Pub Date : 2024-10-01DOI: 10.1016/j.socscimed.2024.117383
Being open about priority-setting decisions is a central element of frameworks enhancing procedural fairness. While challenges in implementing priority-setting frameworks in general have been reported, few studies have empirically examined how the concept of openness is understood and enacted in the day-to-day functioning of hospitals. This paper explores the operationalisation of the policy of “open priorities”, based on long-term ethnographic fieldwork in a Norwegian hospital in 2022. Drawing on the concept of performativity, the study portrays how the ideal of open priorities translates into everyday practices related to why, for whom and which priorities are to be open. The paper shows how openness was portrayed as a central hospital policy, but was also seen as a source of conflicts, hindering effective governance and reducing public trust. Hence, hospital leaders transformed and diluted the ideal of openness into priority-setting decisions with multiple shields of opaqueness. Through omissions and rewritings of the notion of openness, health leaders enacted performativity. The paper adds to the growing body of knowledge of the multifaceted ways policy ideals are transformed by government institutions in the process of implementation and calls for further exploration of efforts to improve everyday and routinised procedural fairness.
{"title":"Open and opaque? The performativity of open priorities in a Norwegian hospital","authors":"","doi":"10.1016/j.socscimed.2024.117383","DOIUrl":"10.1016/j.socscimed.2024.117383","url":null,"abstract":"<div><div>Being open about priority-setting decisions is a central element of frameworks enhancing procedural fairness. While challenges in implementing priority-setting frameworks in general have been reported, few studies have empirically examined how the concept of openness is understood and enacted in the day-to-day functioning of hospitals. This paper explores the operationalisation of the policy of “open priorities”, based on long-term ethnographic fieldwork in a Norwegian hospital in 2022. Drawing on the concept of performativity, the study portrays how the ideal of open priorities translates into everyday practices related to why, for whom and which priorities are to be open. The paper shows how openness was portrayed as a central hospital policy, but was also seen as a source of conflicts, hindering effective governance and reducing public trust. Hence, hospital leaders transformed and diluted the ideal of openness into priority-setting decisions with multiple shields of opaqueness. Through omissions and rewritings of the notion of openness, health leaders enacted performativity. The paper adds to the growing body of knowledge of the multifaceted ways policy ideals are transformed by government institutions in the process of implementation and calls for further exploration of efforts to improve everyday and routinised procedural fairness.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.socscimed.2024.117379
Multimorbidity, commonly defined as the co-existence of two or more long-term conditions, is a major global public health challenge with significant impacts for health and social care systems. There is a substantial body of work identifying different individual- and household-level determinants of multimorbidity, yet the role of place-based characteristics in affecting multimorbidity remains limited. This systematic scoping review identifies place-based risk factors for multimorbidity and further synthesises the potential pathways explaining these relationships using longitudinal evidence. By systematically searching seven major databases, such as Medline, Embase, and Web of Science, using relevant search terms (e.g., MeSH) relating to place-based risk factors and multimorbidity, 76 out of 7761 studies were included for evidence synthesis. We include studies exploring the relationship between place-based risk factors and multimorbidity among the general population older than 18 years old in the setting of community-dwelling, primary, and secondary care. We identified 12 types of place-based risk factors, with the impacts of area-level deprivation/SES, pollution, and urban/rurality on multimorbidity being most frequently considered and with the most consistent findings, with people living in more deprived/low SES, highly polluted, or more urbanised areas having increased risks of multimorbidity. Further, the impact of these place-based risk factors on multimorbidity varied according to the operationalisation of the multimorbidity measure. We also identified that the impacts of other types of place-based factors on multimorbidity remain underexplored, such as social cohesion and greenspace. Finally, using these longitudinal findings, we propose a conceptual framework linking place and multimorbidity. We suggest that future studies explore a wider range of place-level environmental exposures and use more precise measures, exploit electronic health records to implement more consistent and reproducible measurements of multimorbidity, moreover, make greater use of longitudinal study designs or analytical approaches better suited to identifying causal processes.
