Journal of Health and Social Behavior最新文献

英文中文

The Mortality Risk of Raising Grandchildren in the United States. 在美国抚养孙辈的死亡风险。

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-03-09 DOI: 10.1177/00221465261419804

Hongwei Xu,John R Logan,Todd Gardner

In the United States, grandparents who live with and provide primary care to their grandchildren have emerged as a particularly vulnerable group since the 1990s. Using confidential data from the U.S. Census Bureau and Social Security Administration, this study linked individuals ages 50 years or older from the 2000 census long-form sample to their death records from 2000 to 2019 (weighted N = 64,027,000) and examined the longitudinal association between coresident grandparenting status and mortality for non-Hispanic White, non-Hispanic Black, Hispanic, and Asian individuals. We found consistently higher rates of mortality for White coresident grandparents and lower rates for Asian coresident grandparents, regardless of the duration of primary caregiving, compared to their peers without coresident grandchildren. We also found increased risks of mortality among Hispanic long-term primary caregivers but reduced risks among Black short-term primary caregivers compared to their peers without coresident grandchildren.

在美国，自20世纪90年代以来，与孙辈一起生活并为孙辈提供基本照顾的祖父母成为一个特别脆弱的群体。本研究使用美国人口普查局和社会保障局的机密数据，将2000年人口普查长期样本中年龄在50岁或以上的个体与他们2000年至2019年的死亡记录（加权N = 64,027,000）联系起来，并研究了非西班牙裔白人、非西班牙裔黑人、西班牙裔和亚洲人的祖父母身份与死亡率之间的纵向关联。我们发现，与没有孙辈的同龄人相比，无论主要照顾的时间长短，白人祖父母辈的死亡率始终较高，而亚洲祖父母辈的死亡率较低。我们还发现，与没有共同孙辈的同龄人相比，西班牙裔长期主要照顾者的死亡率增加，而黑人短期主要照顾者的死亡率降低。

引用次数: 0

Breaking Bonds, Changing Habits: Understanding Health Behaviors during and after Marital Dissolution. 打破束缚，改变习惯：了解婚姻破裂期间和之后的健康行为。

IF 3.6 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-03-01 Epub Date: 2025-03-04 DOI: 10.1177/00221465251320079

Andrea M Tilstra, Nicole Kapelle

Marital dissolution is a stressful transition that can lead to unhealthy coping strategies, including smoking and drinking. Using fixed effect linear probability models to assess health behavior changes, we analyzed 6,607 women and 6,689 men in the Household, Income, and Labour Dynamics in Australia data set who were either continuously married or experienced marital separation between 2002 and 2020. We observed 1,376 separations (744 women, 632 men). We found that drinking and smoking increases leading to and in the year of separation, with variability by gender, education, and parenthood status. From Cox proportional hazards models, we showed that among individuals who smoked (N = 337) or drank (N = 756) in the year of separation, cessation was most likely for the highly educated and/or women. Unhealthy coping mechanisms throughout marital dissolution suggests a need for targeted support to those separating, especially for men and those with children and lower education.

婚姻破裂是一个充满压力的过渡期，可能导致不健康的应对策略，包括吸烟和饮酒。使用固定效应线性概率模型来评估健康行为的变化，我们分析了澳大利亚家庭、收入和劳动力动态数据集中的6607名女性和6689名男性，他们要么在2002年至2020年期间持续结婚，要么经历了婚姻分居。我们观察到1,376次分离（744名女性，632名男性）。我们发现，在分居前后，饮酒和吸烟的情况有所增加，且随性别、受教育程度和生育状况而变化。从Cox比例风险模型中，我们发现在分离年份吸烟（N = 337）或饮酒（N = 756）的个体中，高学历和/或女性最有可能戒烟。婚姻破裂过程中不健康的应对机制表明，需要有针对性地支持那些分居的人，特别是男性和有子女和受教育程度较低的人。

引用次数: 0

Pathways to Autonomy: Chinese Physicians' Responses to Clinical Pathways amid Institutional Complexity. 自主之路：制度复杂性下中国医师对临床路径的回应。

IF 3.6 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-02-26 DOI: 10.1177/00221465261419783

Lei Jin, Lin Tao

Professionals increasingly encounter tools aimed at rationalizing and standardizing their work. Existing research largely conceptualizes their responses to these tools on a continuum from professional resistance to managerial control. But the institutional logics perspective and emerging empirical evidence suggest more varied responses and diverse, possibly non-zero-sum, outcomes. Using survey data from 1,116 physicians in China's public hospitals, we systematically examined physicians' reactions to pathway implementation and the impacts on clinical autonomy and job satisfaction. Cluster analysis identified four response types: (a) ignoring, where physicians avoided pathways and maintained autonomy; (b) coerced, where imposed pathways reduced autonomy and satisfaction; (c) decoupling, where pathways were adopted superficially, preserving autonomy; and (d) embracing, where physicians actively participated in pathway implementation and enforcement, experiencing high satisfaction and autonomy. The findings help broaden the conceptualization of professionals' reactions to rationalizing tools, uncover multiple pathways to clinical autonomy, and illustrate how professionals navigate institutional complexity in ever-evolving environments.

