Social Science & Medicine最新文献_第7页

Adverse childhood experiences and all-cause mortality in older Japanese adults: a 6-year prospective cohort study, modified by marital status 日本老年人不良童年经历和全因死亡率：一项受婚姻状况影响的6年前瞻性队列研究

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-21 DOI: 10.1016/j.socscimed.2026.119012

Tomoki Kawahara , Yukako Tani , Katsunori Kondo , Takeo Fujiwara

Objectives

Adverse childhood experiences (ACEs) are known to be associated with morbidity and premature death, but the association between ACEs and mortality among older people is unknown in Japan, and whether marital status modifies the associations remains unclear.

Methods

We analyzed data from 12,698 older adults (65+ years) participating in the Japan Gerontological Evaluation Study (JAGES; response rate 70.3 %) in 2013 and were followed for 6 years. ACEs and marital status were assessed at baseline, and mortality was prospectively followed. Cox proportional hazards models were used to assess the association between ACEs and mortality, stratified by sex and marital status adjusted for covariates.

Results

1948 deaths occurred during the follow-up (Men: 1,238, Women: 710). We found no association between ACEs and mortality overall for both sexes. When stratified by marital status, among divorced/unmarried men, those having 3+ ACEs were 4.00 times more likely to die (95 % CI: 1.46–10.95), although there was no association between ACEs and mortality among married men. In contrast, among divorced/unmarried women, having ACEs showed a lower risk of mortality, and married women also showed no association between ACEs and mortality.

Discussion

ACEs were associated with mortality among divorced/unmarried older men, which is not true for married men and all women. Further research is warranted to elucidate the mechanism to prevent the adverse effect of ACEs on mortality among divorced/unmarried men and all women.

目的儿童不良经历（ace）已知与发病率和过早死亡相关，但在日本，ace与老年人死亡率之间的关系尚不清楚，婚姻状况是否会改变这种关联尚不清楚。方法分析2013年参加日本老年学评价研究（JAGES，有效率70.3%）的12698名65岁以上老年人的数据，随访6年。基线时评估ace和婚姻状况，并对死亡率进行前瞻性随访。使用Cox比例风险模型评估ace与死亡率之间的关系，并按性别和婚姻状况分层，调整协变量。结果随访期间死亡1948例（男性1238例，女性710例）。我们没有发现ace与两性总体死亡率之间的联系。当按婚姻状况分层时，在离婚/未婚男性中，有3+ ace的人死亡的可能性是4.00倍（95% CI: 1.46-10.95），尽管在已婚男性中ace和死亡率之间没有关联。相比之下，在离婚/未婚女性中，有ace的死亡风险较低，已婚女性也没有显示ace与死亡率之间的关联。在离异/未婚的老年男性中，ace与死亡率有关，但这并不适用于已婚男性和所有女性。在离婚/未婚男性和所有女性中，需要进一步的研究来阐明预防ace对死亡率不利影响的机制。

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引用次数: 0

Socioeconomic disadvantage explains neighborhood racial inequality in opioid-related mortality 社会经济劣势解释了阿片类药物相关死亡率的社区种族不平等。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.socscimed.2026.119007

Karl Vachuska, Michael Topping

The mortality burden imposed by the opioid crisis has only increased in recent years, with particularly high increases among Black Americans, who now die from overdoses at higher rates than their white counterparts. As such, a large body of work has emphasized the adverse impact of racial and socioeconomic segregation as a key mechanism of enduring racial health disparities. Also, nascent research has increasingly sought to use cell phone mobility data to examine neighborhood outcomes. This work bridges these two areas of work to look at opioid overdose rates from Cook County, Illinois – the county with the largest number of Black overdoses in the United States—to explore how neighborhood-level characteristics shape these disparities. We find that a neighborhood's level of disadvantage, as measured by the everyday visitors to the neighborhood, is a focal predictor. Moreover, while neighborhoods with a higher share of Black residents have higher rates of opioid-related mortality, we illustrate that our measure of mobility-based disadvantage mediates 100 % of the relationship. These findings remain consistent throughout the pre-2020 (2016–2019) and post-2020 (2020–2023) period when opioid-related mortality spikes. Sensitivity analyses with a wide assortment of controls and different specifications confirm these findings and suggest that future work examining neighborhood disadvantage should consider mobility-based measures in addition to static ones to best identify how disadvantage shapes mortality risk.

