in access among high-risk populations. Patients with the greatest burden of risk often face the greatest barriers to early detection because of structural disadvantage, fragmented service delivery, and weak policy support. The literature also suggests that narrow evidentiary standards and cost-effectiveness debates may limit the legitimacy and uptake of screening initiatives. Conclusions: This review does not propose a wholly new model of screening; rather, it offers a biosocial interpretation of existing evidence to explain why screening inequities persist. More equitable oral cancer screening will require not only clinical attention to high-risk populations but also reforms in guideline development, service organization, and health policy to better address structural barriers to access.
This article examines how biomedical HIV prevention technologies, particularly pre-exposure prophylaxis (PrEP) and Undetectable Equals Untransmittable (U = U) messaging, intersect with chemsex practices among gay and bisexual men in Amsterdam. Drawing on semi-structured interviews with 35 men recruited during three years of ethnographic fieldwork (2016-2019) in Amsterdam's sex clubs and private parties, the study employs Rabinow's concept of biosociality to capture the new forms of collective sexual and social life that become possible when pharmaceutical technologies transform shared understandings of risk. Four interrelated themes were developed: biomedical prevention as a catalyst for chemsex (re)initiation; the collective renegotiation of risk within pharmaceutical horizons; PrEP as chemsex infrastructure merging prevention and pleasure; and the formation of new sexual networks and biosocial communities organised around shared pharmaceutical statuses. Findings revealed that PrEP and U = U have not merely reduced HIV anxiety but have actively reshaped the sexual and social landscape of Amsterdam's gay and bisexual communities, generating new forms of intimacy and belonging. These technologies have opened new possibilities for sexual and social life that have exceeded the scope of biomedical intervention and cannot be adequately understood through behavioural risk models or assemblage-based analyses alone.
Media and humanitarian discourses surrounding violence against people with albinism in Tanzania have fostered forms of biosocial relatedness and public recognition. Yet albinism does not consistently consolidate into a stable biosocial identity. Drawing on ethnographic research with Farida, Baraka and other interlocutors with albinism, this article ethnographically develops the concept of "modalities of enfleshment" to attend to how albinism is lived through shifting interpretations and embodied experiences. In this paper, I argue that the condition offers a case study for understanding how bodymind differences are continually revalued across and shaped by biomedical, disability, socio-cultural, economic, political, and institutional domains and practices.
Famine is conventionally understood as a crisis of food supply, yet historical and contemporary evidence reveals it as a product of structural violence: political decisions, colonial extraction, and military force that manufacture scarcity and inscribe its consequences onto human bodies across generations. This conceptual analysis examines the intergenerational biology of famine through three cases: the 1944-45 Dutch Hunger Winter, colonial-era famines in India, and the ongoing famine in Gaza. Drawing on the developmental origins of health and disease (DOHaD) paradigm, social medicine, and global health scholarship, we argue that famine's metabolic, immunological, and neurodevelopmental consequences are enabled not only by the severity and timing of caloric deprivation but by the political structures that determine whether deprivation is temporary or sustained, and whether recovery is supported or obstructed. The Dutch case affirms potent within-generation effects partially buffered by postwar welfare reconstruction; colonial India demonstrates how centuries of imperial extraction produced enduring, population-level metabolic vulnerability; and Gaza combines acute starvation with decades of siege, occupation, and infrastructural destruction. A biosocial framework resituates famine as both immediate violence and long-term biological imprinting, urging accountability beyond humanitarian logics of survival to encompass reparative justice, self-determination, and the dismantling of the political systems that produce manufactured hunger.
