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.
{"title":"Elucidating the role of unemployment in complex social inequalities in mental health: An intersectional mediation analysis of the cross-sectional Spanish National Health Surveys","authors":"Antonio Moreno-Llamas , Amaia Bacigalupe , Unai Martín , Miguel San Sebastián , Per E. Gustafsson","doi":"10.1016/j.socscimed.2026.119041","DOIUrl":"10.1016/j.socscimed.2026.119041","url":null,"abstract":"<div><div>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 (<em>n</em> = 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.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119041"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114745","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.2026.119045
Mahsa Mayeli , David Matuskey , for the Alzheimer's Disease Neuroimaging Initiative
Background
Socioeconomic disadvantage is recognized as a risk factor for cognitive decline, yet its associated neural pathways remain unclear. We investigated whether neighborhood disadvantage, measured by the Area Deprivation Index (ADI), was associated with cognitive performance in older adults and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and whether structural brain differences explained this relationship.
Methods
Participants included 822 older adults (478 cognitively unimpaired [CU], 271 with MCI, and 73 with AD). Associations between ADI, cognition, and brain structure were examined using regression models adjusting for age and sex. Mediation analyses tested whether total brain volume accounted for ADI–cognition relationships.
Results
Higher ADI was associated with poorer cognitive performance across all domains in CU individuals (National ADI: memory β = −0.008, p < 0.001; executive function β = −0.005, p < 0.001; language β = −0.005, p < 0.001; visuospatial β = −0.004, p < 0.001) and across multiple domains in MCI (memory β = −0.007, p = 0.002; executive β = −0.007, p < 0.001). ADI was also associated with smaller total cerebral, gray, and white matter volumes in CU (State ADI and gray matter β = −2.37, FDR-p = 0.006) and greater white matter hyperintensity burden (β = 0.152, FDR-p = 0.009). Associations were weaker in MCI and absent in AD. Mediation analyses showed that total brain volume significantly mediated the effect of ADI on language performance (ACME p = 0.024; proportion mediated = 19.7 %, p = 0.036).
Conclusions
Neighborhood disadvantage is linked to widespread cognitive vulnerability and structural brain differences. However, brain volume explains only a small portion of these associations, suggesting that environmental and contextual factors shape cognitive performance through pathways that extend beyond structural neurodegeneration.
{"title":"Social determinants of brain structure and cognition","authors":"Mahsa Mayeli , David Matuskey , for the Alzheimer's Disease Neuroimaging Initiative","doi":"10.1016/j.socscimed.2026.119045","DOIUrl":"10.1016/j.socscimed.2026.119045","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic disadvantage is recognized as a risk factor for cognitive decline, yet its associated neural pathways remain unclear. We investigated whether neighborhood disadvantage, measured by the Area Deprivation Index (ADI), was associated with cognitive performance in older adults and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD), and whether structural brain differences explained this relationship.</div></div><div><h3>Methods</h3><div>Participants included 822 older adults (478 cognitively unimpaired [CU], 271 with MCI, and 73 with AD). Associations between ADI, cognition, and brain structure were examined using regression models adjusting for age and sex. Mediation analyses tested whether total brain volume accounted for ADI–cognition relationships.</div></div><div><h3>Results</h3><div>Higher ADI was associated with poorer cognitive performance across all domains in CU individuals (National ADI: memory β = −0.008, <em>p</em> < 0.001; executive function β = −0.005, <em>p</em> < 0.001; language β = −0.005, <em>p</em> < 0.001; visuospatial β = −0.004, <em>p</em> < 0.001) and across multiple domains in MCI (memory β = −0.007, <em>p</em> = 0.002; executive β = −0.007, <em>p</em> < 0.001). ADI was also associated with smaller total cerebral, gray, and white matter volumes in CU (State ADI and gray matter β = −2.37, <em>FDR-p</em> = 0.006) and greater white matter hyperintensity burden (β = 0.152, <em>FDR-p</em> = 0.009). Associations were weaker in MCI and absent in AD. Mediation analyses showed that total brain volume significantly mediated the effect of ADI on language performance (ACME <em>p</em> = 0.024; proportion mediated = 19.7 %, <em>p</em> = 0.036).</div></div><div><h3>Conclusions</h3><div>Neighborhood disadvantage is linked to widespread cognitive vulnerability and structural brain differences. However, brain volume explains only a small portion of these associations, suggesting that environmental and contextual factors shape cognitive performance through pathways that extend beyond structural neurodegeneration.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119045"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146151188","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.2026.119015
