Pub Date : 2024-10-25DOI: 10.1016/j.socscimed.2024.117445
Against the backdrop of global aging and escalating pressures on family caregiving, this study delves into the impact of health check-ups for the elderly on alleviating the objective burden of family caregiving by analyzing China's Free Health Check-up Program (FHCP). Using an unbalanced panel dataset spanning 2011, 2013, 2015, 2018, and 2020, comprising approximately 35,000 observations of the elderly population aged 65 and above, the research employs the Difference-in-Differences method. The research reveals a significant 9.18% reduction in family caregiving time following the implementation of FHCP, primarily attributed to the enhancement of the elderly's self-care abilities and health awareness. This study elucidates, for the first time, the efficacy and mechanisms of health check-ups in alleviating caregiving objective burdens, providing evidence for the formulation of pertinent policies. It underscores the significance of routine health check-ups as a public health intervention in supporting family caregivers and addressing the challenges of aging.
{"title":"Easing caregiver strain: The power of health check-ups","authors":"","doi":"10.1016/j.socscimed.2024.117445","DOIUrl":"10.1016/j.socscimed.2024.117445","url":null,"abstract":"<div><div>Against the backdrop of global aging and escalating pressures on family caregiving, this study delves into the impact of health check-ups for the elderly on alleviating the objective burden of family caregiving by analyzing China's Free Health Check-up Program (FHCP). Using an unbalanced panel dataset spanning 2011, 2013, 2015, 2018, and 2020, comprising approximately 35,000 observations of the elderly population aged 65 and above, the research employs the Difference-in-Differences method. The research reveals a significant 9.18% reduction in family caregiving time following the implementation of FHCP, primarily attributed to the enhancement of the elderly's self-care abilities and health awareness. This study elucidates, for the first time, the efficacy and mechanisms of health check-ups in alleviating caregiving objective burdens, providing evidence for the formulation of pertinent policies. It underscores the significance of routine health check-ups as a public health intervention in supporting family caregivers and addressing the challenges of aging.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555026","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 : 2024-10-24DOI: 10.1016/j.socscimed.2024.117440
Repression comes with costs, such as reducing regime legitimacy and citizen conformity. The COVID-19 pandemic was an opportunity and a pretext for authoritarian regimes to repress their populations at a low cost. This paper examines the case of Hong Kong, where restriction-testing declarations (RTDs) were used as a lockdown measure to facilitate mandatory testing for the virus from January 2021 to September 2022. Despite the government's claim that RTDs were implemented for public health reasons, statistical analyses showed that Hong Kong districts that opposed the regime or those with a mobilization legacy were more likely to be subject to RTDs, with the opposition district effect present only when COVID-19 infections were low. These RTDs highlight the authoritarian regime's tradeoff in using a nonpolitical measure to achieve its political aims and illustrates the enduring impact of past election and mobilization activities on the choice of selective repression sites in Hong Kong.
{"title":"From public health to political repression: COVID-19 lockdown measure in Hong Kong's opposition districts","authors":"","doi":"10.1016/j.socscimed.2024.117440","DOIUrl":"10.1016/j.socscimed.2024.117440","url":null,"abstract":"<div><div>Repression comes with costs, such as reducing regime legitimacy and citizen conformity. The COVID-19 pandemic was an opportunity and a pretext for authoritarian regimes to repress their populations at a low cost. This paper examines the case of Hong Kong, where restriction-testing declarations (RTDs) were used as a lockdown measure to facilitate mandatory testing for the virus from January 2021 to September 2022. Despite the government's claim that RTDs were implemented for public health reasons, statistical analyses showed that Hong Kong districts that opposed the regime or those with a mobilization legacy were more likely to be subject to RTDs, with the opposition district effect present only when COVID-19 infections were low. These RTDs highlight the authoritarian regime's tradeoff in using a nonpolitical measure to achieve its political aims and illustrates the enduring impact of past election and mobilization activities on the choice of selective repression sites in Hong Kong.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548493","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 : 2024-10-24DOI: 10.1016/j.socscimed.2024.117444
Background
Addressing individuals with a disability can entail the use of person-first (person with a disability) or identity-first language (disabled person). However, there has been debate about use of these terms, yet there is a lack of evidence to inform preference across people with a broad range of health conditions, demographics, or health related factors.
