Losing a marital partner to death is a stressful life event with adverse health effects, including excess mortality risk. Previous research has focused on examining the widowhood effect within mixed-sex unions. Despite the increasing number of same-sex unions, gender composition within a union has not been considered when investigating the widowhood effect. Utilizing Danish Register Data from 1989 to 2022, this study investigates disparities in mortality risk following partner loss among surviving same-sex and mixed-sex partners. Within three years after widowhood, surviving same-sex partners may have a higher risk of dying than mixed-sex partners, although its statistical significance depends on comparison group. After three years, the mortality disadvantage for surviving same-sex over mixed-sex partners ends or reverses. The results suggest that, in the short term, the health implications of widowhood may be more profound for individuals who were in a same-sex union. Additional minority stress experienced during widowhood, a lack of social support, and higher health concordance among same-sex partners may contribute to increased vulnerability and, consequently, elevated mortality risk. Relationship dynamics within same-sex unions may also prepare surviving same-sex partners to eventually adapt to the new life situation the loss entails.
{"title":"The widowhood effect across diverse partnerships: Mortality risk after partner loss in same-sex and mixed-sex unions","authors":"Estelle Knoblauch , Stefanie Mollborn , Kaare Christensen , Anna Oksuzyan","doi":"10.1016/j.socscimed.2026.119053","DOIUrl":"10.1016/j.socscimed.2026.119053","url":null,"abstract":"<div><div>Losing a marital partner to death is a stressful life event with adverse health effects, including excess mortality risk. Previous research has focused on examining the widowhood effect within mixed-sex unions. Despite the increasing number of same-sex unions, gender composition within a union has not been considered when investigating the widowhood effect. Utilizing Danish Register Data from 1989 to 2022, this study investigates disparities in mortality risk following partner loss among surviving same-sex and mixed-sex partners. Within three years after widowhood, surviving same-sex partners may have a higher risk of dying than mixed-sex partners, although its statistical significance depends on comparison group. After three years, the mortality disadvantage for surviving same-sex over mixed-sex partners ends or reverses. The results suggest that, in the short term, the health implications of widowhood may be more profound for individuals who were in a same-sex union. Additional minority stress experienced during widowhood, a lack of social support, and higher health concordance among same-sex partners may contribute to increased vulnerability and, consequently, elevated mortality risk. Relationship dynamics within same-sex unions may also prepare surviving same-sex partners to eventually adapt to the new life situation the loss entails.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119053"},"PeriodicalIF":5.0,"publicationDate":"2026-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120805","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 : 2026-01-30DOI: 10.1016/j.socscimed.2026.119026
Yue Zhang , Jingjing Su
Subhealth (亚健康) refers to a liminal state between health and disease that, while lacking clear biomedical markers, has become a prominent target of intervention in China's healthcare landscape. This study examines the socio-political construction of subhealth by integrating bibliometric analysis with historical and political-economic perspectives. Drawing on a dataset of nearly 20,000 Chinese-language publications (1995–2022), complemented by discourse analysis of policy documents and academic literature, we analyze three interrelated dimensions: (1) the commercial and economic dynamics that enabled the proliferation of subhealth-related industries and wellness markets; (2) the scientization of Traditional Chinese Medicine (TCM), which legitimized subhealth through diagnostic standardization and biomedical frameworks; and (3) the institutional support by the Chinese state, which incorporated subhealth into public health campaigns and national development goals. By examining these dimensions together, we argue that subhealth has emerged as a hybrid construct shaped by the convergence of market incentives, scientific discourse, and state strategies. This case offers new insight into how medical categories are socially engineered and mobilized within a unique configuration of post-socialist governance and health reform.
