Sexuality is a fundamental part of human development and should be addressed in its physical, emotional, and social dimensions. However, when it involves autistic children and adolescents, the topic remains marked by taboos, silence, and misinformation, especially within families. To understand the experiences of caregivers of autistic children and adolescents in Brazil and Spain regarding communication about sexuality, a qualitative narrative study was carried out based on Bronfenbrenner's Bioecological Theory. The research was conducted in Brazil and Spain. In Brazil, participants were recruited in person and remotely; in Spain, recruitment occurred online with academic and social media support. Data were collected through in-depth interviews and field notes using a semi-structured script. Inductive thematic analysis was used to identify recurring patterns. Nineteen caregivers participated, mostly mothers. Two narrative syntheses emerged: (a) "Breaking the Silence," showing how family silences, trauma, lack of knowledge, and autism-related challenges create emotional and cognitive barriers; and (b) "Navigating Fragilities, Improvisations, and Discoveries," illustrating daily dilemmas, avoided topics, improvised strategies, and limited institutional support. The Bioecological Theory revealed influences from personal, relational, institutional, cultural, and temporal systems. Sexuality, though recognized as essential, remains surrounded by silence, discomfort, and educational gaps, with tensions intensified by the specificities of autism.Lay AbstractSexuality is a natural part of growing up, and this also applies to autistic children and adolescents. However, many families still struggle with silence, taboos, and a lack of reliable information when trying to talk about these issues. This study explored how caregivers in Brazil and Spain experience conversations about sexuality with their autistic children and adolescents. Nineteen caregivers, mostly mothers, participated in in-depth interviews in which they shared their everyday difficulties, worries, and learning processes. The findings revealed two main storylines. The first, "Breaking the Silence," shows how family taboos, past traumas, limited knowledge, and autism-related difficulties create emotional and practical barriers to communication. The second, "Navigating Fragilities, Improvisations, and Discoveries," illustrates how caregivers often face unexpected situations, avoid sensitive topics, improvise strategies, and receive little support from institutions such as schools and health services. Using Bronfenbrenner's Bioecological Theory, the study shows that communication about sexuality is shaped by multiple layers: personal beliefs and emotions, family relationships, institutional guidance, cultural norms, and changes over time. Overall, families recognize the importance of discussing sexuality, but the topic remains surrounded by discomfort and educational gaps, difficulties that become even more complex in the context of autism.
This study examines the governance of sexuality in China in the absence of explicit legislation. Utilizing reflexive thematic analysis of in-depth interviews with 22 sexual minority adults in urban China and informed by a phenomenological approach to participants' lived experiences, we explore a regulatory framework in which same-sex relationships are neither criminalized nor protected. We identify four interrelated mechanisms operating within what we characterize as a state-family governance configuration. First, regulatory ambiguity refers to the lack of explicit laws, which creates ongoing uncertainty, allowing families to assume de facto enforcement roles. Second, familial sovereignty highlights parents' claims to direct the life choices of their adult children, grounded in economic dependencies and legitimized through the concept of mianzi (or "face"). Third, affective governance describes the reciprocal mobilization of emotional and cultural obligations, framing compliance as an expression of care. Finally, economic dependencies rooted in the post-reform neo-familist context provide the material foundation that strengthens the other mechanisms. Our contribution is positioned as a middle-range theorization within the governmentality tradition, specifically applied to post-reform urban China. We highlight familial sovereignty as the most novel mechanism, distinguishing it from perspectives that oversimplify parental authority to intergenerational reciprocity or cultural inheritance.