Methods
A 42-item survey measuring demographic and health condition factors, implicit and explicit preference for person-first and identity-first language use was open for completion by individuals with a self-reported health condition between July 7, 2021 and November 30, 2021. Recruitment was undertaken via posts on relevant social media sites and through community support and advocacy organisations.
Results
Data analysis included responses from 875 valid surveys. Mean age of participants was 39.7 (SD: 13.7) years. There were 89 (10.2%) male, 637 female (72.8%) and 149 (17.0%) non-binary/other participants. When referring to themselves, participants most often reported use of identity first language (n = 335, 42.2%), followed by person-first language (n = 272, 34.1%), then both interchangeably (118, 23.7%). When referring to others, participants most often used person first language (n = 312, 39.4%), followed by both interchangeably (269, 34.0%), then identity-first language (n = 211, 26.6%). Disability language preference varied across health conditions, with participants with neurodevelopmental conditions most likely to use identity-first language and participants with digestive conditions most often preferencing person-first language. Participants who were younger and of non-binary gender preferred use of identity-first language. Appropriate use of identity-first language was rated significantly higher for people with a disability/health condition and family/friends than for third-party representatives, including healthcare professionals, educators, media and the general public.
Conclusion
Findings highlight the need to understand health condition and disability language preference in a more nuanced way to promote respectful language use when addressing people in the context of their disability/health condition.
{"title":"Person-first and identity-first disability language: Informing client centred care","authors":"","doi":"10.1016/j.socscimed.2024.117444","DOIUrl":"10.1016/j.socscimed.2024.117444","url":null,"abstract":"<div><h3>Background</h3><div>Addressing individuals with a disability can entail the use of person-first (person with a disability) or identity-first language (disabled person). However, there has been debate about use of these terms, yet there is a lack of evidence to inform preference across people with a broad range of health conditions, demographics, or health related factors.</div></div><div><h3>Methods</h3><div>A 42-item survey measuring demographic and health condition factors, implicit and explicit preference for person-first and identity-first language use was open for completion by individuals with a self-reported health condition between July 7, 2021 and November 30, 2021. Recruitment was undertaken via posts on relevant social media sites and through community support and advocacy organisations.</div></div><div><h3>Results</h3><div>Data analysis included responses from 875 valid surveys. Mean age of participants was 39.7 (SD: 13.7) years. There were 89 (10.2%) male, 637 female (72.8%) and 149 (17.0%) non-binary/other participants. When referring to themselves, participants most often reported use of identity first language (n = 335, 42.2%), followed by person-first language (n = 272, 34.1%), then both interchangeably (118, 23.7%). When referring to others, participants most often used person first language (n = 312, 39.4%), followed by both interchangeably (269, 34.0%), then identity-first language (n = 211, 26.6%). Disability language preference varied across health conditions, with participants with neurodevelopmental conditions most likely to use identity-first language and participants with digestive conditions most often preferencing person-first language. Participants who were younger and of non-binary gender preferred use of identity-first language. Appropriate use of identity-first language was rated significantly higher for people with a disability/health condition and family/friends than for third-party representatives, including healthcare professionals, educators, media and the general public.</div></div><div><h3>Conclusion</h3><div>Findings highlight the need to understand health condition and disability language preference in a more nuanced way to promote respectful language use when addressing people in the context of their disability/health condition.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523398","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 : 2024-10-24DOI: 10.1016/j.socscimed.2024.117439
While self-rated health (SRH) has long been known to predict mortality in adult populations, the age of respondents plays an interesting and complex role in both explaining and modifying the association. The objective of this study is to test for differences by age in the association of SRH with all-cause mortality. Because much of the research has been conducted with older samples, a wider age range of adults may show that some age groups have more predictive SRH than others. We estimated Cox proportional hazards models to determine if SRH in 1999 predicted survival to 2021 differently based on age, using data from the Panel Study of Income Dynamics. The sample consisted of 5843 respondents aged 25 to 97 who were interviewed in 1999 and followed for survival until 2021. We included demographic and socioeconomic factors, physical health and mental health indicators, and health risk behaviors as covariates to assess their potential mediating role in the predictive ability of SRH. The results showed a significant interaction between SRH and age, with larger and more significant hazards for those aged 40–54 and 55–74. There were no significant effects at all for the youngest group and virtually none for the oldest group. For example, for individuals aged 40–54, there were significant HRs for poor health (2.49, 95% CI 1.05, 5.89) and fair health (1.95, 95% CI 1.11, 3.42) compared to excellent health in the fully adjusted models. Our findings suggest that age group differences in the predictiveness of SRH may reflect an absence of health knowledge and experience for younger respondents, and a survivor bias for the oldest age group due to the lifetime elimination of those with poor health.
