Social Science & Medicine最新文献_第6页

Infant birth weight in Brazil: A cross-sectional historical approach 巴西婴儿出生体重：横断面历史方法。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2025.117677

Cassia Roth

In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, −32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (preta) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, −39]) and infants born to mixed-race (parda) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, −10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality – including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.

1888年，巴西成为美洲最后一个废除奴隶制的国家。历史学家概述了废奴后时期非洲人后裔的种族健康差异。流行病学家已经表明，21世纪的健康差距继续反映出一个多世纪前的模式。这个横断面分析量化在废除后的妇产医院使用婴儿出生体重的健康差距。该研究依靠巴西里约热内卢市Maternidade Laranjeiras医院1922年至1926年间出生的婴儿（n = 2845）的医院记录，运行线性模型，评估婴儿出生体重在母亲肤色、年龄、怀孕次数（胎次）和国籍方面的差异。非洲血统与较低的出生体重相关。非洲裔女性所生婴儿的出生体重估计比欧洲裔女性所生婴儿轻84克（p值= 0.002 [95% CI -137, -32]）。在非洲裔妇女中，黑人（preta）妇女所生婴儿的出生体重估计比白人妇女所生婴儿轻100克（p值= 0.001 [95% CI -160, -39]），混血儿（parda）妇女所生婴儿的出生体重估计比白人妇女所生婴儿轻70克（p值= 0.022 [95% CI -130, -10]）。这些发现很可能是奴隶制遗留问题的结果，尤其是基于种族的社会经济不平等——包括对非洲人后裔来说，更繁重的工作时间表、更差的营养和更不卫生的生活环境。这些发现与目前巴西种族化健康差异的研究结果一致，并表明了历史发现对公共卫生研究的重要性。

{"title":"Infant birth weight in Brazil: A cross-sectional historical approach","authors":"Cassia Roth","doi":"10.1016/j.socscimed.2025.117677","DOIUrl":"10.1016/j.socscimed.2025.117677","url":null,"abstract":"<div><div>In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, −32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (<em>preta</em>) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, −39]) and infants born to mixed-race (<em>parda</em>) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, −10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality – including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117677"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014505","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}

引用次数: 0

How is process tracing applied in health research? A systematic scoping review 过程追踪如何应用于卫生研究？系统的范围审查。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117539

Rebecca Johnson , Derek Beach , Hareth Al-Janabi

Complex health system questions often have a case study (such as a country) as the unit of analysis. Process tracing, a method from policy studies, is a flexible approach for causal analysis within case studies, increasingly used in applied health research. The aim of this study was to identify the ways in which process tracing methods have been used in health research, and provide insights for best practice. We conducted a systematic scoping review of applied studies purporting to use process tracing methods in health research contexts. We examined the range of studies and how they conducted and reported process tracing. We found 84 studies published from 2011 to 2023. Studies were categorised into two groups: those with greater methodological description (n = 19 studies) and those with less methodological description (n = 65 studies). A majority of studies were focused on public health and health policy with around half of studies focused on low and middle income countries. Of those 19 studies that provided greater methodological description eight studies featured four areas of good practice: (1) reporting the development of a mechanistic theory and making it explicit; (2) linking empirical material collected to the mechanistic theory; (3) clearly presenting the causal mechanism tracing; and (4) reporting how consideration of counterfactuals or evidence of alternatives within the study were analysed in practice. The review demonstrates the rapid take-up of process tracing to generate theory and evidence to support a better understanding of causal mechanisms in complex health research. To support future studies in conducting and reporting process tracing, we provide emergent recommendations.

复杂的卫生系统问题通常以案例研究（如一个国家）作为分析单位。进程追踪是政策研究的一种方法，是在案例研究中进行因果分析的一种灵活方法，越来越多地用于应用卫生研究。本研究的目的是确定在卫生研究中使用过程追踪方法的方式，并为最佳实践提供见解。我们对旨在在健康研究背景下使用过程追踪方法的应用研究进行了系统的范围评估。我们检查了研究的范围，以及它们是如何进行和报告过程跟踪的。我们发现从2011年到2023年发表了84项研究。研究被分为两组：方法描述较多的研究（n = 19）和方法描述较少的研究（n = 65）。大多数研究侧重于公共卫生和卫生政策，约有一半的研究侧重于低收入和中等收入国家。在这19项研究中，提供了更多的方法描述，其中8项研究突出了四个方面的良好实践：(1)报告机制理论的发展并使其明确；(2)将收集到的经验材料与机制理论联系起来；(3)清晰呈现因果机制溯源；(4)报告如何在实践中分析研究中的反事实或替代证据。这一综述表明，在复杂的卫生研究中，快速采用过程追踪来产生理论和证据，以支持更好地了解因果机制。为了支持未来在进行和报告过程跟踪方面的研究，我们提供了紧急建议。

