Academic adaptation is crucial for the success and well-being of international students, especially in rural areas where cultural and social support resources may be limited. This study aimed to identify predictors of academic adaptation among international students in the rural southern United States, focusing on social support, cultural integration, alcohol use, and acculturative stress. A cross-sectional study was conducted with 141 international students from two universities: the University of Mississippi/Oxford campus and the University of Alabama. Data were collected through a web-based survey using validated scales to measure cultural integration, acculturative stress, social support, alcohol use, and academic adaptation. Pearson correlation and multiple linear regression analyses were performed to identify significant predictors of academic adaptation. The sample consisted of 54.6% male and 45.4% female students, with a mean age of 29.4 years. The majority were graduate students (89.4%), with the majority being funded by graduate teaching or research assistantships (78.7%). Correlation analyses showed that social support was positively correlated with academic adaptation (r = 0.62, p < 0.01). Also, cultural integration was positively corelated with academic adaptation (r = 0.33, p < 0.001). However, acculturative stress was negatively correlated with academic adaptation (r = −0.20, p < 0.05). The fully adjusted regression analyses identified social support as a positive predictor of academic adaptation among international students in rural U.S. universities. The model demonstrated that each unit increase in the social support score was associated with a 0.61 increase in the academic adaptation score (95% CI [0.44, 0.79], p < 0.001). These findings highlight the need for tailored support programs addressing the unique challenges faced by this population to enhance their academic success and overall well-being.

HIV testing is an entry point for both HIV prevention and treatment, and the CDC recommends that all adults of reproductive age undergo HIV testing at least once in their lifetime. However, HIV testing rates remain suboptimal. This study analyzed trends in HIV testing using Behavioral Risk Factor Surveillance System data from 2017 to 2023 across nine Deep South states—Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, and Texas. Descriptive statistics and Joinpoint linear regression were employed to assess lifetime HIV testing and testing within the past 12 months. Findings showed that the overall trend in having ever tested for HIV rose from 43% in 2017 to 47% in 2019 but declined to 40% in 2022, with a slight increase to 41% in 2023. Significant declines in ever testing were observed in North Carolina and among adults aged 25–44, non-Hispanic Black, non-Hispanic multiracial, and those identifying as lesbian or gay. Furthermore, the overall trend in HIV testing in the past 12 months declined significantly from 48% in 2017 to 42% in 2022, with a slight increase to 43% in 2023. Significant declines were found in Florida, Georgia, Louisiana, North Carolina, and South Carolina, and among adults aged 18–34, non-Hispanic White, non-Hispanic Black, male, female, and heterosexual individuals. These trends, observed largely during the COVID-19 pandemic, underscore the need to scale up HIV prevention and care initiatives, particularly in populations and regions experiencing significant declines. Trends should continue to be monitored and examined post-COVID pandemic.

Few studies have been conducted in Iraq regarding the association of violence at multiple ecological levels and child mental health outcomes. Therefore, the study objectives were (1) to conduct a nationwide analysis to explore violence at multiple socio-ecological levels and children’s mental health outcomes, and (2) to identify the most vulnerable children according to the spatial distribution of Iraqi governorates. This cross-sectional study used the 2018 Iraq Multiple Indicator Cluster Survey (MICS 6), which included 12,358 mothers or caretakers who provided complete information regarding their parenting and disciplinary practices for their children between the ages of 5 and 14. Logistic regression was employed to examine the factors associated with children’s depression and anxiety. This study showed that 22% of children had depression, while 38% experienced anxiety. Notably, children residing in Iraq’s south/central regions, specifically in areas, like Nainawa, Najaf, and Basrah, exhibited notably higher anxiety and depression. The research also showed that living in unsafe neighborhoods, women’s acceptance of domestic violence, and the use of severe physical punishment as corporal discipline were all associated with the development of anxiety and depression. This study addresses the scarcity of information on children’s mental health outcomes in Iraq at national and governorate levels, emphasizing the need for urgent national-level policy discussions to achieve key Sustainable Development Goals related to ending all forms of violence against children by 2030.

