OBJECTIVE: Homophily represents the extent to which people feel others are like them and encourages the uptake of activities they feel people like them do. Currently, there are no data on blood donor homophily with respect to (i) people\'s representation of the average prototypical UK blood donor and (ii) the degree of homophily with this prototype for current donors, non-donors, groups blood services wish to encourage (ethnic minorities), those who are now eligible following policy changes (e.g., men-who-have-sex-with-men: MSM) and recipients. We aim to fill these gaps in knowledge.
METHODS: We surveyed the UK general population MSM, long-term blood recipients, current donors, non-donors and ethnic minorities (n = 785) to assess perceptions of the prototypical donor in terms of ethnicity, age, gender, social class, educational level and political ideology. Homophily was indexed with respect to age, gender and ethnicity.
RESULTS: The prototypical UK blood donor is perceived as White, middle-aged, middle-class, college-level educated and left-wing. Current donors and MSM are more homophilous with this prototype, whereas recipients and ethnic minorities have the lowest homophily. Higher levels of homophily are associated with an increased likelihood of committing to donate.
CONCLUSIONS: The prototype of the UK donor defined this as a White activity. This, in part, may explain why ethnic minorities are less likely to be donors. As well as traditional recruitment strategies, blood services need to consider broader structural changes such as the ethnic diversity of staff and co-designing donor spaces with local communities.

The past two decades have seen growing calls for the \"tobacco endgame.\" Its advocates are united by their commitment to two ideas. First, tobacco-related harms represent a catastrophic health emergency, and second, current tobacco-control approaches are an inadequate response to the scale of that emergency. To endgame advocates, tobacco policy should have more ambitious goals than merely \"controlling\" tobacco. Instead, it should aim to bring about a smoke-free world. While a range of different policies are included under the umbrella of the \"tobacco endgame,\" the most radical proposal is for a complete ban on tobacco. Its advocates argue that in addition to improving global public health, an effective ban on tobacco would also promote overall autonomy and would have important egalitarian benefits. This article critically examines these arguments for a tobacco ban. I argue that they rely on idealizing assumptions about the likely effects of a ban. Because an effective ban would require robust enforcement to control the illegal market in tobacco, it would be more likely to undermine autonomy and equality than it would be to promote them. By relying on idealizing assumptions and ignoring the likely consequences of a tobacco ban, advocates of a ban obscure, rather than clarify, both the policy debate and the ethical stakes. I conclude by considering the ways that idealizing assumptions should-and should not-play a role in debates about ethical issues in public policy.

The equitable allocation of resources has long been a central concern for humanity, prompting extensive research into various motivations that drive the pursuit of distributive justice. In contrast to one of the most fundamental motives, inequality aversion, a conflicting motive has been proposed: rank-reversal aversion. However, it remains unclear whether this rank-reversal aversion persists in the presence of self-rank. Here we provide evidence of rank-reversal aversion in the first-party context and explore diverse moral strategies for distribution. In a modified version of the redistribution game involving 55 online-recruited participants, we observed rank-reversal aversion only when one\'s rank was maintained. When participants\' self-rank was altered, they tended to base their behavior on their new ranks. This behavioral tendency varied among individuals, revealing three distinct moral strategies, all incorporating considerations of rank-reversal. Our findings suggest that rank-reversal aversion can indeed influence one\'s distribution behavior, although the extent of its impact may vary among individuals, especially when self-rank is a factor. These insights can be extended to political and economic domains, contributing to a deeper understanding of the underlying mechanisms of distributive justice.

BACKGROUND: Healthcare triage policies are vital for allocating limited resources fairly and equitably. Despite extensive studies of healthcare equity, consensus on the applied definition of equity in triage remains elusive. This study aimed to investigate how the principles of equity are operationalised in Australian hospital physiotherapy triage tools to guide resource distribution.
METHODS: A retrospective, qualitative content analysis of 13 triage policies from 10 hospitals across Australia was conducted. Triage policies from both inpatient and outpatient settings were sourced. Data were coded deductively using the five discrete domains of the multi-faceted operational definition of health equity posited by Lane et al. (2017): 1) point of equalisation in the health service supply/access/outcome chain, 2) need or potential to benefit, 3) groupings of equalisation, 4) caveats to equalisation, 5) close enough is good enough. Descriptive summative statistics were used to analyse and present the frequency of reported equity domains.
RESULTS: Within the included triage tools, four out of five domains of equity were evident in the included documents to guide decision making. Allocation based on perceived patient need and overall health outcomes were the central guiding principles across both inpatient and outpatient settings. Equal provision of service relative to patient need and reducing wait times were also prioritised. However, explicit inclusion of certain equity domains such as discrimination, ensuring equal capability to be healthy and other patient factors was limited.
CONCLUSIONS: Physiotherapy triage policies consider various domains of equity to guide resource allocation decisions. Policymakers and service providers can use the insights gained from this study to review the application and operationalisation of equity principles within their healthcare systems through mechanisms such as patient triage tools.

