Social Science & Medicine最新文献

{"title":"Explaining subjective social status and health: Beyond education, occupation and income","authors":"Matthew Robson ,&nbsp;Gang Chen ,&nbsp;Jan Abel Olsen","doi":"10.1016/j.socscimed.2025.117869","DOIUrl":"10.1016/j.socscimed.2025.117869","url":null,"abstract":"<div><div>Subjective measures of social status often explain variations in health better than the typical objective measures of education, occupation, and income. This raises the question: if status affects health, then what affects status? To answer this, we ran a survey using representative samples of adult populations in the UK, US and Canada (n = 3,431) to gather data on respondents' subjective social status (SSS) and health-related quality of life (HRQoL), alongside an extensive, rarely gathered set of socioeconomic variables: education, occupation, income, comparative income, wealth, childhood circumstances, parents' education, partner's education, and social and cultural capital. We conduct Shapley-Owen decompositions to identify the relative contributions of these variables in explaining variation in SSS and HRQoL and use RIF (recentered influence function) -regressions to go beyond the mean and identify how these contributions change across the quantiles of SSS and HRQoL. Results show that education, occupation, and income explain relatively little of the explained variation in SSS (26%), while comparative income, wealth and childhood circumstances together explain more than 60%. We find that at higher quantiles of SSS and HRQoL the more subjective and relativistic measures of socioeconomic status contribute more to the explained variation, whilst at lower quantiles, variation is better explained by the more objective socioeconomic variables (i.e. education, occupation, income and wealth). These findings shed light on how policy makers could consider intervening to reduce health inequalities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117869"},"PeriodicalIF":4.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578692","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}

{"title":"Associations of parental internal migration with child growth and nutritional status in low- and middle-income countries: A systematic review","authors":"Emeline Rougeaux,&nbsp;Adriana Vázquez-Vázquez,&nbsp;Laura Busert-Sebela,&nbsp;Mary Fewtrell,&nbsp;Jonathan C.K. Wells","doi":"10.1016/j.socscimed.2025.117899","DOIUrl":"10.1016/j.socscimed.2025.117899","url":null,"abstract":"<div><div>Five to 50% of people in low- and middle-income countries (LMICs) report having ever migrated internally. Studies suggest internal (within-country) migration may influence health within and across generations. This review aims to collate evidence of associations of parental internal migration and child growth and nutritional status in LMICs.</div><div>Observational studies of children with parents who had migrated internally within their resident country, with a non-migrant reference group and outcomes relating to child growth and nutritional status were eligible. Full research articles in peer-reviewed journals from 2000 onwards were included, with no country/setting/language restrictions. The search was conducted in June 2024 in Embase/Global Health/MEDLINE, WoS, Proquest Central, Global Index Medicus, and Google Scholar using relevant keywords. The Newcastle-Ottawa Scale assessed risk of bias. The protocol was registered on PROSPERO (CRD42023423895).</div><div>Twelve studies were identified from China, India, Mexico, Peru, Tanzania, South Africa, and Turkey, most of which focussed on early childhood, and all but one found associations. Of studies comparing rural-urban migrants to <em>rural non-migrants</em> (n=5), migration was associated with reduced risk of child undernutrition and improved linear growth, particularly for children born at urban destination, but also increased weight growth and overweight. In comparison to <em>urban non-migrants</em> (n=11), findings were mixed and showed children of <em>rural-urban migrants</em> had greater/similar levels of undernutrition and poorer growth or greater levels of overweight in early life but better linear growth in late childhood/adolescence.</div><div>This review identifies internal migration as a determinant of child health in LMICs and thus suggests it should be considered when designing policies and interventions to improve child health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117899"},"PeriodicalIF":4.9,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143610066","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}