Background: Cardiovascular disease remains a leading cause of preventable mortality in the United States, with rural counties in the Deep South experiencing disproportionately high burdens. Grounded in the Andersen healthcare utilization model, this study examined how enabling resources, predisposing characteristics, and access-related barriers relate to coronary heart disease (CHD) prevalence and mortality. Methods: This ecological analysis included 418 counties across Alabama, Georgia, Louisiana, Mississippi, and South Carolina. Using Local Indicators of Spatial Association (LISA) and multivariable linear regression, we tested three theory-based hypotheses and assessed the spatial clustering of CHD outcomes, while identifying key structural and sociodemographic predictors. Results: Counties with greater rurality and fewer healthcare providers exhibited significantly higher rates of CHD prevalence and mortality. Primary care provider availability and higher household income were protective factors. Digital exclusion, measured by lack of access to computers or mobile devices, was significantly associated with higher CHD prevalence and mortality. Spatial analysis identified the counties with better-than-expected cardiovascular outcomes despite structural disadvantages, suggesting the potential role of localized resilience factors and unmeasured community-level interventions. Conclusions: The findings affirm the relevance of the Andersen model for understanding rural health disparities and highlight the importance of investing in both digital infrastructure and healthcare capacity. Expanding telehealth without addressing provider shortages and social determinants may be insufficient. Local policy innovations and community resilience mechanisms may offer scalable models for improving cardiovascular health in disadvantaged areas.

There are limited efforts to incorporate different predisposing factors into prediction models that account for population racial/ethnic composition in exploring the burden of high COVID-19 Severe Health Risk Index (COVID-19 SHRI) scores. This index quantifies the risk of severe COVID-19 symptoms among a county’s population depending on the presence of some chronic conditions. These conditions, as identified by the Centers for Disease Control and Prevention (CDC), include Chronic Obstructive Pulmonary Disease (COPD), heart disease, high blood pressure, diabetes, and obesity. Therefore, the objectives of this study were (1) to investigate potential population risk factors preceding the COVID-19 pandemic that are associated with the COVID-19 SHRI utilizing non-spatial regression models and (2) to evaluate the performance of spatial regression models in comparison to non-spatial regression models. The study used county-level data for 3107 United States counties, utilizing publicly available datasets. Analyses were carried out by constructing spatial and non-spatial regression models. Majority White and majority Hispanic counties showed lower COVID-19 SHRI scores when compared to majority Black counties. Counties with an older population, low income, high smoking, high reported insufficient sleep, and a high percentage of preventable hospitalizations had higher COVID-19 SHRI scores. Counties with better health access and internet coverage had lower COVID-19 SHRI scores. This study helped to identify the county-level characteristics of risk populations to help guide resource allocation efforts. Also, the study showed that the spatial regression models outperformed the non-spatial regression models. Racial/ethnic inequalities were associated with disparities in the burden of high COVID-19 SHRI scores. Therefore, addressing these factors is essential to decrease inequalities in health outcomes. This work provides the baseline typology to further explore many social, health, economic, and political factors that contribute to different health outcomes.

Women's attitudes towards domestic violence play an important role in shaping the social acceptance of domestic violence, acting as both a known predictor of victimization and an indicator of disclosure and help-seeking behavior. Therefore, the study objectives were 1) to conduct a nationwide analysis to explore the factors associated with the acceptance of domestic violence among Iraqi women according to the social-ecological framework, and 2) to identify the most vulnerable women according to the spatial distribution of Iraqi governorates. This cross-sectional study was conducted using secondary data analysis from the 2018 Iraq Multiple Indicator Cluster Survey (MICS 6), which included 19,443 married Iraqi women. Logistic regression was employed to examine the factors associated with acceptance of domestic violence. In this study, the analyses were performed according to the Social Ecological Model (SEM). This study revealed that 48.4% of married Iraqi women accepted domestic violence. Yet, women living in South/Central regions of Iraq showed a higher prevalence of domestic violence acceptance namely Anbar, Salahaddin Thiqar, and Misan where the prevalence was (62%-73%). Several factors across the social-ecological model were associated with a higher likelihood of women accepting such behavior, including experiencing functional difficulty, having lower educational attainment, being married to a blood-related husband, and being married to a husband who has multiple wives/partners, living in poverty, residing in rural areas, living in the south and central regions of Iraq, and feeling unsafe in the neighborhood. Conversely, factors that were associated with a lower likelihood of women accepting such behavior were owning a mobile phone and using a computer or tablet. This study provides policymakers with valuable insights to comprehensively assess indicators of attitudes toward domestic violence against women. It also addresses the scarcity of information on the acceptance of domestic violence in Iraq on national and governorate levels, emphasizing the need for urgent national-level policy discussions to achieve key Sustainable Development Goals related to gender equity and good health and well-being.