专业人员越来越多地遇到旨在使他们的工作合理化和标准化的工具。现有的研究在很大程度上概念化了他们对这些工具的反应，从专业抵抗到管理控制。但制度逻辑的视角和新兴的经验证据表明，应对措施和可能非零和的结果更为多样。通过对中国公立医院1116名医生的调查数据，我们系统地考察了医生对路径实施的反应以及对临床自主性和工作满意度的影响。聚类分析确定了四种反应类型：(a)忽视，医生避开路径并保持自主性；(b)强迫，强制的途径降低了自主性和满意度；(c)脱钩，即表面上采用的途径，保留了自主性；(d)拥抱，医生积极参与路径的实施和执行，体验到高满意度和自主性。这些发现有助于拓宽专业人员对合理化工具的反应的概念化，揭示了临床自主的多种途径，并说明了专业人员如何在不断变化的环境中驾驭制度的复杂性。

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引用次数: 0

The Political Economy of Health Care: State Policy Liberalism and the Distribution and Diversity of the U.S. Health Care Workforce, 1960–2019 医疗保健的政治经济学：国家政策自由主义和美国医疗保健劳动力的分布和多样性，1960-2019

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-02-17 DOI: 10.1177/00221465261416495

Rebecca Anna Schut

A burgeoning literature links state policies to health care access/use, yet little research has explored whether state policies relate to the distribution of health care itself. Drawing on census microdata and state policy data from 1960 to 2019, I investigate whether state policy liberalism shapes workforce availability and diversity. First, I find that states in New England and the Middle Atlantic have persistently benefited from larger workforces compared to those in the East South Central and Pacific, with Black and foreign-born workers disproportionately represented in “workforce disadvantaged” states. Second, I show that an increase in policy liberalism is associated with reductions in states’ total health care, physician, and nursing workforces; Black and foreign-born physician and nursing workforces; and foreign-born medical assistant/health aide workforces. Taking a political economy approach toward understanding the (mal)distribution of U.S. health care sheds light on a “two-tiered” system that both reflects and reifies existing geographic inequities in population health.

新兴的文献将国家政策与医疗保健的获取/使用联系起来，但很少有研究探讨国家政策是否与医疗保健本身的分配有关。利用1960年至2019年的人口普查微观数据和州政策数据，我研究了州政策自由主义是否会影响劳动力的可用性和多样性。首先，我发现新英格兰和大西洋中部各州一直受益于比东南中部和太平洋地区更多的劳动力，黑人和外国出生的工人在“劳动力劣势”州的比例过高。其次，我表明，政策自由主义的增加与各州医疗保健、医生和护理人员总数的减少有关；黑人和外国出生的医生和护理人员；以及外国出生的医疗助理/保健助理人员。采用政治经济学的方法来理解美国医疗保健的（不良）分布，揭示了“两层”体系，既反映又体现了人口健康方面现有的地理不平等。

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引用次数: 0

Low-Density Zoning and Health Disparities in Metro Areas 都市地区的低密度分区和健康差异

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-02-11 DOI: 10.1177/00221465261417175

Kate W. Strully, Tse-Chuan Yang, Chunxu Fang, Han Liu

引用次数: 0

State Politics and Policies and Racialized Disability Patterns among Midlife Adults in the United States, 2008-2019. 2008-2019年美国中年人的州政治与政策及种族化残疾模式

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-01-31 DOI: 10.1177/00221465251412290

Courtney E Boen,Elise M Parrish

Although extensive research examines the individual- and household-level determinants of racialized disability patterns, the roles of state political and policy contexts have received less attention. Merging more than a decade of data from the American Community Survey (N = 7,928,386) to data on state politics and economic and social welfare policies, we use two-way fixed-effects models to investigate the links between state political and policy contexts and disability risks, considering whether these links vary across race and race-sex groups. Results show that (1) state contexts diverged dramatically over the period, (2) more liberal political contexts and generous economic and social safety net policies were generally associated with reduced disability risks, and (3) state contexts were strongly associated with the disability of White people, but results were more mixed for Black people, especially Black women. This study highlights the salience of state politics and policy for understanding and redressing racialized disability patterns.