{"title":"How is process tracing applied in health research? A systematic scoping review","authors":"Rebecca Johnson , Derek Beach , Hareth Al-Janabi","doi":"10.1016/j.socscimed.2024.117539","DOIUrl":"10.1016/j.socscimed.2024.117539","url":null,"abstract":"<div><div>Complex health system questions often have a case study (such as a country) as the unit of analysis. Process tracing, a method from policy studies, is a flexible approach for causal analysis within case studies, increasingly used in applied health research. The aim of this study was to identify the ways in which process tracing methods have been used in health research, and provide insights for best practice. We conducted a systematic scoping review of applied studies purporting to use process tracing methods in health research contexts. We examined the range of studies and how they conducted and reported process tracing. We found 84 studies published from 2011 to 2023. Studies were categorised into two groups: those with greater methodological description (n = 19 studies) and those with less methodological description (n = 65 studies). A majority of studies were focused on public health and health policy with around half of studies focused on low and middle income countries. Of those 19 studies that provided greater methodological description eight studies featured four areas of good practice: (1) reporting the development of a mechanistic theory and making it explicit; (2) linking empirical material collected to the mechanistic theory; (3) clearly presenting the causal mechanism tracing; and (4) reporting how consideration of counterfactuals or evidence of alternatives within the study were analysed in practice. The review demonstrates the rapid take-up of process tracing to generate theory and evidence to support a better understanding of causal mechanisms in complex health research. To support future studies in conducting and reporting process tracing, we provide emergent recommendations.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117539"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899783","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}

引用次数: 0

Transition symptom management careers: Historical patterns of mental health symptoms and service use among young adults experiencing a psychiatric crisis 过渡症状管理职业：经历过精神危机的年轻成年人的精神健康症状和服务使用的历史模式。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117657

Sarah C. Narendorf , Umaira Khan , Michelle R. Munson , Vanessa V. Klodnick , Jamaica Harrell

Young adults access mental health services at lower rates than both older and younger age groups despite high levels of need. Mental health service use is known to be influenced by prior experiences with treatment, with episodes of symptoms and treatment producing patterns of service use over time, or what we call a “symptom management career”. This qualitative study examined the symptom management careers of 55 young adults (ages 18–25) who were admitted to an inpatient, short term, crisis stabilization unit. Participants completed research interviews at the hospital following a psychiatrist's assessment. During semi-structured qualitative interviews, participants retrospectively narrated their experiences of mental health symptoms and service use from symptom onset to the current episode. The research team used an inductive qualitative approach to identify distinct patterns of symptom management, while also examining factors that contributed to service use. Six distinct types of symptom management careers were identified based on the timing of symptom onset and service participation. Notably, none of the participants experienced an uninterrupted pattern of service use from adolescence into young adulthood. The team identified a set of themes that influenced these patterns including traumatic experiences, social supports, social service systems, and substance use. Findings highlight the developmental nature of service connection and disconnection and suggest potential points of intervention in non-specialty settings, such as schools, child welfare, and the juvenile legal system. Findings also demonstrate the need for flexible services that respond to the developmental need for autonomy and self-determination as youth transition into young adulthood.

年轻人获得心理健康服务的比例低于老年人和年轻人，尽管他们的需求很高。众所周知，心理健康服务的使用受到先前治疗经历的影响，随着时间的推移，症状和治疗的发作会产生服务使用模式，或者我们称之为“症状管理职业”。本定性研究调查了55名年轻成人（18-25岁）的症状管理职业，他们住进了一个短期的危机稳定住院病房。在精神病医生的评估后，参与者在医院完成了研究访谈。在半结构化定性访谈中，参与者回顾性地叙述了他们从症状出现到当前发作的心理健康症状和服务使用经历。研究小组使用归纳定性方法来确定症状管理的不同模式，同时也检查了导致服务使用的因素。根据症状出现的时间和服务参与，确定了六种不同类型的症状管理职业。值得注意的是，没有一个参与者经历过从青春期到成年早期不间断的服务使用模式。研究小组确定了一系列影响这些模式的主题，包括创伤经历、社会支持、社会服务系统和物质使用。研究结果强调了服务连接和断开的发展性质，并提出了非专业环境（如学校、儿童福利和少年法律系统）的潜在干预点。调查结果还表明，有必要提供灵活的服务，以满足青年向青年过渡时对自主和自决的发展需求。