众所周知，自评健康状况（SRH）可以预测成年人的死亡率，而受访者的年龄在解释和改变这种关联方面起着有趣而复杂的作用。本研究的目的是检验自评定健康状况与全因死亡率之间的关系在年龄上是否存在差异。由于大部分研究都是针对年龄较大的样本进行的，因此更广泛的成人年龄范围可能会显示出某些年龄组的 SRH 比其他年龄组更具预测性。我们利用 "收入动态面板研究"（Panel Study of Income Dynamics）的数据估算了 Cox 比例危险模型，以确定 1999 年的 SRH 预测 2021 年的存活率是否因年龄而异。样本包括 5843 名年龄在 25 岁至 97 岁之间的受访者，他们在 1999 年接受了访谈，并在 2021 年之前对其生存情况进行了跟踪。我们将人口和社会经济因素、身体健康和心理健康指标以及健康风险行为作为协变量，以评估它们在性健康和生殖健康预测能力中的潜在中介作用。结果显示，性健康和生殖健康与年龄之间存在明显的交互作用，40-54 岁和 55-74 岁人群的危害更大、更明显。最年轻的群体没有明显的影响，最年长的群体几乎没有影响。例如，对于 40-54 岁的人，在完全调整模型中，健康状况差（2.49，95% CI 1.05，5.89）和健康状况一般（1.95，95% CI 1.11，3.42）与健康状况优相比有显著的危险性。我们的研究结果表明，性健康和生殖健康预测性方面的年龄组差异可能反映了年轻受访者缺乏健康知识和经验，以及由于健康状况差的受访者终生被淘汰而导致的最年长年龄组的幸存者偏差。
{"title":"Self-rated health predicts mortality -- but it depends on your age","authors":"","doi":"10.1016/j.socscimed.2024.117439","DOIUrl":"10.1016/j.socscimed.2024.117439","url":null,"abstract":"<div><div>While self-rated health (SRH) has long been known to predict mortality in adult populations, the age of respondents plays an interesting and complex role in both explaining and modifying the association. The objective of this study is to test for differences by age in the association of SRH with all-cause mortality. Because much of the research has been conducted with older samples, a wider age range of adults may show that some age groups have more predictive SRH than others. We estimated Cox proportional hazards models to determine if SRH in 1999 predicted survival to 2021 differently based on age, using data from the Panel Study of Income Dynamics. The sample consisted of 5843 respondents aged 25 to 97 who were interviewed in 1999 and followed for survival until 2021. We included demographic and socioeconomic factors, physical health and mental health indicators, and health risk behaviors as covariates to assess their potential mediating role in the predictive ability of SRH. The results showed a significant interaction between SRH and age, with larger and more significant hazards for those aged 40–54 and 55–74. There were no significant effects at all for the youngest group and virtually none for the oldest group. For example, for individuals aged 40–54, there were significant HRs for poor health (2.49, 95% CI 1.05, 5.89) and fair health (1.95, 95% CI 1.11, 3.42) compared to excellent health in the fully adjusted models. Our findings suggest that age group differences in the predictiveness of SRH may reflect an absence of health knowledge and experience for younger respondents, and a survivor bias for the oldest age group due to the lifetime elimination of those with poor health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142548494","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 : 2024-10-24DOI: 10.1016/j.socscimed.2024.117443
Background
Security guards (SGs) play a significant role in health care and are an integral part of many psychiatric institutions. While their main duty is to ensure service users' (SUs) and staff's safety and protect the premises, they are also called upon for other tasks, often ones for which they are not adequately trained. This study aimed to explore the roles, formal and informal tasks performed, training, working conditions and well-being of SGs working in psychiatric services.
Methods
Guided interviews were conducted with n = 12 SGs and n = 18 mental healthcare providers (MHCPs) at a psychiatric hospital in the Western Cape of South Africa. All interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach.