Transgender women (TGW) experience unique hormonal contexts and high HIV incidence, yet the mucosal microbiome among TGW remains understudied. Sex hormones and geography may shape microbial composition, but the relative contributions of gender identity, feminizing hormone therapy (FHT), and location are unclear. We conducted a multi-site study of TGW using FHT and cisgender men who have sex with men (MSM), all without HIV, in Atlanta, USA (n = 58; 25 TGW, 33 MSM) and Bangkok, Thailand (n = 147; 97 TGW, 50 MSM)(n = 205). We also conducted longitudinal sampling in 21 TGW pre/post FHT initiation. Rectal swabs were collected from all participants, with optional neovaginal sampling in TGW. Microbiota composition was analyzed using 16S rRNA sequencing, and associations with gender category, geography, and hormone concentrations were assessed using linear decomposition modeling (LDM) and BOUTH analysis. Here we show that the rectal microbiota differ significantly by both gender category and geography. TGW exhibit enrichment of estrogen-metabolizing taxa across sites, while MSM show Prevotellaceae enrichment in Atlanta only. Alpha diversity varies by location but not gender category. Neovaginal microbiota differ markedly from rectal composition, showing enrichment of skin- and gut-associated taxa and anaerobic taxa associated with HIV seroconversion. No significant rectal microbiota shifts are observed after short-term FHT initiation, possibly reflecting subtherapeutic hormone exposure. These findings underscore the need to consider gender identity as a complex biosocial phenotype in HIV prevention and highlight the potential role of mucosal microbiota in shaping HIV vulnerability in TGW. Transgender women are at elevated risk of acquiring HIV, but little is known about the bacteria that normally live in their bodies and how these might affect health. We studied whether gender identity, hormone use, and geographic location influence these bacteria. We collected rectal samples from transgender women and cisgender men in the United States and Thailand, along with neovaginal samples from some transgender women in Thailand. We also followed a small group of transgender women before and after starting hormone therapy. We found that bacterial communities differed by gender identity and location. Transgender women had more estrogen-linked bacteria, while location influenced overall diversity. Short-term hormone therapy had little effect. These results show that social and biological factors together shape the microbiome and may affect HIV risk.
Transgender women (TGW) experience unique hormonal contexts and high HIV incidence, yet the mucosal microbiome among TGW remains understudied. Sex hormones and geography may shape microbial composition, but the relative contributions of gender identity, feminizing hormone therapy (FHT), and location to mucosal microbial phenotypes among key populations such as TGW are unknown. We conducted a multi-site study of cisgender men who have sex with men (MSM) and TGW using FHT, both without HIV, in Atlanta, Georgia, USA (n = 58; 25 TGW, 33 MSM) and Bangkok, Thailand (n = 147; 97 TGW, 50 MSM), using cross-sectional sampling (n = 205). We also conducted longitudinal sampling in TGW (n = 21) pre/post FHT initiation. Rectal mucosal swabs were collected from all participants with optional neovaginal sampling in TGW. Microbiota composition was analyzed using 16S rRNA sequencing, and associations with gender identity, geography, and serum estradiol and testosterone concentrations were assessed using linear decomposition modeling (LDM)(1) and BOUTH analysis(2). Rectal microbiota differed significantly by both gender identity and geography via LDM and BOUTH analyses. TGW exhibited enrichment of estrogen-metabolizing taxa across sites, while MSM showed Prevotellaceae enrichment in Atlanta but not Bangkok. Alpha diversity varied by location but not gender identity. Neovaginal microbiota differed markedly from rectal composition, showing enrichment of skin- and gut-associated taxa (e.g., Prevotella, Peptostreptococcus, Porphyromonas) and anaerobic taxa associated with HIV seroconversion. Longitudinal analysis revealed no significant rectal microbiota shifts after short-term FHT initiation, possibly reflecting subtherapeutic hormone exposure. These findings underscore the need to consider gender identity as a complex biosocial phenotype in HIV prevention and highlight the potential role of mucosal microbiota in shaping HIV vulnerability in TGW.