{"title":"Transition symptom management careers: Historical patterns of mental health symptoms and service use among young adults experiencing a psychiatric crisis","authors":"Sarah C. Narendorf , Umaira Khan , Michelle R. Munson , Vanessa V. Klodnick , Jamaica Harrell","doi":"10.1016/j.socscimed.2024.117657","DOIUrl":"10.1016/j.socscimed.2024.117657","url":null,"abstract":"<div><div>Young adults access mental health services at lower rates than both older and younger age groups despite high levels of need. Mental health service use is known to be influenced by prior experiences with treatment, with episodes of symptoms and treatment producing patterns of service use over time, or what we call a “symptom management career”. This qualitative study examined the symptom management careers of 55 young adults (ages 18–25) who were admitted to an inpatient, short term, crisis stabilization unit. Participants completed research interviews at the hospital following a psychiatrist's assessment. During semi-structured qualitative interviews, participants retrospectively narrated their experiences of mental health symptoms and service use from symptom onset to the current episode. The research team used an inductive qualitative approach to identify distinct patterns of symptom management, while also examining factors that contributed to service use. Six distinct types of symptom management careers were identified based on the timing of symptom onset and service participation. Notably, none of the participants experienced an uninterrupted pattern of service use from adolescence into young adulthood. The team identified a set of themes that influenced these patterns including traumatic experiences, social supports, social service systems, and substance use. Findings highlight the developmental nature of service connection and disconnection and suggest potential points of intervention in non-specialty settings, such as schools, child welfare, and the juvenile legal system. Findings also demonstrate the need for flexible services that respond to the developmental need for autonomy and self-determination as youth transition into young adulthood.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117657"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142903895","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}

引用次数: 0

20-Year income volatility and cognitive function in the National Longitudinal Survey of Youth (1979) cohort: A replication and extension of CARDIA findings

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2025.117798

Katrina L. Kezios , Calvin L. Colvin , Leslie Grasset , Catherine dP. Duarte , M. Maria Glymour , Adina Zeki Al Hazzouri

Grasset et al. previously reported that income volatility throughout early-to-mid adulthood (occurring during 1990–2010) in the CARDIA cohort was associated with worse midlife cognitive function. However, CARDIA lacked earlier-life cognition data, a major potential confounder. We replicate and extend this study in the National Longitudinal Survey of Youth (1979), which collected cognition measures in approximate adolescence. Following Grasset, we estimated associations between 20-year income volatility throughout early-to-mid adulthood (mean ages 27–47 in 1990–2010) and midlife cognitive function using confounder-adjusted linear regression models. Income volatility was assessed as the standard deviation (SD) of the percent change in income between successive annual or biennial surveys and as the number of income drops >25% between surveys. For cognition, we averaged z-scores on immediate and delayed 10-word recall, backwards counting, and serial 7's tasks. We found that income volatility and number of income drops were negatively associated with midlife cognitive function (e.g., each SD increase in income volatility was associated with 0.081 SD lower cognition z-scores, 95% CI: −0.121, −0.041) independent of earlier-life cognitive skills (e.g., before adjustment,

\hat{β}

= -0.095, 95% CI: −0.136, −0.054). Our study adds to a growing literature suggesting life course financial volatility may adversely impact cognitive aging.

{"title":"20-Year income volatility and cognitive function in the National Longitudinal Survey of Youth (1979) cohort: A replication and extension of CARDIA findings","authors":"Katrina L. Kezios , Calvin L. Colvin , Leslie Grasset , Catherine dP. Duarte , M. Maria Glymour , Adina Zeki Al Hazzouri","doi":"10.1016/j.socscimed.2025.117798","DOIUrl":"10.1016/j.socscimed.2025.117798","url":null,"abstract":"<div><div>Grasset et al. previously reported that income volatility throughout early-to-mid adulthood (occurring during 1990–2010) in the CARDIA cohort was associated with worse midlife cognitive function. However, CARDIA lacked earlier-life cognition data, a major potential confounder. We replicate and extend this study in the National Longitudinal Survey of Youth (1979), which collected cognition measures in approximate adolescence. Following Grasset, we estimated associations between 20-year income volatility throughout early-to-mid adulthood (mean ages 27–47 in 1990–2010) and midlife cognitive function using confounder-adjusted linear regression models. Income volatility was assessed as the standard deviation (SD) of the percent change in income between successive annual or biennial surveys and as the number of income drops >25% between surveys. For cognition, we averaged z-scores on immediate and delayed 10-word recall, backwards counting, and serial 7's tasks. We found that income volatility and number of income drops were negatively associated with midlife cognitive function (<em>e.g.,</em> each SD increase in income volatility was associated with 0.081 SD lower cognition z-scores, 95% CI: −0.121, −0.041) independent of earlier-life cognitive skills (<em>e.g.,</em> before adjustment, <span><math><mrow><mover><mi>β</mi><mo>ˆ</mo></mover></mrow></math></span> = -0.095, 95% CI: −0.136, −0.054). Our study adds to a growing literature suggesting life course financial volatility may adversely impact cognitive aging.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"368 ","pages":"Article 117798"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372166","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}

引用次数: 0

A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis 以生物心理社会方法了解西班牙裔和非西班牙裔白人膝关节骨关节炎患者在运动参与方面的差异。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117610

Navin Kaushal , Donya Nemati , Eric Kholodovsky , Jacob Jahn , Thomas M. Best

Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.