阿片类药物危机造成的死亡率负担近年来只增不增，其中黑人的增幅尤其高，他们现在死于过量服用的比例高于白人。因此，大量工作强调种族和社会经济隔离的不利影响是持久的种族健康差异的关键机制。此外，新兴研究越来越多地寻求使用手机移动数据来检查社区结果。这项工作将这两个工作领域联系起来，研究伊利诺伊州库克县的阿片类药物过量率——美国黑人过量服用人数最多的县——以探索社区水平的特征如何塑造这些差异。我们发现，一个社区的劣势水平是一个焦点预测指标，这是由该社区的日常访客来衡量的。此外，虽然黑人居民比例较高的社区与阿片类药物相关的死亡率较高，但我们表明，我们对基于流动性的劣势的衡量标准介导了这种关系的100%。这些发现在阿片类药物相关死亡率飙升的2020年前（2016-2019年）和2020年后（2020-2023年）期间保持一致。采用多种对照和不同规格进行的敏感性分析证实了这些发现，并建议未来研究社区弱势群体的工作除了考虑静态指标外，还应考虑基于流动性的指标，以最好地确定弱势群体如何影响死亡风险。

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引用次数: 0

The health and wellbeing of incarcerated trans, gender diverse, and non-binary people: An international scoping review 被监禁的跨性别者、多元性别者和非二元性别者的健康和福祉：一项国际范围审查

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-20 DOI: 10.1016/j.socscimed.2026.118972

Matthew Maycock , Tarra Excell , Annette Brömdal , Penelope Abbott , Riki Lane , Paul Leslie Simpson

Globally there is a growing visibility of trans, gender diverse, and non-binary people in contact with prison systems, and growing questions raised by stakeholders about the health and wellbeing of these populations under state care. This scoping review aims to map the global evidence on the key health and wellbeing issues of incarcerated trans, gender diverse, and non-binary adults and young people to enhance researchers, community and policy makers' capacity to use international evidence to develop locally relevant policies and care models. The review follows Arksey and O'Malley's (2005) five-stage iterative process and PRISMA-ScR guidelines. Eight academic databases and grey literature were searched in May 2024 and again in June 2025. Articles published in all languages were considered. After screening, 57 articles were included and categorised into four themes: (1) general and gender-affirming healthcare; (2) violence; (3) mental health and wellbeing; (4) sexual health and infectious disease; and (5) gender embodiment. Despite geographic, thematic, methodological, and subpopulation knowledge gaps, there is consistent evidence on restricted access to gender-affirming healthcare, systemic mental health challenges and exposure to violence, sexual health risks and HIV care gaps, and creativity and resilience among trans, gender diverse, and non-binary people in the face of gender-affirming attire and grooming restrictions. These findings highlight the need for clear and consistently implemented prison policies and prison diversion strategies. Policies and interventions must be evidence-based, integrated, culturally responsive, sustainably resourced in the face populist discourse, and involve community experts and incarcerated people in their design and evaluation.