多病共存通常是指同时存在两种或两种以上的长期病症，它是全球公共卫生面临的一项重大挑战，对医疗和社会护理系统产生了重大影响。目前已有大量研究确定了个人和家庭层面的多病症决定因素，但地方特征在影响多病症方面的作用仍然有限。本系统性范围界定综述确定了多病症的地方风险因素，并利用纵向证据进一步综合了解释这些关系的潜在途径。通过使用与地方风险因素和多病症相关的检索词（如 MeSH）对 Medline、Embase 和 Web of Science 等七个主要数据库进行系统检索，在 7761 项研究中纳入了 76 项进行证据综合。我们纳入的研究探讨了在社区居住、初级和二级护理环境中，18 岁以上普通人群中基于地方的风险因素与多病症之间的关系。我们确定了 12 种基于地方的风险因素，其中地区层面的贫困/社会经济地位、污染和城市/乡村化对多病症的影响被考虑得最多，研究结果也最一致，即生活在更贫困/社会经济地位更低、高污染或更城市化地区的人患多病症的风险更高。此外，这些地方性风险因素对多病症的影响因多病症测量方法的操作而异。我们还发现，其他类型的地方因素（如社会凝聚力和绿地）对多病性的影响仍未得到充分探讨。最后，利用这些纵向研究结果，我们提出了一个将地方和多病症联系起来的概念框架。我们建议未来的研究探索更广泛的地方环境暴露，使用更精确的测量方法，利用电子健康记录对多病症进行更一致和可重复的测量，此外，更多地使用纵向研究设计或更适合确定因果过程的分析方法。
{"title":"The impact of place on multimorbidity: A systematic scoping review","authors":"","doi":"10.1016/j.socscimed.2024.117379","DOIUrl":"10.1016/j.socscimed.2024.117379","url":null,"abstract":"<div><div>Multimorbidity, commonly defined as the co-existence of two or more long-term conditions, is a major global public health challenge with significant impacts for health and social care systems. There is a substantial body of work identifying different individual- and household-level determinants of multimorbidity, yet the role of place-based characteristics in affecting multimorbidity remains limited. This systematic scoping review identifies place-based risk factors for multimorbidity and further synthesises the potential pathways explaining these relationships using longitudinal evidence. By systematically searching seven major databases, such as Medline, Embase, and Web of Science, using relevant search terms (e.g., MeSH) relating to place-based risk factors and multimorbidity, 76 out of 7761 studies were included for evidence synthesis. We include studies exploring the relationship between place-based risk factors and multimorbidity among the general population older than 18 years old in the setting of community-dwelling, primary, and secondary care. We identified 12 types of place-based risk factors, with the impacts of area-level deprivation/SES, pollution, and urban/rurality on multimorbidity being most frequently considered and with the most consistent findings, with people living in more deprived/low SES, highly polluted, or more urbanised areas having increased risks of multimorbidity. Further, the impact of these place-based risk factors on multimorbidity varied according to the operationalisation of the multimorbidity measure. We also identified that the impacts of other types of place-based factors on multimorbidity remain underexplored, such as social cohesion and greenspace. Finally, using these longitudinal findings, we propose a conceptual framework linking place and multimorbidity. We suggest that future studies explore a wider range of place-level environmental exposures and use more precise measures, exploit electronic health records to implement more consistent and reproducible measurements of multimorbidity, moreover, make greater use of longitudinal study designs or analytical approaches better suited to identifying causal processes.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142511355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.socscimed.2024.117367
The Supplemental Nutrition Assistance Program (SNAP) helps millions of families with low incomes to afford and purchase food each year. Prior research has noted that welfare stigma—negative stereotypes about people who participate in public assistance programs—can limit SNAP participation. Stigma may also contribute to worse mental health among subgroups like male participants; qualitative evidence suggests males may struggle to accept public assistance benefits due to norms surrounding gender roles. Yet there is little research about who is most likely to experience stigma, how stigma relates to food insecurity, whether this relationship varies by gender identity, and whether stigma is associated with online shopping (which may protect against stigma). To address these gaps, we analyzed a national survey of 1383 SNAP participants about their experiences of SNAP stigma, food insecurity, and online shopping. In adjusted models, we found that male participants had 40% higher odds (95% CI: 1.09–1.80) of reporting any stigma experience compared to female participants. SNAP participants reporting stigma had over three times the odds (OR: 3.54, 95% CI: 2.60–4.81) of reporting food insecurity relative to those not reporting stigma, and male participants reporting stigma had nearly three times higher odds of food insecurity than female participants reporting stigma (OR: 2.94, 95% CI: 1.53, 5.66). In addition, stigma was not significantly associated with shopping online or using SNAP benefits online. In this national sample of SNAP participants, male respondents had greater odds of welfare stigma, experiences of stigma were associated with greater odds of food insecurity, male respondents experiencing stigma had greater odds of food insecurity compared to female respondents, and stigma was not associated with online shopping behaviors. Efforts to reframe public assistance may be needed to destigmatize programs like SNAP to both improve program uptake among non-participants and improve health outcomes among participants.