有规律的锻炼对控制膝骨关节炎（KOA）症状至关重要。尽管有既定的研究结果，但对于KOA患者来说，持续的运动采用仍然是一个挑战，西班牙裔患者之间存在显著差异，需要确定解释运动参与中种族差异的决定因素。本研究的目的是采用生物心理社会模型来确定运动参与的决定因素，并强调种族差异。来自大学医院诊所的患者（n = 163）进行了医学检查，根据x线片被认为符合研究条件。符合条件的参与者完成了经过验证的调查措施，评估了过去两周的运动参与情况，以及生物、心理和社会领域的措施，以预测未来的运动意图。结构方程模型对路径进行了假设。过去的运动行为预测态度、自我效能和未来的运动意图。疼痛灾难化与运动参与相关，但医生和（个人）社会支持对运动的竞争效应抵消了疼痛灾难化对运动参与的重要性。重要的种族比较发现，非西班牙裔白人患者受教育程度更高，收入更高，身体质量指数更低，态度和自我效能得分更高，锻炼时间更长。两种族间的非显著影响包括意向、医生支持和社会支持。设计一种有助于促进患者医生和最近的朋友/家庭成员支持的干预措施可以在两个种族的运动参与中发挥至关重要的作用。对拉美裔人态度和自我效能感的进一步关注可以解决一些差异。本文还提供了利用生物心理社会方法促进运动公平的进一步说明。

{"title":"A biopsychosocial approach towards understanding disparities in exercise participation between Hispanic and non-Hispanic White patients living with knee osteoarthritis","authors":"Navin Kaushal , Donya Nemati , Eric Kholodovsky , Jacob Jahn , Thomas M. Best","doi":"10.1016/j.socscimed.2024.117610","DOIUrl":"10.1016/j.socscimed.2024.117610","url":null,"abstract":"<div><div>Engaging in regular exercise is essential for managing knee osteoarthritis (KOA) symptoms. Despite the established findings, sustained exercise adoption remains a challenge for KOA patients, with notable disparities among Hispanic patients, warranting a need to identify determinants that explain the racial discrepancy in exercise participation. The purpose of this study was to employ a biopsychosocial model to identify determinants of exercise participation and highlight racial disparities. Patients (n = 163) from a university hospital clinic were medically examined to be considered eligible for the study based on radiographs. Eligible participants completed validated survey measures that assessed exercise participation over the past two weeks, along with measures from biological, psychological and social domains to predict future intention exercise. Structural equation modelling tested hypothesized the paths. Past exercise behavior predicted attitudes, self-efficacy, and future exercise intentions. Pain catastrophizing correlated with exercise participation, but the competing effects of physician and (personal) social support on exercise nullified the significance of pain catastrophizing to exercise participation. Significant ethnicity comparisons found non-Hispanic white patients to have higher education, income, lower BMI, stronger scores on attitudes and self-efficacy, and greater exercise participation time. Non-significant effects between the two ethnicities include intention, physician support, and social support. Designing an intervention that helps foster support from the patient's physician and proximal friends/family members can play a vital role in exercise participation for both ethnicities. Additional focus on developing attitudes and self-efficacy among Hispanics can address some disparities. Further notes on promoting exercise equity using a biopsychosocial approach are provided.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117610"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872613","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}

引用次数: 0

Female versus viral: Understanding the UK gender health inequalities during the Covid-19 pandemic using e-archives 女性与病毒：利用电子档案了解Covid-19大流行期间英国的性别健康不平等。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117589

Chen Qu

Despite the development of digital health infrastructure, female health inequalities have worsened during the pandemic. This transdisciplinary study, through health, feminist, and infrastructural geographical lens, examines how gender health inequalities may have emerged or worsened during Covid-19 in the UK. This study leverages a novel web archive collection, Python coding-powered data-handling text analysis (of over 0.2 billion words), and thematic analysis to examine three themes: vaccines, social minority groups, and women’s self-care. The findings suggest that the pandemic has impacted health inequalities among British women and girls and more, in a ‘more-than-gender’ way in terms of health (care) outcomes and access. In addition to reflecting on the use of e-archives in this study including suggesting the potential of combining e-archiving, coding, natural language processing (NLP) and generative AI/Large Language Models (LLMs) in producing and analysing trans-temporal (big) datasets, I argue that a geographical crisis perspective that balances the needs of everyday life and possible crises can be considered when preparing for public health emergencies. I adopt the e-archiving of this study to rethink ‘digital health infrastructure’ as ‘actors’, ‘facilitators’, and ‘voicers’, revealing how human-computer interaction and people in the virtual realm can be infrastructure.