Sexual health is a fundamental aspect of wellbeing, encompassing physical, emotional, mental, and social dimensions. However, sex-positive approaches often focus on younger populations, neglecting middle-aged and older adults (aged 45 years and above). Sex positivity treats sexuality as natural and healthy, emphasizing consensual, respectful, non-judgmental expression, and promoting autonomy, inclusivity, and access to accurate sexual health information and services. This study explored how sex-positive frameworks can promote pleasurable, healthy sexual lives among middle-aged and older adults. A co-creation workshop was organized at the STI & HIV World Congress 2025 in Montreal, Canada, inviting selected participants to small-group discussions on what a sex-positive approach might look like. This was followed by participatory discussions between co-authors and adults aged over 45 years, exploring perceptions, experiences, and barriers related to a sex-positive approach among middle-aged and older adults. Data were analyzed thematically to identify key influences on sexual health and pleasure. Participants highlighted that stigma, silence, and cultural norms shape understanding of sexuality in middle and later life. These were reinforced by the discomfort of healthcare providers in discussing sexual issues and widespread misconceptions that sexual desire inevitably declines with age. Such barriers limited access to accurate information and supportive care. Despite this, participants expressed enthusiasm for inclusive, age-appropriate campaigns and health services that affirm pleasure, intimacy, and connection as vital components of well-being. Findings underscore the need to integrate sexual health into aging policies, clinical training, and public health advocacy. Embedding sex-positive principles across the life span ensures that desire and intimacy remain recognized, supported, and celebrated throughout life.
This study examined the associations among problematic pornography consumption (PPC), sexual self-esteem, and sexual machismo attitudes in men aged 18 to 30 years from Francisco Morazán, Honduras. It also tested whether sexual self-esteem statistically mediated the association between PPC and sexual machismo. A cross-sectional study was conducted with 392 men (M age = 23.7 years, SD = 3.63) recruited through online convenience and snowball sampling. Participants completed the Problematic Pornography Consumption Scale, the Sexual Self-Esteem subscale of the Sexuality Scale, and the Sexual Machismo Scale. Descriptive analyses, two-way MANOVA, follow-up ANOVAs, and mediation models were estimated. A second mediation model controlled for relationship status and sexual orientation. Overall, 15.3% of participants were classified as at risk of PPC, whereas 84.7% reported normal levels. Sexual self-esteem scores were moderate, and sexual machismo attitudes were low to moderate. PPC was consistently associated with higher sexual machismo, including after controlling for relationship status and sexual orientation. PPC was also associated with lower sexual self-esteem. However, sexual self-esteem was not significantly associated with sexual machismo and did not statistically mediate the PPC-sexual machismo association. PPC was associated with sexual machismo attitudes among young Honduran men, but this association was not explained by sexual self-esteem. These findings suggest that other psychosocial, cultural, or gender-role mechanisms may better account for the link between PPC and sexual machismo. Given the cross-sectional design and non-probabilistic sampling, results should be interpreted as exploratory associations rather than causal evidence.
To evaluate whether prostate size influences perioperative, urinary, and sexual outcomes following Aquablation for benign prostatic hyperplasia (BPH), by comparing men with prostates < 80 cc and ≥ 80 cc treated within a prospective real-world cohort. This prospective, single-center cohort study included consecutive men undergoing Aquablation between 2023 and 2025. Patients were stratified by prostate volume (< 80 cc vs. ≥80 cc). Baseline characteristics, perioperative parameters, and functional outcomes were assessed using validated instruments, including IPSS, IPSS-QoL, irritative subscore, ICIQ-SF, IIEF-EF, MSHQ-EjD, and MSHQ-bother, at baseline and at 3, 6, 12, and 24 months. Complications were graded according to the Clavien-Dindo classification. A total of 628 men were included (324 with prostates < 80 cc and 304 with prostates ≥ 80 cc). Men with larger prostates had higher rates of preoperative catheter dependence (34% vs. 18.2%, p < 0.001). Operative time (40.6 ± 14.1 vs. 36.2 ± 12.6 min, p = 0.001) and hospitalization duration (2.5 ± 1.5 vs. 2.09 ± 0.8 days, p < 0.001) were longer in the ≥ 80 cc group. Both cohorts demonstrated marked and durable improvement in urinary symptoms, with mean IPSS improving from 24.5 to 6.7 in the < 80 cc group and from 24.9 to 6.0 in the ≥ 80 cc group at 24 months. Irritative symptom scores improved from 10.3 to 3.5 and from 10.5 to 2.1, respectively (p < 0.001). Sexual outcomes remained stable across prostate sizes, with preserved erectile function and low ejaculatory bother scores. High-grade complications (Clavien-Dindo III-IV) were uncommon and comparable between groups (2.7% vs. 4.3%), while reoperation rates remained low (3.1% vs. 3.9%). Aquablation provides durable symptom relief with preservation of sexual function across a broad range of prostate volumes, supporting its role as a size-independent surgical treatment option for BPH.
