Social Science & Medicine最新文献

{"title":"The long-term effects of housing insecurity in young adulthood on subsequent material hardship, physiological and mental health","authors":"Mary K. Roberts ,&nbsp;Aarti C. Bhat ,&nbsp;Andrew Fenelon","doi":"10.1016/j.socscimed.2025.117761","DOIUrl":"10.1016/j.socscimed.2025.117761","url":null,"abstract":"<div><div>Economic and material hardship, including housing insecurity – limited or uncertain availability or access to safe, quality, and affordable housing – is strongly linked to negative physical and mental health outcomes among adolescents and adults. However, data limitations and the inherent selectivity of housing insecurity have hindered comprehensive analysis of its long-term effects on physiological and mental health. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to construct a sample of participants who experienced housing insecurity between the ages of 18–26 (Wave III) to a suitable control group using propensity score matching. We assess the effects of housing insecurity on (1) material hardship at Wave IV (ages 24–32), (2) allostatic load (AL) and depression symptoms at Waves IV and V (ages 33–43), and (3) the change in allostatic load and depression symptoms from Wave IV to V. Further, we evaluate whether effects differ by sex. Experiencing housing insecurity is associated with a significantly higher likelihood of experiencing material hardship at Wave IV and significantly worse depressive symptoms at both Waves IV and V. The treatment effects are more pronounced among women, with housing insecurity being linked to a significant increase in allostatic load from Wave IV to Wave V exclusively for women. Our results provide crucial support that housing insecurity is not just an outcome of economic hardship but a cause of it in the future, with downstream effects on health and well-being, particularly for women.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117761"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061268","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":"Sick of debt: How over-indebtedness is hampering health in rural Cambodia","authors":"Dalia Iskander ,&nbsp;Fiorella Picchioni ,&nbsp;Giacomo Zanello ,&nbsp;Vincent Guermond ,&nbsp;Katherine Brickell","doi":"10.1016/j.socscimed.2025.117678","DOIUrl":"10.1016/j.socscimed.2025.117678","url":null,"abstract":"<div><div>This paper evidences how many rural poor Cambodians are sick of debt. Based on original, mixed-method data (2020–2022), exploring credit provisioning in this context, the aim of this paper is to illuminate some of the conditions leading to rural Cambodians taking on debt to bolster their health, and the effects this is having on borrowers' physical, psychological, emotional and social health. Specifically, we show how the health of our participants is constrained by a range of major illnesses that many suffer from and their poor food conditions, both exacerbated by the effects of climate change. Against this backdrop, many resort to debt-taking from multiple sources, including microfinance, as a coping strategy to pay for out-of-pocket health expenses and to cover food costs. While such loans offer a short-term means of sustaining health, we show that the extent of debt needed is leading to over-indebtedness which ultimately undermines health in the longer-term. Debtors are pushed to make further undue sacrifices to their food, treatment options and living conditions, specifically to service debt. We show how they are then rendered vulnerable to being exposed to, and experiencing, the negative effects of health and economic shocks, as well as to different forms of psychological, physical, emotional, social, and moral suffering to meet payments. Being sick of debt is especially acute for overindebted women who take on an increased double shift of productive and reproductive work to pay loans. While some of the adverse effects of over-indebtedness are made visible here, we warn that other forms of suffering potentially remain hidden, and will likely be expressed as longer-term population patterns of ill-health. In this context, over-indebtedness is hampering the government's aim of achieving universal health coverage and interventions are needed that reduce the debt crisis among the rural poor in order to improve health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117678"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069114","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 physical activity and mental health in pregnant women: A cross-sectional isotemporal substitution analysis","authors":"Huan Zhang ,&nbsp;Youcheng Yue ,&nbsp;Yundan Mei ,&nbsp;Yulu Zhang ,&nbsp;Qile Lu ,&nbsp;Qiang Chen ,&nbsp;Xun Lei ,&nbsp;Lili Yu ,&nbsp;Mingfang Zhou ,&nbsp;Yao Fan","doi":"10.1016/j.socscimed.2025.117745","DOIUrl":"10.1016/j.socscimed.2025.117745","url":null,"abstract":"<div><h3>Background</h3><div>Prenatal mental health is an increasing public concern. At present, it has been shown that increasing physical activity (PA) is effective in promoting mental health of pregnant women. However, mental health may depend not only on the amount of time spent on a specific activity, but also on the intensity and type of the activity that it replaces. This study is aimed to explore the impact of replacing 60 min of one health behavior with another on the mental health of pregnant women.</div></div><div><h3>Methods</h3><div>The cross-sectional study recruited 983 pregnant women from Chongqing, China between June and December 2021. The pregnant women self-reported their movement behaviors using the Pregnancy Physical Activity Questionnaire–Chinese version (PPAQ-C). Participants also completed three measures of mental health: Childbirth Attitudes Questionnaire (CAQ), 9-item Patient Health Questionnaire (PHQ-9) and the Positive affect sub-scale. An Isotemporal Substitution Model was used to evaluate mental health after replacing one movement behavior.