{"title":"Nexus between biomedicalization and Traditional Chinese Medicine: conceptualization of subhealth","authors":"Yue Zhang , Jingjing Su","doi":"10.1016/j.socscimed.2026.119026","DOIUrl":"10.1016/j.socscimed.2026.119026","url":null,"abstract":"<div><div>Subhealth (亚健康) refers to a liminal state between health and disease that, while lacking clear biomedical markers, has become a prominent target of intervention in China's healthcare landscape. This study examines the socio-political construction of subhealth by integrating bibliometric analysis with historical and political-economic perspectives. Drawing on a dataset of nearly 20,000 Chinese-language publications (1995–2022), complemented by discourse analysis of policy documents and academic literature, we analyze three interrelated dimensions: (1) the commercial and economic dynamics that enabled the proliferation of subhealth-related industries and wellness markets; (2) the scientization of Traditional Chinese Medicine (TCM), which legitimized subhealth through diagnostic standardization and biomedical frameworks; and (3) the institutional support by the Chinese state, which incorporated subhealth into public health campaigns and national development goals. By examining these dimensions together, we argue that subhealth has emerged as a hybrid construct shaped by the convergence of market incentives, scientific discourse, and state strategies. This case offers new insight into how medical categories are socially engineered and mobilized within a unique configuration of post-socialist governance and health reform.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119026"},"PeriodicalIF":5.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108091","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 : 2026-01-30DOI: 10.1016/j.socscimed.2026.119040
Elizabeth Hornyak-Bell , Aliki Thomas , Allison Chrestensen , Andrea Quaiattini , Patrick Lavoie , Marie-Ève Caty , Marie-Josée Drolet , Annie Rochette , Elizabeth Anne Kinsella
Epistemic injustice, the unfair treatment of individuals in their capacity as knowers, has implications for the credibility, autonomy, and well-being of healthcare professionals. This scoping review addressed the following question: “What is known about epistemic injustice in healthcare professional practice as it relates to the experience of practitioners?”. Guided by Arksey & O'Malley's methodology (2005), we searched eight databases for English and French language publications from 2007 to 2024. Of the 4186 records retrieved, 30 papers met the inclusion criteria. Fifteen papers originated in North America, with twenty-seven published between 2020 and 2024. Epistemic injustice was predominantly conceptualized through Miranda Fricker's constructs of testimonial and hermeneutical injustice, with numerous studies building on or extending Fricker's conceptualizations, and introducing other theorists and evolving concepts. The papers used qualitative research methodologies and theoretical analysis/commentary approaches; none used quantitative or mixed methods designs. Five themes related to epistemic injustice in healthcare professional practice were identified: (1) hierarchy of epistemic credibility, (2) epistemic politics, (3) constrained agency of healthcare practitioners, (4) pressures to modify professional self or identity, and (5) complex interplay of intersectional and social identities. A sixth cross-cutting theme highlighted (6) approaches aimed at mitigating epistemic injustice. The findings highlight the contextual, complex, and often obscure nature of epistemic injustice in the knowledge sharing practices of healthcare professionals. The review underscores the need for a more nuanced and justice-oriented conceptualization of these dynamics, greater visibility of their impact in everyday practice, and structural and educational reforms to foster more equitable knowledge sharing environments.
{"title":"Epistemic injustice in healthcare professional practice: A scoping review","authors":"Elizabeth Hornyak-Bell , Aliki Thomas , Allison Chrestensen , Andrea Quaiattini , Patrick Lavoie , Marie-Ève Caty , Marie-Josée Drolet , Annie Rochette , Elizabeth Anne Kinsella","doi":"10.1016/j.socscimed.2026.119040","DOIUrl":"10.1016/j.socscimed.2026.119040","url":null,"abstract":"<div><div>Epistemic injustice, the unfair treatment of individuals in their capacity as knowers, has implications for the credibility, autonomy, and well-being of healthcare professionals. This scoping review addressed the following question: “What is known about epistemic injustice in healthcare professional practice as it relates to the experience of practitioners?”. Guided by Arksey & O'Malley's methodology (2005), we searched eight databases for English and French language publications from 2007 to 2024. Of the 4186 records retrieved, 30 papers met the inclusion criteria. Fifteen papers originated in North America, with twenty-seven published between 2020 and 2024. Epistemic injustice was predominantly conceptualized through Miranda Fricker's constructs of testimonial and hermeneutical injustice, with numerous studies building on or extending Fricker's conceptualizations, and introducing other theorists and evolving concepts. The papers used qualitative research methodologies and theoretical analysis/commentary approaches; none used quantitative or mixed methods designs. Five themes related to epistemic injustice in healthcare professional practice were identified: (1) hierarchy of epistemic credibility, (2) epistemic politics, (3) constrained agency of healthcare practitioners, (4) pressures to modify professional self or identity, and (5) complex interplay of intersectional and social identities. A sixth cross-cutting theme highlighted (6) approaches aimed at mitigating epistemic injustice. The findings highlight the contextual, complex, and often obscure nature of epistemic injustice in the knowledge sharing practices of healthcare professionals. The review underscores the need for a more nuanced and justice-oriented conceptualization of these dynamics, greater visibility of their impact in everyday practice, and structural and educational reforms to foster more equitable knowledge sharing environments.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119040"},"PeriodicalIF":5.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144278","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 : 2026-01-30DOI: 10.1016/j.socscimed.2026.119049
