Michael Stellefson

Objectives: This study investigated the prevalence of adverse social determinants of health (SDOH) and health-related social needs (HRSN) and their associations with physical and mental distress among U.S. adults with Chronic Obstructive Pulmonary disease (COPD). Methods: Data from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for respondents across 37 U.S. states who self-reported COPD and completed the Social Determinants and Health Equity module. Weighted prevalence estimates and logistic regression models evaluated associations between SDOH, HRSN, and self-reported physical/mental health, controlling for demographics. Results: Among 32,962 respondents with COPD, social isolation (23.08%) and mental stress (24.80%) were common. Females experienced high rates of food insecurity (65.59%) and housing insecurity (65.90%). Social isolation (OR = 1.84, 95% CI: 1.83–1.85) and life dissatisfaction (OR = 2.10, 95% CI: 2.09–2.11) were associated with increased odds of frequent physical distress. For mental distress, life dissatisfaction (OR = 5.07, 95% CI: 5.04–5.10), stress (OR = 7.11, 95% CI: 7.07–7.14), and transportation barriers (OR = 2.15, 95% CI: 2.14–2.16) were associated with increased odds. Discussion: Social isolation, life dissatisfaction, stress, and transportation barriers were associated with increased physical and mental distress in COPD.

Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory condition that requires ongoing education and self-management support to reduce symptom burden, prevent exacerbations, and ...

Informal caregiving for individuals with chronic obstructive pulmonary disease (COPD) places substantial emotional and physical demands on caregivers. However, many educational resources remain difficult to use due to high reading levels, dense medical language, and limited accessibility. Given that a large proportion of U.S. adults experience challenges with health literacy, existing caregiver toolkits may not provide the clear, actionable guidance needed to support caregiver self-efficacy or improve patient outcomes. This study introduces a reproducible, three-phase workflow that uses generative artificial intelligence (AI) to simplify and refine caregiver education materials, with application to the COPD Caregiver’s Toolkit. Four AI tools were used to simplify text, followed by human-guided refinement using the Sydney Health Literacy Lab (SHeLL) health literacy editor to ensure conceptual accuracy and usability. Readability indices and blinded assessments were used to evaluate changes in understandability and actionability across versions. AI-assisted simplification improved readability and clarity while maintaining high levels of actionability and preserving key instructional content. This scalable, adaptable approach may help public health researchers and practitioners improve the accessibility of educational resources across settings. Multi-phase, human-in-the-loop AI workflows may reduce linguistic complexity and improve the dissemination of essential health information to caregiving populations.

School-based food education is sometimes approached as if nutrition messages are culturally neutral. In reality, eating practices are shaped by culture and origin, religious beliefs, family norms, ...

Poor dental hygiene is deleterious to overall health. The objective of this study is to assess factors that influence dental health behaviors of college students by applying constructs of the TPB. Three hundred and seventy (n = 370) college students, between the ages of 18 to 24, were recruited from a large university in the southeastern United States. Survey data were collected electronically via Qualtrics; binary logistic regression was used for analysis. The sample (n = 370) consisted primarily of students aged 21 (n = 124, 33.5%), female (n = 337, 91.1%), and Non-Hispanic White (n = 294, 79.5%). Only 233 (63%) met the recommendations for brushing; and only 74 (20%) met the recommendation for interdental cleaning. Bivariate regression analysis indicated subjective norms and perceived behavioral control were significant. Findings indicate that interventions should focus on normative beliefs and perceived behavioral control by exploring external factors and teaching students how to master the practice of dental hygiene behaviors.

Despite growing recognition of the role that social determinants of health (SDOHs) and health-related social needs (HRSNs) play in chronic disease, limited research has examined their associations with Chronic Obstructive Pulmonary Disease (COPD) in population-based studies. This cross-sectional study analyzed 2022 Behavioral Risk Factor Surveillance System (BRFSS) data from 37 U.S. states and territories to determine how financial hardship, food insecurity, employment loss, healthcare access barriers, and psychosocial stressors influence the prevalence of COPD. Weighted logistic regression models were used to assess the associations between COPD and specific SDOHs and HRSNs. Several individual SDOH and HRSN factors were significantly associated with COPD prevalence, with financial strain emerging as a particularly strong predictor. In models examining specific SDOH factors, economic hardships like inability to afford medical care were strongly linked to higher COPD odds. Psychosocial HRSN risks, such as experiencing mental stress, also showed moderate associations with increased COPD prevalence. These findings suggest that addressing both structural and individual-level social risks may be critical for reducing the prevalence of COPD in populations experiencing financial challenges.

Background Subjective cognitive decline (SCD), an early indicator of cognitive impairment, may affect COPD care and outcomes, yet its sociodemographic associations in Chronic Obstructive Pulmonary Disease (COPD) remain poorly understood. Objective To investigate the prevalence of SCD among people with COPD across different age groups and identify associations between demographics, risk behaviors, comorbidities, and self-reported SCD. Design Pooled 2019 BRFSS data from 24 states using the Cognitive Decline module were analyzed. Logistic regression assessed relationships between demographics, behaviors, comorbidities, and SCD, adjusting for confounders. Participants A total of 12,003 adults with COPD aged ≥ 45 were included in the study (weighted population = 617,792). Main Measures Prevalence of SCD, associations with demographics, behaviors, health status, income, employment, and smoking. Key Results Among adults with COPD, 24.1% reported SCD. The prevalence among those with SCD was highest in those aged 55–64 (30.2%), followed by 65–74 (24.5%) and 45–54 (23.1%). Older age (55 to 64: AOR = 0.63, 95% CI: 0.49 – 0.80; 65 to 74: AOR = 0.54, 95% CI: 0.40 – 0.72; 75 to 79: AOR = 0.41, 95% CI: 0.29 – 0.60; 80 + : AOR = 0.47, 95% CI: 0.32 – 0.69) and higher annual income (e.g., $25,000 to $49,999: AOR = 0.80, 95% CI: 0.65 – 0.99; $50,000 to $74,999: AOR = 0.68, 95% CI: 0.51 – 0.91) were associated with lower odds of reporting SCD, while unemployment (AOR = 1.73, 95% CI: 1.33 – 2.27), history of stroke (AOR = 1.35, 95% CI: 1.05 – 1.74), and fair or poor health (AOR = 0.47, 95% CI: 0.39 – 0.57) were linked to higher odds of reporting SCD. Conclusions Among adults with COPD, the prevalence of SCD varied by age, with the highest rates in those aged 55–64, and was independently associated with socioeconomic factors and health risks, emphasizing the complex interplay of demographic and health-related factors in SCD.

The racialized and institutionalized structure of the NCAA, college sports, and the PWIs that host most athletic programs positions racial and ethnic identity as a potential barrier to the social and academic engagement, mental health, and identity development of student-athletes. However, few studies examine the relationship, role, and influence of racial, student, and athlete identities outside of domain-specific outcomes. We collected data from 343 student-athletes to explore the relationships between student-athletes' academic and athletic identities, race centrality, and private and public regard, while also examining how race and ethnicity influence these identity dynamics. Our results revealed race and ethnicity to have statistically significant effects on three of the five identity constructs, as well as eight significant underlying relationships among the identity constructs, which were further impacted by participants’ racial and ethnic identities. We provide insight into nuanced relationships between academic and athletic identities, race centrality, and private and public regard, and the impact of race and ethnicity on their interrelatedness. Through this study, we addressed critical gaps in literature by responding to calls for more comprehensive analyses of the multidimensional and intersecting identities of student-athletes and further substantiate the need for inclusive support and research on the interplay and development of the identity dynamics among an increasingly diverse student-athlete population.