{"title":"Food for thought: The intersection between SNAP stigma, food insecurity, and gender","authors":"","doi":"10.1016/j.socscimed.2024.117367","DOIUrl":"10.1016/j.socscimed.2024.117367","url":null,"abstract":"<div><div>The Supplemental Nutrition Assistance Program (SNAP) helps millions of families with low incomes to afford and purchase food each year. Prior research has noted that welfare stigma—negative stereotypes about people who participate in public assistance programs—can limit SNAP participation. Stigma may also contribute to worse mental health among subgroups like male participants; qualitative evidence suggests males may struggle to accept public assistance benefits due to norms surrounding gender roles. Yet there is little research about who is most likely to experience stigma, how stigma relates to food insecurity, whether this relationship varies by gender identity, and whether stigma is associated with online shopping (which may protect against stigma). To address these gaps, we analyzed a national survey of 1383 SNAP participants about their experiences of SNAP stigma, food insecurity, and online shopping. In adjusted models, we found that male participants had 40% higher odds (95% CI: 1.09–1.80) of reporting any stigma experience compared to female participants. SNAP participants reporting stigma had over three times the odds (OR: 3.54, 95% CI: 2.60–4.81) of reporting food insecurity relative to those not reporting stigma, and male participants reporting stigma had nearly three times higher odds of food insecurity than female participants reporting stigma (OR: 2.94, 95% CI: 1.53, 5.66). In addition, stigma was not significantly associated with shopping online or using SNAP benefits online. In this national sample of SNAP participants, male respondents had greater odds of welfare stigma, experiences of stigma were associated with greater odds of food insecurity, male respondents experiencing stigma had greater odds of food insecurity compared to female respondents, and stigma was not associated with online shopping behaviors. Efforts to reframe public assistance may be needed to destigmatize programs like SNAP to both improve program uptake among non-participants and improve health outcomes among participants.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142394601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.socscimed.2024.117382
Living in poor and physically deteriorating neighborhoods is associated with heightened likelihood of experiencing depression. At the same time, not all people experience their neighborhoods in the same way. We predicted and tested the possibility that variability in this association can be explained by the social support that people derive both from their personal networks and other people residing in the same neighborhood, and that this moderation varies by race/ethnicity. Health and Retirement Study data (2018/2020 waves) were used to evaluate the role of individual-level and contextual risk and resilience factors in association with depression among US older non-Hispanic white adults (n = 4,986, mean age 67 years), non-Hispanic black adults (n = 1,342, mean age 65 years), and Hispanic adults (n = 937, mean age 64 years). Four notable findings emerged. First, perceived neighborhood disorder was related to increased depression risk for non-Hispanic white and black participants, but not Hispanic participants. Second, participants residing in census tracts with higher poverty rates were more likely to report depression. Third, non-Hispanic white participants residing in census tracts with greater Hispanic resident density had reduced depression risk. This same pattern was not observed among non-Hispanic black participants. Finally, perceived support from family was associated with reduced depression risk among all participants. These data suggest both individual- and contextual-level sources of risk and resiliency for depression. The implications for theories that seek to explain the relative resilience to neighborhood disorder observed among US Hispanic residents are discussed.