在全球范围内，越来越多的跨性别者、性别多元化者和非二元性别者与监狱系统接触，利益相关者对这些在国家护理下的人群的健康和福祉提出了越来越多的问题。这项范围审查的目的是绘制关于被监禁的跨性别者、性别多样化者和非二元性成年人和年轻人的关键健康和福祉问题的全球证据地图，以增强研究人员、社区和政策制定者利用国际证据制定当地相关政策和护理模式的能力。该审查遵循Arksey和O'Malley（2005）的五阶段迭代过程和PRISMA-ScR指南。在2024年5月和2025年6月分别检索了8个学术数据库和灰色文献。审议了以所有语文出版的文章。经筛选，纳入了57篇文章，并将其分为四个主题：(1)一般和性别肯定医疗；(2)暴力;（三）心理健康和福祉；（四）性健康和传染病；(5)性别体现。尽管存在地理、专题、方法和亚人群方面的知识差距，但有一致的证据表明，在获得性别肯定医疗服务的机会有限、系统性心理健康挑战和遭受暴力、性健康风险和艾滋病毒护理方面存在差距，以及跨性别者、性别多样化者和非二元性别者在面对性别肯定着装和打扮限制时的创造力和复原力。这些调查结果突出了明确和一贯执行监狱政策和监狱转移战略的必要性。政策和干预措施必须是基于证据的、综合的、响应文化的、面对民粹主义话语的可持续资源，并让社区专家和被监禁者参与其设计和评估。

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引用次数: 0

Type of water and sanitation facilities and risk of non-partner sexual violence: A multilevel analysis across 31 low- and middle-income countries 水和卫生设施类型与非伴侣性暴力风险：对31个低收入和中等收入国家的多层次分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.119005

Hyejun Chi , Abigail Puno-Balagosa , Anoop Jain , S.V. Subramanian , Rockli Kim

Background

Disadvantaged access to water, sanitation, and hygiene (WASH) is acknowledged as a risk factor for non-partner sexual violence (NPSV), particularly in the context of low- and middle-income countries (LMICs). However, gaps in knowledge regarding the associations between inadequate WASH and NPSV persist.

Methods

Demographic and Health Surveys from 31 low- and middle-income countries (2013–2021) were used for the analysis of 259,208 women aged 15–49 years. For the experience of NPSV in the last 12 months, its associations with source of drinking water (private [reference], public, open source) and type of toilet facilities (private [reference], shared, no facilities) were estimated using three-level logistic regressions.

Results

Overall, 0.5 % had a recent experience of NPSV. After adjusting for sociodemographic characteristics, women who used public (Adjusted odds ratio [AOR] = 1.27, 95 % confidence interval [CI] = 1.06–1.52) or open source for drinking water (AOR = 1.37, 95 % CI = 1.02–1.84) were more likely to experience NPSV. Similarly, women who used shared toilet facilities (AOR = 1.16, 95 % CI = 1.01–1.34) and who had no facilities (AOR = 1.40, 95 % CI = 1.17–1.68) had greater risk for NPSV. The interaction was only marginally significant (p-value = 0.07).

Conclusions

The findings support the need to expand WASH-related programs, which can contribute to the prevention of sexual violence and empowerment of women in LMICs. National and global advocacy is essential to resolve discriminatory climates that condone and facilitate violence against women in water-related contexts.

在获得水、环境卫生和个人卫生（WASH）方面处于不利地位被认为是非伴侣性暴力（NPSV）的一个风险因素，特别是在低收入和中等收入国家（LMICs）。然而，关于不充分的WASH与NPSV之间关系的知识差距仍然存在。方法采用来自31个低收入和中等收入国家（2013-2021年）的人口与健康调查，分析了259,208名年龄在15-49岁之间的妇女。对于过去12个月的NPSV经验，使用三级逻辑回归估计其与饮用水来源（私人[参考]，公共，开源）和厕所设施类型（私人[参考]，共享，无设施）的关联。结果总体而言，0.5%的患者近期有NPSV的经历。在调整社会人口统计学特征后，使用公共饮用水（调整优势比[AOR] = 1.27, 95%可信区间[CI] = 1.06-1.52）或开放水源饮用水（AOR = 1.37, 95% CI = 1.02-1.84）的女性更容易出现NPSV。同样，使用公用厕所设施的妇女（AOR = 1.16, 95% CI = 1.01-1.34）和没有公用厕所设施的妇女（AOR = 1.40, 95% CI = 1.17-1.68）患NPSV的风险更高。交互作用仅为边际显著（p值= 0.07）。结论：研究结果支持有必要扩大与wash相关的项目，这有助于在中低收入国家预防性暴力和赋予妇女权力。国家和全球宣传对于解决在与水有关的情况下纵容和促进暴力侵害妇女行为的歧视性气氛至关重要。