Weixuan Chen , Yuxiang Wang , Izzy Yi Jian , Kar Him Mo
Rapid urbanisation has contributed to the increasing prevalence of high-density high-rise housing (HDHRH) as a common urban typology worldwide. While HDHRH presents an efficient solution for land use in densely populated areas, it also introduces distinct challenges to residents' health and well-being, including potential social isolation and environmental stress. Existing research has highlighted the potential for community engagement to correlate with positive perceived health outcomes, yet the specific mechanisms and contextual factors at play in HDHRH remain under-explored. This paper explores how community engagement influences residents' perceived health in HDHRH, using Hong Kong's public housing as a case study. Employing a mixed-methods approach, the research combines structural equation modelling of survey data from 644 residents with interviews. The results reveal that community engagement is positively associated with perceived health both directly and indirectly through two key pathways: community satisfaction and collective learning. Community satisfaction mediates the relationship by fostering a sense of belonging and trust, whilst collective learning is linked to the acquisition of new skills and perspectives, which correlate with reduced isolation and enhanced self-efficacy. Additionally, the duration of residence moderates the engagement-satisfaction association, with longer-term residents deriving greater benefits. This research contributes to the literature by refining social capital theory and providing empirical evidence of the perceived health benefits associated with community engagement in HDHRH. It also offers practical insights for policymakers, urban planners and welfare organisations on designing and implementing community programmes.
{"title":"\"Empower and be empowered\": Unveiling how community engagement influences residents' perceived health in high-density high-rise housing","authors":"Weixuan Chen , Yuxiang Wang , Izzy Yi Jian , Kar Him Mo","doi":"10.1016/j.socscimed.2026.119015","DOIUrl":"10.1016/j.socscimed.2026.119015","url":null,"abstract":"<div><div>Rapid urbanisation has contributed to the increasing prevalence of high-density high-rise housing (HDHRH) as a common urban typology worldwide. While HDHRH presents an efficient solution for land use in densely populated areas, it also introduces distinct challenges to residents' health and well-being, including potential social isolation and environmental stress. Existing research has highlighted the potential for community engagement to correlate with positive perceived health outcomes, yet the specific mechanisms and contextual factors at play in HDHRH remain under-explored. This paper explores how community engagement influences residents' perceived health in HDHRH, using Hong Kong's public housing as a case study. Employing a mixed-methods approach, the research combines structural equation modelling of survey data from 644 residents with interviews. The results reveal that community engagement is positively associated with perceived health both directly and indirectly through two key pathways: community satisfaction and collective learning. Community satisfaction mediates the relationship by fostering a sense of belonging and trust, whilst collective learning is linked to the acquisition of new skills and perspectives, which correlate with reduced isolation and enhanced self-efficacy. Additionally, the duration of residence moderates the engagement-satisfaction association, with longer-term residents deriving greater benefits. This research contributes to the literature by refining social capital theory and providing empirical evidence of the perceived health benefits associated with community engagement in HDHRH. It also offers practical insights for policymakers, urban planners and welfare organisations on designing and implementing community programmes.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119015"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133403","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.2026.119037
Sayali Gore , Katie Attwell , Emma Campbell , Jane Williams , Stacy M. Carter , Julie Leask , Kerrie Wiley
Several countries have revised their policies to make vaccine refusal more difficult. The role of the public in this process has seldom been examined. We analysed the public consultation process for the Australian government's 2016 ‘No Jab No Pay’ mandatory childhood vaccination policy to better understand who participated, their arguments, and how their contributions were incorporated into the legislative process.
Publicly available submissions and hearing transcripts were categorised by submitter type, stance on the legislation, and writing style. We undertook a qualitative reflexive thematic analysis of the submissions’ structure and content and compared our findings with the Inquiry Report.
Most public submissions (95 %) opposed the legislation. Vaccine-rejecting submitters focused on safety arguments to argue the legislation was unjustified, unethical or ineffective. Vaccine-supportive submitters focused on the importance of vaccination but supported or opposed the legislation based on positions that weighed collective goods against individual rights.