{"title":"Depression risk and resilience in a diverse sample of older adults in the United States","authors":"","doi":"10.1016/j.socscimed.2024.117382","DOIUrl":"10.1016/j.socscimed.2024.117382","url":null,"abstract":"<div><div>Living in poor and physically deteriorating neighborhoods is associated with heightened likelihood of experiencing depression. At the same time, not all people experience their neighborhoods in the same way. We predicted and tested the possibility that variability in this association can be explained by the social support that people derive both from their personal networks and other people residing in the same neighborhood, and that this moderation varies by race/ethnicity. Health and Retirement Study data (2018/2020 waves) were used to evaluate the role of individual-level and contextual risk and resilience factors in association with depression among US older non-Hispanic white adults (<em>n</em> = 4,986, mean age 67 years), non-Hispanic black adults (<em>n</em> = 1,342, mean age 65 years), and Hispanic adults (<em>n</em> = 937, mean age 64 years). Four notable findings emerged. First, perceived neighborhood disorder was related to increased depression risk for non-Hispanic white and black participants, but not Hispanic participants. Second, participants residing in census tracts with higher poverty rates were more likely to report depression. Third, non-Hispanic white participants residing in census tracts with greater Hispanic resident density had reduced depression risk. This same pattern was not observed among non-Hispanic black participants. Finally, perceived support from family was associated with reduced depression risk among all participants. These data suggest both individual- and contextual-level sources of risk and resiliency for depression. The implications for theories that seek to explain the relative resilience to neighborhood disorder observed among US Hispanic residents are discussed.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.socscimed.2024.117381
The cyclical nature of agriculture exposes farmers to challenges that vary over time, influenced by a myriad of external factors beyond their control. This longitudinal study aimed to examine mental health trajectories for Western Australian farmers over a 12 month period, and determine associations with key risk and protective factors. Farmers and farm residents (N = 125) completed an online survey at three timepoints (baseline, 6 months and 12 months) that assessed anxiety, depression, stress, farming stressors, coping strategies, sense of belonging and social supports. Survey timing coincided with periods of harvest and seeding. Risk factors associated with poorer mental health among farmers included a range of dysfunctional and emotion coping strategies, family/relationship stressors, financial/external stressors and daily stressors. Protective factors included sense of belonging and social support. Stress was found to change over time and family/relationship stressors and financial/external stressors at baseline were found to moderate anxiety and stress at 6 months and 12 months. Addressing factors associated with poor mental health trajectories and bolstering factors that are protective for mental health over time will aid clinical and community services in tailoring their services to meet the needs of farmers.
{"title":"Supporting mental health in farming communities where and when it is needed most: A longitudinal analysis of risk and protective factors","authors":"","doi":"10.1016/j.socscimed.2024.117381","DOIUrl":"10.1016/j.socscimed.2024.117381","url":null,"abstract":"<div><div>The cyclical nature of agriculture exposes farmers to challenges that vary over time, influenced by a myriad of external factors beyond their control. This longitudinal study aimed to examine mental health trajectories for Western Australian farmers over a 12 month period, and determine associations with key risk and protective factors. Farmers and farm residents (<em>N</em> = 125) completed an online survey at three timepoints (baseline, 6 months and 12 months) that assessed anxiety, depression, stress, farming stressors, coping strategies, sense of belonging and social supports. Survey timing coincided with periods of harvest and seeding. Risk factors associated with poorer mental health among farmers included a range of dysfunctional and emotion coping strategies, family/relationship stressors, financial/external stressors and daily stressors. Protective factors included sense of belonging and social support. Stress was found to change over time and family/relationship stressors and financial/external stressors at baseline were found to moderate anxiety and stress at 6 months and 12 months. Addressing factors associated with poor mental health trajectories and bolstering factors that are protective for mental health over time will aid clinical and community services in tailoring their services to meet the needs of farmers.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.socscimed.2024.117372
This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability – factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space – size, greenness, and type of available public outdoor spaces; (3) Food environment – ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR).
Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or “protective” associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability.
