Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117726
Gabriel Salgado Ribeiro de Sá
Leading up to the 2020 U.S. presidential elections, the scientific consensus on hydroxychloroquine's ineffectiveness in treating COVID-19 was dismissed by Executive branch scientists, who promoted it as both a therapeutic solution and a political tool. This article examines how experimental pharmaceuticals were rationalized even before the pandemic declaration, aligning with medical advocacy groups linked to Donald Trump, who criticized the crisis management capacity of existing health institutions. Framing the emergency as requiring extraordinary measures, White House researchers advocated for executive unilateralism and eventually sought to securitize public health by replacing key health authorities with operational medicine specialists. The most controversial case involved an attempt of planned pharmaceutical intervention aimed at saving lives and restoring public confidence in the administration's pandemic response before the 2020 election. The article draws on confidential documents released by the 2022 House Select Subcommittee on the Coronavirus Crisis.
{"title":"Populism and medical advocacy: The case of hydroxychloroquine prior the 2020 United States presidential election","authors":"Gabriel Salgado Ribeiro de Sá","doi":"10.1016/j.socscimed.2025.117726","DOIUrl":"10.1016/j.socscimed.2025.117726","url":null,"abstract":"<div><div>Leading up to the 2020 U.S. presidential elections, the scientific consensus on hydroxychloroquine's ineffectiveness in treating COVID-19 was dismissed by Executive branch scientists, who promoted it as both a therapeutic solution and a political tool. This article examines how experimental pharmaceuticals were rationalized even before the pandemic declaration, aligning with medical advocacy groups linked to Donald Trump, who criticized the crisis management capacity of existing health institutions. Framing the emergency as requiring extraordinary measures, White House researchers advocated for executive unilateralism and eventually sought to securitize public health by replacing key health authorities with operational medicine specialists. The most controversial case involved an attempt of planned pharmaceutical intervention aimed at saving lives and restoring public confidence in the administration's pandemic response before the 2020 election. The article draws on confidential documents released by the 2022 House Select Subcommittee on the Coronavirus Crisis.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117726"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117770
Signe K. Bennetsen , Bertina Kreshpaj , Signe Hald Andersen , Tjeerd Rudmer de Vries , Karsten Thielen , Theis Lange , Naja Hulvej Rod , Leonie K. Elsenburg
Background
Childhood adversity has been associated with early school leaving and reliance on social benefits. In this mediation study, we disentangle the contribution of differential likelihood of and differential susceptibility to early school leaving in the association between childhood adversity and long-term use of social benefits in young adulthood.
Methods
We used nationwide register data from the Danish Life Course cohort study on individuals born between Jan 1, 1980, and Oct 2, 1987, who did not die or emigrate before age 16, with complete information on education at age 30 (n = 370,165). Individuals were assigned to one of five trajectory groups based on annual exposure to 12 adversities from age 0–15 across three dimensions. Early school leaving was defined as not completing upper secondary schooling before age 30. Long-term social benefit use was defined as receiving benefits for 52 consecutive weeks between age 30 and 35 years. Using counterfactual mediation analysis, we estimated how differential likelihood of and susceptibility to early school leaving contributed to the association between childhood adversity and long-term use of social benefits.
Results
Childhood adversity was associated with between 31 and 262 additional cases of long-term social benefit use per 1000 individuals. Between 26 % and 31 % of these additional cases were attributed to differential likelihood of early school leaving. The contribution of differential susceptibility to early school leaving ranged from negligible to 27 % across the childhood adversity groups.
Interpretation
A higher likelihood as well as a greater susceptibility to early school leaving among individuals with a history of childhood adversity, explains a substantial proportion of the additional cases of long-term social benefit use observed in these groups. Multifaceted policies and interventions are needed to address the ramifications of childhood adversity, reduce early school leaving, and limit long-term use of social benefits in the population.