Results
In addition to ensuring safety, SGs take on numerous informal tasks, often for which they are not adequately trained and which formally fall under the purview of other MHCPs, mostly nurses, including talking with SUs about their mental health issues, dressing, showering, feeding, and administering medication. SGs also serve informally as interpreters, raising ethical concerns regarding accuracy and confidentiality. SGs lack formal training for working in psychiatric services and handling aggressive SUs, which may lead to increased violence instead of de-escalation and, in the worst case, injuries. SGs work under precarious working conditions (i.e. low salary, outsourced employment, absence of labour rights and job insecurity) and lack professional recognition, potentially leading to lower job satisfaction and increased emotional distress.
Conclusion
Addressing the challenges outlined in the study requires collaborative efforts between government, psychiatric institutions, private security companies, SGs and MHCPs. The establishment of clear roles, implementation of comprehensive formal training, psychosocial support and improved working conditions, particularly in-house employment, higher pay, increased employee rights and job security, are needed.
背景：保安员（SGs）在医疗保健中发挥着重要作用，是许多精神病院不可或缺的一部分。虽然他们的主要职责是确保服务使用者（SUs）和工作人员的安全并保护场所，但他们也被要求执行其他任务，而这些任务往往没有经过适当的培训。本研究旨在探讨在精神科服务机构工作的秘书长的角色、执行的正式和非正式任务、培训、工作条件和福利：对南非西开普省一家精神病院的 n = 12 名秘书长和 n = 18 名精神卫生保健提供者（MHCPs）进行了有指导的访谈。所有访谈均进行了录音、逐字记录，并采用主题分析法进行了分析：除了确保安全之外，秘书长还承担了许多非正式的任务，这些任务往往没有经过适当的培训，而正式的任务则属于其他精神健康护理人员（主要是护士）的职责范围，其中包括与 SU 谈论他们的精神健康问题、穿衣、洗澡、喂食和用药。SG 也非正式地充当口译员，这就引起了有关准确性和保密性的伦理问题。SG 缺乏在精神科工作和处理具有攻击性的 SU 的正规培训，这可能会导致暴力事件的增加，而不是缓和，在最坏的情况下还会造成伤害。秘书长在不稳定的工作条件下工作（即低工资、外包工作、缺乏劳动权利和工作不稳定），缺乏专业认可，可能导致工作满意度降低和情绪困扰增加：要应对研究中概述的挑战，需要政府、精神病院、私营保安公司、秘书长和医护人员通力合作。需要确立明确的角色、实施全面的正规培训、提供社会心理支持和改善工作条件，特别是内部就业、提高薪酬、增加员工权利和工作保障。
{"title":"“They are not even called by name”: Security guards in a South African psychiatric hospital","authors":"","doi":"10.1016/j.socscimed.2024.117443","DOIUrl":"10.1016/j.socscimed.2024.117443","url":null,"abstract":"<div><h3>Background</h3><div>Security guards (SGs) play a significant role in health care and are an integral part of many psychiatric institutions. While their main duty is to ensure service users' (SUs) and staff's safety and protect the premises, they are also called upon for other tasks, often ones for which they are not adequately trained. This study aimed to explore the roles, formal and informal tasks performed, training, working conditions and well-being of SGs working in psychiatric services.</div></div><div><h3>Methods</h3><div>Guided interviews were conducted with n = 12 SGs and n = 18 mental healthcare providers (MHCPs) at a psychiatric hospital in the Western Cape of South Africa. All interviews were audio recorded, transcribed verbatim and analyzed using a thematic analysis approach.</div></div><div><h3>Results</h3><div>In addition to ensuring safety, SGs take on numerous informal tasks, often for which they are not adequately trained and which formally fall under the purview of other MHCPs, mostly nurses, including talking with SUs about their mental health issues, dressing, showering, feeding, and administering medication. SGs also serve informally as interpreters, raising ethical concerns regarding accuracy and confidentiality. SGs lack formal training for working in psychiatric services and handling aggressive SUs, which may lead to increased violence instead of de-escalation and, in the worst case, injuries. SGs work under precarious working conditions (i.e. low salary, outsourced employment, absence of labour rights and job insecurity) and lack professional recognition, potentially leading to lower job satisfaction and increased emotional distress.</div></div><div><h3>Conclusion</h3><div>Addressing the challenges outlined in the study requires collaborative efforts between government, psychiatric institutions, private security companies, SGs and MHCPs. The establishment of clear roles, implementation of comprehensive formal training, psychosocial support and improved working conditions, particularly in-house employment, higher pay, increased employee rights and job security, are needed.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570048","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 : 2024-10-24DOI: 10.1016/j.socscimed.2024.117442