{"title":"The built environment and its association with type 2 diabetes mellitus incidence: A systematic review and meta-analysis of longitudinal studies","authors":"","doi":"10.1016/j.socscimed.2024.117372","DOIUrl":"10.1016/j.socscimed.2024.117372","url":null,"abstract":"<div><div>This study aimed to systematically review longitudinal studies examining associations between the incidence of type 2 diabetes mellitus (T2DM) and built environmental factors. This review adhered to the 2020 PRISMA guidelines. Longitudinal studies examining associations between T2DM incidence and built environmental features were eligible. Built environment constructs corresponded to the following themes: 1) Walkability – factors such as sidewalks/footpaths, crosswalks, parks, and density of businesses and services; (2) Green/open space – size, greenness, and type of available public outdoor spaces; (3) Food environment – ratio of healthful food outlets (e.g., greengrocers, butchers, supermarkets, and health food shops) to unhealthful food outlets (e.g., fast-food outlets, sweet food retailers, and convenience stores). Five databases (e.g., Medline) were searched from inception until July 2023. Qualitative and quantitative synthesis were used to summarise key findings, including a meta-analysis of adjusted Hazard Ratios (aHR).</div><div>Of 3,343 articles, 16 longitudinal studies from seven countries, published between 2015 and 2023, involving 13,403,902 baseline participants (median of 83,898), were included. In four of the five studies, unhealthful food environment was significantly associated with higher incident T2DM. Five of seven greenspace studies and two of four walkability studies showed that greater greenery and greater walkability were statistically significantly associated with lesser incident T2DM. In pooled analyses, greater T2DM incidence was associated with unhealthful relative to healthful food environments (pooled HR: 1.21; 95% CI: 1.04, 1.42), and T2DM incidence was inversely associated with green/open space environments (pooled HR: 0.82; 95% CI: 0.74, 0.92). Greater walkability was associated with a slight 2% lesser incidence of T2DM (pooled HR: 0.98; 95% CI: 0.98, 0.99). This review underscores consistency in the nature of associations between built environment features related to T2DM. We observed statistically significant inverse or “protective” associations between T2DM and walkability and healthful food environments. These results support calls for policies and guidelines that promote healthful food environments and walkability.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-29DOI: 10.1016/j.socscimed.2024.117371
This study introduces a social capital perspective to the majority-minority gap in wellbeing. We explore the role of social trust and test specifically whether racial and ethnic minorities may experience a triple trust penalty. First is a level penalty, where minorities exhibit lower levels of trust, potentially adversely affecting their wellbeing. Second, there may be a return penalty, where minorities may experience a diminished return from being trustful. Third, there may be a protection penalty, where minorities experience reduced benefits from residing in a high-trust context. Our empirical analyses are based on data from multiple waves of the European Social Survey (Round 4–10, 2008–2020) with over 300,000 individuals from 38 European countries. Our analyses indicate support for the level penalty, but we found no evidence for the return or protection penalties. Specifically, we show that racial and ethnic minorities’ lower levels of trust can have harmful impacts on their happiness and life satisfaction. However, an increase in trust yields greater wellbeing among racial and ethnic minorities, and residing in a high-trust context also appears to have a more substantial impact on the well-being of racial and ethnic minorities as compared to their counterparts. The results suggest that promoting trust can effectively narrow the wellbeing gap among various racial groups.
{"title":"A triple trust penalty? The majority-minority gap in subjective wellbeing","authors":"","doi":"10.1016/j.socscimed.2024.117371","DOIUrl":"10.1016/j.socscimed.2024.117371","url":null,"abstract":"<div><div>This study introduces a social capital perspective to the majority-minority gap in wellbeing. We explore the role of social trust and test specifically whether racial and ethnic minorities may experience a triple trust penalty. First is a level penalty, where minorities exhibit lower levels of trust, potentially adversely affecting their wellbeing. Second, there may be a return penalty, where minorities may experience a diminished return from being trustful. Third, there may be a protection penalty, where minorities experience reduced benefits from residing in a high-trust context. Our empirical analyses are based on data from multiple waves of the European Social Survey (Round 4–10, 2008–2020) with over 300,000 individuals from 38 European countries. Our analyses indicate support for the level penalty, but we found no evidence for the return or protection penalties. Specifically, we show that racial and ethnic minorities’ lower levels of trust can have harmful impacts on their happiness and life satisfaction. However, an increase in trust yields greater wellbeing among racial and ethnic minorities, and residing in a high-trust context also appears to have a more substantial impact on the well-being of racial and ethnic minorities as compared to their counterparts. The results suggest that promoting trust can effectively narrow the wellbeing gap among various racial groups.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-28DOI: 10.1016/j.socscimed.2024.117360
Background
Most choices in healthcare are not made in social isolation. However, current econometric models treat patients' preferences as the sole determinants of their choices.