{"title":"Childhood adversity, early school leaving and long-term social benefit use: A longitudinal mediation analysis of a population-wide study","authors":"Signe K. Bennetsen , Bertina Kreshpaj , Signe Hald Andersen , Tjeerd Rudmer de Vries , Karsten Thielen , Theis Lange , Naja Hulvej Rod , Leonie K. Elsenburg","doi":"10.1016/j.socscimed.2025.117770","DOIUrl":"10.1016/j.socscimed.2025.117770","url":null,"abstract":"<div><h3>Background</h3><div>Childhood adversity has been associated with early school leaving and reliance on social benefits. In this mediation study, we disentangle the contribution of differential likelihood of and differential susceptibility to early school leaving in the association between childhood adversity and long-term use of social benefits in young adulthood.</div></div><div><h3>Methods</h3><div>We used nationwide register data from the Danish Life Course cohort study on individuals born between Jan 1, 1980, and Oct 2, 1987, who did not die or emigrate before age 16, with complete information on education at age 30 (n = 370,165). Individuals were assigned to one of five trajectory groups based on annual exposure to 12 adversities from age 0–15 across three dimensions. Early school leaving was defined as not completing upper secondary schooling before age 30. Long-term social benefit use was defined as receiving benefits for 52 consecutive weeks between age 30 and 35 years. Using counterfactual mediation analysis, we estimated how differential likelihood of and susceptibility to early school leaving contributed to the association between childhood adversity and long-term use of social benefits.</div></div><div><h3>Results</h3><div>Childhood adversity was associated with between 31 and 262 additional cases of long-term social benefit use per 1000 individuals. Between 26 % and 31 % of these additional cases were attributed to differential likelihood of early school leaving. The contribution of differential susceptibility to early school leaving ranged from negligible to 27 % across the childhood adversity groups.</div></div><div><h3>Interpretation</h3><div>A higher likelihood as well as a greater susceptibility to early school leaving among individuals with a history of childhood adversity, explains a substantial proportion of the additional cases of long-term social benefit use observed in these groups. Multifaceted policies and interventions are needed to address the ramifications of childhood adversity, reduce early school leaving, and limit long-term use of social benefits in the population.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117770"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2024.117248
Simon McNamara , Aki Tsuchiya , John Holmes
{"title":"Corrigendum to ‘Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment’ [Soc. Sci. Med. Volume 269, January 2021, 113573]","authors":"Simon McNamara , Aki Tsuchiya , John Holmes","doi":"10.1016/j.socscimed.2024.117248","DOIUrl":"10.1016/j.socscimed.2024.117248","url":null,"abstract":"","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117248"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117690
Serim Lee
Alcohol is a highly addictive substance, presenting significant global public health concerns, particularly among adolescents. Previous studies have been limited by traditional research methods, making it challenging to encompass diverse risk factors and automate screening or prediction of adolescents’ alcohol use. This study aimed to develop prediction algorithms for adolescent alcohol use in South Korea using machine learning (ML) and deep learning (DL) models, and to identify important features. The study utilized a combination of DL (i.e., Auto-encoder) and ML (i.e., Logistic regression, Ridge, LASSO, Elasticnet, Decision tree, Random forest, AdaBoost, and XGBoost) algorithms to develop the prediction models. It involves 41,239 Korean adolescents and 46 socio-ecological input variables based on cross-sectional data. The analysis revealed that the prediction algorithms had AUC scores ranging from 0.6325 to 0.7214. The feature importance analysis indicates that variables within the domains of sociodemographic characteristics, physical and mental health, behavioral problems, family factors, school factors, and social factors all play significant roles. The developed algorithms enable automatic and early identification of adolescent alcohol use within public health practice settings. By leveraging a comprehensive array of input variables, these methods surpass the limitations of traditional regression approaches, offering novel insights into the critical risk factors associated with alcohol use among Korean adolescents, thereby facilitating early and targeted prevention efforts.