尽管广泛的研究考察了种族化残疾模式的个人和家庭层面的决定因素，但国家政治和政策背景的作用受到的关注较少。将美国社区调查（N = 7,928,386）十多年的数据与州政治、经济和社会福利政策的数据结合起来，我们使用双向固定效应模型来调查州政治和政策背景与残疾风险之间的联系，并考虑这些联系是否因种族和种族性别群体而异。结果表明：(1)不同时期的国家环境差异显著；(2)更自由的政治环境和慷慨的经济和社会安全网政策通常与降低残疾风险相关；(3)国家环境与白人的残疾密切相关，但对黑人，特别是黑人妇女的影响更为复杂。这项研究强调了国家政治和政策对于理解和纠正种族化残疾模式的重要性。

引用次数: 0

Saving Maternal Health: The Racialized Labor and Burnout of Birthworkers of Color in the United States. 拯救产妇健康：美国有色人种生育工人的种族化劳动和倦怠。

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-01-21 DOI: 10.1177/00221465251406237

Hyeyoung Oh Nelson,Ashlyn Lange,Mercy Kibet,Maleeha K Shah

Medicalized birth experiences are associated with poor outcomes for people of color. Nonclinical birthworkers, such as doulas, have been identified as a solution to this inequity. With this reliance on birthworkers of color to reverse racial maternal health disparities, how do these individuals experience birthwork? Drawing from interviews with 24 birthworkers of color in the United States from November 2021 through April 2024, we reveal the weight of birthwork endured by this group. We situate these individuals' experiences within scholarship on burnout, emotional labor, racialized labor, and theories on mothering to explain the concept of "racialized burnout." Racialized burnout refers to a multifaceted process borne out of unequal racialized and gendered experiences encountered by birthworkers of color. Racialized burnout also acts as a producer of racial inequity within the maternal health field; as individuals of color encounter racialized burnout, they are at increased risk of leaving maternal health work.

对有色人种来说，医疗化的分娩经历与糟糕的结果有关。非临床助产士，如助产师，被认为是解决这种不平等的办法。依靠有色人种的生辰工来扭转种族孕产妇健康差异，这些人是如何经历生辰工的呢？从2021年11月到2024年4月，我们对美国24名有色人种的生辰工作者进行了采访，揭示了这一群体所承受的生辰压力。我们将这些个体的经历置于职业倦怠、情绪劳动、种族化劳动和育儿理论的学术研究中，以解释“种族化职业倦怠”的概念。种族倦怠是指有色人种出生工人所遇到的不平等的种族化和性别化经历所产生的一个多方面的过程。种族倦怠也在产妇保健领域造成种族不平等；由于有色人种遭遇种族倦怠，他们离开孕产妇保健工作的风险增加。

引用次数: 0

Early-Life War Exposure and Later-Life Chronic Pain in Vietnam: Risk, Resilience, and Timing 越南早期战争暴露和后期慢性疼痛：风险、恢复力和时机

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-01-08 DOI: 10.1177/00221465251401249

Rui Huang, Yuhang Li, Hanna Grol-Prokopczyk, Zachary Zimmer, Tran Khanh Toan

Life course theories predict that early-life war experiences will impact later-life health through both risk and resilience processes, which may vary by age cohort. This study uses data on older adults from the 2018 Vietnam Health and Aging Study (N = 1,826) to explore associations between early-life war experiences and later-life moderate/severe chronic pain, highlighting the role of war-related risk or protective factors and testing for heterogeneity across child, adolescent, and young adult cohorts. Regression models reveal that Vietnam War exposures dramatically increase the risk of later-life pain and that war generates both risk and protective factors (e.g., greater social engagement). However, Karlson, Holm, and Breen mediation analyses show that the impact of war on pain is primarily driven by increases in physical and mental health problems. Wartime children were more vulnerable to the effects of wartime violence on later-life pain than older age cohorts, demonstrating the importance of age at exposure to traumatic experiences.

生命历程理论预测，生命早期的战争经历将通过风险和恢复过程影响晚年的健康，这可能因年龄群而异。本研究使用2018年越南健康与老龄化研究（N = 1826）的老年人数据，探索早年战争经历与晚年中度/重度慢性疼痛之间的关系，强调战争相关风险或保护因素的作用，并测试儿童、青少年和年轻人群体的异质性。回归模型显示，越南战争暴露大大增加了晚年疼痛的风险，战争产生了风险和保护因素（例如，更大的社会参与）。然而，Karlson， Holm和Breen的调解分析表明，战争对疼痛的影响主要是由身体和精神健康问题的增加所驱动的。与年龄较大的同龄人相比，战时儿童更容易受到战时暴力对晚年痛苦的影响，这表明年龄在创伤经历中的重要性。