Most women with breast cancer undergo radiation therapy (RT) as part of treatment, but the impact of prior sexual trauma on their RT experience remains unclear. We sought to understand the patient experience and comfort during breast RT with a focus on how sexual trauma may negatively affect the RT experience of patients. Between May and October 2022, IRB-approved surveys were distributed to female breast cancer patients treated with radiation at Sidney Kimmel Cancer Center. The 35-question survey assessed demographics, treatment details, body image satisfaction, comfort during various times throughout the RT process, and trauma history. Statistical analysis was performed using chi-square. Of the 505 surveys collected, 420 met the inclusion criteria. At the time of their radiation treatment, most patients surveyed were over 60 (70%), postmenopausal (75%), and had at least a college degree (63%). Most patients had localized breast cancer (69%), had undergone a lumpectomy prior to radiation (79%), were treated by a female physician (53%), and had completed radiation therapy less than five years prior (61%) at the time of the survey. Although most patients reported general comfort during RT, notable discomfort was associated with gender dynamics. Fewer patients felt uncomfortable changing for treatment (9.8%), waiting in the general area (20%), or being set up for RT (22%), but many more expressed discomfort in waiting rooms with men (43%) or when treated by male radiation therapists (38%). A history of trauma exposure was prevalent: 38% had experienced verbal harassment, 39% an unwanted sexual advance, 33% unwanted sexual touching, and 19% an unwanted sexual encounter. Trends towards greater discomfort were associated with body exposure during treatment (p = 0.29), setup (p = 0.18) and being left alone in the treatment room (p = 0.29), though none of these differences reached statistical significance. This study underscores the potential negative influence of prior sexual trauma on the RT experience for breast cancer patients. Although most patients reported overall comfort, those with a trauma history experienced trends toward greater distress related to exposure during treatment. Adopting trauma-informed practices to increase provider training, gender considerations, and patient-centered modifications could enhance patient comfort, adherence, and satisfaction for breast cancer treatment.
This study aims to identify factors associated with HPV vaccination among adults aged 27 to 45 in the United States, emphasizing the relationship between vaccination rates and sexual behaviors. Retrospective cross-sectional cohort study. National Survey of Family Growth (NSFG), 2022 to 2023. We analyzed data from 6014 adults aged 27 to 45 years, representing approximately 82.8 million US adults. The primary outcome was HPV vaccination status. The primary independent variable was the presence of multiple sexual partners in the past year. Multivariable logistic regression analyses evaluated associations between demographic characteristics, sexual behaviors, and HPV vaccination. HPV vaccination rates were low overall in adults aged 27 to 45. Individuals with multiple sexual partners in the past year were significantly more likely to receive HPV vaccination aged 27 and older if previously unvaccinated (OR: 1.89, 95% CI: 1.08-3.31). However, an increased number of sexual partners did not demonstrate a linear relationship with vaccination likelihood. Female sex, higher educational attainment, private or public insurance coverage, recent healthcare access, and higher income levels were independently associated with greater vaccination rates. Race/ethnicity and age had variable influences, with younger adults significantly more likely to be vaccinated. HPV vaccination rates remain low among middle-aged adults despite expanded eligibility. Sexual activity, specifically having multiple partners, moderately increased vaccination likelihood. More robust predictors of vaccination include healthcare access, educational status, and socioeconomic factors, highlighting the importance of targeted educational initiatives and improved healthcare access to enhance vaccination uptake.