{"title":"“The highest decision-making level” – Multidisciplinary team meetings as boundary spaces","authors":"Henriette List ,&nbsp;Dorthe Brogård Kristensen ,&nbsp;Ole Graumann","doi":"10.1016/j.socscimed.2025.117886","DOIUrl":"10.1016/j.socscimed.2025.117886","url":null,"abstract":"<div><div>Multidisciplinary team meetings (MDMs), also known as tumor boards, play a crucial role in collaborative decision-making within Western healthcare systems. This study explores the significance of MDMs in Danish cancer care through an ethnographic lens, based on fieldwork conducted at five university hospitals. Clinicians regard these meetings as fostering efficiency, reflexivity, consistency, transparency, and security in patient care, and recognize MDMs as “the highest decision-making level” in cancer care. Analytically, we conceptualize MDMs as boundary spaces where professionals engage in collaborative boundary work across disciplines. We introduce a typology of this work—calibrating, reflecting, and guarding—which are conducted before, during, and in relation to MDMs. Our analysis demonstrates how these practices afford relational agency as an enhanced form of individual agency. At the same time, we uncover how these practices establish “gate mechanisms” that privilege certain voices, knowledge, and expertise within the boundary space. This reconfigures professional identities and power dynamics, shaping a specific treatment and care regime as decisions are collectively made by a confined group of clinical actors.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117886"},"PeriodicalIF":4.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591583","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}

{"title":"Evolution of intimate partner violence impacts from cash transfers, food transfers, and behaviour change communication: Mixed-method experimental evidence from a nine-year post-programme follow-up in Bangladesh","authors":"Michelle Lokot ,&nbsp;Nasrin Sultana ,&nbsp;Melissa Hidrobo ,&nbsp;Akhter Ahmed ,&nbsp;John Hoddinott ,&nbsp;Deboleena Rakshit ,&nbsp;Shalini Roy ,&nbsp;Meghna Ranganathan","doi":"10.1016/j.socscimed.2025.117901","DOIUrl":"10.1016/j.socscimed.2025.117901","url":null,"abstract":"<div><div>Cash or food transfers can reduce intimate partner violence (IPV), but knowledge gaps remain on how impacts evolve over time, and the role of complementary ‘plus’ activities and contextual factors. We conducted a mixed-method analysis of how the Transfer Modality Research Initiative in Bangladesh affected IPV over time. The programme was implemented from 2012 to 2014, following a randomised controlled trial (RCT) design, across Northern and Southern Bangladesh. Intervention arms included monthly cash or food transfers, with or without complementary nutrition behaviour change communication (BCC). We estimate post-programme impacts on IPV using quantitative data collected in 2014–2015, 2018, and 2022, and combine this with qualitative data collected in 2023 to explore how and why IPV impacts evolved over time and the role of contextual factors. In the North, combining cash with BCC led to sustained IPV reductions in each post-programme round, while cash alone reduced IPV in 2022 but not the previous two rounds; food transfers showed no post-programme impacts. In the South, combining food with BCC led to post-programme IPV reductions in 2014–2015; no intervention sustained IPV reductions thereafter. Sustained IPV reductions are primarily driven by improved household economic security and emotional well-being. Other pathways – family relationships (including in-laws’ roles), women's empowerment, and social and community support – contributed to changing couples' relationships during the programme but became less salient after the programme ended. Contextual factors, including demographic changes, climate-related changes, external projects and norms condoning IPV appear to influence the sustainability of impacts. Results suggest that ‘plus’ programming was key to sustaining IPV impacts soon after the interventions, but less so by nine years post-programme, as economic security increasingly drove impacts. More mixed method research is needed from the outset to unpack if and how pathways to IPV reduction can be sustained in different contexts over time.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117901"},"PeriodicalIF":4.9,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143591497","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}

{"title":"“The system's not getting my grandchild”: A qualitative study of caregiver relationship formation for children born to incarcerated mothers","authors":"Bethany Kotlar ,&nbsp;Aisha Yousafzai ,&nbsp;Carolyn Sufrin ,&nbsp;Monik Jimenez ,&nbsp;Henning Tiemeier","doi":"10.1016/j.socscimed.2025.117881","DOIUrl":"10.1016/j.socscimed.2025.117881","url":null,"abstract":"<div><div>Women who give birth during their incarceration in most states in the US are separated from their newborns, who are placed with non-maternal caregivers. Infants of incarcerated mothers are a highly vulnerable population for which caregiving relationships may be particularly important for their wellbeing. Despite this, incarcerated mothers may be responsible for selecting a caregiver with no formal guidance. However, this process is poorly understood. The goal of this study was to understand how families form caregiving relationships during a mother's incarceration in state prisons in Georgia. Data were drawn from initial interviews from a mixed methods cohort of children exposed prenatally to incarceration. Thirty-six interviews with caregivers and 13 interviews with mothers released from incarceration were analyzed using thematic analysis. Researchers validated data through focus groups with caregivers and nonprofit staff. Caregivers and formerly incarcerated mothers discussed avoiding child welfare custody when making caregiving decisions. Mothers prioritized caregivers who they believed would help them reunify with the child. Caregivers and mothers discussed keeping the child with a family member if possible; mothers overwhelmingly preferred their own parents as caregivers. When mothers choose between several potential caregivers, they prioritized the safety and security of their infant, rejecting those who were substance users, had a history of incarceration, had serious health issues, or who they deemed irresponsible. These factors were frequently brought up when discussing children's fathers as potential caregivers. Thus, choice of caregivers for infants born during incarceration was motivated by family unity and safety and security. Policymakers should target these children and their families for intensive support through social services.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117881"},"PeriodicalIF":4.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511268","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}