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引用次数: 0

Bordering in Canadian healthcare: How the criminalization of immigrants with precarious status undermines their children's right to health 加拿大医疗保健的边界：对身份不稳定的移民定罪如何损害其子女的健康权

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.119003

Monica D. Gagnon

Increases in migration to Canada have implications for healthcare, as immigration and health policies are intertwined, and most people without permanent status are ineligible for publicly funded health coverage. Among Canadian provinces and territories, Ontario is home to the largest population of people who do not have citizenship or permanent resident status. Babies born in Ontario to people who reside in Ontario are Canadian citizens, eligible for health coverage (OHIP) at birth. However, they are often denied registration due to their parents' status. Such denials present a significant barrier to parents accessing healthcare for their newborns. In these instances, a parent's immigration status becomes an important determinant of their child's health. This paper analyzes denial of registration for health coverage to babies born in Ontario hospitals, theorizing such denial as a set of bordering practices policing access to rights of citizenship for populations deemed less deserving. I present a new typology of bordering, practiced through omission, devolution, obfuscation, and intimidation, and discuss how these mechanisms can be strategically resisted. Together, the four bordering mechanisms facilitate surveillance, discrimination, and racial profiling in Ontario hospitals, with negative effects on families' health. Bordering in health policy and practice normalizes the criminalization of a broad population of non-permanent residents and obstructs access to healthcare, even when children are legally entitled.

移民到加拿大的人数增加对医疗保健有影响，因为移民和卫生政策是相互交织的，大多数没有永久身份的人没有资格享受公共资助的医疗保险。在加拿大的省份和地区中，安大略省是没有公民身份或永久居民身份的人口最多的地方。居住在安大略省的人在安大略省所生的婴儿是加拿大公民，出生时有资格享受健康保险（OHIP）。然而，由于他们父母的身份，他们经常被拒绝注册。这种否认对父母获得新生儿保健服务构成重大障碍。在这些情况下，父母的移民身份成为其子女健康的重要决定因素。本文分析了拒绝在安大略省医院出生的婴儿进行健康保险登记的情况，并将这种拒绝作为一套边境做法进行理论化，以监管那些被认为不太值得享有公民权的人群。我提出了一种新的边界类型，通过省略、权力下放、混淆和恐吓来实践，并讨论了如何从战略上抵制这些机制。这四种相邻机制共同促进了安大略省医院的监督、歧视和种族定性，对家庭健康产生了负面影响。卫生政策和做法的边界化使广泛的非永久居民人口被定为犯罪正常化，并妨碍获得保健，即使儿童在法律上有权获得保健。

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引用次数: 0

Prison healthcare and other paradoxes 监狱医疗和其他矛盾。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.119004

Harley Pomper , Manu S. Sundaresan

Section 400.4.1 of the Cook County Sheriff's Law Enforcement Manual mandates staff shackle, handcuff, and chain incarcerated patients to medical beds during visits. Section 400.4.3 suggests those same restraints cannot interfere with medical procedures or tests. These fault lines—formed between patient rights and procedural realities—traverse the landscape of prison and jail healthcare in the United States. This article examines three such features of carceral healthcare logic (or anti-logic): i) the legal responsibility to provide healthcare to incarcerated patients, ii) administrative systems designed to discharge that responsibility, and iii) navigation of those systems by staff and patients. In doing so, we draw upon case law, correctional policy, and direct testimony from insiders and activists incarcerated in Cook County Jail and the Illinois Department of Corrections. Scaling our analysis across legal premises, administrative aims, and individual behavior, we shed light on the fragility of prisoners' rights to healthcare, the phenomena of risk management and service rationing, and the inverse relationship between demanding and receiving care inside. We find contradictions are not merely consequent to but constitutive of carceral healthcare. Ultimately, this article asks the following: how do the defining contradictions of prison and jail healthcare impact the incarcerated? As the answer comes into view, we resolve and identify the carceral space as a site of paradox, one fundamentally incompatible with the notion of healthcare.