Lower free testosterone (T) appears more strongly associated with male sexual dysfunction than total T, but most evidence is based on calculated free T (cFT) rather than measured free T (mFT). This study examined associations between mFT and sexual function in community-dwelling men. Cross-sectional analysis of 526 European Male Ageing Study participants. Sexual function was assessed by validated questionnaire. mFT was measured by liquid chromatography tandem mass spectrometry (LC-MS/MS) following equilibrium dialysis. Vermeulen-derived cFT was calculated from LC-MS/MS total T and sex-hormone binding globulin. Associations of sexual outcomes with total T, cFT and mFT were analysed using proportional ordinal logistic regression and restricted cubic splines adjusted for age, body mass index (BMI) and centre. Participants had a mean age 70.5 ± 8.5 years, BMI 27.3 ± 3.3 kg/m2, cFT 269.2 ± 86.6 pmol/L and mFT 198 ± 82 pmol/L. Lower mFT was significantly associated with erectile dysfunction (odds ratio (OR) per 10 pmol/L decrease 1.04[1.01-1.06]), fewer sexual intercourse (OR 1.03[1.00-1.06]), lower orgasm frequency (OR 1.03[1.01-1.06]) and reduced sexual desire (OR 1.03[1.01-1.05]). Total T was not associated with any outcome and cFT only with erectile dysfunction (OR 1.03[1.01-1.05]) and reduced sexual desire (OR 1.03[1.00-1.05]). Non-linear associations were observed for mFT with erectile function and orgasm frequency, with markedly steeper increase in predicted probability below 163 and 138 pmol/L, respectively. In community-dwelling men, lower mFT was associated with worse erectile function, fewer sexual intercourse attempts, reduced orgasm frequency, and lower sexual desire, with apparent non-linear thresholds for erectile dysfunction and orgasm frequency at 163 and 138 pmol/L, respectively.
Adolescence is characterized by heightened emotional reactivity and rapid maturation of emotion regulation (ER) capacities. Sexual abuse during adolescence disrupts normal ER development. Adolescents often struggle to modulate intrusive memories, hypervigilance, and intense affect following sexual abuse, resulting in increased distress and maladaptive coping strategies, including non-suicidal self-injury. Using an embedded mixed-methods design, emotional dysregulation and mental health outcomes among sexually abused adolescents were examined. Three focused group discussions with 18 professionals and 43 key interviews with 25 adolescents (14 with penetrative abuse, including 1 gang rape case, and 11 with non-penetrative abuse) and 18 parents/caregivers (N = 61) were conducted at child-care institutions and hospital settings. Thematic frequency analysis resulted in 572 codes, 38 subthemes/subdomains, and 6 themes/domains across the three sample groups. Multi-informant perspectives and multiple settings were considered to draw more generalizable conclusions. Screening measures, namely the Patient Health Questionnaire-9 (PHQ-9), Screen for Child Anxiety Related Emotional Disorders (SCARED), and the Children's Revised Impact of Event Scale (CRIES-13), were used. Qualitative data focused on emotional impact, triggers, relational difficulties, academic consequences, and coping strategies, while quantitative data assessed depressive, anxiety, and post-traumatic stress symptoms. Across all groups, themes converged on persistent emotional pain, somatic and affective reactivity, hypervigilance, mistrust in relationships, academic decline, and self-harm. Adolescents consistently reported profound emotional dysregulation, including fear, persistent crying spells, anger outbursts, and social withdrawal. Parents highlighted mood volatility, anger, withdrawal, and emotional numbing, whereas professionals identified chronic dysregulation and attachment ruptures as enduring sequelae of abuse. All adolescents scored above the cutoff on the PHQ-9, while 14 scored above the cutoff on the SCARED, and 13 on the CRIES-13. The effects of sexual abuse type, gender differences, parental support, and the obtained themes are discussed in the context of impact severity and ER.