引用次数: 0

Emotion Work and Spousal Dementia Caregiving: Influences of Gender and Sexual Orientation. 情绪工作与配偶失智照护：性别与性倾向的影响。

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-01-07 DOI: 10.1177/00221465251398808

Toni Calasanti,Brian de Vries,Sadie Snow,Jing Geng

That heterosexual women caring for spouses living with dementia typically report greater stress than do men is often linked to empathic approaches to care, suggesting differences in identity-based stress appraisal. We examine this further, focusing on emotion work (manipulating one's own emotions to affect another's) versus feeling management (that targets the self) and gender and sexual orientation (GSO) identity. Using data from in-depth interviews with a nationwide sample (N = 69) of community-dwelling heterosexual, gay, and lesbian spousal/partner caregivers, we explore how GSO intersects to shape stress appraisal and emotion work provision. Thematic analysis reveals that identities centered around task completion resulted in feeling management engagement only (predominantly heterosexual men); emotion work was performed by those adopting an empathetic approach alone (mostly straight women) or combining this with a task orientation (typically gay and lesbian caregivers). These findings suggest how GSO might influence stress appraisal when challenges contradict caregivers' identities.

照顾患有痴呆症的配偶的异性恋女性通常比男性报告更大的压力，这通常与移情护理方法有关，这表明基于身份的压力评估存在差异。我们进一步研究了这一点，将重点放在情绪工作（操纵自己的情绪来影响他人的情绪）与情绪管理（针对自我）和性别和性取向（GSO）认同上。利用对全国范围内居住在社区的异性恋、同性恋和女同性恋配偶/伴侣照顾者的深度访谈数据，我们探索了GSO如何交叉影响压力评估和情感工作提供。主题分析显示，以任务完成为中心的身份只会导致管理投入感（主要是异性恋男性）；情感工作是由那些单独采用移情方法的人（主要是异性恋女性）或将其与任务导向相结合的人（通常是男同性恋和女同性恋看护者）进行的。这些发现表明，当挑战与照顾者的身份相矛盾时，GSO可能会影响压力评估。

引用次数: 0

Do Health Care Professionals Trust Parents? A Team Ethnography of Childhood Vaccine Hesitancy from Seven European Countries. 医疗保健专业人员信任父母吗？来自七个欧洲国家的儿童疫苗犹豫的团队人种志。

IF 5 1区医学 Q1 PSYCHOLOGY, SOCIAL

Journal of Health and Social Behavior

Pub Date : 2026-01-07 DOI: 10.1177/00221465251398796

Dino Numerato,Jaroslava Hasmanová Marhánková,Mario Cardano,Alice Scavarda,Luigi Gariglio,Alistair Anderson,Petra Auvinen,Piet Bracke,Ana Patrícia Hilário,Pru Hobson-West,Aapo Kuusipalo,Esther Lermytte,Joana Mendonça,Paulina Polak,Tadeusz Józef Rudek,Maria Świątkiewicz-Mośny,Pia Vuolanto,Aleksandra Wagner

Social-scientific scholarship on vaccination has often stressed the importance of trust. Vaccine hesitancy has commonly been viewed as determined by the degree of trust that parents have in expert knowledge, health care authorities, and health care professionals (HCPs). Focusing primarily on parents as trustors, the bilateral nature of trust and HCPs' trust in parents have seldom been considered. This article systematically explores these commonly overlooked aspects of trust-building. Drawing on a team ethnography in seven European countries consisting of 466 hours of observations, 167 in-depth interviews with vaccine-hesitant parents, and 171 in-depth interviews with HCPs, this article explores the levels, expressions, and outcomes of trust in the vaccination context. We suggest that trustful relationships are influenced by interpersonal and generalized trust and expressed through both the affective and cognitive dimensions. We further explore interactions where HCPs' (dis)trust may mitigate vaccine hesitancy. We conclude by providing policy implications for education, campaigns, and interventions.

关于疫苗接种的社会科学研究经常强调信任的重要性。疫苗犹豫通常被认为是由父母对专家知识、卫生保健当局和卫生保健专业人员（HCPs）的信任程度决定的。信任的双边性质和医护人员对父母的信任主要集中在作为托管人的父母身上，很少被考虑。这篇文章系统地探讨了建立信任的这些通常被忽视的方面。在7个欧洲国家进行了一项团队人种志研究，其中包括466小时的观察，167次对疫苗犹豫的父母的深度访谈，以及171次对医护人员的深度访谈，本文探讨了疫苗接种背景下信任的水平、表达和结果。我们认为信任关系受到人际信任和广义信任的影响，并通过情感和认知两个维度来表达。我们进一步探讨了HCPs的不信任可能减轻疫苗犹豫的相互作用。最后，我们提供了教育、运动和干预的政策含义。

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