Canan Karatekin

Social and structural determinants of health and health inequities (SSDHHI) include upstream factors influencing policies that shape health. We conducted a qualitative case study of the 2023 passage of the Minnesota Child Tax Credit (CTC) to refine and extend an SSDHHI framework [Karatekin et al. (Re-politicizing the WHO’s social determinants of health framework. Health Promot Int 2024;39:daae122)] that centers power and the agents who use power to shape SSDHHI. We coded interviews with key players in the state administration, legislature, and advocacy organizations (N = 15); and related news items and hearings. We operationalized the framework’s components, including “Agents, Power, Governance, and Institutional Practices,” the “Election System,” and “Ideas” fueling narratives about the CTC. Using the results, we refined the framework by linking “Agents” and “Power”; considering the types, dimensions, and motivations for “Power”; pointing out components that need further clarification; and introducing bidirectional links between components. We extended the framework by including a temporal dimension to highlight historical roots and emphasizing the importance of the conjunctions of factors that affect SSDHHI. This framework can be used to analyze other SSDHHI and to guide action by practitioners, e.g., by identifying individual or institutional targets of interventions and strategies for obtaining and using “Power” to drive policy change and improve public health.

Decades of research have explored how neighborhood conditions relate to child and adolescent health, spawning numerous reviews focused on specific predictors, outcomes, or populations. Less is known about the design and characteristics underpinning this work. We conducted a scoping review of 754 studies examining neighborhood conditions and health‐related factors among children and adolescents (aged 0–18) published between 2015 and 2024. This growing area of literature is largely based on observational, cross‐sectional evidence of associations between objective socioeconomic status (SES) conditions and health, with over 100 studies focusing on associations between neighborhood SES and physical health, specifically. The findings of this review suggest that the current “state of the science” on neighborhoods and health among children and adolescents often does not lend itself to strong developmental conclusions, due to a reliance on observational, cross‐sectional designs. Moreover, extant literature provides limited insight into whether neighborhood conditions beyond SES are associated with health. Longitudinal studies of multidomain neighborhood conditions and health represent important directions for future research.

Although the World Health Organization’s (WHO’s) framework on social and structural determinants of health and health inequities (SSDHHI) has done much to raise awareness of these determinants, it does not go far enough in considerations of politics and power. The framework has become more de-politicized since its publication, with the definition of social determinants shifting toward downstream and individualized factors. In the meantime, new research fields on legal, commercial and political determinants of health and health inequities have emerged; however, these have not become integrated adequately into broader SSDHHI frameworks. To address these challenges, we argue for a re-politicization and an expansion of the WHO’s framework by including the agents who have power over shaping structural determinants and the ways they use power to shape these determinants. We also provide a more detailed conceptualization of structural determinants to facilitate research. We propose a guideline for evaluating studies according to the extent to which they point upstream versus downstream and incorporate agents and considerations of power. We then use this framework to encourage more research on associations among agents, mechanisms of power, and structural determinants; how changes in structural determinants affect power dynamics among agents; and a wider focus on structural determinants beyond laws and policies, such as broad economic and sociopolitical systems. We also urge researchers to consider societal and institutional forces shaping their research with respect to SSDHHI. Research based on this framework can be used to provide evidence for advocacy for structural changes and to build more just systems that respect the fundamental human right to a healthy life.

Objectives: We aimed to determine how universities can tailor delivery of stress‐related interventions and intervention‐related messages for students with adverse childhood experiences (ACEs).Method: We assessed 762 undergraduates (76% female; average age = 20.3) on an expanded ACEs measure, stress, health, and past use of interventions and what types of interventions they would like to cope with stress. We also experimentally manipulated websites advertising mental health services to test whether certain message frames and types of intervention delivery would appeal differentially to students with more ACEs.Results: ACEs were associated with worse health, more stress, and a greater likelihood of having used health‐related interventions. Students with more ACEs were more willing to try the interventions on the websites, regardless of messaging and type of delivery. They also expressed a greater desire for face‐to‐face interactions centered on mental health.Conclusions: School‐wide adoption of ACE‐informed policies can change lifelong trajectories of students with ACEs.

This study examines the potential moderating role of interpersonal factors on revictimization risk in two demographically distinct samples. The two samples included undergraduates (N = 275) and women residing in a domestic violence (DV) shelter (N = 38), which resulted in a combined sample of N = 313. Participants reported on history of childhood and adulthood victimization, parent-child relationship quality, and perceived social support. DV shelter participants reported significantly greater victimization and lower parent-child relationship quality and social support than undergraduates. Childhood victimization significantly predicted adulthood victimization, even after accounting for statistically significant effects due to sample. However, none of the interpersonal factors examined (i.e., parent-child relationship quality and perceived social support) moderated the relationship between childhood and adulthood victimization. Results highlight the need to consider the limitations of interpersonal factors for mitigating risk for revictimization and to further investigate whether benefits offered by interpersonal factors may be specific to other outcomes such as psychological maladjustment.

Experiencing victimization in childhood increases risk of adulthood revictimization, and it is important to understand what may contribute to such risk. One factor that may help to explain the increased risk of future victimization is disclosure. However, the literature is mixed as to whether disclosure of prior victimization is helpful for protecting against adverse outcomes, and much of the research on disclosure focuses solely on sexual victimization. The current study examines the relationship between various forms of childhood and adulthood victimization and whether disclosure moderates this relationship. In addition, this study investigates whether characteristics of disclosure are associated with revictimization risk. The sample included 275 undergraduates (M age = 19.52 years; 75.6% female, 77.5% non-Hispanic White or Caucasian). Participants reported on previous history of various forms of childhood and adulthood victimization. They also reported whether or not they had disclosed childhood victimization, and, if so, characteristics related to disclosure. Results revealed that number of childhood victimization experiences significantly predicted number of adulthood victimization experiences, and nearly every type of childhood victimization significantly increased risk of experiencing each type of adulthood victimization. Disclosure did not moderate the relationship between childhood and adulthood victimization. Participants who disclosed were more likely to disclose crime and peer/sibling victimization and disclose to parents or friends. Positive reactions to disclosure were more common than negative reactions; however, 75% of disclosers received at least one negative reaction. Finally, revictimized individuals received more overall negative reactions than nonrevictimized individuals. They also received more reactions characterized by the person they disclosed to trying to take control of their decisions or treating them differently. Results highlight the importance of examining relationships between various forms of victimization, considering how characteristics of disclosure relate to risk of revictimization, and the importance of educating potential support networks about appropriate responses to disclosure.