Sexual-identity disparities in substance use among U.S. veterans, and whether mental-health treatment mitigates risk for those with depression, remain under-examined. Using data on veterans from the 2021-2023 National Survey on Drug Use and Health (NSDUH; N = 7,212), disparities were estimated in past-30-day nicotine, marijuana, binge drinking, and polysubstance use, as well as severe psychological distress (K6≥13) and past-year suicidal ideation. Guided by a biosocial/minority-stress framework, multiple imputation was applied (m = 20) and survey-weighted logistic regression adjusting for age, year, race/ethnicity, sex, education, metro status, insurance, marital status, employment, and income; among veterans with a past-year major depressive episode (MDE), interactions were tested between sexual identity and (a) depression-related clinical contact (DRC) and (b) prescription medication for depressive feelings. Bisexual veterans showed the highest prevalence of marijuana (33.5%) and polysubstance use (30.6%), exceeding that of heterosexual (11.8%, 14.9%) and gay/lesbian veterans (24.0%, 18.8%). Models restricted to veterans with MDE, past-year DRC (DRC defined as any visit or conversation with a health professional about depressive feelings) moderated risk for gay/lesbian veterans, with DRC associated with lower odds of binge drinking and polysubstance use; prescription medication showed a similar moderating pattern for nicotine and polysubstance outcomes. Findings for severe psychological distress and suicidal ideation were mixed and consistent with confounding by indication. Results should be interpreted cautiously given the cross-sectional data, self-report, small sexual-minority subgroups, and non-aligned recall windows (past-year mental health/treatment vs past-30-day substance use). Overall, sexual-identity disparities in substance use are evident, with bisexual veterans bearing the greatest burden, and engagement in DRC and medication among veterans with MDE, particularly gay/lesbian veterans, showing associations consistent with a buffering effect of affirming care. Longitudinal and qualitative studies are needed to test causal pathways and to illuminate lived experiences, and policy/clinical efforts should expand culturally competent, integrated services and routine SOGI data collection to monitor and reduce inequities.
Concerns about the consequences of rapid population aging in the USA and England often neglect the key demographic processes of cohort succession and its influence on population health. In this study, we quantify the extent to which trends between 2004 and 2018 in older US and English adults' cognition functioning are related to population composition changes in three areas: (i) age distribution, (ii) socioeconomic factors, and (iii) chronic disease prevalence. Using data from the USA-based Health and Retirement Study (n = 17 305 person-years) and the English Longitudinal Study of Aging (n = 7557 person-years), we apply the Kitagawa-Oaxaca-Blinder two-fold decomposition to estimate the contributions of changes in each country's population composition to changes in overall cognitive functioning between 2004 and 2018. For both men and women, improvements in cognitive functioning were largely driven by cohort succession increasing the average educational attainment of the two populations. Increases in the proportions of the youngest old adults counteracted the negative contributions of increased proportions of the oldest adults. However, increases in the prevalence of psychological conditions (for US men, US women, and English women) and the prevalence of diabetes and divorce (for US women) emerge as specific risk factors that are detrimental to continued gains in cognitive functioning. Population aging may not necessarily portend an increasing burden of cognitive diseases when cohorts bring different socioeconomic and health protective and risk factors with them into older adulthood.
The biosocial theory of borderline personality disorder (BPD) posits that emotional dysregulation develops from the transaction between a biological vulnerability and an invalidating environment (e.g., childhood adversity), and in turn leads to behavioral dyscontrol. This study aimed to empirically test this core mechanistic pathway in a non-Western clinical sample. We hypothesized that the relationship between childhood adversity and the hallmark BPD trait of negative urgency (acting impulsively when distressed) would be mediated by difficulties in emotion regulation. A cross-sectional study was conducted with 45 adult patients with a Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnosis of BPD in Hyderabad, India. Participants completed the Childhood Experience of Care and Abuse Questionnaire (CECA-Q), the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF), and the Short UPPS-P (urgency, premeditation, perseverance, sensation seeking, and positive urgency) Impulsive Behaviour Scale. A bootstrapping-based mediation analysis (Hayes' PROCESS Model 4) was used to test the hypothesized indirect effect. The analysis revealed a significant indirect effect of childhood adversity on negative urgency through emotional dysregulation (Indirect Effect = 0.31, 95% bootstrapped CI: 0.14, 0.52). The direct effect of childhood adversity on negative urgency, which was significant in the initial correlation, became non-significant (B = 0.08, p = 0.450) after accounting for the mediator. This pattern is consistent with full mediation. This study provides strong, mechanism-based support for the biosocial model of BPD in an under-researched Indian context. The findings demonstrate that the pathogenic impact of childhood adversity on emotion-based impulsivity is explained by its disruption of emotion regulation capacities. This offers a clear empirical rationale for prioritizing emotion regulation-focused psychotherapies, such as dialectical behavior therapy, as the primary treatment approach for BPD.