《库克县警长执法手册》第400.4.1节规定，工作人员在探视期间将被监禁的病人铐在医疗病床上。第400.4.3节规定，这些限制不得干扰医疗程序或检查。这些在病人权利和程序现实之间形成的断层线贯穿了美国监狱和监狱医疗保健的各个方面。本文研究了监狱医疗保健逻辑（或反逻辑）的三个特征：i)为监禁患者提供医疗保健的法律责任，ii)为履行该责任而设计的管理系统，以及iii)工作人员和患者对这些系统的导航。在此过程中，我们借鉴了判例法、惩教政策以及库克县监狱和伊利诺伊州惩教局关押的内部人士和活动人士的直接证词。将我们的分析扩展到法律前提、行政目标和个人行为，我们揭示了囚犯医疗保健权利的脆弱性、风险管理和服务配给现象，以及囚犯内部要求和接受护理之间的反比关系。我们发现矛盾不仅是医疗保健的结果，而且是医疗保健的组成部分。最后，本文提出以下问题：监狱和监狱医疗保健的定义矛盾如何影响被监禁者？随着答案的出现，我们解决并确定了carceral空间作为一个悖论的场所，一个与医疗保健概念根本不相容的场所。

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引用次数: 0

Policing and care in mental health crisis response: Boundary work and the politics of safety and authority 心理健康危机应对中的警务和护理：边界工作和安全和权威政治

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.118982

Mark D. Fleming , Dani MacVicar , Aoife M. McDermott , Amanda L. Brewster

Demands for alternatives to police responses to mental health crises have driven significant transformations in the frontlines of emergency care. This ethnographic study (2022-2025) analyzes how the boundaries between policing and behavioral health have been negotiated, contested, and reconstructed during the implementation of a large-scale crisis response initiative in California, USA. Taking an ethnographic approach, we demonstrate how boundary work among law enforcement, behavioral health professionals, and organizational leaders unfolds through intertwined dynamics of competition, collaboration, and reconfiguration. Our findings highlight how boundary work is embedded within broader socio-political contexts shaped by advocacy for racial justice, critiques of police violence, and demands for systemic reform. Specifically, we reveal how the frontline enactment of crisis response is characterized by ongoing negotiations around authority, legitimacy, safety, and care, reflecting and reshaping political and ethical debates on criminalization and police reform. This paper contributes to boundary work theory by illustrating how professional and institutional boundaries are dynamic sites of dialectical engagement that both respond to and actively shape contemporary struggles around race, violence, mental health, and justice.

对警察应对心理健康危机的替代方案的需求，推动了急救一线的重大变革。这项民族志研究（2022-2025）分析了在美国加利福尼亚州实施大规模危机应对计划期间，警务和行为健康之间的界限是如何协商、争议和重建的。采用人种学方法，我们展示了执法部门、行为健康专业人员和组织领导者之间的边界如何通过竞争、合作和重组的相互交织的动态展开。我们的研究结果强调了边界工作如何嵌入更广泛的社会政治背景中，这些背景是由倡导种族正义、批评警察暴力和要求系统改革所形成的。具体来说，我们揭示了危机应对的前线制定是如何以围绕权威、合法性、安全和关怀的持续谈判为特征的，反映和重塑了关于刑事定罪和警察改革的政治和伦理辩论。本文通过说明专业和机构边界如何成为辩证参与的动态场所，既回应又积极塑造当代围绕种族、暴力、心理健康和正义的斗争，为边界工作理论做出了贡献。

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引用次数: 0

Contraceptive autonomy of adolescents and young adults in the U.S. South: The influence of healthcare providers, partners, and parents 美国南部青少年和年轻人的避孕自主权：医疗保健提供者、合作伙伴和父母的影响。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.118999