尽管数字卫生基础设施得到了发展，但在大流行期间，女性卫生不平等现象加剧。这项跨学科研究通过健康、女权主义和基础设施地理视角，研究了英国在2019冠状病毒病期间性别健康不平等是如何出现或恶化的。这项研究利用了一个新颖的网络档案收集，Python编码驱动的数据处理文本分析（超过2亿字），以及主题分析来研究三个主题：疫苗，社会少数群体和妇女自我保健。调查结果表明，就卫生（保健）结果和获取而言，疫情影响了英国妇女和女孩等群体的卫生不平等，其影响“超越了性别”。除了反思本研究中电子档案的使用，包括建议将电子存档、编码、自然语言处理（NLP）和生成式人工智能/大型语言模型（llm）结合起来生产和分析跨时间（大）数据集的潜力之外，我认为，在准备应对突发公共卫生事件时，可以考虑从地理危机的角度来平衡日常生活的需求和可能的危机。我采用本研究的电子存档，将“数字卫生基础设施”重新思考为“行动者”、“促进者”和“发声者”，揭示虚拟领域中的人机交互和人如何成为基础设施。

{"title":"Female versus viral: Understanding the UK gender health inequalities during the Covid-19 pandemic using e-archives","authors":"Chen Qu","doi":"10.1016/j.socscimed.2024.117589","DOIUrl":"10.1016/j.socscimed.2024.117589","url":null,"abstract":"<div><div>Despite the development of digital health infrastructure, female health inequalities have worsened during the pandemic. This transdisciplinary study, through health, feminist, and infrastructural geographical lens, examines how gender health inequalities may have emerged or worsened during Covid-19 in the UK. This study leverages a novel web archive collection, Python coding-powered data-handling text analysis (of over 0.2 billion words), and thematic analysis to examine three themes: vaccines, social minority groups, and women’s self-care. The findings suggest that the pandemic has impacted health inequalities among British women and girls and more, in a ‘more-than-gender’ way in terms of health (care) outcomes and access. In addition to reflecting on the use of e-archives in this study including suggesting the potential of combining e-archiving, coding, natural language processing (NLP) and generative AI/Large Language Models (LLMs) in producing and analysing trans-temporal (big) datasets, I argue that a geographical crisis perspective that balances the needs of everyday life and possible crises can be considered when preparing for public health emergencies. I adopt the e-archiving of this study to rethink ‘digital health infrastructure’ as ‘actors’, ‘facilitators’, and ‘voicers’, revealing how human-computer interaction and people in the virtual realm can be infrastructure.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117589"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142878000","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}

引用次数: 0

“The mannequins have been pink for a very long time.” Navigating whiteness and realness in simulation “人体模型是粉红色的已经有很长时间了。”导航白色和真实模拟。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117647

David A. Ansari , Emily R. Via , Christine S. Park

Simulation training provides health professions learners access to training not readily available to them and in a manner that does not harm patients. Simulation also supports learners to develop dispositions and professional communication and reflect on their biases. This study examines how learners, clinical education faculty, and simulation professionals reflect on diversity and antiracism in simulation and contextualize these reflections with their lived experience. We undertook interviews and focus group discussions with medical students, simulation professionals, and clinical education faculty (n = 47) at a public medical school in the U.S. Midwest with three campuses. Students, faculty, and simulation professionals recognized the importance of simulation as a safe and judgment free zone where they could build rapport with patients with a variety of health conditions and medical histories. Moreover, students recognized how simulation professionals created environments where they could ask questions, practice techniques, and feel more prepared for their future clinical encounters. Students, faculty, and simulation professionals recognized how cases written by faculty, simulation professionals and equipment were insufficiently inclusive of the patient populations that students would eventually see, in terms of race, language, disability, body size, and age. Simulation reproduced biases and posed challenges to the perceived realness of encounters with simulated patients. Students who were visible minorities found it harder to relate to simulated patients and found these patients to be biased towards them. The ways faculty wrote cases and the inability to relate to standardized patients reinforced perceptions that the simulation did not feel real enough. While simulation has the potential to address the dimensions of medical training and practice that harm students and patients, it can also inadvertently reproduce these dimensions. We contend that these harmful products of simulation hinder the very efforts to create cultures of belonging and solidarity that antiracist practices in simulation seek to achieve.

模拟培训以不伤害患者的方式为卫生专业学习者提供了他们无法获得的培训。模拟还支持学习者发展性格和专业沟通，并反思他们的偏见。本研究考察了学习者、临床教育教师和模拟专业人员如何反思模拟中的多样性和反种族主义，并将这些反思与他们的生活经验联系起来。我们在美国中西部有三个校区的一所公立医学院与医学生、模拟专业人员和临床教育教师（n = 47）进行了访谈和焦点小组讨论。学生、教师和模拟专业人员认识到模拟作为一个安全和自由判断的区域的重要性，在那里他们可以与各种健康状况和病史的患者建立融洽的关系。此外，学生们认识到模拟专业人员如何创造环境，让他们可以提出问题，练习技术，并为未来的临床接触做好准备。学生、教师和模拟专业人员认识到，教师、模拟专业人员和设备编写的病例不足以涵盖学生最终看到的患者群体，包括种族、语言、残疾、体型和年龄。模拟再现了偏见，并对与模拟患者接触的感知真实性提出了挑战。少数族裔学生发现更难与模拟病人建立联系，并发现这些病人对他们有偏见。教师撰写病例的方式以及无法与标准化患者建立联系，强化了人们的看法，即模拟的感觉不够真实。虽然模拟有可能解决医疗培训和实践中伤害学生和患者的问题，但它也可能无意中再现这些问题。我们认为，这些模拟的有害产物阻碍了创造归属感和团结文化的努力，而这正是模拟中的反种族主义做法所寻求实现的。

