Social Science & Medicine最新文献

{"title":"Causal mediation of the association between educational attainment and late-life cognitive function by trajectories of social participation","authors":"Yu-Tien Hsu ,&nbsp;Francine Grodstein ,&nbsp;Tzu-Hung Liu ,&nbsp;Chia-Rui Chang ,&nbsp;Ichiro Kawachi ,&nbsp;Jarvis T. Chen","doi":"10.1016/j.socscimed.2025.117861","DOIUrl":"10.1016/j.socscimed.2025.117861","url":null,"abstract":"<div><h3>Background</h3><div>Education is a well-established predictor for late-life cognition. Moreover, social participation is associated with late-life cognition and could mediate the association between education and cognitive function. Yet, few studies have formally tested this question within a causal mediation framework.</div></div><div><h3>Methods</h3><div>We used data from the Taiwan Longitudinal Study in Aging. Participants were aged 50 or above and recruited in 1989 (n = 4,400), stratified by age group (aged 50–64 years versus 65 or above). We used sequence analysis and optimal matching techniques to define clustered patterns of social participation and work trajectories. We then used a four-way decomposition to identify causal mediation of the association between educational attainment and cognitive function by social participation. Cognitive function was measured by the Short Portable Mental Status Questionnaire.</div></div><div><h3>Results</h3><div>The mediating pathway through social participation accounted for 5% or less of the total relation of education on late-life cognitive function for both younger and older subgroups. The interaction between education and social participation accounted for 22% (middle/high school) and 34% (college+) of the total effect, contrasting with no formal education. We estimated that 36% (95% C.I. = 0.09, 0.69) of the educational disparity in late-life cognition among the younger cohort could be eliminated if the least educated group's social participation matched that of the college or above group. Social participation was not a significant mediator in the older subgroup.</div></div><div><h3>Conclusion</h3><div>To mitigate educational disparities in late-life cognitive function, further exploration of encouraging more active social participation or stable employment should be undertaken.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117861"},"PeriodicalIF":4.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479775","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":"Perceived discrimination among migrants in Germany: Does social capital moderate harmful effects on mental health?","authors":"Louise Biddle ,&nbsp;Barbara Stacherl ,&nbsp;Ellen Heidinger","doi":"10.1016/j.socscimed.2025.117854","DOIUrl":"10.1016/j.socscimed.2025.117854","url":null,"abstract":"<div><h3>Background</h3><div>The harmful mental health effects of perceived discrimination for migrant populations are well established. The potential buffering effect of regional-level social capital, however, has not previously been explored.</div></div><div><h3>Methods</h3><div>Using data from the German Socio-Economic Panel (SOEP; 2009–2018) we apply multilevel models to assess the effect of frequent or infrequent perceived discrimination on mental health (MCS subscale of the SF-12) adjusting for individual- and regional-level confounding in a cross-sectional research design. We assess interaction with general social capital (civic engagement, electoral participation, generalised trust) and migrant-specific resources (proportion of non-nationals). We juxtapose non-refugee migrants (n = 13478) with refugees subject to mobility restrictions (n = 5558) to account for bias introduced by selective mobility into regions.</div></div><div><h3>Results</h3><div>In the non-refugee sample, we confirm the negative effects of discrimination experiences on MCS (ß frequent: −3.74, 95%-CI: [−4.40; −3.09]/ß infrequent: −1.88, 95%-CI: [−2.24; −1.52]). Moderation analyses among non-refugees show no buffering of general social capital, but a negative interaction effect of the proportion of non-nationals with experiences of discrimination (ß frequent: −0.54, 95%-CI: [−0.87; −0.21]/ß infrequent: −0.68, 95%-CI: [−1.29; −0.07]). Analyses among refugees also demonstrate a negative effect of discrimination on MCS with stronger overall effects than in the migrant sample (ß frequent: −6.24, 95%-CI: [−7.44; −5.05]/ß infrequent: −3.56, 95%-CI: [−4.25; −2.86]). In the refugee sample, the effect is exacerbated by the proportion of non-nationals (ß frequent: −1.70, 95%-CI: [−2.84; −0.56]) and buffered by generalised trust (ß: 0.87, 95%-CI: [0.13; 1.60]).</div></div><div><h3>Conclusions</h3><div>When faced with experiences of discrimination, levels of community trust seem to buffer the negative mental health impacts for refugees. We do not find buffering effects of social capital on the mental health of non-refugee migrants, possibly due to established social networks. Furthermore, our results suggest that the proportion of non-nationals within a community may have a negative reinforcing impact on the relationship between discrimination and mental health for both migrant samples. As this dynamic is currently underexplored in the German context, more community-based research is needed to develop appropriate policy interventions.