Armed conflicts increase distress levels among affected populations, particularly impacting refugees who often face barriers to accessing psychological support. We evaluate an online version of a previously tested in-person and endorsed for online adaptation by the WHO Self-Help Plus (SH+) program among Ukrainian refugees dispersed across 17 countries, internally displaced and not displaced Ukrainians. This is the first randomized controlled trial to test an online psychological intervention simultaneously on refugees, internally displaced, and non-displaced conflict-affected populations. This study is an online two-arm, individually randomized controlled trial among participants above 18 years old in Ukraine or EU countries who were randomly assigned to receive either the Self-Help Online (SHO) intervention and passive informational resource or the passive informational resource alone. We recruited 652 participants starting the program on July 7th, 2022. The analysis focused on 292 participants who completed the final survey one week after the end of the program. Results indicated significant distress reduction among refugees (β −2.16, 95% CI −4.17 to −0.16; p = 0.03; d −0.47) but not among internally displaced in Ukraine (β 0.56, 95% CI −1.1 to 2.99; p = 0.17; d 0.2) or non-displaced participants in Ukraine (β 0.2, 95% CI −0.95 to 1.35; p = 0.73; d 0.08). The effect size in stress reduction for refugees was comparable to other similar interventions but with lower average costs. The average cost per participant was €11, with €46.16 for each benefiting (refugee) participant, suggesting cost-effectiveness for scale-up. These findings suggest that Self-Help Online is an effective psychological intervention for reducing stress among geographically dispersed refugees at a low cost. We also find that the online delivery format of psychological interventions is feasible for internally displaced and non-displaced conflict-affected populations.
{"title":"A low-cost digital first aid tool to reduce psychological distress in refugees: A multi-country randomized controlled trial of self-help online in the first months after the invasion of Ukraine","authors":"","doi":"10.1016/j.socscimed.2024.117442","DOIUrl":"10.1016/j.socscimed.2024.117442","url":null,"abstract":"<div><div>Armed conflicts increase distress levels among affected populations, particularly impacting refugees who often face barriers to accessing psychological support. We evaluate an online version of a previously tested in-person and endorsed for online adaptation by the WHO Self-Help Plus (SH+) program among Ukrainian refugees dispersed across 17 countries, internally displaced and not displaced Ukrainians. This is the first randomized controlled trial to test an online psychological intervention simultaneously on refugees, internally displaced, and non-displaced conflict-affected populations. This study is an online two-arm, individually randomized controlled trial among participants above 18 years old in Ukraine or EU countries who were randomly assigned to receive either the Self-Help Online (SHO) intervention and passive informational resource or the passive informational resource alone. We recruited 652 participants starting the program on July 7th, 2022. The analysis focused on 292 participants who completed the final survey one week after the end of the program. Results indicated significant distress reduction among refugees (β −2.16, 95% CI −4.17 to −0.16; p = 0.03; d −0.47) but not among internally displaced in Ukraine (β 0.56, 95% CI −1.1 to 2.99; p = 0.17; d 0.2) or non-displaced participants in Ukraine (β 0.2, 95% CI −0.95 to 1.35; p = 0.73; d 0.08). The effect size in stress reduction for refugees was comparable to other similar interventions but with lower average costs. The average cost per participant was €11, with €46.16 for each benefiting (refugee) participant, suggesting cost-effectiveness for scale-up. These findings suggest that Self-Help Online is an effective psychological intervention for reducing stress among geographically dispersed refugees at a low cost. We also find that the online delivery format of psychological interventions is feasible for internally displaced and non-displaced conflict-affected populations.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142555027","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 : 2024-10-21DOI: 10.1016/j.socscimed.2024.117434
Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12–29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (N = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.