Through the lens of sociology and medical sociology theories, this paper presents a systematic literature review of identifiable social influences on patients’ choices, serving as a first step in developing a social-interdependent choice paradigm.
Methods
Following the PRISMA guideline and using nine databases, we identified the individual agents or groups involved in health-related choices, the functional content through which social relationships influence patients, and the choice constructs affected by these processes. From 9036 screened articles, we selected 208 to develop an analytical framework connecting social relationships with choice constructs.
Results
Social influences predominantly come from family, friends, specialized physicians, and general practitioners. We decomposed the functional content of social relationships into functions and contents. Dyadic interactions and expert knowledge were prominent functions, followed by social control. Prescriptive and informational contents were prevalent, followed by instrumental and emotional ones. Expert knowledge and social norms aligned with prescriptive and informational signals, while dyadic interactions provide emotional and instrumental signals. Reference points for social norms included friends, coworkers, and patients. Social relationships primarily impact which alternatives are evaluated, followed by alternative evaluation strategies and goal selection. Distinctions between medical domains and dimensions emerged, highlighting how the medical area conditions the social influence process.
Conclusion
This systematic review presents a comprehensive framework that elucidates the social influence process in healthcare patient decision-making. By detailing the functional content of social relationships into functions and contents and linking these components to the elements of the choice process, we created a structured approach to understanding how social relationships impact patient choices. This will facilitate the systematic integration of social relationships into econometric models of patient choice.
{"title":"Sources and processes of social influence on health-related choices: A systematic review based on a social-interdependent choice paradigm","authors":"","doi":"10.1016/j.socscimed.2024.117360","DOIUrl":"10.1016/j.socscimed.2024.117360","url":null,"abstract":"<div><h3>Background</h3><div>Most choices in healthcare are not made in social isolation. However, current econometric models treat patients' preferences as the sole determinants of their choices.</div><div>Through the lens of sociology and medical sociology theories, this paper presents a systematic literature review of identifiable social influences on patients’ choices, serving as a first step in developing a social-interdependent choice paradigm.</div></div><div><h3>Methods</h3><div>Following the PRISMA guideline and using nine databases, we identified the individual agents or groups involved in health-related choices, the functional content through which social relationships influence patients, and the choice constructs affected by these processes. From 9036 screened articles, we selected 208 to develop an analytical framework connecting social relationships with choice constructs.</div></div><div><h3>Results</h3><div>Social influences predominantly come from family, friends, specialized physicians, and general practitioners. We decomposed the functional content of social relationships into functions and contents. Dyadic interactions and expert knowledge were prominent functions, followed by social control. Prescriptive and informational contents were prevalent, followed by instrumental and emotional ones. Expert knowledge and social norms aligned with prescriptive and informational signals, while dyadic interactions provide emotional and instrumental signals. Reference points for social norms included friends, coworkers, and patients. Social relationships primarily impact which alternatives are evaluated, followed by alternative evaluation strategies and goal selection. Distinctions between medical domains and dimensions emerged, highlighting how the medical area conditions the social influence process.</div></div><div><h3>Conclusion</h3><div>This systematic review presents a comprehensive framework that elucidates the social influence process in healthcare patient decision-making. By detailing the functional content of social relationships into functions and contents and linking these components to the elements of the choice process, we created a structured approach to understanding how social relationships impact patient choices. This will facilitate the systematic integration of social relationships into econometric models of patient choice.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-27DOI: 10.1016/j.socscimed.2024.117376
Prior research has challenged genetic determinism by highlighting the complex ways lay people engage with genetics. However, most of these critiques took place prior to the availability of direct-to-consumer (DTC) genetic health testing and were based on reactions to genetic testing administered in a clinical context due to either symptoms or family history. Today, many lay people interact with genetic health information outside of medicine, and often without pre-existing symptoms or family history. This suggests the need to revisit genetic determinism in the context of this new mode of public engagement with genetic information about health. In this paper we examine how a sample of 39 people who had previously taken a DTC genetic test for health make sense of their results. We find genetic determinism is prominent, but takes on several distinct forms, including protective determinism, motivating determinism, and absolute determinism. Considering this, we argue that genetic determinism should not be treated as a singular or fixed concept and cannot be dismissed as insignificant, given its continued salience for DTC genetic test-takers. Our analysis also pays particular attention to how test-takers interpret negative results (i.e., no elevated risks detected), as this is a common outcome of DTC genetic tests but has not been a focus of prior research.
