Journal of Health and Social Behavior最新文献

Although most clinicians have come to perceive invasive life-sustaining treatments as overly aggressive at the end of life, some of the public and greater proportions of some socially disadvantaged groups have not. Drawing on 1,500+ hours of observation in four intensive care units and 69 interviews with physicians and patients' family members, I find inequality occurs through two mechanisms complementary to the cultural health capital and fundamental causes explanations prevalent in existing health disparities literature: in valuation, as the attitudes and values of the socially disadvantaged are challenged and ignored, and in standardization, as the outcomes preferred by less advantaged groups are defined as inappropriate and made harder to obtain by the informal and formal practices and policies of racialized organizations. I argue inequality is produced in part because wealthier and White elites shape institutional preferences and practices and, therefore, institutions and clinical standards to reflect their cultural tastes.

We investigate how loneliness develops over the marital dissolution process in older age (i.e., transition at or after age 50) while paying close attention to heterogeneities by the dissolution pathway-widowhood and separation-and gender. Using data from over 8,000 Household, Income and Labour Dynamics in Australia survey respondents, we assess the association of interest using fixed effects regressions. Findings indicate that loneliness increased in the year before widowhood or separation among both women and men. Levels spiked in the year of dissolution, particularly for widowhood but less for separation. Widowed men were substantially more affected than widowed women, and gender differences were negligible for separation. Although loneliness levels gradually declined, widowed men remained vulnerable for remarkably long periods. Such chronic loneliness might be linked to other health disadvantages. These findings highlight the importance of long-term and gender-specific approaches to social support and integration after marital dissolution.

Early initiation and consistent use of prenatal care is linked with improved health outcomes. American Indian birthing people have higher rates of inadequate prenatal care (IPNC), but limited research has examined IPNC among people living on American Indian reservations. The current study uses birth certificate data from the state of Montana (n = 57,006) to examine predictors of IPNC. Data on the community context is integrated to examine the role of community health in mediating the associations between reservation status and IPNC. Results suggest that reservation-dwelling birthers are more likely to have IPNC, an association partially mediated by community health. Odds of IPNC are higher for reservation-dwelling American Indian people compared to reservation-dwelling White birthers, highlighting intersecting inequalities of race and place.

Observing an association between socioeconomic status (SES) and health reliably leads to the question, "What are the pathways involved?" Despite enormous investment in research on the characteristics, behaviors, and traits of people disadvantaged with respect to health inequalities, the issue remains unresolved. We turn our attention to actions of more advantaged groups by asking people to self-report their exposure to disrespect, discrimination, exclusion, and shaming (DDES) from people above them in the SES hierarchy. We developed measures of these phenomena and administered them to a cross-sectional U.S. national probability sample (N = 1,209). Consistent with the possibility that DDES represents a pathway linking SES and health, the SES→health coefficient dropped substantially when DDES variables were controlled: 112.9% for anxiety, 43.8% for self-reported health, and 49.4% for cardiovascular-related conditions. These results illustrate a need for a relational approach emphasizing the actions of more advantaged groups in shaping health inequities.

Racial inequalities in breastfeeding have been a U.S. national concern, prompting health science research and public discourse. Social science research reveals structural causes, including racism in labor conditions, maternity care practices, and lactation support. Yet research shows that popular and health science discourses disproportionately focus on individual and community factors, blaming Black women and communities for unequal breastfeeding rates. This study examines how scientific reports are communicated to the public through a critical analysis of 104 U.S. news articles reporting research on racial disparities in breastfeeding. Findings show that articles acknowledge unequal treatment within maternity care but justify it by presenting Black patients as overburdening the maternity care systems they use due to low socioeconomic status, welfare dependency, poor family support, and poor health. Through these representations, articles co-construct racialized motherhood and maternity care systems in ways that hide manifestations of obstetric racism and combat social support for systemic change.

We examine whether the COVID-19 pandemic was associated with changes to daily activity limitations due to poor physical or mental health and whether those changes were different within and between gendered and racialized groups. We analyze 497,302 observations across the 2019 and 2020 waves of the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System survey. Among White men and women, the COVID-19 pandemic was associated with fewer days of health-related activity limitations and decreased frequent activity limitation (≥14 days in the past month) compared to the prepandemic period. By contrast, Latina and Black women experienced increased days of activity limitation and greater likelihood of frequent activity limitation, and these changes were significantly different than for White women. These findings are robust to the inclusion of structural inequality measures and demonstrate how systemic racism and sexism likely exacerbate a myriad of pandemic-related health problems.