Links between obesity, weight stigma and learning in adolescence: a qualitative study

Background Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap. Methods We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically. Results We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the ‘right’ friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them. Conclusions Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Landmine Clearance and Peacebuilding: Evidence from Somaliland

The mine action sector has struggled to demonstrate the socioeconomic benefits of mine clearance. Previous academic studies have made important contributions but have been limited in offering in-depth discussions of causal pathways. This paper seeks to fill that gap. It proposes a new framework, the Mine Clearance and Peacebuilding Synergies (MPS) framework that combines the Humanitarian Mine Action Peacebuilding Palette, the Mine Action- Sustainable Development Goals (SDGs) framework and theoretical considerations from the Infrastructure as Peacebuilding framework to interrogate this interaction. Using Somaliland's post-conflict reconstruction as a case study, we analyze qualitative and quantitative data to map both the direct and indirect benefits of mine clearance in relation to infrastructure development. We find that mine clearance can influence both economic and physical reconstruction through its impact on dominant economic sectors as well as critical strategic infrastructure, including ports and roads, and demonstrate the synergies therein with an array of SDGs.

Gene-Environment Causal Pathway to Impoverished Cognitive Development Contributes to Psychotic-Like Experience in Children

Identifying the social and biological mechanisms of cognitive and psychological development of children is essential for optimizing preventive and educational efforts. However, the causal pathways by which genetic and environmental factors affect cognitive and psychiatric outcomes remain unknown, especially in early childhood. We examined the causal relationships among genes, the environment, intelligence, and psychotic-like experiences in 7,632 multiethnic (5,905 with European ancestry) children aged 9-10 years old from the Adolescent Brain Cognitive Development (ABCD) Study. Using up-to-date computational causal analysis and rigorous path modeling, we found a significant causal influence of residential, family, and school environments and genome-wide polygenic scores of cognitive capacities on preadolescents' psychotic-like experiences mediated by intelligence. Mitigation of good parenting behavior and positive school environments on psychotic-like experiences dominated the pernicious effects of genetic and residential adversities. Our findings support that intelligence may be a biological resilience factor for psychosis. To the best of our knowledge, this is the first study to identify casual trajectories of neurocognitive development in early childhood and the first to provide empirical evidence that positive parenting behavior and school environment can impose a considerable degree of causal impact on children's cognitive and psychiatric outcomes. We suggest the implementation of socioeconomic policies to improve family and school environments and promote local economic development to enhance children's cognitive ability and mental health.

Resilience to crisis and resistance to change: a comparative analysis of the determinants of crisis outcomes in Latin American regional organisations

Latin American regionalism displays a long history of crises, which have affected almost all regional organisations (ROs) across different waves of regionalism. The article conducts the first comparative analysis of the outcomes of crises in Latin American ROs across time, tackling the following questions: What have been the outcomes of the crises faced by Latin American ROs? Under what conditions does a crisis result in the survival or breakdown of the affected RO in Latin America? We adopt a multi-method approach that combines QCA with process tracing to identify the causal pathways to the survival or breakdown of ROs across a universe of eight crises. The findings show that Latin American ROs have been resilient to crises, which resulted in RO survival in seven cases out of eight. The QCA reveals how the distributive nature of interstate conflicts and the availability of majority voting are both sufficient conditions for Latin American ROs to survive a crisis. Analysis of the outlier case of UNASUR shows that normative conflicts that take place in the absence of majority voting constitute a ‘perfect storm’ configuration that can lead to RO breakdown. The findings also show that Latin America ROs’ tendency to survive crises is associated with the preservation of the status quo in terms of institutional design, which in some cases is achieved through the temporary flexibilisation of existing rules. Differently from the case of the EU, then, the crises of Latin American ROs have not led to the deepening of regional integration, but rather to institutional inertia.

Education and Political Participation

Whether education affects political participation is a long-standing and central question in political philosophy and political science. In this review, we provide an overview of the three main theoretical models that explain different causal pathways. We then synthesize the surge in research using causal inference strategies and show that this literature has generated mixed results about the causal impact of education, even when using similar methods and data. These findings do not provide clear support for any of the three theories. Our next section covers research on civic education and political participation. The quantity of civic education matters little for political participation, but how civic education is taught does matter. Namely, strategies falling under the rubric of active learning show promise. These strategies seem especially effective for historically marginalized students. Our final section calls for more research on how civic education is taught. Expected final online publication date for the Annual Review of Political Science, Volume 25 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Health Effects of Power Loss After Hurricane Irma on Nursing Home Residents in Florida