The findings of this analysis differed somewhat from the Inquiry Report that analysed the same evidence. The Report identified similar key legislation-specific concerns, but the committee's explicit position on the importance of vaccines meant that vaccination concerns were not considered relevant. The Report drew heavily on supportive arguments from academics, medical organisations, and government, while minimising critical arguments.
Our findings suggest a process that epistemically privileged expert opinion in favour of mandates and discounted testimony driven by experiences, emotion, and beliefs of opponents. Future consultations on vaccination policy might consider approaches which are designed to connect high quality evidence with the plural values of citizens.
{"title":"A critical analysis of the Australian public consultation on childhood vaccine mandate introduction","authors":"Sayali Gore , Katie Attwell , Emma Campbell , Jane Williams , Stacy M. Carter , Julie Leask , Kerrie Wiley","doi":"10.1016/j.socscimed.2026.119037","DOIUrl":"10.1016/j.socscimed.2026.119037","url":null,"abstract":"<div><div>Several countries have revised their policies to make vaccine refusal more difficult. The role of the public in this process has seldom been examined. We analysed the public consultation process for the Australian government's 2016 ‘No Jab No Pay’ mandatory childhood vaccination policy to better understand who participated, their arguments, and how their contributions were incorporated into the legislative process.</div><div>Publicly available submissions and hearing transcripts were categorised by submitter type, stance on the legislation, and writing style. We undertook a qualitative reflexive thematic analysis of the submissions’ structure and content and compared our findings with the Inquiry Report.</div><div>Most public submissions (95 %) opposed the legislation. Vaccine-rejecting submitters focused on safety arguments to argue the legislation was unjustified, unethical or ineffective. Vaccine-supportive submitters focused on the importance of vaccination but supported or opposed the legislation based on positions that weighed collective goods against individual rights.</div><div>The findings of this analysis differed somewhat from the Inquiry Report that analysed the same evidence. The Report identified similar key legislation-specific concerns, but the committee's explicit position on the importance of vaccines meant that vaccination concerns were not considered relevant. The Report drew heavily on supportive arguments from academics, medical organisations, and government, while minimising critical arguments.</div><div>Our findings suggest a process that epistemically privileged expert opinion in favour of mandates and discounted testimony driven by experiences, emotion, and beliefs of opponents. Future consultations on vaccination policy might consider approaches which are designed to connect high quality evidence with the plural values of citizens.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119037"},"PeriodicalIF":5.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133418","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 : 2026-01-28DOI: 10.1016/j.socscimed.2026.119038
Megan Comfort , Jennifer Amegashie , Jordana Hemberg , Richa Ruwala , Jennifer Lorvick
Background
Homelessness is a visible and persistent manifestation of social and structural inequity in the United States. When individuals experience homelessness, their ontological security, which refers to the sense of constancy, safety, and trust in daily life, is often deeply eroded. We explored the connections between embodied experiences and ontological security among residents of a transitional housing program implemented during the COVID-19 pandemic.
Methods
We conducted in-depth interviews between November 2022 and October 2023 with 24 former residents of Operation Safer Ground (OSG), an Alameda County, California program that provided non-congregate supportive housing for medically vulnerable people experiencing homelessness. Data were analyzed using reflexive thematic analysis.
Results
Participants described OSG residences as supporting physical wellbeing, comfort, and restoration. When experienced daily, these features contributed to embodied ease and ontological security for most participants. Rules and security measures often enhanced feelings of safety and order, but some residents found them infantilizing and destabilizing through inconsistent enforcement. OSG's low-barrier model of care produced mixed effects: for some, proximity to fellow residents' substance use, mental health crisis, or death heightened vigilance and anxiety; for others, being housed with family members and pets stabilized identity and strengthened continuity.
Conclusions
By exploring participants' embodied responses to the OSG program's physical environment, rules and regulations, and communal living, we were able to chart how experiences that evoke visceral feelings of safety, control, and well-being can influence ontological security in the context of a transitional housing program.