Sexual and gender minority families navigate complex stress exposures that span developmental periods and social contexts, including early-life adversity, ongoing discrimination, and minority stress. This study tested competing models of stress accumulation and stress sensitization in a diverse, United States national sample of sexual and gender minority parents (N = 568) with children under the age of 18. Using multivariate distance matrix regression, we examined how parent-reported adverse childhood experiences, everyday discrimination, and internalizing symptoms were associated with multivariate profiles of parent and child mental health. Parent adverse childhood experiences, discrimination, anxiety, and depression were each independently associated with variation in child mental health outcomes, consistent with a stress accumulation model. No interaction effects consistent with stress sensitization emerged. These findings underscore the cumulative impacts of trauma-related stressors in sexual and gender minority families and highlight the utility of person-centered, multivariate methods for capturing co-occurring symptom patterns in intergenerational trauma research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
While neighborhood collective efficacy is theorized to promote community intervention against child maltreatment, the mechanisms of informal social control (ISC) through protective versus punitive pathways remain poorly understood. This study aims to examine whether the association between collective-efficacy-based neighborhood ISC and contact child sexual abuse (CSA) is differentially mediated by protective versus punitive child-maltreatment-specific ISC (ISC_CM) in Nepal. Data were drawn from a two-wave, nationally representative sample of 1089 mother-adolescent dyads across 100 Nepali wards. The study employed a stratified four-stage national random probability proportional to size (PPS) cluster sampling design. A multilevel parallel mediation model was used to test the relationships between ward-aggregated neighborhood ISC expectations and protective versus punitive ward responses at Wave 1. These mediators, in turn, were used to model children's past-year contact sexual abuse at Wave 2, adjusting for individual and community covariates. The model revealed two distinct, opposing pathways. Neighborhood ISC expectations were positively associated with both protective and punitive ISC_CM. Punitive ISC_CM was significantly linked to increased contact CSA risk, whereas protective ISC_CM showed a non-significant negative trend. The indirect effect via punitive ISC_CM was significant, while the pathway via protective ISC_CM was not. The null total effect suggested these opposing indirect paths may have canceled each other out. Findings indicate that the role of neighborhood ISC in CSA prevention is not uniform; rather, it depends critically on the type of ISC it fosters. While general neighborhood ISC (traditional collective efficacy measure) promotes both protective and punitive responses to child maltreatment, only the protective pathway holds potential for risk reduction, whereas the punitive pathway inadvertently appears to heighten CSA risk. These results lend support to cultivate protective, supportive community-based child protection interventions over punitive control.
Divorce is an important social issue that has destructive consequences for both the individual and the family. It is a multi-dimensional and complex phenomenon that occurs under the influence of various factors, so this research was conducted to explain the reasons for divorce among young couples in the West of Iran with a qualitative approach. This research was carried out with a qualitative approach and conventional content analysis. Purposeful and snowball sampling were used to identify the participants. Semi-structured interviews were used to collect data and continued until theoretical saturation was reached. In this research, 16 key informants and 32 main participants were present. For data analysis, Graneheim and Lundman method was used. Also, to increase the quality of the research, Guba and Lincoln's four criteria were observed. 212 primary codes, 24 subcategories, and 3 categories came from the analysis of the interviews. Categories and sub-categories include 1- individual factors (sexual problems, mental-psychological disorders, spouse's behavioral characteristics, individualism, physical appearance problems, Formation of a positive understanding of divorce consequences, having defective relationships before marriage, drug use), 2- socio-cultural factors (de-tabooing of divorce, women-oriented social changes, media and social networks, lack of a suitable support system, inappropriate spouse choosing, economic challenges, modeling of divorce), 3- family factors (job's impact on family life, improper communication with spouse's family, accumulation of negative feelings in marital life, issues related to children, cheating on spouse, inefficient relationships, heterogeneity of lifestyle, violence, inability to manage challenges). The results indicate that divorce is a complex, multi-dimensional phenomenon influenced by individual, social, cultural, and family factors. Prevention requires multi-level interventions, including educating couples on sexual issues and communication skills, promoting responsible marital roles, preventing superficial marriages, reducing stigma around seeking psychological help, managing personality and lifestyle differences, guiding families on conflict resolution, and providing access to counseling and mental health services before and after marriage.
Inadequate prenatal care (PNC) is linked to adverse pregnancy outcomes, including those related to untreated sexually transmitted infections (STIs) such as syphilis. Many populations with low PNC utilization disproportionately access the emergency department (ED). ED visits in early pregnancy may represent a critical opportunity for screening and linkage to PNC. This study aims to evaluate STI screening, diagnosis rates, and access to PNC among pregnant ED patients. This is a retrospective review of pregnant individuals who visited a large, urban ED and later delivered the infant at the same hospital or had ectopic pregnancies. Descriptive statistics were used to report testing and PNC data, which were extracted from the electronic medical record. Of 1770 ED visits with positive pregnancy tests, 401 (22.7%) resulted in live births in the same hospital and 69 (3.9%) in ectopic pregnancies. In the live birth group, average gestational age at ED presentation was 9 (SD 4.5) weeks, and 49.1% reported plans to access PNC. Only 13.2% of ED encounters included testing for HIV, 4.7% for syphilis, and 22.9% for gonorrhea/chlamydia. More than half (54.5%) of 32 individuals with gonorrhea or chlamydia and 80% of the five with syphilis were not tested during their ED visit. This study demonstrates large gaps in STI testing and access to PNC among pregnant persons visiting the ED. These findings highlight an important opportunity for early diagnosis, prevention of complications like congenital syphilis, and linkage to PNC for underserved communities utilizing the ED early in pregnancy.