{"title":"“The mannequins have been pink for a very long time.” Navigating whiteness and realness in simulation","authors":"David A. Ansari , Emily R. Via , Christine S. Park","doi":"10.1016/j.socscimed.2024.117647","DOIUrl":"10.1016/j.socscimed.2024.117647","url":null,"abstract":"<div><div>Simulation training provides health professions learners access to training not readily available to them and in a manner that does not harm patients. Simulation also supports learners to develop dispositions and professional communication and reflect on their biases. This study examines how learners, clinical education faculty, and simulation professionals reflect on diversity and antiracism in simulation and contextualize these reflections with their lived experience. We undertook interviews and focus group discussions with medical students, simulation professionals, and clinical education faculty (n = 47) at a public medical school in the U.S. Midwest with three campuses. Students, faculty, and simulation professionals recognized the importance of simulation as a safe and judgment free zone where they could build rapport with patients with a variety of health conditions and medical histories. Moreover, students recognized how simulation professionals created environments where they could ask questions, practice techniques, and feel more prepared for their future clinical encounters. Students, faculty, and simulation professionals recognized how cases written by faculty, simulation professionals and equipment were insufficiently inclusive of the patient populations that students would eventually see, in terms of race, language, disability, body size, and age. Simulation reproduced biases and posed challenges to the perceived realness of encounters with simulated patients. Students who were visible minorities found it harder to relate to simulated patients and found these patients to be biased towards them. The ways faculty wrote cases and the inability to relate to standardized patients reinforced perceptions that the simulation did not feel real enough. While simulation has the potential to address the dimensions of medical training and practice that harm students and patients, it can also inadvertently reproduce these dimensions. We contend that these harmful products of simulation hinder the very efforts to create cultures of belonging and solidarity that antiracist practices in simulation seek to achieve.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117647"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899706","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}

引用次数: 0

Disparities in quality of life by race, gender, and sexual orientation: An intersectional analysis of population-representative data in Gauteng, South Africa 种族、性别和性取向在生活质量上的差异：南非豪登省人口代表性数据的交叉分析。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117651

Nicholas Metheny , Gabriel John Dusing , Pedzisai Ndagurwa , Sthembiso Pollen Mkhize

Background

South Africa's history of apartheid has led to persistent inequalities. While progress has been made since 1994, disparities in quality of life (QoL) remain, particularly along racial lines. This study examines how race, gender, and sexual orientation intersect to influence QoL in Gauteng - South Africa's most populous and economically vibrant province.

Methods

Using data from the Gauteng City-Region Observatory's QoL 6 (2020/2021) Survey, we analyzed a sample of 10,760 respondents. We employed inverse probability weighting with regression adjustment (IPWRA) to estimate the Average Treatment Effect (ATE) of race, gender, and sexual minority status on QoL, while controlling for socioeconomic factors.

Results

Significant QoL disparities were observed across intersecting identities. White heterosexual men had the highest QoL scores, while Black sexual minority women had the lowest. After adjusting for covariates, all Black groups exhibited significantly lower QoL scores compared to their White counterparts. The largest gap was between White sexual minority women and Black sexual minority men (ATE: -14.47; 95%CI: -17.18,-11.76). Within the Black population, heterosexual men had significantly higher QoL than heterosexual women (ATE: -0.98; 95%CI: -1.54, −0.42).

Conclusions

Despite progress since apartheid, substantial QoL disparities persist in Gauteng, primarily along racial lines, particularly in access to services and socio-economic opportunities. The intersectionality of race, gender, and sexual orientation creates distinct vulnerabilities, particularly for Black sexual minority women. These findings suggest that current policies aimed at improving equity may be insufficient. Addressing these disparities requires a multifaceted approach that considers the complex interplay of race, gender, and sexual orientation in shaping QoL.