{"title":"Development of deep learning auto-encoder algorithms for predicting alcohol use in Korean adolescents based on cross-sectional data","authors":"Serim Lee","doi":"10.1016/j.socscimed.2025.117690","DOIUrl":"10.1016/j.socscimed.2025.117690","url":null,"abstract":"<div><div>Alcohol is a highly addictive substance, presenting significant global public health concerns, particularly among adolescents. Previous studies have been limited by traditional research methods, making it challenging to encompass diverse risk factors and automate screening or prediction of adolescents’ alcohol use. This study aimed to develop prediction algorithms for adolescent alcohol use in South Korea using machine learning (ML) and deep learning (DL) models, and to identify important features. The study utilized a combination of DL (i.e., Auto-encoder) and ML (i.e., Logistic regression, Ridge, LASSO, Elasticnet, Decision tree, Random forest, AdaBoost, and XGBoost) algorithms to develop the prediction models. It involves 41,239 Korean adolescents and 46 socio-ecological input variables based on cross-sectional data. The analysis revealed that the prediction algorithms had AUC scores ranging from 0.6325 to 0.7214. The feature importance analysis indicates that variables within the domains of sociodemographic characteristics, physical and mental health, behavioral problems, family factors, school factors, and social factors all play significant roles. The developed algorithms enable automatic and early identification of adolescent alcohol use within public health practice settings. By leveraging a comprehensive array of input variables, these methods surpass the limitations of traditional regression approaches, offering novel insights into the critical risk factors associated with alcohol use among Korean adolescents, thereby facilitating early and targeted prevention efforts.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117690"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117786
Mariana Campos Lichtsztejn , Anna Molas Closas , Joan Pujol-Tarrés
The biomedical model of attention focuses on preventive risk assessment to mitigate the apparition of future diseases. In the event of a pregnancy classified “at risk” of preeclampsia, screening undertaken in first-term ultrasound controls determines which patients receive preventive treatment. This article examines women's narratives on the communication dynamics with health professionals by drawing on an eight-month ethnographic fieldwork, between 2022 and 2023, in a Barcelona hospital's obstetrics department and 24 semi-structured interviews with women in the postpartum period. The participants of this study had been classified at high risk of developing preeclampsia, which is determined through a screening undertaken during the first trimester of pregnancy, or had a diagnosis of preeclampsia. The results suggest that risk classification significantly impacts the decision-making process and the technical parameters. As we contend, participants experienced difficulties receiving quality information and communicating with professionals, making shared decision-making challenging. As we conclude, doctor-patient dialogue and shared decisions are increasingly replaced by institutional protocols where patients feel their knowledge and experiences have little room.
{"title":"Risk and decision-making: Communication between health professionals and pregnant women at risk of preeclampsia in Catalonia","authors":"Mariana Campos Lichtsztejn , Anna Molas Closas , Joan Pujol-Tarrés","doi":"10.1016/j.socscimed.2025.117786","DOIUrl":"10.1016/j.socscimed.2025.117786","url":null,"abstract":"<div><div>The biomedical model of attention focuses on preventive risk assessment to mitigate the apparition of future diseases. In the event of a pregnancy classified “at risk” of preeclampsia, screening undertaken in first-term ultrasound controls determines which patients receive preventive treatment. This article examines women's narratives on the communication dynamics with health professionals by drawing on an eight-month ethnographic fieldwork, between 2022 and 2023, in a Barcelona hospital's obstetrics department and 24 semi-structured interviews with women in the postpartum period. The participants of this study had been classified at high risk of developing preeclampsia, which is determined through a screening undertaken during the first trimester of pregnancy, or had a diagnosis of preeclampsia. The results suggest that risk classification significantly impacts the decision-making process and the technical parameters. As we contend, participants experienced difficulties receiving quality information and communicating with professionals, making shared decision-making challenging. As we conclude, doctor-patient dialogue and shared decisions are increasingly replaced by institutional protocols where patients feel their knowledge and experiences have little room.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117786"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143123982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117801
Maud Gelly
The COVID-19 epidemic exposed a glaring imbalance between the need for hospitalization and the material and human resources required to meet it. A qualitative study was conducted in a hospital in a region of France overwhelmed by the epidemic in 2020, and this resulting article analyzes how hospital employees came to terms with the shortage of hospital resources. Research reveals the contradictions between the denial of patient sorting by top national leadership and hospital management and its everyday practice by hospital agents in direct contact with the public. Agents who had to sort the sick did not experience a moral dilemma in making these decisions, but those who were not in decision-making positions but had to manage the consequences did. This article contributes to the sociology of sorting by focusing on the practices of agents, being attentive to their moral quandaries and after-the-fact rationalizations in addition to the tactical dimensions of sorting, meaning the concrete local issues to which it responds.