Traditional political science frameworks frequently neglect the biological and systems-level substrates that enable authoritarian regimes to maintain long-term stability despite structural inefficiencies. This study develops a a conceptual biosocial framework integrating evolutionary biology, neurophysiology, and bioeconomics to conceptualize authoritarian resilience as an emergent property of multi-level selection processes. In particular, the analysis identifies a dual feedback architecture consisting of (i) the activation of dominance-based heuristics rooted in ancestral environments and (ii) the induction of population-wide learned helplessness as an energy-minimization strategy. Drawing on recent advances in neuroscience, these processes are linked to measurable alterations in stress physiology and executive neural function. In contemporary contexts, the expansion of digital surveillance infrastructures further automates compliance while potentially amplifying chronic stress through conditions of algorithmic vulnerability. Importantly, the framework is extended through incorporation of historical and evolutionary dynamics of large-scale cooperation, as described in ultrasociality theory, emphasizing the role of cultural group selection and intergroup competition in shaping hierarchical institutions. Authoritarianism is therefore interpreted not merely as a political configuration but as a biosocial equilibrium state that prioritizes short-term systemic efficiency over long-term adaptive capacity. Designing resilient institutions requires explicit consideration of these evolutionary and physiological constraints.
The impact of higher ambient temperature on suicide is well documented in the general population, although it remains unclear in youths despite their particular biosocial vulnerability. In an ecological study, the authors examined this relationship, focusing on seasonal differences. The authors calculated monthly suicide rates in young people (ages 5-24) by county using data from the U.S. Centers for Disease Control and Prevention and the U.S. Census Bureau from 1980 to 2004 in the contiguous United States. Fixed-effects regression was used to estimate relative risk of suicide per 1°C change in average monthly temperature overall and by season, accounting for precipitation, region, county, month, and year. Age-stratified analysis (ages 4 to 65+) assessed whether effects were unique to young people. Heterogeneity models examined the impacts of legal sex, income, race, education, geographic division, and rurality. Averaged across seasons, suicide in young people increased 0.75% (95% CI=0.34, 1.16) per 1°C increase, comparable to the general population (0.73%, 95% CI=0.53, 0.93). This effect was significant only in summer, and it was substantially larger in summer (2.68% per 1°C; 95% CI=1.42, 3.94). Age stratification showed that 15- to 24-year-olds were uniquely vulnerable compared to other age groups (2.97% per 1°C; 95% CI=1.30, 4.65). Most geographic regions experienced this association, and no sociodemographic differences were identified. Summer heat is associated with higher suicide rates among late adolescents and young adults, who appear most at risk. This association likely reflects neurobiological and socioenvironmental conditions of young people that amplify heat-related mental health risk. These data highlight the need to study how ambient temperature impacts youth mental health and develop biosocially informed interventions as temperatures rise.
Vosoritide, a biotechnological therapy designed to increase growth in children with achondroplasia, has introduced new pressures and bodily possibilities for families navigating this rare genetic condition. While debates around its use often centre on its efficacy as a non-surgical growth treatment for the most common form of non-lethal human dwarfism, far less attention has been paid to how the medication (re)shapes the temporal landscape of maternal decision-making, children's bodily autonomy, and community dynamics. Drawing on qualitative interviews with mothers from UK dwarfism communities, comprising both average-statured and dwarf mothers, this research locates maternal decision-making within broader regimes of health governance, biosocial communities, and concepts of 'good' mothering. Conceptually, the article foregrounds how Vosoritide functions as a future-oriented health technology and a site of anticipatory biopolitics; governing decision-making through overlapping and complex regimes of temporality, maternal responsibilisation, and biosociality. Vosoritide emerges not only as a site of biomedical possibility, but also as a biopolitical discourse, shaping how mothers of children with dwarfism (re)imagine and manage their child's body, future, and identity. In doing so, this research advances sociological scholarship by exposing the temporal and anticipatory 'logics' through which biopower operates in the governance of dwarfism.