Kathleen Broussard , Laura D. Lindberg , Emily S. Mann

A growing body of research describes coercive experiences in contraceptive care in the clinic setting, a phenomenon that disproportionately constrains the contraceptive autonomy of women who are young, low-income, Black, or Latinx. Less research has examined how other social influences may constrain contraceptive use and decision-making. We examine contraceptive autonomy across three domains of interpersonal influence (healthcare providers, sexual partners, and parents) and by race (Black vs. White). Between July–September 2023, we surveyed 1207 Black and White adolescents and young adults (AYAs) assigned female at birth living in five southern states. Over half of all respondents reported feeling social pressure related to their contraceptive use. More respondents spoke with a sexual partner or healthcare provider than with a parent about contraception, but those who did speak with a parent were most likely to report contraceptive pressure. Furthermore, respondents who reported social pressure were less likely to be using their preferred method of contraception. Black (vs. White) AYAs were less likely to have conversations with healthcare providers and sexual partners about contraception; more likely to report social pressure across all interpersonal domains; and less likely to be using their preferred method. By examining social pressures beyond the clinic setting, findings reveal the multifaceted and socially patterned ways that bodily autonomy is constrained for AYAs assigned female at birth and how this is magnified for Black AYAs.

越来越多的研究描述了诊所环境中避孕护理的强制性经历，这种现象不成比例地限制了年轻、低收入、黑人或拉丁裔妇女的避孕自主权。关于其他社会影响如何限制避孕药具的使用和决策的研究较少。我们在人际影响的三个领域（医疗保健提供者、性伴侣和父母）和种族（黑人与白人）中检查避孕自主权。在2023年7月至9月期间，我们调查了1207名出生时被分配为女性的黑人和白人青少年和年轻人（AYAs）。半数以上的答复者报告在使用避孕药具方面感到社会压力。与父母相比，更多的受访者与性伴侣或医疗保健提供者谈论避孕问题，但那些与父母交谈的人最有可能报告避孕压力。此外，报告社会压力的受访者不太可能使用他们首选的避孕方法。黑人（相对于白人）助理医生不太可能与医疗保健提供者和性伴侣就避孕进行对话；更有可能在所有人际关系领域报告社会压力；而且不太可能使用他们喜欢的方法。通过检查诊所环境之外的社会压力，研究结果揭示了多方面和社会模式的方式，即出生时被指定为女性的AYAs身体自主权受到限制，以及黑人AYAs如何放大。

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引用次数: 0

Energy poverty consequences of aggressive tobacco tax policies 激进的烟草税政策造成的能源贫困

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.119002

MohammadHossein Hadi , Dennis Petrie , Umair Khalil

This paper presents the first empirical evidence linking tobacco tax policies to unintended social consequences in the form of increased energy poverty. We focus on Australia, where smokers face some of the world's highest cigarette prices. We analyse an unanticipated aggressive tax regime implemented in 2010 using a difference-in-differences approach with a nationally representative panel dataset covering 14 years. Our findings indicate significant increases in the incidence of energy poverty among smoking households. Relative to the smoking cohort's pre-policy mean, subjective reports of heating difficulties rose by 24 %, while objective measures increased by 38 % (10 % energy-burden threshold), 15 % (twice-median burden), and 26 % under the Low-Income High Costs (LIHC) measure. Mechanism analyses indicate that reduced energy expenditures and compromised financial stability exacerbate the observed energy poverty. The impacts were particularly pronounced among lower-income families, heavy smokers, and individuals who find quitting hard. This research highlights the complex trade-offs involved in aggressive tobacco taxation and emphasises the need for targeted measures to mitigate the negative consequences on the energy well-being of vulnerable smokers and their families.