{"title":"Types of genetic determinism in direct-to-consumer genetic testing for health","authors":"","doi":"10.1016/j.socscimed.2024.117376","DOIUrl":"10.1016/j.socscimed.2024.117376","url":null,"abstract":"<div><div>Prior research has challenged genetic determinism by highlighting the complex ways lay people engage with genetics. However, most of these critiques took place prior to the availability of direct-to-consumer (DTC) genetic health testing and were based on reactions to genetic testing administered in a clinical context due to either symptoms or family history. Today, many lay people interact with genetic health information outside of medicine, and often without pre-existing symptoms or family history. This suggests the need to revisit genetic determinism in the context of this new mode of public engagement with genetic information about health. In this paper we examine how a sample of 39 people who had previously taken a DTC genetic test for health make sense of their results. We find genetic determinism is prominent, but takes on several distinct forms, including <em>protective determinism</em>, <em>motivating determinism</em>, and <em>absolute determinism</em>. Considering this, we argue that genetic determinism should not be treated as a singular or fixed concept and cannot be dismissed as insignificant, given its continued salience for DTC genetic test-takers. Our analysis also pays particular attention to how test-takers interpret negative results (i.e., no elevated risks detected), as this is a common outcome of DTC genetic tests but has not been a focus of prior research.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-26DOI: 10.1016/j.socscimed.2024.117369
Background
Due to rapidly increasing youth suicides in the U.S state of Utah, the legislature funded creation of a 24/7 texting-based smartphone app in Spanish and English targeting Utah's school aged population. Recent research elsewhere (in the Netherlands) suggests cost inhibits help seeking among the economically disadvantaged. We evaluate the relationship between poverty and app usage during the onset of the COVID-19.
Method
Local demographics, social determinants of health and COVID-19 infection rates were modeled using a Bayesian spatio-temporal approach examining usage rates.
Results
When controlling for generally researched suicide crisis covariates, app usage is shown to vary depending on economic status of the population, with the largest relative increases in use among disadvantaged youth.
Discussion
This bilingual Spanish/English, texting (SMS) based, smart phone app crisis hotline proved effective at providing adolescents from certain populations access to mental health care. The groups discussed are in Census Block Groups (CBGs – neighborhoods) with higher poverty, and/or lower population density (rural areas). The usage of the crisis hotline by these populations increased relative to the overall population as the COVID-19 pandemic unfolded. However, adolescents from areas of higher mobility (our proxy for housing insecure) and those in areas with larger non-White populations had a relative decrease in usage.
{"title":"Assessing access: Texting hotline app provides mental health crisis care for economically deprived youth","authors":"","doi":"10.1016/j.socscimed.2024.117369","DOIUrl":"10.1016/j.socscimed.2024.117369","url":null,"abstract":"<div><h3>Background</h3><div>Due to rapidly increasing youth suicides in the U.S state of Utah, the legislature funded creation of a 24/7 texting-based smartphone app in Spanish and English targeting Utah's school aged population. Recent research elsewhere (in the Netherlands) suggests cost inhibits help seeking among the economically disadvantaged. We evaluate the relationship between poverty and app usage during the onset of the COVID-19.</div></div><div><h3>Method</h3><div>Local demographics, social determinants of health and COVID-19 infection rates were modeled using a Bayesian spatio-temporal approach examining usage rates.</div></div><div><h3>Results</h3><div>When controlling for generally researched suicide crisis covariates, app usage is shown to vary depending on economic status of the population, with the largest relative increases in use among disadvantaged youth.</div></div><div><h3>Discussion</h3><div>This bilingual Spanish/English, texting (SMS) based, smart phone app crisis hotline proved effective at providing adolescents from certain populations access to mental health care. The groups discussed are in Census Block Groups (CBGs – neighborhoods) with higher poverty, and/or lower population density (rural areas). The usage of the crisis hotline by these populations increased relative to the overall population as the COVID-19 pandemic unfolded. However, adolescents from areas of higher mobility (our proxy for housing insecure) and those in areas with larger non-White populations had a relative decrease in usage.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":null,"pages":null},"PeriodicalIF":4.9,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382144","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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