IntroductionRepeated induced abortion is an important public health concern globally. While its burden spans both developed and developing contexts, complications are disproportionately higher in low-resource settings.ObjectiveTo assess the prevalence and associated factors of repeated induced abortion among women seeking abortion care services in public hospitals in Northwest Ethiopia.Study DesignAn Institutional based cross-sectional study was employed.MethodsThe study was conducted among 406 systematically selected women seeking abortion care between April 10 and June 15, 2022. Data were collected using interviewer-administered questionnaires via EpiCollect. Analysis was performed using SPSS version 25. Binary logistic regression was utilized to identify potential factors influencing the outcome variable. Odds ratios with their 95% confidence intervals were used to determine the strength of association and variables with a p-value below 0.05 were considered statistically significant factors for the outcome variable. Reporting follows the Strengthening the Reporting of Observational Studies in Epidemiology statement.ResultsOf the 406 participants 21.9% (95% CI: 18.1-26.1) reported repeated induced abortion. Age ≥ 30 years (adjusted odds ratio (AOR) = 5.505; 95% CI: 1.279-23.696), having multiple sexual partner (AOR = 5.148; 95% CI: 2.410-10.997), and alcohol consumption (AOR = 2.535; 95% CI: 1.033-6.218) were the significant factors associated with repeated induced abortion.ConclusionApproximately one in five women seeking abortion care reported a lifetime history of repeat induced abortion. Rather than relying on uniform approaches, it is crucial to implement tailored counseling and behavioral assessments that focus specifically on older women, those with multiple sexual partners, and women who consume alcohol, as these subgroups exhibit significantly higher odds of repeat induced abortion.
Cytology is a valuable diagnostic tool in veterinary medicine, allowing rapid and minimally invasive diagnosis. However, its application in the reproductive tracts of small animals is limited, primarily used to assess mammary masses and stage the estrous cycle. This study evaluated the cytologic characteristics of healthy queen ovaries throughout the estrous cycle. Twenty-four domestic shorthair queens were included and submitted to a conventional ovariohysterectomy. A blood sample was obtained to assess the serum concentration of estradiol and progesterone. One ovary was immersed in paraformaldehyde for histology purposes, whereas the other was used for cytology. Blood parameters and histology were used to classify the queens into 4 different groups: anestrous, follicular, luteal phase, and luteal cell phase groups. When comparing the groups, statistically significant (p < 0.05) differences were observed only in the percentage of luteal and mesenchymal cells and mitotic figures. Luteal cells were only present in those ovaries belonging to the luteal phase group. Mesenchymal cells were present in the follicular and the luteal phase groups. Mitotic figures were observed in the anestrus and follicular phases. It can be concluded that the ovarian cytology in the queen varies according to the reproductive cycle.
This paper discusses the oeuvres of two psychoanalytic scholars: Laplanche and Loewald. Each has made significant contributions to psychoanalytic theory and its influence on clinical interactions. Both distinguished analysts have engaged in serious, yet different challenges to Freudian theory. This paper will offer some similarities in their theoretical approaches, but the emphasis is on their special differences. Underscoring their significant departures a clinical example is provided which illuminates their essential distinctions. In this context I am highlighting both their unique views on psychoanalytic theory and its effect on their clinical contributions.
Objectives. To assess differences in social determinants of health identified through International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision (ICD-10-CM) codes between lesbian, gay, bisexual, and other nonheterosexual ("sexual minority") veterans and heterosexual veterans who utilize primary care services in the US Veterans Health Administration. Methods. We used the Veterans Health Administration Survey of Healthcare Experiences of Patients, weighted descriptive statistics, and multivariable logistic regression to examine differences in sociodemographic characteristics and social determinants of health-related ICD-9-CM and ICD-10-CM code domains by sexual orientation (sexual minority vs heterosexual). Results. Of the 455 165 veterans surveyed, roughly 3% (n = 14 065) identified as sexual minority. Compared with heterosexual veterans, sexual minority veterans were often younger and more likely to be racially/ethnically diverse, live in urban areas, and identify as female. All sexual minority groups had a greater risk of issues related to housing, economic circumstances, and other psychosocial circumstances than heterosexual veterans. Conclusions. Sexual minority veterans had increased vulnerabilities across various social determinants of health ICD-9-CM and ICD-10-CM code domains associated with health and well-being. Future research should continue to explore this relationship and develop evidence-based interventions to support sexual minority veterans effectively. (Am J Public Health. Published online ahead of print July 30, 2026:e1-e11. https://doi.org/10.2105/AJPH.2026.308563).