背景：南非的种族隔离历史导致了持续的不平等。虽然自1994年以来取得了进展，但生活质量（QoL）的差异仍然存在，特别是在种族之间。本研究考察了种族、性别和性取向如何相互影响豪登省（南非人口最多、经济最活跃的省份）的生活质量。方法：利用豪登省城市-地区观测站第6次生活质量（2020/2021）调查数据，对10,760名受访者进行分析。在控制社会经济因素的情况下，我们采用回归调整逆概率加权（IPWRA）来估计种族、性别和性少数状况对生活质量的平均治疗效应（ATE）。结果：在交叉身份中观察到显著的生活质量差异。白人异性恋男性的生活质量得分最高，而黑人性少数女性的生活质量得分最低。在调整协变量后，所有黑人组的生活质量得分都明显低于白人组。白人性少数女性与黑人性少数男性之间的差距最大(ATE: -14.47；95%置信区间:-17.18,-11.76)。在黑人人群中，异性恋男性的生活质量显著高于异性恋女性(ATE: -0.98；95%ci: -1.54, -0.42)。结论：尽管自种族隔离以来取得了进步，但豪登省的生活质量差距仍然存在，主要是种族差异，特别是在获得服务和社会经济机会方面。种族、性别和性取向的相互交织造成了明显的脆弱性，尤其是对黑人性少数女性而言。这些发现表明，目前旨在改善公平的政策可能是不够的。解决这些差异需要多方面的方法，考虑种族、性别和性取向在塑造生活质量方面的复杂相互作用。

{"title":"Disparities in quality of life by race, gender, and sexual orientation: An intersectional analysis of population-representative data in Gauteng, South Africa","authors":"Nicholas Metheny , Gabriel John Dusing , Pedzisai Ndagurwa , Sthembiso Pollen Mkhize","doi":"10.1016/j.socscimed.2024.117651","DOIUrl":"10.1016/j.socscimed.2024.117651","url":null,"abstract":"<div><h3>Background</h3><div>South Africa's history of apartheid has led to persistent inequalities. While progress has been made since 1994, disparities in quality of life (QoL) remain, particularly along racial lines. This study examines how race, gender, and sexual orientation intersect to influence QoL in Gauteng - South Africa's most populous and economically vibrant province.</div></div><div><h3>Methods</h3><div>Using data from the Gauteng City-Region Observatory's QoL 6 (2020/2021) Survey, we analyzed a sample of 10,760 respondents. We employed inverse probability weighting with regression adjustment (IPWRA) to estimate the Average Treatment Effect (ATE) of race, gender, and sexual minority status on QoL, while controlling for socioeconomic factors.</div></div><div><h3>Results</h3><div>Significant QoL disparities were observed across intersecting identities. White heterosexual men had the highest QoL scores, while Black sexual minority women had the lowest. After adjusting for covariates, all Black groups exhibited significantly lower QoL scores compared to their White counterparts. The largest gap was between White sexual minority women and Black sexual minority men (ATE: -14.47; 95%CI: -17.18,-11.76). Within the Black population, heterosexual men had significantly higher QoL than heterosexual women (ATE: -0.98; 95%CI: -1.54, −0.42).</div></div><div><h3>Conclusions</h3><div>Despite progress since apartheid, substantial QoL disparities persist in Gauteng, primarily along racial lines, particularly in access to services and socio-economic opportunities. The intersectionality of race, gender, and sexual orientation creates distinct vulnerabilities, particularly for Black sexual minority women. These findings suggest that current policies aimed at improving equity may be insufficient. Addressing these disparities requires a multifaceted approach that considers the complex interplay of race, gender, and sexual orientation in shaping QoL.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117651"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899765","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}

引用次数: 0

Patient passports and vulnerability: Disjunctures in health policy instruments for people with rare diseases 病人护照和脆弱性：罕见病患者卫生政策工具的脱节。

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2024.117642

Małgorzata Rajtar

Rare diseases have had a special status within European Union (EU) health policy since the late 1990s. According to key EU legal documents, rare disease patients are entitled to the same good quality care as others. These individuals are particularly vulnerable due to the “low prevalence” and “uniqueness” of their disease. To ensure that patients with rare disorders in Europe can access high-quality care in their respective countries, the Council of the European Union (2009) recommended that member states adopt plans or strategies for rare diseases. Poland adopted its first Plan for Rare Diseases in 2021.

This article draws from bioethical and social science scholarship on vulnerability as well as ethnographic research that I conducted among people with rare metabolic diseases, their families, health professionals, and patient advocacy groups in Poland between 2016 and 2023. I examine instruments developed within healthcare policies that are tailored to rare diseases, notably the patient passport, which is a site of disjuncture (Appadurai, 1990) embedded in healthcare policies and practices tailored to people with rare diseases. I argue that although such instruments are meant to benefit patients, they almost exclusively focus on the patient's sick body and the needs of health professionals, who are unfamiliar with a given rare disease. Thus, these instruments may engender paternalistic practices and they may contribute to discrimination and stigmatization as well as to the datafication of health vulnerabilities. Furthermore, the focus on inherent vulnerability obscures its other “layers” (Luna, 2009, 2019) or “degrees” (Traianou and Hammersley, 2023).