{"title":"“It's more than just being in a place, it's more like a peace of mind”: Ontological security among residents of a transitional housing program implemented during the COVID-19 pandemic","authors":"Megan Comfort , Jennifer Amegashie , Jordana Hemberg , Richa Ruwala , Jennifer Lorvick","doi":"10.1016/j.socscimed.2026.119038","DOIUrl":"10.1016/j.socscimed.2026.119038","url":null,"abstract":"<div><h3>Background</h3><div>Homelessness is a visible and persistent manifestation of social and structural inequity in the United States. When individuals experience homelessness, their ontological security, which refers to the sense of constancy, safety, and trust in daily life, is often deeply eroded. We explored the connections between embodied experiences and ontological security among residents of a transitional housing program implemented during the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We conducted in-depth interviews between November 2022 and October 2023 with 24 former residents of Operation Safer Ground (OSG), an Alameda County, California program that provided non-congregate supportive housing for medically vulnerable people experiencing homelessness. Data were analyzed using reflexive thematic analysis.</div></div><div><h3>Results</h3><div>Participants described OSG residences as supporting physical wellbeing, comfort, and restoration. When experienced daily, these features contributed to embodied ease and ontological security for most participants. Rules and security measures often enhanced feelings of safety and order, but some residents found them infantilizing and destabilizing through inconsistent enforcement. OSG's low-barrier model of care produced mixed effects: for some, proximity to fellow residents' substance use, mental health crisis, or death heightened vigilance and anxiety; for others, being housed with family members and pets stabilized identity and strengthened continuity.</div></div><div><h3>Conclusions</h3><div>By exploring participants' embodied responses to the OSG program's physical environment, rules and regulations, and communal living, we were able to chart how experiences that evoke visceral feelings of safety, control, and well-being can influence ontological security in the context of a transitional housing program.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119038"},"PeriodicalIF":5.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146127070","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 : 2026-01-28DOI: 10.1016/j.socscimed.2026.119025
Yanyang Ma, Meifang Zhang
During the War of Resistance Against Japan (1937–1945), China faced severe public health crises amid military and political upheaval, making hygiene and epidemic prevention critical to safeguarding public health and national survival. While the Communist Party of China (CPC) newspapers' role in wartime political culture is recognized, systematic research on how their hygiene discourse shaped national identity is scarce. This study adopted qualitative discourse analysis of 586 hygiene-related reports from New China Daily (1937–1941) and Liberation Daily (1941–1945), sourced from databases such as the National Newspaper Index, to explore their identity-construction mechanisms. It found that the newspapers adopted three interrelated strategies: popularizing scientific hygiene knowledge to reshape public perceptions, politicizing health campaigns to turn private practices into patriotic obligations, and embedding hygiene into daily life via education and institutions to consolidate collective consciousness. These narratives not only mobilized public support for the war but also localized Foucault's biopolitics and Douglas's purity and danger theory, redefining hygiene as a patriotic duty and collective resistance, illustrating how public health discourse shapes collective identity and drives public health practice in crises and broadening Western theories' applicability in the Chinese context.
{"title":"Hygiene narratives as public health discourse: Constructing the national body and national identity in wartime China (New China Daily & Liberation Daily, 1937–1945)","authors":"Yanyang Ma, Meifang Zhang","doi":"10.1016/j.socscimed.2026.119025","DOIUrl":"10.1016/j.socscimed.2026.119025","url":null,"abstract":"<div><div>During the War of Resistance Against Japan (1937–1945), China faced severe public health crises amid military and political upheaval, making hygiene and epidemic prevention critical to safeguarding public health and national survival. While the Communist Party of China (CPC) newspapers' role in wartime political culture is recognized, systematic research on how their hygiene discourse shaped national identity is scarce. This study adopted qualitative discourse analysis of 586 hygiene-related reports from <em>New China Daily</em> (1937–1941) and <em>Liberation Daily</em> (1941–1945), sourced from databases such as <em>the National Newspaper Index</em>, to explore their identity-construction mechanisms. It found that the newspapers adopted three interrelated strategies: popularizing scientific hygiene knowledge to reshape public perceptions, politicizing health campaigns to turn private practices into patriotic obligations, and embedding hygiene into daily life via education and institutions to consolidate collective consciousness. These narratives not only mobilized public support for the war but also localized Foucault's biopolitics and Douglas's purity and danger theory, redefining hygiene as a patriotic duty and collective resistance, illustrating how public health discourse shapes collective identity and drives public health practice in crises and broadening Western theories' applicability in the Chinese context.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119025"},"PeriodicalIF":5.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144293","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 : 2026-01-28DOI: 10.1016/j.socscimed.2026.119039
Marie-Catherine Gagnon-Dufresne , Iván Sarmiento , Sarah Cooper , Md Mizanur Rahman , Protyasha Ghosh , Neil Andersson , Kate Zinszer
Background
Although community participation is a key strategy for decolonizing global health research, there are significant difficulties in the meaningful engagement of urban communities in low- and middle-income countries. Addressing barriers and leveraging enablers before beginning research could facilitate more equitable collaborations. To guide researchers in this endeavour, this scoping review mapped available evidence and identified factors influencing the participation of urban communities in global health research in low- and middle-income countries.