Justice-involved youth report increased mental health concerns, substance misuse, and risky sexual behavior compared to non-justice-involved youth. Supporting Youth Navigating Choices (SYNC) is a manualized evidence-based practice for justice-involved youth that has demonstrated success in reducing sexual risk behaviors, aggression, and recidivism. Dissemination and scale-up are necessary for SYNC to reach more justice-involved youth. This study examined barriers and facilitators of implementing SYNC using the Consolidated Framework for Implementation Research to strengthen SYNC's future implementation. Participants (n = 18) were individuals who work with justice-involved youth and received training to deliver SYNC. Structured interviews were deductively coded using Consolidated Framework for Implementation Research domains and subdomains, and data were examined to identify patterns. As facilitators, participants expressed that SYNC provides necessary skills to youth, and they highlighted the strong training, curriculum, and manual. As barriers, participants noted program length, instructor discomfort, lack of leadership support, and staffing concerns. Applying recommendations may facilitate improved dissemination, implementation, and scalability.
Parkinson's disease (PD) affects individuals across diverse cultural, linguistic, and socioeconomic backgrounds worldwide. While non-motor symptoms (NMS) are among the most disabling features of PD, the influence of culture on their recognition, reporting, and management remains underexplored. This review examines cultural factors that shape the experience and care of NMS in PD, with particular attention to Asian populations, which have historically received limited focus in health disparities literature. Drawing on evidence from diverse global populations, we explore how cultural beliefs, stigma, family dynamics, spirituality, language, and trust in healthcare systems influence symptom interpretation, help-seeking behaviors, treatment engagement, caregiving, and end-of-life decision-making. Sensitive symptoms such as bladder, bowel and sexual dysfunction, as well as mental health symptoms may be underreported because of stigma, shame, or cultural norms. Immigrant populations may avoid "bothering" healthcare providers, while language barriers and mistrust can further impede communication and access to care. Cultural values also influence decision-making preferences. In contrast to Western models that prioritize individual autonomy, some patients prefer family-centered decision-making, with designated family members guiding healthcare choices. Concepts such as filial piety, "familismo", and culturally defined gender roles (superwoman schema and stoic masculinity) shape caregiving and acceptance of treatment recommendations. Culturally enabled care is essential to equitable and person-centered PD management and can improve communication, reduce disparities, foster trust, and enhance quality of life for people living with PD and their families. Further research is urgently needed to better understand how culture intersects with NMS management and to develop culturally enabled models of care.
Effectively preventing child sexual exploitation and abuse (CSEA) requires understanding the barriers that hinder program success. This study examines barriers to program implementation (hindering set-up and maintenance), access (hindering groups of individuals from access), and utilization (hindering individuals from engaging with or benefiting from programs), to identify barriers with high and low levels of endorsement across European Union (EU) Member States. Participants were experts in CSEA prevention. A modified two-round Delphi technique was used. Round 1 was a qualitative online survey analyzed using reflexive thematic analysis, capturing diverse perspectives to inform the development of the Round 2 survey. Round 2 was a quantitative online survey analyzed using a three-step strategy: (1) retaining only items rated by experts from at least two-thirds of EU Member States, (2) calculating country-level mean ratings for each item, and (3) calculating the proportion of Member States endorsing each item, categorizing them as barriers with low, medium, or high levels of endorsement. Negative public perception, lack of funding, concern for practitioner wellbeing, and a preference for punitive policies were identified as barriers with high levels of endorsement, mainly concerning the implementation of prevention initiatives. Specific legal regulations and a lack of certain prevention initiatives were identified as having low levels of endorsement across Member States but still requiring country-specific targeting. To enhance CSEA prevention, improved public perceptions, sustainable funding, and practitioner support should be prioritized across the EU. Targeted strategies are needed to address country-specific barriers with low levels of endorsement.