{"title":"Sorting patients and institutional bad faith: A study of a hospital during the COVID-19 epidemic in France","authors":"Maud Gelly","doi":"10.1016/j.socscimed.2025.117801","DOIUrl":"10.1016/j.socscimed.2025.117801","url":null,"abstract":"<div><div>The COVID-19 epidemic exposed a glaring imbalance between the need for hospitalization and the material and human resources required to meet it. A qualitative study was conducted in a hospital in a region of France overwhelmed by the epidemic in 2020, and this resulting article analyzes how hospital employees came to terms with the shortage of hospital resources. Research reveals the contradictions between the denial of patient sorting by top national leadership and hospital management and its everyday practice by hospital agents in direct contact with the public. Agents who had to sort the sick did not experience a moral dilemma in making these decisions, but those who were not in decision-making positions but had to manage the consequences did. This article contributes to the sociology of sorting by focusing on the practices of agents, being attentive to their moral quandaries and after-the-fact rationalizations in addition to the tactical dimensions of sorting, meaning the concrete local issues to which it responds.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117801"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2025.117727
Mingming Cheng , Qin Luo , Chao Fang , Alastair Comery , John Troyer
China's emerging palliative care services are heavily influenced by Western models of palliative medicine, which emphasize dignity, autonomy and individuality. How palliative care is designed and provided, however, within the distinctively non-Western context of Chinese society has yet to be fully explored. To examine palliative care as a socio-cultural construct, this qualitative study investigates what a good death means in China from the perspective of bereaved family members. Thirty-one semi-structured interviews were conducted, followed by an inductive thematic analysis. Four main themes were identified: (1) Negotiating Autonomy in Family Contexts; (2) Familial Obligations and Cultural Practices; (3) Security and Resource Stability; (4) Meaning and Legacy at the End of Life. We found that, for family members, a good death is primarily mediated by the objectives of family harmony and continuity, often overriding the dying person's individual wishes. This emphasis on the family can act as a double-edged sword, both supporting and complicating the experience of death in China. Based on our findings, we propose a social support system that balances individual and family interests, to inform more culturally informed end-of-life care within practical and policy paradigms.
{"title":"Exploring good death in China: A qualitative study from the perspectives of family members","authors":"Mingming Cheng , Qin Luo , Chao Fang , Alastair Comery , John Troyer","doi":"10.1016/j.socscimed.2025.117727","DOIUrl":"10.1016/j.socscimed.2025.117727","url":null,"abstract":"<div><div>China's emerging palliative care services are heavily influenced by Western models of palliative medicine, which emphasize dignity, autonomy and individuality. How palliative care is designed and provided, however, within the distinctively non-Western context of Chinese society has yet to be fully explored. To examine palliative care as a socio-cultural construct, this qualitative study investigates what a good death means in China from the perspective of bereaved family members. Thirty-one semi-structured interviews were conducted, followed by an inductive thematic analysis. Four main themes were identified: (1) Negotiating Autonomy in Family Contexts; (2) Familial Obligations and Cultural Practices; (3) Security and Resource Stability; (4) Meaning and Legacy at the End of Life. We found that, for family members, a good death is primarily mediated by the objectives of family harmony and continuity, often overriding the dying person's individual wishes. This emphasis on the family can act as a double-edged sword, both supporting and complicating the experience of death in China. Based on our findings, we propose a social support system that balances individual and family interests, to inform more culturally informed end-of-life care within practical and policy paradigms.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117727"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143208150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2024.117669
Tamanna Majid , Ahmed Ehsanur Rahman , Janet E. Perkins