Methods
Following guidelines from the Joanna Briggs’ Institute and PRISMA-ScR, we searched six databases for articles published in English and French without date restriction. Two independent reviewers screened articles in two stages. We used narrative synthesis to describe included studies and fuzzy cognitive mapping to summarize categories of factors influencing participation.
Results
We included 59 of 7,994 articles identified. Studies covered 36 countries on five continents, with half using qualitative methods. They addressed diverse health issues, one third of them targeting environmental health. Terminology and approaches for community participation varied greatly. We identified 251 distinct factors influencing participation through 1623 relationships. Fuzzy cognitive mapping summarized the most influential categories including researcher-community relationships, contextual adaptation of methods/activities, community decision-making power, ease of planning/implementation, and valuing different knowledge types.
Conclusion
Results confirm that meaningful participation requires researchers sharing power and making space for community voices. Adopting reflexive and transformative approaches can balance power asymmetries in research partnerships for global health, a vital step in the broader efforts towards decolonization.
{"title":"Why urban communities in low- and middle-income countries participate in global health research: A scoping review and fuzzy cognitive mapping summary","authors":"Marie-Catherine Gagnon-Dufresne , Iván Sarmiento , Sarah Cooper , Md Mizanur Rahman , Protyasha Ghosh , Neil Andersson , Kate Zinszer","doi":"10.1016/j.socscimed.2026.119039","DOIUrl":"10.1016/j.socscimed.2026.119039","url":null,"abstract":"<div><h3>Background</h3><div>Although community participation is a key strategy for decolonizing global health research, there are significant difficulties in the meaningful engagement of urban communities in low- and middle-income countries. Addressing barriers and leveraging enablers before beginning research could facilitate more equitable collaborations. To guide researchers in this endeavour, this scoping review mapped available evidence and identified factors influencing the participation of urban communities in global health research in low- and middle-income countries.</div></div><div><h3>Methods</h3><div>Following guidelines from the Joanna Briggs’ Institute and PRISMA-ScR, we searched six databases for articles published in English and French without date restriction. Two independent reviewers screened articles in two stages. We used narrative synthesis to describe included studies and fuzzy cognitive mapping to summarize categories of factors influencing participation.</div></div><div><h3>Results</h3><div>We included 59 of 7,994 articles identified. Studies covered 36 countries on five continents, with half using qualitative methods. They addressed diverse health issues, one third of them targeting environmental health. Terminology and approaches for community participation varied greatly. We identified 251 distinct factors influencing participation through 1623 relationships. Fuzzy cognitive mapping summarized the most influential categories including researcher-community relationships, contextual adaptation of methods/activities, community decision-making power, ease of planning/implementation, and valuing different knowledge types.</div></div><div><h3>Conclusion</h3><div>Results confirm that meaningful participation requires researchers sharing power and making space for community voices. Adopting reflexive and transformative approaches can balance power asymmetries in research partnerships for global health, a vital step in the broader efforts towards decolonization.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119039"},"PeriodicalIF":5.0,"publicationDate":"2026-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146114763","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 : 2026-01-27DOI: 10.1016/j.socscimed.2026.119034
Sharmind Neelotpol , Alastair WM. Hay , Mike W. Woolridge
Background
Maternal lead exposure, shaped by environmental and cultural factors, can transfer to the foetus. Culturally embedded practices among South Asian women, including dietary habits and traditional cosmetics, may increase exposure compared with Caucasian women. This study measured ante-natal blood lead levels in South Asian mothers in Leeds, UK, and examined associated environmental, ethno-cultural, lifestyle, and foetal outcome factors.
Methods
Pregnant SA and Caucasian women were recruited from Leeds, UK. Participants donated ante-natal blood sample, and completed a lifestyle questionnaire. BLLs were analysed using Inductively Coupled Plasma Mass-Spectrometry. Foetal birth outcomes were recorded after delivery.