Jack G.R. Wippell , Dana L. Haynie , David Riedman
Gun violence is a leading cause of death among children and adolescents in the United States, and school shootings represent one of its most traumatic and visible manifestations. These events can generate severe and long-lasting consequences for children, but also extend beyond direct victims to affect entire communities. Yet responses to this public health crisis remain mired in political polarization: some advocate for stricter firearm regulations to limit opportunities for violence, while others promote expanded access in the name of deterrence. Meanwhile, limited prior empirical work has formally examined firearm legislation as a structural intervention capable of reducing school shooting risk. Integrating 20 years of data on K-12 school shootings (2000–2019) with that on state firearm legislation, we conduct a state-year panel analysis to examine how restrictive firearm laws (measured both as an aggregated restrictiveness index and partitioned by policy type) relate to the incidence of school shootings. Results show that the implementation of more restrictive gun laws is significantly associated with fewer school shootings, yetmeaningful heterogeneity emerges across policy types. Notably, none of the examined laws show evidence of increasing school shootings, contrary to deterrence claims. These findings align with prior literatures linking state firearm legislation and violence, and position firearm regulation as a potential structural intervention for preventing violence against children.
{"title":"Preventable tragedies: A longitudinal analysis of state firearm laws and K-12 school shootings in the United States (2000–2019)","authors":"Jack G.R. Wippell , Dana L. Haynie , David Riedman","doi":"10.1016/j.socscimed.2026.119049","DOIUrl":"10.1016/j.socscimed.2026.119049","url":null,"abstract":"<div><div>Gun violence is a leading cause of death among children and adolescents in the United States, and school shootings represent one of its most traumatic and visible manifestations. These events can generate severe and long-lasting consequences for children, but also extend beyond direct victims to affect entire communities. Yet responses to this public health crisis remain mired in political polarization: some advocate for stricter firearm regulations to limit opportunities for violence, while others promote expanded access in the name of deterrence. Meanwhile, limited prior empirical work has formally examined firearm legislation as a structural intervention capable of reducing school shooting risk. Integrating 20 years of data on K-12 school shootings (2000–2019) with that on state firearm legislation, we conduct a state-year panel analysis to examine how restrictive firearm laws (measured both as an aggregated <em>restrictiveness</em> index and partitioned by policy type) relate to the incidence of school shootings. Results show that the implementation of more restrictive gun laws is significantly associated with fewer school shootings, yetmeaningful heterogeneity emerges across policy types. Notably, none of the examined laws show evidence of increasing school shootings, contrary to deterrence claims. These findings align with prior literatures linking state firearm legislation and violence, and position firearm regulation as a potential structural intervention for preventing violence against children.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119049"},"PeriodicalIF":5.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182534","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 : 2026-01-30DOI: 10.1016/j.socscimed.2026.119023
Denise Anthony , Amanda Stanhaus
This study analyzes how U.S. healthcare organizations view regulatory changes to the accessibility of patient health information as part of the 21st Century Cures Act. Rulemaking for the Cures Act recommended a technical change that would enable vendors in the consumer marketplace outside the institutional context and special data protections of health care to gain access to private patient data. We examine organizational stakeholders’ comments during the Notice of Public Rulemaking to show how organizational actors both inside and outside of health care use the institutional values and relationships of health care versus the market to evaluate the impact of the technical change. Healthcare insiders use professional ethics and doctor-patient relationships to defend the status quo of data protections in health care. Outsiders, such as consumer health apps, use the logic and relationships of the marketplace to challenge clinical control of patient information as well as data protections and property rights over patient health data. Technical change alone does not alter the information order of health care, but it creates an opening to challenge the existing meaning and management of information and thereby potentially disrupt established institutions in health care in the United States.