{"title":"Racism-related experiences and substance use: A systematic and meta-analytic review","authors":"","doi":"10.1016/j.socscimed.2024.117434","DOIUrl":"10.1016/j.socscimed.2024.117434","url":null,"abstract":"<div><div>Examinations highlighting interpersonal racism-related experiences as risk factors for substance use are well documented, particularly for alcohol use. The associations between racism-related experiences across other levels of influence (e.g., historical trauma, online, internalized) and use of other types of substances, while emerging, have yielded mixed findings. The present systematic review and meta-analyses examined the associations between multilevel racism-related experiences and different types of substances including substance use overall, alcohol, binge drinking, tobacco/nicotine, cannabis, illicit drugs, and polysubstance use among ethnoracially minoritized adolescents and emerging adults (12–29 years old). A systematic literature search and the Newcastle-Ottawa Scale (NOS) were used to identify, assess quality, and bias of included articles. Random-effects meta-analyses estimated pooled effect sizes for seven substance use outcomes and by age, sex, and race/ethnicity. Out of a total of 3190 articles, 91 (<em>N</em> = 190,065 participants) met inclusion criteria, 79 of which were included in the meta-analysis. The studies included were predominantly cross-sectional, school-based samples, and focused on Black individuals. Most examined interpersonal racism and few examined online and historical forms of racism. Meta-analyses demonstrated a significant positive association, with a small pooled effect size, between racism-related experiences and each substance use outcome. Moderations by age, sex, and race/ethnicity were found. Racism-related experiences are a risk factor for substance use among ethnoracially minoritized adolescents and emerging adults. Interventions addressing racism-related experiences across multiple dimensions are critical for the prevention and treatment of substance use among ethnoracially minoritized communities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511367","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 : 2024-10-21DOI: 10.1016/j.socscimed.2024.117437
Puerto Ricans are underrepresented in genetic research. This underrepresentation denies Puerto Ricans the benefit from therapeutic developments that could mitigate health disparities arising from conditions for which genetically-derived treatments exist. The Puerto Rican diaspora, especially post-2017 due to economic and environmental crises, has expanded within the USA. Prior research suggests that Latin American diaspora communities are less likely to participate in genetic research. We hypothesized, specifically, that the Puerto Rican diaspora in the USA would be less likely to participate in genetic research than would Puerto Ricans in their homeland's archipelago, and that accounting for social and cultural determinants related to the diaspora experience would mitigate this disparity. We implemented an analytical cross-sectional study of archipelago-residing Puerto Ricans and of the USA-residing diaspora to evaluate this hypothesis. With 1582 Puerto Ricans (723 in Puerto Rico, 859 in the USA), we found that while most participants would participate in genetic research, participation rates varied significantly by diaspora status. Puerto Ricans born and living in the USA were initially more likely to decline participation compared to those in Puerto Rico (OR = 1.54, p < 0.01). However, once adjusted for social and cultural variables, this difference was eliminated (aOR = 1.08, p = n.s.). The factors influencing non-participation include oppression, discrimination, distrust, and social determinants, aligning with the theory of minoritization. An important community in the USA and in the world, Puerto Ricans have the right to participate in well-conducted research and to benefit from its findings, particularly around topics that could help address existing disparities in health outcomes.
{"title":"Social determinants of participation in genetic research among Puerto Ricans and in the Puerto Rican diaspora","authors":"","doi":"10.1016/j.socscimed.2024.117437","DOIUrl":"10.1016/j.socscimed.2024.117437","url":null,"abstract":"<div><div>Puerto Ricans are underrepresented in genetic research. This underrepresentation denies Puerto Ricans the benefit from therapeutic developments that could mitigate health disparities arising from conditions for which genetically-derived treatments exist. The Puerto Rican diaspora, especially post-2017 due to economic and environmental crises, has expanded within the USA. Prior research suggests that Latin American diaspora communities are less likely to participate in genetic research. We hypothesized, specifically, that the Puerto Rican diaspora in the USA would be less likely to participate in genetic research than would Puerto Ricans in their homeland's archipelago, and that accounting for social and cultural determinants related to the diaspora experience would mitigate this disparity. We implemented an analytical cross-sectional study of archipelago-residing Puerto Ricans and of the USA-residing diaspora to evaluate this hypothesis. With 1582 Puerto Ricans (723 in Puerto Rico, 859 in the USA), we found that while most participants would participate in genetic research, participation rates varied significantly by diaspora status. Puerto Ricans born and living in the USA were initially more likely to decline participation compared to those in Puerto Rico (OR = 1.54, p < 0.01). However, once adjusted for social and cultural variables, this difference was eliminated (aOR = 1.08, p = n.s.). The factors influencing non-participation include oppression, discrimination, distrust, and social determinants, aligning with the theory of minoritization. An important community in the USA and in the world, Puerto Ricans have the right to participate in well-conducted research and to benefit from its findings, particularly around topics that could help address existing disparities in health outcomes.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511299","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 : 2024-10-20DOI: 10.1016/j.socscimed.2024.117431
Introduction
Access to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies.