本文首次提出了将烟草税政策与能源贫困加剧的意外社会后果联系起来的实证证据。我们关注的是澳大利亚，那里的吸烟者面临着世界上最高的卷烟价格。我们对2010年实施的一项出人意料的激进税收制度进行了分析，采用了差异中的差异方法，并采用了涵盖14年的全国代表性面板数据集。我们的发现表明，在吸烟家庭中，能源贫困的发生率显著增加。相对于吸烟队列政策前的平均值，供暖困难的主观报告增加了24%，而客观测量增加了38%（10%的能源负担阈值），15%（两倍中位数负担），在低收入高成本（LIHC）测量下增加了26%。机制分析表明，能源支出减少和金融稳定受损加剧了所观察到的能源贫困。这种影响在低收入家庭、重度吸烟者和难以戒烟的个人中尤为明显。这项研究强调了积极征收烟草税所涉及的复杂权衡，并强调需要采取有针对性的措施来减轻对弱势吸烟者及其家庭能源健康的负面影响。

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引用次数: 0

Engaging patients in blood systems: A qualitative study on immune globulin recipient perspectives 参与患者血液系统：免疫球蛋白受体视角的定性研究。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118997

Umair Majid , Quinn Grundy , Stephanie Kelly , Kelly Holloway

Background

Plasma-derived medical products (PDMPs) can represent life-saving treatments for immunodeficiencies, autoimmune diseases, and other health conditions. Immunogloublin (Ig) is a PDMP used to treat a large number of inherited or acquired diseases. As the beneficiaries of a highly complex supply chain, recipients of Ig can illuminate the practical implications of supply challenges and policy initiatives on their health and well-being. This study explores the perspectives of Ig recipients.

Methods

This paper stems from a study based on Narrative Inquiry, which delved into the experiences and perspectives of Ig recipients. A two-interview format was employed to capture 1, the recipient's diagnostic journey and challenges, reported elsewhere; and 2, their knowledge, awareness, and engagement in Ig production and distribution. The second interviews were analyzed with reflexive thematic analysis and are reported in this manuscript.

Results

Participants in this study described access to Ig as variable and uncertain. The uncertainty was shaped by the relationships that they negotiated with the other social actors in the blood system. They described feeling bound to their physician as the gatekeeper to a diagnosis, and therefore treatment, and to navigate a complex health system on their behalf. They were deeply grateful for the plasma donor, but when access felt precarious, the reliance on the donor was unsettling due to uncertainty around product availability. Finally, participants felt removed from the process in which decisions were made about treatment.

Conclusions

Our study engaged Ig recipients as important social actors in the systems responsible for collecting and distributing Ig. Participants offered specific and thorough recommendations for meaningful change. Such guidance holds the potential to foster a more integrated environment in which all interest-holders collaborate to meet patient needs more equitably and sustainably.

背景：血浆源性医疗产品（PDMPs）可以代表免疫缺陷、自身免疫性疾病和其他健康状况的救命疗法。免疫球蛋白（Ig）是一种用于治疗大量遗传或获得性疾病的PDMP。作为高度复杂供应链的受益者，Ig的接受者可以阐明供应挑战和政策举措对其健康和福祉的实际影响。本研究探讨了Ig接受者的观点。方法：本文以叙事探究为基础，深入研究Ig接受者的经历和观点。采用两次访谈的形式来捕捉1，接受者的诊断过程和挑战，报告在其他地方；第二，他们在Ig制作和发行方面的知识、意识和参与度。第二次访谈用反身性主题分析进行分析，并在本文中报告。结果：本研究的参与者将获得Ig描述为可变和不确定的。这种不确定性是由他们与血液系统中其他社会参与者谈判的关系形成的。他们认为医生是诊断和治疗的把关人，并代表他们在复杂的卫生系统中导航。他们对血浆捐献者深表感激，但当获得血浆感到不稳定时，由于产品供应的不确定性，对捐献者的依赖令人不安。最后，参与者感到被排除在决定治疗的过程之外。结论：我们的研究将Ig接受者作为负责收集和分发Ig的系统中的重要社会行为者。与会者为有意义的变革提出了具体而彻底的建议。这种指导有可能促进一个更加一体化的环境，在这种环境中，所有利益相关者合作，更公平和可持续地满足患者的需求。

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