</div></div><div><h3>Results</h3><div>The analysis showed that replacing 60 min of sedentary behavior (SB) with moderate-to-vigorous intensity PA (MVPA) promoted positive emotions, and replacing SB with light intensity PA (LPA) reduced childbirth fear. Regarding PA types, replacing inactivity with household, occupational, or transport PA could reduce fear, and replacing inactivity, occupational, household or transport PA with sport PA could improve positive emotions and alleviate depression.</div></div><div><h3>Conclusion</h3><div>An active pregnancy lifestyle with higher levels of moderate-to-vigorous physical activity and light physical activity and less sedentary behavior time and other inactive states may improve mental health. Future health promotion for pregnant women should consider the flexibility of physical activity types and intensities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117745"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076155","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 ‘us and them divide’: A qualitative study of student experiences of global health education through the lens of ‘inclusivity’","authors":"Mariam Sbaiti ,&nbsp;Eliel Cohen ,&nbsp;Xuan Odofin ,&nbsp;Julianne K. Viola ,&nbsp;Jin Keng Stephen Lam","doi":"10.1016/j.socscimed.2025.117759","DOIUrl":"10.1016/j.socscimed.2025.117759","url":null,"abstract":"<div><div>The Global Health (GH) field is characterised by stark inequalities, including a strong over-representation of GH leaders from/trained in high-income countries (HICs). There are no empirical studies exploring how experiences of GH education in HICs could have a role in reproducing, or potentially challenging, these inequalities. We address this by qualitatively analysing student and alum experiences of a one-year GH Bachelor of Science course at a research-intensive UK university (April 2019 and April 2020). Drawing from educational literature, we mobilise the concept of inclusivity to access participants' course experiences, and the concept of ‘tensionality’ to situate the ‘lived’ context of the GH classroom. We also situate this context within broader theories of a Western or foreign ‘gaze’, the concept of ‘cognitive’ or ‘epistemic’ (in)justice and field of critical pedagogy. We find that the underpinning inequalities in GH, the ways in which communities that are the “object of study” are re-presented and their frequent absence (non-representation), creates a tension experienced by all students, regardless of their identities. However, the inclusive/non-inclusive dichotomy is not a simple one. GH education can be experienced as simultaneously empowering and alienating. The paper identifies the most promising curricular and pedagogic principles and concludes that GH educators must embrace the underpinning ‘tensionality’ of GH education. Whilst doing so is insufficient to resolve tensions and inequalities, it can enhance educational by modelling simple action to acknowledge cognitive injustice, gesturing towards pluriversality and engaging practically with the potential of the GH education sector to impact inequalities in the field.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"367 ","pages":"Article 117759"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143145683","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":"Economic hardships during COVID-19 and maternal mental health: Combining samples with low incomes across three cities","authors":"Anne Martin ,&nbsp;Elizabeth B. Miller ,&nbsp;Rachel S. Gross ,&nbsp;Pamela A. Morris-Perez ,&nbsp;Daniel S. Shaw ,&nbsp;Luciane da Rosa Piccolo ,&nbsp;Jennifer Hill ,&nbsp;Marc A. Scott ,&nbsp;Mary Jo Messito ,&nbsp;Caitlin F. Canfield ,&nbsp;Lauren O'Connell ,&nbsp;Richard C. Sadler ,&nbsp;Ashleigh I. Aviles ,&nbsp;Chelsea Weaver Krug ,&nbsp;Christina N. Kim ,&nbsp;Juliana Gutierrez ,&nbsp;Ravi Shroff ,&nbsp;Alan L. Mendelsohn","doi":"10.1016/j.socscimed.2024.117636","DOIUrl":"10.1016/j.socscimed.2024.117636","url":null,"abstract":"<div><div>The COVID-19 pandemic increased maternal depression and anxiety, imperiling both mothers' own wellbeing and that of their children. To date, however, little is known about the extent to which these increases are attributable to economic hardships commonly experienced during the pandemic: income loss, job loss, and loss of health insurance. Few studies have examined the individual impacts of these hardships, and none have lasted beyond the first year of the pandemic. This study harmonizes data from six evaluations of pediatric-based parenting programs for women with young children and low incomes across three U.S. cities (<em>N</em> = 1,254). Low-income mothers are of special interest because their families have been disproportionately affected by economic shocks due to COVID-19, and mothers of young children have been more distressed than other mothers by COVID-19. The studies’ combined window of observation lasted from the onset of the pandemic to over three years later. Results indicate that income loss, job loss, and health insurance loss were all significantly associated with depression and anxiety. When each hardship was assessed net of the others, lost income was associated with more than a two-fold increase in the odds of anxiety, and a lost job and lost health insurance were associated with 50% and 90% greater odds of depression, respectively. Associations between hardships and maternal mental health did not diminish over time during the window of observation. These associations are likely to have been even greater in the absence of generous social policies enacted during the pandemic.