{"title":"Disrupting the information order in health care: Institutions, policy regimes, and the value of data","authors":"Denise Anthony , Amanda Stanhaus","doi":"10.1016/j.socscimed.2026.119023","DOIUrl":"10.1016/j.socscimed.2026.119023","url":null,"abstract":"<div><div>This study analyzes how U.S. healthcare organizations view regulatory changes to the accessibility of patient health information as part of the <em>21</em>st <em>Century Cures Act</em>. Rulemaking for the <em>Cures Act</em> recommended a technical change that would enable vendors in the consumer marketplace outside the institutional context and special data protections of health care to gain access to private patient data. We examine organizational stakeholders’ comments during the Notice of Public Rulemaking to show how organizational actors both inside and outside of health care use the institutional values and relationships of health care versus the market to evaluate the impact of the technical change. Healthcare insiders use professional ethics and doctor-patient relationships to defend the <em>status quo</em> of data protections in health care. Outsiders, such as consumer health apps, use the logic and relationships of the marketplace to challenge clinical control of patient information as well as data protections and property rights over patient health data. Technical change alone does not alter the information order of health care, but it creates an opening to challenge the existing meaning and management of information and thereby potentially disrupt established institutions in health care in the United States.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"395 ","pages":"Article 119023"},"PeriodicalIF":5.0,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193048","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 : 2026-01-29DOI: 10.1016/j.socscimed.2026.119022
Takeru Shiroiwa , Yasuhiro Morii , Eri Hoshino , Tatsunori Murata , Richard Norman , Brendan Mulhern , Nan Luo , Donna Rowen , Takashi Fukuda
Health universalists believe that preference-based measure (PBM) instruments can be applied across cultures because they share similar health concepts in the world. This is the prevailing policy in PBM development. However, health pluralists refute this idea, as they argue that the concept and components of health differ depending on culture. To incorporate the pluralist view, we developed the Asian Preference-Based Measure-7 Dimensions (AP-7D), a “culture-specific” PBM for Asian countries. This survey aimed to address cultural differences in utility measurement by developing an AP-7D value set in Japan, as part of a series of AP-7D developments. This study used a web-based survey to evaluate AP-7D health states with a triplet discrete choice experiment (DCE). The design followed an established international protocol. We conducted the web-based survey and data collection in October 2024. Respondents aged 20–79 were recruited via quota sampling based on sex and age. A total of 2681 individuals were included in the DCE analysis. We applied a mixed logit model to the DCE data and obtained decrements for each level in each domain. The worst health state had an AP-7D value of −0.448. Pain/discomfort, mobility, and burden to others were the most influential items on AP-7D values. Only one non-monotonicity were observed. Our survey successfully created the first AP-7D culture-specific PBM value set, and we can convert responses to AP-7D value for QALY calculation. We believe that our pluralistic approach is a novel and important attempt to reconsider health universalism and inform the future development of PBMs.
{"title":"Departures from health universalism? A value set of AP-7D in Japan as an attempt to develop a “culture-specific” preference-based measure","authors":"Takeru Shiroiwa , Yasuhiro Morii , Eri Hoshino , Tatsunori Murata , Richard Norman , Brendan Mulhern , Nan Luo , Donna Rowen , Takashi Fukuda","doi":"10.1016/j.socscimed.2026.119022","DOIUrl":"10.1016/j.socscimed.2026.119022","url":null,"abstract":"<div><div>Health universalists believe that preference-based measure (PBM) instruments can be applied across cultures because they share similar health concepts in the world. This is the prevailing policy in PBM development. However, health pluralists refute this idea, as they argue that the concept and components of health differ depending on culture. To incorporate the pluralist view, we developed the Asian Preference-Based Measure-7 Dimensions (AP-7D), a “culture-specific” PBM for Asian countries. This survey aimed to address cultural differences in utility measurement by developing an AP-7D value set in Japan, as part of a series of AP-7D developments. This study used a web-based survey to evaluate AP-7D health states with a triplet discrete choice experiment (DCE). The design followed an established international protocol. We conducted the web-based survey and data collection in October 2024. Respondents aged 20–79 were recruited via quota sampling based on sex and age. A total of 2681 individuals were included in the DCE analysis. We applied a mixed logit model to the DCE data and obtained decrements for each level in each domain. The worst health state had an AP-7D value of −0.448. Pain/discomfort, mobility, and burden to others were the most influential items on AP-7D values. Only one non-monotonicity were observed. Our survey successfully created the first AP-7D culture-specific PBM value set, and we can convert responses to AP-7D value for QALY calculation. We believe that our pluralistic approach is a novel and important attempt to reconsider health universalism and inform the future development of PBMs.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119022"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146120830","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 : 2026-01-29DOI: 10.1016/j.socscimed.2026.119047
Emily Kocsis , Joshua Garcia-Barrios , Rony Aguilar , Sara Wyngaarden , Hannah Neufeld , Matthew Little , Warren Dodd