{"title":"When the invisible becomes the impossible: Direct care workers’ experience of organizational change","authors":"Jane S. VanHeuvelen ,&nbsp;Tom VanHeuvelen ,&nbsp;Janette S. Dill","doi":"10.1016/j.socscimed.2025.117887","DOIUrl":"10.1016/j.socscimed.2025.117887","url":null,"abstract":"<div><div>The covid-19 pandemic transformed the experience of work for many in the healthcare sector. In the current paper, we focus on the nature of healthcare work transformation in response to a sudden and unexpected onset of organizational change for <em>direct care workers (DCWs)</em>. DCWs provide hands-on care for older and disabled adults and children, are the largest occupational group in the US, and were in a central position of healthcare administrative and organization change during the covid-19 pandemic and recovery. Analyses are based on 26 in-depth interviews with women DCWs who were employed during the covid-19 pandemic. We find changes in staffing and procedures associated with the covid-19 pandemic increased DCWs’ formal and more visible job responsibilities while reducing the amount of time DCWs were able to spend on informal or invisible aspects of their work, primarily engaging in meaningful and non-routine interactions with patients. For many, reconciling demands to accomplish more tasks in ways that felt rewarding to themselves and to their patients were severely challenged.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117887"},"PeriodicalIF":4.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563617","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}

{"title":"Comprehensive assessment of the impact of mandatory community-based health insurance in Burkina Faso","authors":"Delphine Boutin ,&nbsp;Laurène Petitfour ,&nbsp;Yvonne Allard ,&nbsp;Souleymane Kountoubré ,&nbsp;Valéry Ridde","doi":"10.1016/j.socscimed.2025.117870","DOIUrl":"10.1016/j.socscimed.2025.117870","url":null,"abstract":"<div><div>Health coverage for informal workers in Sub-Saharan Africa remains a major challenge. This study evaluates an alternative approach: bundling health insurance with microcredit. We conducted a randomized controlled trial in Ouagadougou, Burkina Faso, to assess the impact of mandatory health insurance linked to microcredit. The study covered 88 microcredit groups (44 treated, 44 control), analyzing outcomes for 1,095 individuals who reported illness episodes in the six months preceding the final survey in January–February 2022. Results show that the insurance requirement did not lead to program dropout, with loan renewal rates remaining stable between groups. Health insurance had a significant positive impact on financial protection: out-of-pocket expenses decreased by over 50% and payment difficulties by 36%. The study also reveals changes in health-seeking behaviors. Use of modern healthcare facilities increased by 7%, while reliance on traditional medicine decreased by 61%. Insured individuals also sought care more quickly, with 23% more seeking care on the same day symptoms appeared. However, no significant impact was observed on physical or psychological health outcomes. These findings suggest that bundling health insurance with other services like microcredit can be a viable solution for deploying mandatory health coverage to populations working in the informal sector. This approach provides significant financial protection against health risks and improves access to healthcare.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117870"},"PeriodicalIF":4.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143578443","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}