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117636"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899771","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":"Medical ambivalence and Long Covid: The disconnects, entanglements, and productivities shaping ethnic minority experiences in the UK","authors":"Damien T. Ridge ,&nbsp;Alex Broom ,&nbsp;Nisreen A. Alwan ,&nbsp;Carolyn A. Chew-Graham ,&nbsp;Nina Smyth ,&nbsp;Dipesh Gopal ,&nbsp;Tom Kingstone ,&nbsp;Patrycia Gaszczyk ,&nbsp;Samina Begum","doi":"10.1016/j.socscimed.2024.117603","DOIUrl":"10.1016/j.socscimed.2024.117603","url":null,"abstract":"<div><div>Structural violence - related to ‘isms’ like racism, sexism, and ableism – pertains to the ways in which social institutions harm certain groups. Such violence is critical to institutional indifference to the plight of ethnic minority people living with long-term health conditions. With only emergent literature on the lived experiences of ethnic minorities with Long Covid, we sought to investigate experiences around the interplay of illness and structural vulnerabilities. Thirty-one semi-structured interviews with a range of UK-based participants of varying ethnic minorities, ages and socio-economic situations were undertaken online between June 2022 and June 2023. A constant comparison analysis was used to develop three over-arching themes: (1) Long Covid and social recognition; (2) The violence of medical ambivalence; and (3) Pathways to recognition and support. Findings showed that while professional recognition and support were possible, participants generally faced the spectre and deployment of a particular mode of structural violence, namely ‘medical ambivalence’. The contours of medical ambivalence in the National Health Service (NHS) as an institution had consequences, including inducing or accentuating suffering via practices of care denial. Despite multiple structurally shaped ordeals (like healthcare, community stigma, and sexism), many participants were nevertheless able to gain recognition for their condition (e.g. online, religious communities). Participants with more resources were in the best position to ‘cobble together’ their own approaches to care and support, despite structural headwinds.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117603"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899795","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":"Getting the numbers right: Power, creativity and ‘good’ routine maternal and neonatal health data in Southern Tanzania","authors":"Jil Molenaar ,&nbsp;Amani Kikula ,&nbsp;Josefien van Olmen ,&nbsp;Andrea Pembe ,&nbsp;Lenka Beňová","doi":"10.1016/j.socscimed.2024.117668","DOIUrl":"10.1016/j.socscimed.2024.117668","url":null,"abstract":"<div><div>What makes routine maternal and neonatal health data to be ‘good quality’? That depends on whom you ask – the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards of two hospitals in Southern Tanzania. We draw from focused ethnographic observation at these two labour wards and 29 in-depth qualitative interviews with health care workers (HCWs), hospital leaders, and relevant district- and regional-level managers.</div><div>We distinguish between two different types of power that shape how people engage with routine maternal and neonatal health data: authoritative and discretionary power. Authoritative power, or top-down power ‘over’, is reflected in how maternal and neonatal health targets and measurement demands are imposed on individuals lower in the power hierarchy. We show how this results in an environment where data are seen as ‘political things’ and where HCWs feel pressured and fear being blamed for poor health outcomes. Yet, data can also be a means for HCWs to exercise discretionary power – a type of bottom-up power to act creatively to deflect scrutiny and protect themselves and others.</div><div>Strategically handling and manipulating data, HCWs ‘get the numbers right’ by balancing their own needs, top-down expectations, and structural challenges. HCWs may hereby compromise their own definitions of ‘good’ data, and as as consequence, limit the usefulness of routine data to inform clinical decision making and health system planning. We underline the importance of supportive supervision, feasibility and perceived relevance of routine health data for those tasked to collect and report it, in order to better navigate the blurry line between constructive accountability and counter-productive pressure.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117668"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957590","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":"Socioeconomic inequality in the outcomes of a psychological intervention for depression for South Africans with a co-occurring chronic disease: A decomposition analysis","authors":"Amarech Obse ,&nbsp;Susan Cleary ,&nbsp;Rowena Jacobs ,&nbsp;Bronwyn Myers","doi":"10.1016/j.socscimed.2024.117659","DOIUrl":"10.1016/j.socscimed.2024.117659","url":null,"abstract":"<div><div>Task-shared psychological interventions are effective for reducing the severity of depression symptoms, but differences in treatment outcome by socioeconomic status is uncertain. This study examines socioeconomic inequalities (SEI) in depression outcomes among people with HIV and/or diabetes who participated in a cluster randomised controlled trial in the Western Cape Province of South Africa. The trial took place at 24 primary care