Literature Collection

As the aging population in the United States grows, the need for an integrated approach to support older adults has become increasingly urgent. The SUNSHINE framework, Seniors Uniting Nationwide to Support Health, INtegrated Care, and Evolution, offers a model for advancing resilience, defined as the capacity of individuals, families, systems, and communities to adapt and thrive in the face of adversity. SUNSHINE promotes this goal through the alignment of older and aging adults, families, healthcare systems, public health agencies, social services, and community resources. Using the Theory of Change modeling, SUNSHINE emphasizes whole-person health, interdisciplinary collaboration, and the strategic use of technology to address the evolving needs of aging populations. The framework promotes systems integration supported by research infrastructure and multi-sector collaboration to enhance the well-being of older adults and family caregivers. SUNSHINE places a strong emphasis on mental health, particularly depression, and highlights the importance of social connection and prevention in addressing health disparities and care gaps associated with aging. It conceptualizes resilience as both a desired outcome and a driver of transformation, guiding the redesign and evaluation of health and social systems. The framework also identifies opportunities to leverage artificial intelligence and machine learning (AI/ML) technologies, grounded in scientific evidence, to support personalized prevention, treatment, and care strategies. These technologies are critical for optimizing decision-making, improving care delivery, and enhancing system flexibility. Finally, SUNSHINE aspires to advance a future of aging that is healthy, resilient, and fair, guided by principles of equity, defined as fairness and impartiality in health opportunities and outcomes.

Research suggests that household social risks are associated with worse mental health in adolescents, but prior studies have been limited. We evaluated the association between social risks and symptoms of depression and anxiety in adolescents 1 year later by conducting a retrospective cohort study at an integrated health system with 45 practices. Adolescents were screened for depression using the Patient Health Questionnaire-2 (PHQ-2) and anxiety using the Generalized Anxiety Disorder-2 (GAD-2). Of the 4748 adolescents, 1220 (25.7%) had at least 1 social risk, 226 (5.7%) reported symptoms of depression, and 410 (10.2%) reported symptoms of anxiety. Adolescents in households with at least 1 social risk were more likely to report symptoms of depression (β = 0.15, 95% confidence interval [CI] = 0.07-0.23) and anxiety (β = 0.21, 95% CI = 0.11-0.31) and had greater odds of a positive PHQ-2 (odds ratio [OR] = 1.50, 95% CI = 1.12-2.01) and positive GAD-2 (OR = 1.57; 95% CI = 1.32, 1.87).

BACKGROUND: Concerns have been raised that pharmacists sometimes act as barriers to patients with opioid use disorder (OUD) accessing buprenorphine treatment. The present research explores how community pharmacists' endorsement (vs non-endorsement) of stigmatizing beliefs about patients taking buprenorphine relate to intentions, comfort, and decisions regarding dispensing buprenorphine for OUD. In addition, we assessed attitudes toward risk in pharmacy practice as a novel correlate of dispensing intentions and decisions. METHODS: A sample of 207 active community-based pharmacists practicing in the United States responded to survey items measuring stigma, risk tolerance, and intentions to dispense buprenorphine. The survey included 2 vignettes in which patients presented to the pharmacy with a prescription for buprenorphine, and respondents rated their comfort with dispensing and decisions regarding dispensing in the vignette. RESULTS: Results suggest that both stigma toward patients taking buprenorphine to treat OUD and tolerance for risk in pharmacy settings are related to differences in pharmacists' intentions to and willingness to dispense buprenorphine for OUD. CONCLUSIONS: Findings support the need for interventions to reduce stigma associated with buprenorphine use among pharmacists and suggest that risk tolerance is an important determinant of pharmacists' behavior that merits further study.