{"title":"Natural disaster-induced dementia and cognitive decline: A meta-analysis and systematic review","authors":"Jacob Thompson ,&nbsp;Maryam Vasefi","doi":"10.1016/j.socscimed.2025.117898","DOIUrl":"10.1016/j.socscimed.2025.117898","url":null,"abstract":"<div><div>Recently, some studies have noted a negative cognitive impact on individuals in the aftermath of large-scale natural disasters; however, the causal relationship between disasters and cognitive/neurodegenerative effects remains widely unexplored. This review analyzes the impact of natural disasters on the development of cognitive decline (CD), all-cause dementia, and Alzheimer's disease (AD) in disaster-affected individuals. Studies reported from their inception to August 2023 were obtained via public online databases. All data presented in this review was derived from precalculated study results, data presented within/alongside articles, or statistics calculated using data obtained by contacting the articles' authors for ancillary information. Data from 28 studies, representing 4,606,561 individuals, 158,994 CD events, 179,694 dementia events, and 47,193 AD events was included for analysis. The pooled odds ratio (OR) and 95% confidence interval (CI) estimates showed that natural disasters significantly increased the risk of CD (OR: 1.25, CI: 1.20–1.30), all-cause dementia (OR: 1.07, CI: 1.05–1.08), and AD (OR: 1.07, CI: 1.05–1.10) in disaster victims as opposed to less- or non-impacted individuals. The greatest effects were noted following hurricanes, earthquakes with tsunamis, and heat waves. The findings from this meta-analysis indicate that natural disasters are significantly associated with the development of CD, all-cause dementia, and AD.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117898"},"PeriodicalIF":4.9,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143526727","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}

{"title":"The power paradox of patient-centred care in Chinese community health: Towards a conceptualisation","authors":"Bo Li","doi":"10.1016/j.socscimed.2025.117883","DOIUrl":"10.1016/j.socscimed.2025.117883","url":null,"abstract":"<div><div>Patient-centred care (PCC) is widely heralded as a transformative healthcare paradigm, designed to prioritise patients' unique needs, preferences, and values in clinical decision-making. By potentially shifting away from the historically provider-centric model, PCC aims to empower patients as autonomous, active participants. However, critical questions remain: Does PCC genuinely dismantle power asymmetries, or does it merely serve as rhetoric subtly reinforcing existing hierarchies under the guise of empowerment? This study examines this power paradox—the disconnect between PCC's rhetorical positioning and its superficial implementation—through Steven Lukes' three dimensions of power, focusing on China's community healthcare system, where patient-centred ideals are strongly advocated. A year-long non-participant observation at a major community health centre in Shenzhen, complemented by semi-structured interviews with 16 general practitioners (GPs) and 18 hypertensive patients (HPs), informed an iterative thematic analysis. The analysis identified three paradoxes that complicate PCC's vision of patient empowerment. First, protective authority demonstrates how GPs' protective intentions manifest as directive behaviours, fostering dependency and limiting patient agency. Second, framing authority reveals how organisational norms, policies, and clinical expectations constrain patient choice, prioritising compliance over autonomy. Lastly, internalised compliance highlights PCC's ideological power, where HPs internalise adherence as integral to their identity as ‘good’ patients, embedding deference to medical authority within their sense of well-being. These findings offer critical insights into PCC's power paradox, questioning its theoretical capacity to redress entrenched provider-patient power imbalances. Addressing these challenges necessitates systemic reforms and shifts in clinical practice to genuinely prioritise patient-centredness.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117883"},"PeriodicalIF":4.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521260","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}

{"title":"Disputed and disfavored: Pain, mental illness, and invisible conditions in disability discrimination cases","authors":"Rachel Kahn Best ,&nbsp;Yan Fang ,&nbsp;Catherine Fisk ,&nbsp;Linda Hamilton Krieger ,&nbsp;Diana Reddy","doi":"10.1016/j.socscimed.2025.117885","DOIUrl":"10.1016/j.socscimed.2025.117885","url":null,"abstract":"<div><div>When they sue their employers for disability discrimination, do plaintiffs with some types of conditions fare better than others? This paper analyzes legal outcomes for three types of conditions that are potentially disputed (subject to suspicion and doubt) or disfavored (subject to stigma or judgment): mental illnesses, invisible conditions, and subjectively diagnosed pain conditions. Using logistic regression to analyze over 1,100 judicial opinions in the US federal courts, we find that invisible conditions tend to be disputed and mental illnesses tend to be disfavored. We find the strongest and most consistent disadvantages for subjectively diagnosed pain conditions; plaintiffs with these conditions are significantly less likely to be deemed a person with a disability and to win in court. The disadvantages for plaintiffs with difficult-to-document pain conditions persist even if they are deemed to be persons with disabilities, suggesting that skepticism about these conditions pollutes judges’ overall impression of plaintiffs.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117885"},"PeriodicalIF":4.9,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512239","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}