clinics randomised to deliver a task-shared psychological intervention or treatment as usual (TAU). The trial enrolled 1119 participants meeting criteria for probable depression. Depression symptom severity was evaluated at baseline and 24-month follow-up. Using a concentration index (CI), SEIs in depression were assessed for the intervention and TAU arms. Demographic and socioeconomic variables were used to decompose the CI to identify contributors to SEI. Results indicate poorer participants at the intervention arm have significantly worse 24-month outcomes than wealthier counterparts (CI = – 0.080; SE = 0.025). Race (34.2%), unemployment (17.4%) and food insecurity (15%) were the main contributing factors. While policymakers need to invest in psychological interventions to reduce the burden caused by depression, this study suggests treatment outcomes may be different across the socioeconomic spectrum. Decomposition of these findings points to structural constraints, such as unemployment, as the key contributors towards poorer treatment outcomes. These findings suggest a need to combine psychological interventions with structural interventions that address the broader socio-economic determinants of mental health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117659"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142957593","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":"Infant birth weight in Brazil: A cross-sectional historical approach","authors":"Cassia Roth","doi":"10.1016/j.socscimed.2025.117677","DOIUrl":"10.1016/j.socscimed.2025.117677","url":null,"abstract":"<div><div>In 1888, Brazil became the last country in the Americas to abolish slavery. Historians have outlined the racialized health disparities of people of African descent in the post-abolition period. Epidemiologists have shown that twenty-first-century health disparities continue to mirror patterns from over a century ago. This cross-sectional analysis quantifies health disparities in a post-abolition maternity hospital using infant birth weight. It relies on hospital records on infants delivered between 1922 and 1926 (n = 2845) at the Maternidade Laranjeiras in the city of Rio de Janeiro, Brazil to run linear models assessing differences in infant birth weight by maternal skin color, age, number of pregnancies (parity), and nationality. African ancestry was correlated with lower birth weights. Infants born to Afro-descendant women had birth weights estimated to be 84 g lighter (p-value = 0.002 [95% CI -137, −32]) than infants born to Euro-descendant women. Among Afro-descendant women, infants born to Black (<em>preta</em>) women had birth weights estimated to be 100 g lighter (p-value = 0.001 [95% CI -160, −39]) and infants born to mixed-race (<em>parda</em>) women had birth weights estimated to be 70 g lighter (p-value = 0.022 [95% CI -130, −10]) than infants born to White women. The findings were likely the consequence of slavery's legacy, particularly race-based socioeconomic inequality – including more strenuous work schedules, poorer nutrition, and less sanitary living environments for people of African descent. The findings are consistent with current-day research on racialized health disparities in Brazil and demonstrate the importance of historical findings to public health research.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117677"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143014505","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":"How is process tracing applied in health research? A systematic scoping review","authors":"Rebecca Johnson ,&nbsp;Derek Beach ,&nbsp;Hareth Al-Janabi","doi":"10.1016/j.socscimed.2024.117539","DOIUrl":"10.1016/j.socscimed.2024.117539","url":null,"abstract":"<div><div>Complex health system questions often have a case study (such as a country) as the unit of analysis. Process tracing, a method from policy studies, is a flexible approach for causal analysis within case studies, increasingly used in applied health research. The aim of this study was to identify the ways in which process tracing methods have been used in health research, and provide insights for best practice. We conducted a systematic scoping review of applied studies purporting to use process tracing methods in health research contexts. We examined the range of studies and how they conducted and reported process tracing. We found 84 studies published from 2011 to 2023. Studies were categorised into two groups: those with greater methodological description (n = 19 studies) and those with less methodological description (n = 65 studies). A majority of studies were focused on public health and health policy with around half of studies focused on low and middle income countries. Of those 19 studies that provided greater methodological description eight studies featured four areas of good practice: (1) reporting the development of a mechanistic theory and making it explicit; (2) linking empirical material collected to the mechanistic theory; (3) clearly presenting the causal mechanism tracing; and (4) reporting how consideration of counterfactuals or evidence of alternatives within the study were analysed in practice. The review demonstrates the rapid take-up of process tracing to generate theory and evidence to support a better understanding of causal mechanisms in complex health research. To support future studies in conducting and reporting process tracing, we provide emergent recommendations.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"366 ","pages":"Article 117539"},"PeriodicalIF":4.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899783","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}