BACKGROUND: The research environment is a complex ecosystem but is vital for nurturing excellence, vitality and sustainability. The Research Excellence Framework (REF) applies to research in the four nations of the UK. The framework and principles for the next REF have been published, with submissions due in 2028 and the results to be published in 2029. The three elements of the REF have changed and new weightings applied, with \'People, Culture and Environment\' forming 25% of the whole.
OBJECTIVE: To inform research leaders, investigators, clinical nurse researchers, and doctoral and postdoctoral students about how to prepare dynamic research strategies that prioritise inclusivity in talent management and succession.
CONCLUSIONS: This article considers inclusivity in research cultures, what has been learned from the previous REF and what more needs to be done collectively across the sector and specifically in nursing. The discussion draws on the author\'s personal knowledge and experience as a research leader, senior manager and university governor. It is intended to be challenging and practically oriented.
CONCLUSIONS: The article sets out provocations to shape an agenda for promoting inclusive research cultures to ensure organisational readiness for REF 2029.
CONCLUSIONS: The article provides pragmatic suggestions for moving forward at pace with making the culture in nursing research more open, transparent and fair.

As we enter the era of digital interdependence, artificial intelligence (AI) emerges as a key instrument to transform health care and address disparities and barriers in access to services. This viewpoint explores AI\'s potential to reduce inequalities in cancer care by improving diagnostic accuracy, optimizing resource allocation, and expanding access to medical care, especially in underserved communities. Despite persistent barriers, such as socioeconomic and geographical disparities, AI can significantly improve health care delivery. Key applications include AI-driven health equity monitoring, predictive analytics, mental health support, and personalized medicine. This viewpoint highlights the need for inclusive development practices and ethical considerations to ensure diverse data representation and equitable access. Emphasizing the role of AI in cancer care, especially in low- and middle-income countries, we underscore the importance of collaborative and multidisciplinary efforts to integrate AI effectively and ethically into health systems. This call to action highlights the need for further research on user experiences and the unique social, cultural, and political barriers to AI implementation in cancer care.

The Centering Equality, Race, and Cultural Literacy in Family Planning (CERCL-FP) program aims to break racial silence and dismantle structural racism in the field of family planning, by providing racial equity workshops and trainings.
OBJECTIVE: The objective of this study was to begin a multi-phased, rigorous evaluation to determine the impact and outcomes of the work of CERCL-FP.
METHODS: A needs assessment with former graduates and current directors of fellowships in family planning was conducted using qualitative interviews. The focus of these interviews was to determine the ability, readiness, and willingness of the field of family planning to retrofit new curricula grounded in equity, race, and cultural literacy.
RESULTS: Nine (N = 9) interviews were completed with seven board certified obstetrician-gynecologists and two board certified family medicine physicians. Three themes were identified: (1) Establishing the Distribution of Work; (2) The Push/Pull of Change from Inside and Outside: Curricula and Faculty Responsibilities; and (3) Reproductive Justice and Fellowships in Family Planning. Despite acknowledging the need to retrofit the field of family planning with content grounded in equity, race, and cultural literacy, there are structural, institutional, and individual level barriers that have limited the adoption of CERCL-FP curricula within family planning curriculum nationwide.
CONCLUSIONS: Findings from this study illuminate multiple barriers that should be considered when expanding foundational knowledge of clinicians and researchers.
CONCLUSIONS: Similar to the slow integration of research findings into clinical practice, this study shows that integration of social science and new curricula within the field of family planning faces significant barriers. Strategies to address these barriers are crucial to ensuring successful integration of equity, race, and cultural literacy within family planning.

BACKGROUND: Digital health research plays a vital role in advancing equitable health care. The diversity of research teams is thereby instrumental in capturing societal challenges, increasing productivity, and reducing bias in algorithms. Despite its importance, the gender distribution within digital health authorship remains largely unexplored.
OBJECTIVE: This study aimed to investigate the gender distribution among first and last authors in digital health research, thereby identifying predicting factors of female authorship.
METHODS: This bibliometric analysis examined the gender distribution across 59,980 publications from 1999 to 2023, spanning 42 digital health journals indexed in the Web of Science. To identify strategies ensuring equality in research, a detailed comparison of gender representation in JMIR journals was conducted within the field, as well as against a matched sample. Two-tailed Welch 2-sample t tests, Wilcoxon rank sum tests, and chi-square tests were used to assess differences. In addition, odds ratios were calculated to identify predictors of female authorship.
RESULTS: The analysis revealed that 37% of first authors and 30% of last authors in digital health were female. JMIR journals demonstrated a higher representation, with 49% of first authors and 38% of last authors being female, yielding odds ratios of 1.96 (95% CI 1.90-2.03; P<.001) and 1.78 (95% CI 1.71-1.84; P<.001), respectively. Since 2008, JMIR journals have consistently featured a greater proportion of female first authors than male counterparts. Other factors that predicted female authorship included having female authors in other relevant positions and gender discordance, given the higher rate of male last authors in the field.
CONCLUSIONS: There was an evident shift toward gender parity across publications in digital health, particularly from the publisher JMIR Publications. The specialized focus of its sister journals, equitable editorial policies, and transparency in the review process might contribute to these achievements. Further research is imperative to establish causality, enabling the replication of these successful strategies across other scientific fields to bridge the gender gap in digital health effectively.