Integrated Management of Childhood Illness (IMCI) is a strategy that aims to standardise clinical assessment and treatment of sick children. In this article, we examine the aspirations and unfolding of introducing a revised IMCI strategy in Bangladesh. We carried out ethnographic fieldwork among project implementors and in IMCI health service delivery settings in Kushtia district, including 36 semi-structured interviews with policymakers, programmers and IMCI service providers. We focused on the IMCI register, a paper-based technology designed to guide health service providers to enact standardised treatment and decision-making during healthcare encounters. During its design, policymakers and programmers aspired to produce a register that would be simple to use and guide health service providers to enact care uniformly. However, simplicity was muddled by the range of agendas and negotiations around what should be standardised and how. In health facility settings, despite national approval, the register's legitimacy was ambiguous as it was perceived as a materialisation of an external project, and its introduction did little to reconfigure how providers enacted health care. However, it operated as a powerful material to make claims about the types of care that matter, as providers saw the work of completing the register as compromising their ability to do the highly valued work of interfacing with patients. Moreover, the register became a tool to negotiate and index intra-institutional hierarchies. Rather than pointing to project failure, these findings reflect the nature of technologies, which are always reconfigured within the systems and social worlds in which they are embedded.
{"title":"The promises and limits of standardisation through paper-based technologies: An ethnographic exploration of integrated management of childhood illness (IMCI) in Bangladesh","authors":"Tamanna Majid , Ahmed Ehsanur Rahman , Janet E. Perkins","doi":"10.1016/j.socscimed.2024.117669","DOIUrl":"10.1016/j.socscimed.2024.117669","url":null,"abstract":"<div><div>Integrated Management of Childhood Illness (IMCI) is a strategy that aims to standardise clinical assessment and treatment of sick children. In this article, we examine the aspirations and unfolding of introducing a revised IMCI strategy in Bangladesh. We carried out ethnographic fieldwork among project implementors and in IMCI health service delivery settings in Kushtia district, including 36 semi-structured interviews with policymakers, programmers and IMCI service providers. We focused on the IMCI register, a paper-based technology designed to guide health service providers to enact standardised treatment and decision-making during healthcare encounters. During its design, policymakers and programmers aspired to produce a register that would be simple to use and guide health service providers to enact care uniformly. However, simplicity was muddled by the range of agendas and negotiations around what should be standardised and how. In health facility settings, despite national approval, the register's legitimacy was ambiguous as it was perceived as a materialisation of an external project, and its introduction did little to reconfigure how providers enacted health care. However, it operated as a powerful material to make claims about the types of care that matter, as providers saw the work of completing the register as compromising their ability to do the highly valued work of interfacing with patients. Moreover, the register became a tool to negotiate and index intra-institutional hierarchies. Rather than pointing to project failure, these findings reflect the nature of technologies, which are always reconfigured within the systems and social worlds in which they are embedded.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117669"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2024.117666
Alexa B. D'Angelo , Michelle Dearolf , Arjee Restar , Emma K. Tsui , Naomi Zewde , Christian Grov
Over the past decade, access to and insurance coverage for gender-affirming medical and surgical treatment for transgender (trans) individuals in the U.S. has improved. Despite this, trans individuals continue to experience insurance-related barriers to gender-affirming care (GAC)—and in particular, transmasculine individuals may face gender-specific barriers resulting from regulations on masculinizing hormones. In this study, we interviewed transmasculine individuals from across the U.S. about their gender-affirming care experiences with a focus on insurance, payment and policy-related barriers to care. Interviews were conducted via video-conferencing software, analyzed using a codebook approach to thematic analysis, and contextualized within a broader analysis of the policy landscape dictating coverage for gender-affirming care. Participants reported insurance denials for gender-affirming care, as well as challenges with prior-authorization requirements, letter requirements, restrictive formulary lists and other challenges that complicated and/or barred access to care. Many discussed adaptive strategies to these challenges, which included utilizing community resources and knowledge, as well as receiving material support from family, friends, and partners, and developing technical and interpersonal savvy skills in response to insurance challenges. Participants expressed a range of emotional responses with regard to payment and related challenges, from annoyance and frustration to hopelessness. Our findings illuminate the persisting challenges that transmasculine individuals face when attempting to access and pay for gender-affirming care, despite improvements in insurance coverage and legal protections in recent years resulting from the Bostock ruling by the Supreme Court and the expansion of the ACA’s Section 1557.
