Social determinants of health (SDOH) are the conditions in which people are born, grow, live, work, and age that influence health outcomes, and structural and systemic drivers of health (SSD) are the social, cultural, political, and economic contexts that create and shape SDOH. With the integration of constructs from previous examples, we propose an SSD model that broadens the contextual effect of these driving forces or factors rooted in the Centers for Disease Control and Prevention's SDOH framework. Our SSD model (1) presents systems and structures as multidimensional, (2) considers 10 dimensions as discrete and intersectional, and (3) acknowledges health-related effects over time at different life stages and across generations. We also present an application of this SSD model to the housing domain and describe how SSD affect SDOH through multiple mechanisms that may lead to unequal resources, opportunities, and consequences contributing to a disproportionate burden of disease, illness, and death in the US population. Our enhanced SDOH framework offers an innovative and promising model for multidimensional, collaborative public health approaches toward achieving health equity and eliminating health disparities.

Background: Health education materials translated for limited English proficiency audiences should be clear and easy to understand. They should be reviewed by fluent and culturally competent reviewers using a standardised and validated assessment tool. Design/Setting: A total of 139 US Centers for Disease Control and Prevention COVID-19-translated health education materials were reviewed for cultural and linguistic appropriateness. Method(s): Reviewers were trained to collect data using a standardised assessment tool, and recorded issues found in translated materials by issue, material and media type. Reviewers were selected for their fluency in the language being reviewed as well as their cultural knowledge of the intended audience. Result(s): Reviewers identified 150 issues related to words, phrases and images that were confusing, difficult to interpret or held multiple possible interpretations. Reviewers took an average completion time of 16 minutes per material across all media types. Conclusion(s): This assessment demonstrated the feasibility and efficiency of conducting reviews with culturally and linguistically competent in-house reviewers using a quality assessment protocol that includes a review for cultural and linguistic accuracy. Despite mainly using certified translators, critical issues with the text and images contained in the COVID-19-translated health education materials were identified. Similar forms of assessment could provide high-quality translated materials without undergoing major document revision. Copyright © The Author(s) 2023.

Menthol-labelled cigarettes accounted for almost one-third of the US cigarette market in 2012.1 Menthol may be present in cigarettes not labelled to contain menthol, either by intentional addition in small quantities,2 as a contaminant in the manufacturing facilities which were used for menthol cigarettes production,3 or as a naturally occurring constituent in tobacco.4 We previously examined menthol amounts in 46 commercial cigarettes. The amount of menthol measured in the whole cigarettes ranged from 2.9 to 19.6 mg/cigarette for menthol-flavoured cigarettes and from 0.002 to 0.07 mg/cigarette for cigarettes without a detectable menthol flavour.5 In an effort to understand how menthol may be used by various cigarette manufacturers, here we present the repeated and additional measurements of menthol quantities in the cigarette rods, cigarette filters and whole cigarettes of these 46 cigarettes from the following manufacturers: Commonwealth Brands, Liggett Group, Lorillard Tobacco, Philip Morris USA, RJ Reynolds Tobacco, British American Tobacco and Santa Fe Natural Tobacco (SFNTC) and compare them with University of Kentucky reference cigarettes. SFNTC Company is a subsidiary of RJ Reynolds Tobacco Company and the University of Kentucky only makes reference cigarettes which are not for commercial consumption. Instead of examining the menthol levels of different cigarette brands,5 we consider the levels of menthol application among cigarette manufacturers and explore whether there are patterns with different manufacturers for menthol-flavoured cigarettes. We also consider possible sources of menthol in non-menthol-flavoured cigarettes (intentionally added or contamination in the manufacturing facility). Menthol content measured in the whole cigarette for the 46 products of these manufacturers is shown in figure 1. There are three products with measured menthol content >10 mg/cigarette: two are Camel Crush cigarettes and the other is SFNTC Natural American Spirit (NAS) Light Green Menthol. Another tested SFNTC NAS menthol cigarette also has a relatively high level of menthol (7.9 mg/cigarette). All of these products are from RJ Reynolds Tobacco Company and its subsidiary, SFNTC. Except for these four products, the menthol contents in the other 19 menthol cigarette products span a relatively narrow range as can be seen in figure 1. This menthol range (3.3–6.4 mg/cigarette) covers cigarettes across six tobacco manufacturers. RJ Reynolds’ Capri Green has the least menthol content (3.27 mg/cigarette) among the tested menthol cigarettes. However, this lowest tested menthol level is more than three times higher than the menthol perceptive threshold of 1 mg/g of tobacco.6 Other manufacturers such as Philip Morris, Lorillard Tobacco and Liggett Group also have menthol products at this level (<4 mg/cigarette). Considering cigarette design features, for example, tobacco weight, paper permeability and filter ventilation, the menthol content added to different brands of cigarettes should exhibit differences in menthol delivery to the smoker.3 The observed narrow ranges of menthol content suggest that menthol application is relatively consistent for menthol-flavoured cigarettes across US cigarette manufacturers.