Findings
A significant difference in BLL was observed between pregnant South Asian (n = 98) and Caucasian (n = 38) women living in the UK (t = 4.00, df = 134, p = 0.0005). For South Asian women alone, factors associated with raised BLLs were: living in a home built before 1970 (t = 2.558, df = 97, p = 0.012); using pesticides for gardening in SA (t = 2.880, p=0.005), purchasing fish (fresh or dried (shutki)) from ethnic shops (t = 3.494, p=0.001), shopping for cosmetics (PC11: surma, tilaka, sindoor) from ethnic shops (t = 3.251, p = 0.002); buying canned food (PC1: fruit juice, tomato, cola) from local markets (t = 3.101, p = 0.003), ‘use of amulets’ (proxy for a lifestyle choice) (t = 3.137, p = 0.002). Factors associated with decreased BLLs were: purchasing food (PC1: vegetables, canned food, fish) from supermarket (t = 4.280, p = 0.0001), high intake of Vitamin E (PC21: broccoli, kiwi, mango) (t = −3.321, p=0.001). No significant differences in birth outcomes were shown between the groups, apart from ‘Premature Rupture of the Membranes’ (t = 2.47, df = 134 p = 0.015).
Conclusion
The ethno-diversity of this study sample, its size and location, made it possible to identify risk factors for reducing body lead burden among South Asian participants living in the UK. Based on these findings, policy makers might update ‘lead-free lifestyle’ guidelines for reducing the overall body lead content among South Asian women; improving outcomes for minority ethnic and ‘hard-to-reach’ groups.
{"title":"Ethno-cultural risk of ante-natal lead exposure among South Asian women in the UK","authors":"Sharmind Neelotpol , Alastair WM. Hay , Mike W. Woolridge","doi":"10.1016/j.socscimed.2026.119034","DOIUrl":"10.1016/j.socscimed.2026.119034","url":null,"abstract":"<div><h3>Background</h3><div>Maternal lead exposure, shaped by environmental and cultural factors, can transfer to the foetus. Culturally embedded practices among South Asian women, including dietary habits and traditional cosmetics, may increase exposure compared with Caucasian women. This study measured ante-natal blood lead levels in South Asian mothers in Leeds, UK, and examined associated environmental, ethno-cultural, lifestyle, and foetal outcome factors.</div></div><div><h3>Methods</h3><div>Pregnant SA and Caucasian women were recruited from Leeds, UK. Participants donated ante-natal blood sample, and completed a lifestyle questionnaire. BLLs were analysed using Inductively Coupled Plasma Mass-Spectrometry. Foetal birth outcomes were recorded after delivery.</div></div><div><h3>Findings</h3><div>A significant difference in BLL was observed between pregnant South Asian (n = 98) and Caucasian (n = 38) women living in the UK (t = 4.00, df = 134, <em>p</em> = 0.0005). For South Asian women alone, factors associated with raised BLLs were: living in a home built before 1970 (t = 2.558, df = 97, <em>p</em> = 0.012); using pesticides for gardening in SA (t = 2.880, <em>p=</em>0.005), purchasing fish (fresh or dried (shutki)) from ethnic shops (t = 3.494, <em>p=</em>0.001), shopping for cosmetics (PC1<sup>1</sup>: surma, tilaka, sindoor) from ethnic shops (t = 3.251, <em>p</em> = 0.002); buying canned food (PC1: fruit juice, tomato, cola) from local markets (t = 3.101, <em>p</em> = 0.003), ‘use of amulets’ (<em>proxy for a lifestyle choice</em>) (t = 3.137, <em>p</em> = 0.002). Factors associated with decreased BLLs were: purchasing food (PC1: vegetables, canned food, fish) from supermarket (t = 4.280, <em>p</em> = 0.0001), high intake of Vitamin E (PC2<sup>1</sup>: broccoli, kiwi, mango) (t = −3.321, <em>p=</em>0.001). No significant differences in birth outcomes were shown between the groups, apart from ‘Premature Rupture of the Membranes’ (t = 2.47, df = 134 <em>p</em> = 0.015).</div></div><div><h3>Conclusion</h3><div>The ethno-diversity of this study sample, its size and location, made it possible to identify risk factors for reducing body lead burden among South Asian participants living in the UK. Based on these findings, policy makers might update ‘lead-free lifestyle’ guidelines for reducing the overall body lead content among South Asian women; improving outcomes for minority ethnic and ‘hard-to-reach’ groups.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119034"},"PeriodicalIF":5.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146081001","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 : 2026-01-27DOI: 10.1016/j.socscimed.2026.119036
Chloe R. Bennett , Heather Cole-Lewis , Stephanie Farquhar , Naama Haamel , Boris Babenko , Oran Lang , Mathias S. Fleck , Ilana Traynis , Charles Lau , Yun Liu , Ivor Horn , Courtney Lyles