The departure of men and boys from rural communities significantly affects the lives of those “left behind”. Drawing on qualitative data from a rural community in the Western Highlands of Guatemala and guided by a systems thinking approach, the objectives of this study were: 1) to examine the multifaceted health determinants, risks, outcomes, and impacts associated with male out-migration for non-migrating household members; and 2) to apply a causal loop diagram to describe and model the system dynamics shaping health in a high-volume migrant-sending community. Semi-structured interviews were conducted with community members (n = 38) and individuals involved in community health provision (n = 10). Interviews were audio-recorded, transcribed, and thematically analyzed to inform a causal loop analysis to examine how male out-migration influenced health determinants, risks, outcomes, and impacts among non-migrants. Seven feedback loops were delineated to model overall system behaviour. Results suggest that a central element governing the system is declining trust in public healthcare, mediated by social and financial remittances, as well as changing household roles and care responsibilities. As the primary population left behind, women are disproportionately experiencing adverse acute and chronic health impacts, particularly psychosocial issues. This modelling exercise indicates that efforts to improve health should focus on leveraging community assets, such as a volunteer health committee and existing women's health knowledge networks. This study represents a novel approach to model the interrelated factors that impact health for left-behind populations in high out-migration contexts, and can be used to describe and guide analyses of similar dynamics in other settings.
{"title":"A system dynamics approach for examining the health implications of male out-migration on non-migrating household members in the Western Highlands of Guatemala","authors":"Emily Kocsis , Joshua Garcia-Barrios , Rony Aguilar , Sara Wyngaarden , Hannah Neufeld , Matthew Little , Warren Dodd","doi":"10.1016/j.socscimed.2026.119047","DOIUrl":"10.1016/j.socscimed.2026.119047","url":null,"abstract":"<div><div>The departure of men and boys from rural communities significantly affects the lives of those “left behind”. Drawing on qualitative data from a rural community in the Western Highlands of Guatemala and guided by a systems thinking approach, the objectives of this study were: 1) to examine the multifaceted health determinants, risks, outcomes, and impacts associated with male out-migration for non-migrating household members; and 2) to apply a causal loop diagram to describe and model the system dynamics shaping health in a high-volume migrant-sending community. Semi-structured interviews were conducted with community members (n = 38) and individuals involved in community health provision (n = 10). Interviews were audio-recorded, transcribed, and thematically analyzed to inform a causal loop analysis to examine how male out-migration influenced health determinants, risks, outcomes, and impacts among non-migrants. Seven feedback loops were delineated to model overall system behaviour. Results suggest that a central element governing the system is declining trust in public healthcare, mediated by social and financial remittances, as well as changing household roles and care responsibilities. As the primary population left behind, women are disproportionately experiencing adverse acute and chronic health impacts, particularly psychosocial issues. This modelling exercise indicates that efforts to improve health should focus on leveraging community assets, such as a volunteer health committee and existing women's health knowledge networks. This study represents a novel approach to model the interrelated factors that impact health for left-behind populations in high out-migration contexts, and can be used to describe and guide analyses of similar dynamics in other settings.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"395 ","pages":"Article 119047"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146193272","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 : 2026-01-29DOI: 10.1016/j.socscimed.2025.118920
Lisa Hobbs , Scott Devenish , Louise Reynolds , Anita Westwood , Brianna Larsen
Ambulance service workplace demographic has become more feminized, therefore female-specific issues must be included in workforce planning, policies, and procedures. Ambulance personnel who menstruate, including women, trans, and non-binary paramedics who menstruate as well as undergraduate paramedicine students attending clinical placement, may face additional difficulties when managing their menstruation in the workplace. Research on menstrual health amongst individuals working in the ambulance service environment is limited, prompting this investigation into how those – ambulance service personnel or undergraduate paramedicine students - who menstruate, manage their menstrual cycle while performing workplace duties or completing clinical placements in the emergency ambulance [health] service workplace environment. To our knowledge, this is the first study to investigate, describe, and measure the impacts and experiences of people who menstruate while working for Australasian ambulance services. Participants in this study completed an anonymous online survey about their menstrual cycle and effects on their workplace performance. Results indicate those who menstruate whilst working in an ambulance environment are adversely impacted by their menstruation. This psychological safety, and health and wellbeing issue requires addressing both in research and workforce policy for the ambulance industry. The findings and discussion are informed by Foucauldian analyses of disciplinary power to illustrate how organizational practices regulate, normalize, and produce gendered bodies, determining the conditions under which they are either rendered invisible or made visible. As paramedicine continues to grow as a profession, and diversify, it is imperative that bodily difference is not treated as a private inconvenience but as a legitimate consideration of organizational responsibility. Addressing menstrual inequity is a matter of workplace gendered practices, dignity, wellbeing, justice, and basic human rights. The researchers recommend the ambulance industry/paramedic profession moves towards open discussions, education of the workforce, and the instigation of supportive workplace practices that have a positive impact on people who menstruate while working in the ambulance service environment.