BackgroundDialectical Behavior Therapy's (DBT) original biosocial theory and subsequent iterations as a transactional model suggest that invalidating social and family environments can contribute to emotion dysregulation and patterns of self-invalidation that may lead to suicidal and non-suicidal self-injurious behaviors over time. To our knowledge, no studies have examined the relationship between parental and self-invalidation on suicidality in a treatment setting or longitudinally over the course of treatment from pre-to post-treatment. This study examined the relationship between youth-reported parental invalidation, self-invalidation, and suicidality over the course of treatment in a comprehensive DBT partial hospitalization program (PHP).MethodsTwo hundred sixty-four adolescents and young adults admitted to a four-week comprehensive DBT PHP that incorporated family, individual, and skills group therapy components. All patients completed surveys evaluating perceived parental-invalidation, self-invalidation, and suicidality pre- and post-treatment.ResultsPatients reported significant decreases on all outcome measures: perceived mother and father invalidation, self-invalidation, and suicidality after 4 weeks. Changes (reductions) in both self-invalidation and mother invalidation were significant predictors of reduced suicidality.ConclusionComprehensive DBT is a viable treatment option for decreasing invalidation and suicidality in four weeks. These findings emphasize the importance of parent involvement in improving treatment outcomes for adolescents and young adults. Dialectical Behavior Therapy’s (DBT) Biosocial Theory suggests that invalidating environments (an environment where individuals feel ignored, belittled, or misunderstood) can lead to difficulties in managing emotions and the tendency to self-invalidate (mistrust, minimize or dismiss internal thoughts, feelings and experiences). These patterns may increase the risk of suicidal thoughts and behaviors. This study explores how parental and self-invalidation are related to the severity and frequency of suicidal thoughts and behaviors (suicidality) in adolescents and young adults receiving DBT treatment. A total of 264 adolescents and young adults attended a four-week DBT Partial Hospitalization Program (PHP) that included therapy with families, individual sessions, and skills groups. Participants filled out surveys on their first day of treatments and again, four weeks later to measure perceived parental invalidation, self-invalidation, and suicidality. Our patients reported a decrease in perceived parental invalidation, self-invalidation, and suicidality after four weeks of adherent DBT treatment. Further, our results showed that changes in self-invalidation and mother invalidation were the strongest predictors of change in child suicidality. Thus, greater decreases in self-invalidation and mother invalidation predicted a greater decrease in child suicidality after four weeks of treatment. These findings support the effectiveness of DBT in reducing invalidation and suicidality and highlight the importance of familial involvement in improving treatment effectiveness and outcomes for adolescents and young adults.
Maladaptive daydreaming (MD) is a mental disorder characterized by excessive, immersive fantasy activity that interferes with daily functioning. Considering that emotion dysregulation has been identified as a characteristic of both MD and borderline personality disorder (BPD), predictors of MD will probably be the same as those specified by the biosocial model of BPD. Therefore, in this study, we aimed to identify MD predictors, such as emotional vulnerability, an invalidating environment, and fantasy proneness, and to compare the strength of relationships among variables in two research groups, people with (1) low and (2) high levels of BPD symptoms. The sample size included 364 people. The Pearson correlation, Mann-Whitney U test, and regression analyses were conducted. MD was positively predicted by invalidation from the mother in people with low BPD symptoms. In the high BPD group, the model was positively predicted by fantasy proneness. Findings offer clinical insights for tailoring MD interventions based on BPD symptom severity.