自20世纪90年代末以来，罕见病在欧洲联盟（欧盟）的卫生政策中具有特殊地位。根据欧盟重要的法律文件，罕见病患者有权获得与其他人一样的优质护理。由于其疾病的“低患病率”和“独特性”，这些人特别容易受到伤害。为了确保欧洲罕见疾病患者能够在各自国家获得高质量的护理，欧洲联盟理事会（2009年）建议成员国通过罕见疾病计划或战略。波兰于2021年通过了第一个罕见病计划。本文借鉴了我在2016年至2023年期间在波兰对罕见代谢疾病患者、他们的家人、卫生专业人员和患者倡导团体进行的关于脆弱性的生物伦理和社会科学奖学金以及民族志研究。我研究了针对罕见病的医疗保健政策中开发的工具，特别是患者护照，这是针对罕见病患者的医疗保健政策和实践中的一个脱节点（Appadurai, 1990）。我认为，尽管这些仪器是为了造福病人，但它们几乎只关注病人患病的身体和不熟悉某种罕见疾病的卫生专业人员的需求。因此，这些文书可能导致家长式做法，并可能导致歧视和污名化以及健康脆弱性的数据化。此外，对固有脆弱性的关注掩盖了它的其他“层”（Luna， 2009年，2019年）或“度”（Traianou和Hammersley， 2023年）。

{"title":"Patient passports and vulnerability: Disjunctures in health policy instruments for people with rare diseases","authors":"Małgorzata Rajtar","doi":"10.1016/j.socscimed.2024.117642","DOIUrl":"10.1016/j.socscimed.2024.117642","url":null,"abstract":"<div><div>Rare diseases have had a special status within European Union (EU) health policy since the late 1990s. According to key EU legal documents, rare disease patients are entitled to the same good quality care as others. These individuals are particularly vulnerable due to the “low prevalence” and “uniqueness” of their disease. To ensure that patients with rare disorders in Europe can access high-quality care in their respective countries, the Council of the European Union (2009) recommended that member states adopt plans or strategies for rare diseases. Poland adopted its first Plan for Rare Diseases in 2021.</div><div>This article draws from bioethical and social science scholarship on vulnerability as well as ethnographic research that I conducted among people with rare metabolic diseases, their families, health professionals, and patient advocacy groups in Poland between 2016 and 2023. I examine instruments developed within healthcare policies that are tailored to rare diseases, notably the patient passport, which is a site of disjuncture (Appadurai, 1990) embedded in healthcare policies and practices tailored to people with rare diseases. I argue that although such instruments are meant to benefit patients, they almost exclusively focus on the patient's sick body and the needs of health professionals, who are unfamiliar with a given rare disease. Thus, these instruments may engender paternalistic practices and they may contribute to discrimination and stigmatization as well as to the datafication of health vulnerabilities. Furthermore, the focus on inherent vulnerability obscures its other “layers” (Luna, 2009, 2019) or “degrees” (Traianou and Hammersley, 2023).</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117642"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899832","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}

引用次数: 0

Moving opportunistically: Interstate migration after medicaid expansion

IF 4.9 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2025-02-01 DOI: 10.1016/j.socscimed.2025.117771

Matthew C. Baker, Thomas Stratmann

The large-scale expansion of Medicaid eligibility following the Affordable Care Act provides an ideal setting to explore whether changes to state-provided health insurance benefits predict migration across state lines. Using the American Community Survey's person-level data from 2009 to 2019 about moving during the prior 12 months, we examine whether Medicaid's selective expansion after the Affordable Care Act prompted in-migration to states that greatly expanded Medicaid eligibility for the populations most targeted by the expansion. We find that states expanding Medicaid by the largest margin was related to higher in-migration, equating to 0.23 percentage points greater annual population growth in the target population, 0.42 percent for the disabled subpopulation, and 0.25 percent for the parent subpopulation. Our results translate to 56,659 interstate moves after Medicaid enrollment growth. The effect was concentrated among individuals who previously lived close to a state's border. The implications of this study are that high-needs individuals in certain states may be impacted by welfare magnets and modestly prone to being undercounted in projected government expenditures.

{"title":"Moving opportunistically: Interstate migration after medicaid expansion","authors":"Matthew C. Baker, Thomas Stratmann","doi":"10.1016/j.socscimed.2025.117771","DOIUrl":"10.1016/j.socscimed.2025.117771","url":null,"abstract":"<div><div>The large-scale expansion of Medicaid eligibility following the Affordable Care Act provides an ideal setting to explore whether changes to state-provided health insurance benefits predict migration across state lines. Using the American Community Survey's person-level data from 2009 to 2019 about moving during the prior 12 months, we examine whether Medicaid's selective expansion after the Affordable Care Act prompted in-migration to states that greatly expanded Medicaid eligibility for the populations most targeted by the expansion. We find that states expanding Medicaid by the largest margin was related to higher in-migration, equating to 0.23 percentage points greater annual population growth in the target population, 0.42 percent for the disabled subpopulation, and 0.25 percent for the parent subpopulation. Our results translate to 56,659 interstate moves after Medicaid enrollment growth. The effect was concentrated among individuals who previously lived close to a state's border. The implications of this study are that high-needs individuals in certain states may be impacted by welfare magnets and modestly prone to being undercounted in projected government expenditures.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117771"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081801","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}

引用次数: 0