{"title":"Managing menstruation while working in the Australasian ambulance service environment","authors":"Lisa Hobbs , Scott Devenish , Louise Reynolds , Anita Westwood , Brianna Larsen","doi":"10.1016/j.socscimed.2025.118920","DOIUrl":"10.1016/j.socscimed.2025.118920","url":null,"abstract":"<div><div>Ambulance service workplace demographic has become more feminized, therefore female-specific issues must be included in workforce planning, policies, and procedures. Ambulance personnel who menstruate, including women, trans, and non-binary paramedics who menstruate as well as undergraduate paramedicine students attending clinical placement, may face additional difficulties when managing their menstruation in the workplace. Research on menstrual health amongst individuals working in the ambulance service environment is limited, prompting this investigation into how those – ambulance service personnel or undergraduate paramedicine students - who menstruate, manage their menstrual cycle while performing workplace duties or completing clinical placements in the emergency ambulance [health] service workplace environment. To our knowledge, this is the first study to investigate, describe, and measure the impacts and experiences of people who menstruate while working for Australasian ambulance services. Participants in this study completed an anonymous online survey about their menstrual cycle and effects on their workplace performance. Results indicate those who menstruate whilst working in an ambulance environment are adversely impacted by their menstruation. This psychological safety, and health and wellbeing issue requires addressing both in research and workforce policy for the ambulance industry. The findings and discussion are informed by Foucauldian analyses of disciplinary power to illustrate how organizational practices regulate, normalize, and produce gendered bodies, determining the conditions under which they are either rendered invisible or made visible. As paramedicine continues to grow as a profession, and diversify, it is imperative that bodily difference is not treated as a private inconvenience but as a legitimate consideration of organizational responsibility. Addressing menstrual inequity is a matter of workplace gendered practices, dignity, wellbeing, justice, and basic human rights. The researchers recommend the ambulance industry/paramedic profession moves towards open discussions, education of the workforce, and the instigation of supportive workplace practices that have a positive impact on people who menstruate while working in the ambulance service environment.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 118920"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158663","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 : 2026-01-29DOI: 10.1016/j.socscimed.2026.119041
Antonio Moreno-Llamas , Amaia Bacigalupe , Unai Martín , Miguel San Sebastián , Per E. Gustafsson
Women, migrants and those in manual occupations face barriers in the labor market and are more vulnerable to unemployment, which in turn may impact mental health and contributes to inequalities. Previous research has not considered the intertwinement of multiple inequalities. This study examined intersectional inequalities (intersecting gender, social class, and migration status) in poor mental health and the mediation role of unemployment in the Spanish adult population, using the 2012 and 2017 cross-sectional Spanish National Health Surveys (n = 22,383, 18–64 years, response rates: 89.6 % and 74.0 %). Mental health was measured using the GHQ-12 and classified into good and poor. Unemployment was classified as employed or unemployed. Gender (men or women), social class (manual or non-manual) and migration status (born in Spain or migrant) were cross-classified in eight intersectional strata. Intersectional mediation analysis showed that, compared to non-manual native men, poorer mental health was found in women, migrants and manual occupations (total effect). Unemployment completely mediates mental health inequalities in strata of men with manual occupations but partially in strata of women. Moreover, mental health inequality was explained by both higher unemployment prevalence (pure indirect effect) and by greater vulnerability to unemployment (mediated interaction effect) among native men and women in manual occupations and immigrant women in non-manual occupations compared to non-manual native men. In conclusion, complex mental health inequalities seem to be underpinned by the dual processes of higher risks and worse consequences of unemployment. Health policies should target strata of manual occupations since they were more likely to be unemployed.
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