Methods
In 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically.
Results
Participants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation.
Conclusion
Although sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.
{"title":"The adoption and implementation of local government planning policy to manage hot food takeaways near schools in England: A qualitative process evaluation","authors":"","doi":"10.1016/j.socscimed.2024.117431","DOIUrl":"10.1016/j.socscimed.2024.117431","url":null,"abstract":"<div><h3>Introduction</h3><div>Access to hot food takeaways, particularly near schools, is of growing concern for policymakers seeking to reduce childhood obesity globally. In England, United Kingdom (UK), local government jurisdictions are implementing planning policies to reduce access by restricting or denying planning permission for new takeaway outlets near schools. We used a qualitative approach to explore local government officers’ perspectives on the barriers to and facilitators of the adoption, implementation, and perceived effectiveness of these policies.</div></div><div><h3>Methods</h3><div>In 2021–2022, we conducted semi-structured interviews with 29 local planning (‘planners’) and public health government officers from 15 different local authorities across England who adopted a policy to restrict new takeaways. Data were analysed thematically.</div></div><div><h3>Results</h3><div>Participants explained that they mostly thought the policies facilitated the refusal of applications for new takeaways near schools. However, participants speculated that businesses identified alternative opportunities to operate including functioning as ‘restaurants’ or within other locations. Effective working relationships between planners and public health officers were important for adoption and implementation, although planning and public health agendas did not always align and there were tensions between economic development and health improvement goals. The policy was adapted to suit local needs and priorities; in some cases, the policy was not used in areas where economic growth was prioritised. Clarity in policy wording and establishing a formal process for implementing policies including a designated individual responsible for checking and reviewing takeaway applications helped ensure consistency and confidence in policy implementation.</div></div><div><h3>Conclusion</h3><div>Although sometimes challenging, the policies were commonly described as feasible to implement. However, they may not completely prevent new takeaways opening, particularly where takeaways are relied upon to enhance local economies or where takeaway businesses find alternative ways to operate. Nevertheless, the policies can serve to shift the balance of power that currently favours commercial interests over public health priorities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511301","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 : 2024-10-19DOI: 10.1016/j.socscimed.2024.117428
Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.
We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).
Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3rd nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.
We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.
{"title":"Exploring the risks of fragmentation in health care markets – An analysis of inpatient care in Georgia","authors":"","doi":"10.1016/j.socscimed.2024.117428","DOIUrl":"10.1016/j.socscimed.2024.117428","url":null,"abstract":"<div><div>Private providers play an important role in health systems in low-and middle-income countries. In many such contexts, markets are characterized by a high number of relatively small private facilities. The potential risks from highly concentrated healthcare markets are well-researched, and feature in the “Theories of Harm” investigated by competition regulators. However, there is limited evidence on markets that exhibit substantial harms as a result of very low concentration. This paper explores the risks associated with such market fragmentation, drawing on the example of Georgia, which has a largely privatized provider network.</div><div>We used a mixed-method study design to analyze the inpatient market in Georgia. Market structure was described using administrative data on bed capacity and discharge numbers and geo-location data on travel time between facilities. The implications of the market structure were explored through in-depth interviews (n = 35) with policymakers, healthcare managers, and local experts and an anonymous online survey of similar groups (n = 97).</div><div>Georgia's inpatient sector is characterized by a high number of small hospitals in terms of bed numbers and inpatient volumes, mitigated to a limited degree by the presence of provider networks. Travel time to the 3<sup>rd</sup> nearest competitor was extremely short, ranging from 3 to 5 min in big cities to 10 min in small towns and 33 min in remote locations. The fragmented nature of the market, together with inadequate regulatory and purchasing mechanisms, was argued to exacerbate challenges in the availability and competence of clinical staff, while the financial challenges caused by intense competition encouraged wasteful marketing, harmful cost-cutting measures, and demand inducement.</div><div>We present “Theories of Harm” from market fragmentation, and argue that an effective policy response requires market-shaping activities using regulatory, financing, and purchasing mechanisms to encourage appropriate levels of market consolidation and so enhance quality, efficiency, and effective governance.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523397","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}
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