The field of artificial intelligence (AI) is rapidly influencing health and healthcare, but bias and inadequate subgroup performance persists. Previous work has clearly outlined the need for more rigorous attention to data representativeness and model performance to advance population health and reduce bias. However, there is an opportunity to leverage best practices of social epidemiology, behavior science, and health services research to help develop hypotheses for associations found, particularly when using explainable AI (XAI) methods. This paper introduces a novel human-in-the-loop model that couples generative XAI with a wraparound interdisciplinary expert panel review process. This human-centered approach critically assesses AI model explanations from multiple perspectives, effectively identifying areas of bias and pinpointing directions for future research. We summarize the approach, highlighting processes and findings where the interdisciplinary expert panel produced interpretations which were historically and contextually informed. In particular, the interdisciplinary panel identified potential confounders and brought in scientific evidence from previous studies, which have clear implications to reduce bias. This promising human-centered framework not only maximizes multidisciplinary methodological rigor for AI model improvement and eventual implementation but also proactively fosters team science opportunities in future research.
{"title":"Interdisciplinary expertise to advance human-centered explainable AI","authors":"Chloe R. Bennett , Heather Cole-Lewis , Stephanie Farquhar , Naama Haamel , Boris Babenko , Oran Lang , Mathias S. Fleck , Ilana Traynis , Charles Lau , Yun Liu , Ivor Horn , Courtney Lyles","doi":"10.1016/j.socscimed.2026.119036","DOIUrl":"10.1016/j.socscimed.2026.119036","url":null,"abstract":"<div><div>The field of artificial intelligence (AI) is rapidly influencing health and healthcare, but bias and inadequate subgroup performance persists. Previous work has clearly outlined the need for more rigorous attention to data representativeness and model performance to advance population health and reduce bias. However, there is an opportunity to leverage best practices of social epidemiology, behavior science, and health services research to help develop hypotheses for associations found, particularly when using explainable AI (XAI) methods. This paper introduces a novel human-in-the-loop model that couples generative XAI with a wraparound interdisciplinary expert panel review process. This human-centered approach critically assesses AI model explanations from multiple perspectives, effectively identifying areas of bias and pinpointing directions for future research. We summarize the approach, highlighting processes and findings where the interdisciplinary expert panel produced interpretations which were historically and contextually informed. In particular, the interdisciplinary panel identified potential confounders and brought in scientific evidence from previous studies, which have clear implications to reduce bias. This promising human-centered framework not only maximizes multidisciplinary methodological rigor for AI model improvement and eventual implementation but also proactively fosters team science opportunities in future research.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"394 ","pages":"Article 119036"},"PeriodicalIF":5.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138036","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 : 2026-01-27DOI: 10.1016/j.socscimed.2026.119033
Jessie Chien , Benjamin F. Henwood , Randall Kuhn
Cities across the United States are relying more on criminalization policies—including laws targeting behaviors deemed disruptive to public order, such as sleeping or camping in public spaces—to remove visible homelessness. How the enforcement of these policies impacts the health of unhoused people is unclear. The present study leverages monthly survey data from a prospective cohort of unhoused individuals in Los Angeles County (n = 731) to examine the longitudinal associations of experiences with police encounters and homeless sweeps on physical and psychosocial health. We estimated multilevel mixed-effects models using repeated monthly observations nested within individuals that adjusted for sociodemographic, housing, and health-related covariates. Police encounters and sweep experiences were associated with poorer self-rated physical health (police: β = 0.12, 95 %CI = [0.06,0.18]; sweeps: β = 0.10, 95 %CI = [0.03,0.16]) and greater psychological distress (police: β = 0.32, 95 %CI = [0.08,0.56]; sweeps: β = 0.35, 95 %CI = [0.08, 0.61] in the same month. Police encounters were also associated with same-month increases in feelings of loneliness (β = 0.07, 95 %CI = [0.02,0.13]). These effects were partly mediated by experiences of displacement, accounting for 22–34 % of the total effects, suggesting that enforcement-related displacement contributes to adverse health likely through disruptions to individuals’ physical and social environments. Greater cumulative exposure to police encounters and to sweeps was associated with poorer physical and psychosocial health over time. As federal courts continue to evaluate the legality of criminalization policies, this study provides empirical evidence of their measurable health harms towards unhoused individuals, offering a basis for local authorities to consider alternatives to criminalization.