UNASSIGNED: Children and young people experiencing chronic pain are at greater risk of inequitable and poor-quality pain management, which has implications for future management of pain in adulthood. Most chronic pain research is conducted with adults who are more likely to be middle-class, white and monocultured. Inclusive and diverse recruitment practices in paediatric pain research can be an area in which we can address this imbalance of representation. The aim of this current work was to explore these practices and to co-produce recommendations regarding recruitment strategies for paediatric pain research.
UNASSIGNED: The research team worked with Your Rheum, a United Kingdom young person\'s advisory group (ages 11-24 years) and diagnosed with rheumatic condition(s), the opportunity to input into rheumatology research. At a virtual Your Rheum meeting, eight young people (female = 7, male = 1, age range 12-24) took part in group discussions, sharing their experiences of taking part in research and their decision process. Online tools, including Mentimeter and Miro, were used to aid conversations and share ideas.
UNASSIGNED: Most young people had experience of taking part in research as a study participant (n = 5). Recommendations synthesised included increased awareness of research in general. The young people discussed being open to hearing about research opportunities; they reflected that they are rarely exposed to these invitations or hear about current research. The clinic environment was highlighted as a \"good and trustworthy\" recruitment area - being approached by a member of the research team was considered ideal, even if it was someone they had not met previously. Many young people recalled little discussions of research at their clinical appointments. Deciding to participate in research included the following considerations: benefit/impact; connecting with others; research topic; which is then balanced against convenience, and reimbursement. The young people felt that taking part in research was empowering and helped them take ownership of their pain management.
UNASSIGNED: It is essential to understand the perspectives of potential study participants, to plan successful recruitment strategies. Ensuring we consider these factors when designing our studies and recruitment strategies is beneficial to all involved. Co-produced recruitment strategies would aid inclusive (and increased) research participation.

BACKGROUND: Despite several theories suggesting online learning during the COVID-19 pandemic would aggravate ethnoracial disparities in mental health among adolescents, extant findings suggest no ethnoracial differences in mental health or that those from minoritized ethnoracial groups reported better mental health than their White counterparts.
OBJECTIVE: This study aimed to identify why findings from prior studies appear to not support that ethnoracial disparities in mental health were aggravated by testing 2 pathways. In pathway 1 pathway, online learning was associated with reporting fewer confidants, which in turn was associated with poorer mental health. In pathway 2, online learning was associated with reporting better sleep, which in turn was associated with better mental health.
METHODS: We analyzed survey data from a US sample (N=540) of 13- to 17-year-olds to estimate how school modality was associated with mental health via the 2 pathways. The sample was recruited from the AmeriSpeak Teen Panel during spring of 2021, with an oversample of Black and Latino respondents. Ethnoracial categories were Black, Latino, White, and other. Mental health was measured with the 4-item Patient Health Questionnaire, which assesses self-reported frequency of experiencing symptoms consistent with anxiety and depression. School modality was recorded as either fully online or with some in-person component (fully in-person or hybrid). We recorded self-reports of the number of confidants and quality of sleep. Covariates included additional demographics and access to high-speed internet. We estimated bivariate associations between ethnoracial group membership and both school modality and mental health. To test the pathways, we estimated a path model.
RESULTS: Black and Latino respondents were more likely to report being in fully online learning than their White counterparts (P<.001). Respondents in fully online learning reported fewer confidants than those with any in-person learning component (β=-.403; P=.001), and reporting fewer confidants was associated with an increased likelihood of reporting symptoms consistent with anxiety (β=-.121; P=.01) and depression (β=-.197; P<.001). Fully online learning respondents also reported fewer concerns of insufficient sleep than their in-person learning counterparts (β=-.162; P=.006), and reporting fewer concerns was associated with a decreased likelihood of reporting symptoms consistent with anxiety (β=.601; P<.001) and depression (β=.588; P<.001). Because of these countervailing pathways, the total effect of membership in a minoritized ethnoracial group on mental health was nonsignificant.
CONCLUSIONS: The findings compel more nuanced discussions about the consequences of online learning and theorizing about the pandemic\'s impact on minoritized ethnoracial groups. While online learning may be a detriment to social connections, it appears to benefit sleep. Interventions should foster social connections in online learning and improve sleep, such as implementing policies to enable later start times for classes. Future research should incorporate administrative data about school modality, rather than relying on self-reports.