Previous research establishes that hurricanes adversely affect nursing home (NH) resident health but specific causal pathways are still unclear. We combined power outage data with Medicare claims to determine the effects of power loss from Hurricane Irma(2017) among NH residents in Florida. Out of 580 facilities, 289 reported power loss. These facilities had higher star ratings; higher beds counts, and were preferentially in the Southeast region of Florida compared to facilities without outages. There were 27,767 residents living in a NH without power. They were comparable in characteristics to residents that did not lose power (N=26,383). We ran adjusted generalized linear models with robust standard errors, clustering for NH. We found power loss was associated with a trend towards increased odds of mortality within 7-days (OR:1.12, 95% CI:0.96, 1.30) and 30-days (OR:1.10, 95% CI:1.00, 1.21) post-storm, but not with hospitalization. Future research should investigate the time-specific effects of power outages.

Economic inequality in malnutrition: a global systematic review and meta-analysis

ObjectiveTo describe the evidence on global and regional economic inequality in malnutrition, and the associations between economic inequality and malnutrition.MethodsWe conducted a systematic review and meta-analysis. Between 1 November 2020 and 22 January 2021, we searched Medline, Embase, Global Health, Eldis, Web of Science and EBSCO Discovery Service. We contacted 39 experts and tracked citations. We included any study reporting a concentration index (CIX) relating economic status and nutritional status and any multilevel study reporting an association between economic inequality and nutritional status. Nutritional status was measured as stunting, wasting, anaemia, or overweight in children (<5 years), or underweight, overweight or obesity, or anaemia in adults (15–49 years). We had no study date or language restriction. Quality was assessed using the Appraisal Tool for Cross-Sectional Studies (AXIS tool). We mapped estimates and pooled them using multilevel random-effects meta-analyses.ResultsFrom 6185 results, 91 studies provided 426 CIX (>2.9 million people) and 47 associations (~3.9 million people). Stunting (CIX −0.15 (95% CI −0.19 to −0.11)) and wasting (−0.03 (95% CI −0.05 to −0.02)) are concentrated among poor households. Adult overweight and obesity is concentrated in wealthier households (0.08 (95% CI −0.00 to 0.17)), particularly in South Asia (0.26 (95% CI 0.19 to 0.34)), but not in Europe and Central Asia (−0.02 (95% CI −0.08 to 0.05)) or North America (−0.04 (95% CI −0.10 to 0.03)). We found no association between 0.1 increase in Gini coefficient and adult underweight (OR 1.03 (95% CI 0.94 to 1.12)) or overweight and obesity (0.92 (95% CI 0.80 to 1.05)).ConclusionsThere is good evidence that the prevalence of malnutrition varies by levels of absolute economic status. Undernutrition is concentrated in poor households, whereas concentration of overweight and obesity by economic status depends on region, and we lack information on economic inequalities in anaemia and child overweight. In contrast, links between malnutrition and relative economic status are less clear and should not be assumed; robust evidence on causal pathways is needed.PROSPERO registration numberCRD42020201572.

Understanding therapists’ perceived determinants of trauma narrative use

Background Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists’ use of TNs. Methods Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. Results While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. Conclusions These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.

Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol

Background Advancing causal implementation theory is critical for designing tailored implementation strategies that target specific mechanisms associated with evidence-based practice (EBP) use. This study will test the generalizability of a conceptual model that integrates organizational constructs and behavioral theory to predict clinician use of cognitive-behavioral therapy (CBT) techniques in community mental health centers. CBT is a leading psychosocial EBP for psychiatric disorders that remains underused despite substantial efforts to increase its implementation. Methods We will leverage ongoing CBT implementation efforts in two large public health systems (Philadelphia and Texas) to recruit 300 mental health clinicians and 600 of their clients across 40 organizations. Our primary implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. As CBT comprises discrete components that vary in complexity and acceptability, we will measure clinician use of six discrete components of CBT. After finishing their CBT training, participating clinicians will complete measures of organizational and behavior change constructs delineated in the model. Clinicians also will be observed twice via audio recording delivering CBT with a client. Within 48 h of each observation, theorized moderators of the intention-behavior gap will be collected via survey. A subset of clinicians who report high intentions to use CBT but demonstrate low use will be purposively recruited to complete semi-structured interviews assessing reasons for the intention-behavior gap. Multilevel path analysis will test the extent to which intentions and determinants of intention predict the use of each discrete CBT component. We also will test the extent to which theorized determinants of intention that include psychological, organizational, and contextual factors explain variation in intention and moderate the association between intentions and CBT use. Discussion Project ACTIVE will advance implementation theory, currently in its infancy, by testing the generalizability of a promising causal model of implementation. These results will inform the development of implementation strategies targeting modifiable factors that explain substantial variance in intention and implementation that can be applied broadly across EBPs.