美国各地的城市正在更多地依赖于刑事化政策——包括针对被认为破坏公共秩序的行为的法律，比如在公共场所睡觉或露营——来消除可见的无家可归现象。这些政策的执行如何影响无家可归者的健康尚不清楚。本研究利用来自洛杉矶县无家可归者前瞻性队列的月度调查数据（n = 731）来检查与警察接触和无家可归者扫荡的经历对身体和心理健康的纵向关联。我们使用嵌套在个体内的重复月度观察来估计多水平混合效应模型，并对社会人口统计学、住房和健康相关协变量进行了调整。警察遇到和扫描经验与贫穷有关自我报告身体健康(警察:β = 0.12,95 CI % = [0.06,0.18];清洁工:β = 0.10,95 CI % = [0.03,0.16])和更大的心理压力(警察:β = 0.32,95 CI % = [0.08,0.56];清洁工:β = 0.35,95 CI % = [0.08,0.61]在同一个月。与警察接触也与当月孤独感的增加有关（β = 0.07,95 %CI = [0.02,0.13]）。这些影响部分由流离失所经历介导，占总影响的22% - 34% %，这表明与执法有关的流离失所可能通过破坏个人的身体和社会环境而对健康造成不利影响。随着时间的推移，警察遭遇和扫荡的累积暴露程度越高，身体和心理健康状况就越差。随着联邦法院继续评估刑事定罪政策的合法性，本研究提供了经验证据，证明这些政策对无家可归者的健康造成了可衡量的危害，为地方当局考虑替代刑事定罪提供了依据。
{"title":"Criminalizing homelessness: Longitudinal associations of police encounters and homeless sweeps with psychosocial health among the unhoused community in Los Angeles","authors":"Jessie Chien , Benjamin F. Henwood , Randall Kuhn","doi":"10.1016/j.socscimed.2026.119033","DOIUrl":"10.1016/j.socscimed.2026.119033","url":null,"abstract":"<div><div>Cities across the United States are relying more on criminalization policies—including laws targeting behaviors deemed disruptive to public order, such as sleeping or camping in public spaces—to remove visible homelessness. How the enforcement of these policies impacts the health of unhoused people is unclear. The present study leverages monthly survey data from a prospective cohort of unhoused individuals in Los Angeles County (n = 731) to examine the longitudinal associations of experiences with police encounters and homeless sweeps on physical and psychosocial health. We estimated multilevel mixed-effects models using repeated monthly observations nested within individuals that adjusted for sociodemographic, housing, and health-related covariates. Police encounters and sweep experiences were associated with poorer self-rated physical health (police: β = 0.12, 95 %CI = [0.06,0.18]; sweeps: β = 0.10, 95 %CI = [0.03,0.16]) and greater psychological distress (police: β = 0.32, 95 %CI = [0.08,0.56]; sweeps: β = 0.35, 95 %CI = [0.08, 0.61] in the same month. Police encounters were also associated with same-month increases in feelings of loneliness (β = 0.07, 95 %CI = [0.02,0.13]). These effects were partly mediated by experiences of displacement, accounting for 22–34 % of the total effects, suggesting that enforcement-related displacement contributes to adverse health likely through disruptions to individuals’ physical and social environments. Greater cumulative exposure to police encounters and to sweeps was associated with poorer physical and psychosocial health over time. As federal courts continue to evaluate the legality of criminalization policies, this study provides empirical evidence of their measurable health harms towards unhoused individuals, offering a basis for local authorities to consider alternatives to criminalization.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 119033"},"PeriodicalIF":5.0,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108077","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}
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