Approximately 15% of women report depressive symptoms during pregnancy, with Black women more likely to report depressive symptoms prenatally compared with White women. Depressive symptoms are associated with small for gestational age infants and preterm birth. Neighborhood affordability, socioeconomic, ethnic, and racial segregation may adversely influence maternal mental health. We sought to estimate the effect(s) of residential racial composition (ie, percentage of Black residents living within the block group) and neighborhood socioeconomic factors on depressive symptoms among Black pregnant women attending prenatal clinics in Detroit, MI and Columbus, OH. This was a secondary analysis of the Biosocial Impact on Black Births study. We analyzed self-reported depressive symptoms in Black women (N = 565) at 8 to 18 weeks' gestation. The primary measure was the Center for Epidemiological Studies-Depression Scale (CES-D). The primary explanatory variables were neighborhood-level residential racial composition and rates of poverty, homeownership, household assistance, and educational attainment. A 2-level mixed-effects regression model was used to account for clustering of participants within the study areas. For each percent increase in residential racial composition, there was a 0.66-point decrease in the Center for Epidemiological Studies-Depression Scale (-0.66; 95% CI, -0.112 to -0.021). Adjusting for individual differences among women, the protective effect of residential racial composition on the CES-D persisted (-0.62; 95% CI, -0.108 to -0.017). Our results suggest that living in neighborhoods with a greater proportion of Black individuals may be protective of depressive symptoms for pregnant Black women. These findings were not significant for neighborhood socioeconomic factors.
Long covid involves diverse chronic physical and cognitive symptoms with poorly understood mechanisms and limited treatment options. Many affected individuals turn to community groups for support. Drawing on ethnographic research with the Long Covid Choir, a patient-run online singing and support group, in this paper I examine how participants use overlapping sensory experiences to cultivate belonging, foster biosocial solidarity, structure care, and counter isolation. Through shared auditory and visual practices - collective breathing, guided mindfulness, and gentle stretching - the choir cultivates multi-sensory connection. These activities foster digitally mediated social intimacy for individuals who face significant barriers to in-person participation.
In his analysis of 'ignorance culture' in eating disorder services, Downs describes how repeated alarms raised by patients, carers and clinicians are routinely ignored, deflected or reframed as individual pathology. In this Opinion piece, I reflect on the clinical implications of that analysis, arguing that ignorance culture is enacted through everyday treatment structures that misread multi-layered presentations, invalidate advocacy and displace responsibility. Drawing on dialectical theory and biosocial frameworks, and using multidiagnostic eating disorder-dialectical behaviour therapy as an illustrative example, I suggest that addressing ignorance culture requires treatment models that operationalise responsibility rather than merely espouse it.
Enhanced cognitive behaviour therapy (CBT-E) remains a cornerstone of evidence-based treatment for eating disorders (EDs). While effective for many individuals, its conceptual and procedural scope may not fully capture the clinical realities of some autistic, neurodivergent, multidiagnostic, and treatment-experienced populations. Drawing on recent research and clinical experience, we describe how ED behaviours in these groups are often shaped by sensory and interoceptive processes, neurobiological threat responses, chronic invalidation, trauma histories, and difficulties with emotional and interpersonal regulation that may operate alongside, or independently of, weight and shape concerns. When such mechanisms are under-specified, behaviour is more likely to be misinterpreted as resistance or non-compliance, and lived experience may lack uptake within dominant treatment frameworks. The challenge for the field is not to replace CBT-E, but to recognise the limits of any single model and to develop integrative treatment architectures that incorporate neurobiological, biosocial, and contextual determinants of behaviour. Using Multidiagnostic Eating Disorders-Dialectical Behavior Therapy (MED-DBT) an adaptation of DBT designed for individuals with eating disorders and co-occurring high-risk and regulatory difficulties, as an illustrative example, we outline a dialectical approach that supports epistemic humility, reduces misinterpretation, and promotes more inclusive and effective care for individuals least well served by existing models.
Digital phenotyping uses data from smartphones and wearables to extract behavioural and biosocial markers of psychopathology in situ. Traditional entropy-based measures capture static system properties that neglect temporal dependencies critical to psychiatric phenomena. We propose a "dynamic" approach to the modelling of digital data capturing the time-varying aspects of processes of mental disorders. We defend that the resulting dynamic digital markers better capture variability in regulatory mechanisms of psychopathology. Digital phenotyping uses information from smartphones and wearable devices to track patterns in behavior and physiology related to mental health. Most current methods summarize this data in ways that miss how experiences change over time. We propose a new, dynamic approach that focuses on how patterns evolve moment by moment. By capturing these changes, our method aims to better reflect how mental disorders involve shifting and unstable processes of regulation in everyday life.