{"title":"Navigating payment and policy barriers to gender-affirming care for transmasculine individuals: A qualitative study and policy assessment","authors":"Alexa B. D'Angelo , Michelle Dearolf , Arjee Restar , Emma K. Tsui , Naomi Zewde , Christian Grov","doi":"10.1016/j.socscimed.2024.117666","DOIUrl":"10.1016/j.socscimed.2024.117666","url":null,"abstract":"<div><div>Over the past decade, access to and insurance coverage for gender-affirming medical and surgical treatment for transgender (trans) individuals in the U.S. has improved. Despite this, trans individuals continue to experience insurance-related barriers to gender-affirming care (GAC)—and in particular, transmasculine individuals may face gender-specific barriers resulting from regulations on masculinizing hormones. In this study, we interviewed transmasculine individuals from across the U.S. about their gender-affirming care experiences with a focus on insurance, payment and policy-related barriers to care. Interviews were conducted via video-conferencing software, analyzed using a codebook approach to thematic analysis, and contextualized within a broader analysis of the policy landscape dictating coverage for gender-affirming care. Participants reported insurance denials for gender-affirming care, as well as challenges with prior-authorization requirements, letter requirements, restrictive formulary lists and other challenges that complicated and/or barred access to care. Many discussed adaptive strategies to these challenges, which included utilizing community resources and knowledge, as well as receiving material support from family, friends, and partners, and developing technical and interpersonal savvy skills in response to insurance challenges. Participants expressed a range of emotional responses with regard to payment and related challenges, from annoyance and frustration to hopelessness. Our findings illuminate the persisting challenges that transmasculine individuals face when attempting to access and pay for gender-affirming care, despite improvements in insurance coverage and legal protections in recent years resulting from the <em>Bostock</em> ruling by the Supreme Court and the expansion of the ACA’s Section 1557.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117666"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.socscimed.2024.117621
Rebecca Meiksin, Ruth Ponsford, Nambusi Kyegombe, Chris Bonell
Dating and relationship violence (DRV) among young people is widespread. DRV is associated with subsequent mental ill health, substance use and sexual risk among girls and boys and is a leading cause of morbidity and mortality among girls globally. Harmful social norms are widely recognised for their role in sustaining DRV, and interventions often seek to change these. However, little evidence is available to suggest which specific norms are most salient and where protective norms might be strengthened. We conducted, audio-recorded and transcribed consultations and semi-structured interviews with students (years 9 and 10), school staff and parents/carers from ten secondary schools in England. We also audio-recorded discussions in staff DRV trainings in four of these schools. Data collection took place between April 2017 and July 2018. This research explored participant accounts of social norms relating to gender and to DRV in schools and their influence on DRV behaviours. Drawing on Giddens' structuration theory, our thematic analysis found that sexist social norms subjugating girls to boys facilitated gendered practices of harassment and abuse, including DRV; and that these practices, in turn, reproduced this gendered power structure. Our data suggest that while physical DRV is socially proscribed, norms supporting controlling behaviours and inhibiting disclosure of victimisation directly underpin DRV. They further suggest that indirectly, gender norms concerning cross-gender friendships; sexual harassment; the policing of girls’ sexuality; homophobic abuse; and dominance, control and sexual activity as masculine ideals indirectly sustain DRV. Accounts demonstrated that students and staff challenge harmful norms, but that these efforts can be ineffective and socially punished. Our findings can inform DRV interventions, which should draw on evidence to foster protective norms and shift those that sustain DRV.
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