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117854"},"PeriodicalIF":4.9,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511313","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":"Adverse childhood experiences and loneliness: A systematic review and meta-analysis","authors":"Aisling Curtis ,&nbsp;Martina Luchetti ,&nbsp;Cian Prendergast ,&nbsp;Elayne Ahern ,&nbsp;Ann-Marie Creaven ,&nbsp;Emma M. Kirwan ,&nbsp;Eileen K. Graham ,&nbsp;Páraic S. O’Súilleabháin","doi":"10.1016/j.socscimed.2025.117860","DOIUrl":"10.1016/j.socscimed.2025.117860","url":null,"abstract":"<div><div>Adverse childhood experiences are considered a powerful determinant of emotional health. One indicator of emotional health is loneliness, which refers to a distressing experience that one's social relationships are less in quality and quantity than those desired. This preregistered review aimed to examine the association between adverse childhood experiences (e.g., physical abuse/neglect, emotional abuse/neglect, sexual abuse, parental separation/divorce, family conflict, domestic violence) and loneliness in adulthood. A database search (Embase, Ovid, Cochrane Library, APA PsychINFO, Medline, Pubmed, Scopus) was conducted. After removal of duplicates, 3689 papers were reviewed and 20 met inclusion criteria. When feasible, results were pooled using a random-effects meta-analysis and inverse variance modelling and reported narratively. Meta-analyses revealed a statistically significant association between cumulative adverse childhood experiences and loneliness (<em>r</em> = 0.30, 95% CI [0.22–0.37]; prediction interval = 0.04–0.52) and between specific adversity types and loneliness, namely sexual abuse, physical abuse, physical neglect, emotional abuse, and emotional neglect. Some heterogeneity was observed across studies. Subgroup and sensitivity analyses revealed no differences in age, gender, age group, continent, or measures of adversity/loneliness. This research indicates that adversities in childhood may have some long-term influences on loneliness, both cumulatively and within adversity subtypes.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117860"},"PeriodicalIF":4.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488349","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":"Strategies of containment: Financialization and Latinx immigrants' health care exclusion in Colorado's mountain resort region","authors":"Sarah B. Horton","doi":"10.1016/j.socscimed.2025.117863","DOIUrl":"10.1016/j.socscimed.2025.117863","url":null,"abstract":"<div><div>This article examines the way public hospital staff in an elite new destination in Colorado, USA, conceptualized recent Latinx arrivals as a “threat” to the hospital's finances and image, implementing spatializing strategies to keep them far from its main campus and Emergency Room (ER). The literature on immigrants' “bureaucratic incorporation”—that is, the degree of institutional responsiveness to immigrant newcomers in new destinations— suggests that federal policy may make the ER relatively welcoming. However, based on interviews conducted between July 2018 and July 2023 with 17 Latinx immigrant women, 15 clinic staff, 13 area officials, a media review, and bureaucratic accompaniment of immigrants seeking care and financial assistance, I show that the hospital engaged in a suite of “strategies of containment” to distance immigrants from its ER: it attempted to confine immigrants to a “Latino clinic,” charged them up-front for care, diverted them to Denver, and excluded the undocumented from charity care. I argue that in a financialized landscape of frequent hospital consolidations and mergers, hospital officials viewed Latinx immigrants as portending uncompensated care that could jeopardize their independence and compromise their resort brand. By examining the responses of a resort hospital in a racially homogeneous new destination to the perceived “influx” of Latinx immigrant outsiders, the parallel between hospital practices and strategies of containment become clear. This article suggests the relevance of the literature on the spatialization of immigration enforcement to analyses of how hospitals evade their obligations to provide emergency care—whether through externalization, deterrence, or diversion.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"371 ","pages":"Article 117863"},"PeriodicalIF":4.9,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143521261","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":"Expanding contexts of medicalization: The role of policy legacies, race, and class in the prevalence of treatment courts","authors":"Meagan Rainock","doi":"10.1016/j.socscimed.2025.117859","DOIUrl":"10.1016/j.socscimed.2025.117859","url":null,"abstract":"<div><div>The current study seeks to examine the association between political and sociodemographic contexts and medicalization by analyzing the prevalence of treatment courts. Using a compiled dataset of 3,132 U.S. counties across all 50 states in 2020, I examine the effect of policy legacies and racial and socioeconomic makeup on the prevalence of treatment courts, which are medicalized alternatives to traditional criminal justice involvement (e.g., incarceration). Regardless of rates of mental distress, substance use, crime rates, population size, and other relevant measures, I find that counties with higher proportions of Black and college educated residents are more likely to have mental health treatment courts. I also find that counties in conservative states and in the South have fewer treatment courts, and that counties with punitive state criminal justice policies (e.g., the death penalty) report fewer treatment courts. I discuss the implications of these findings for our understanding of the social and political contexts that facilitate medicalization, as well as for the spread of treatment courts.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117859"},"PeriodicalIF":4.9,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143463815","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":"Exposure to behaviour change techniques and self-management tasks in a nationally-implemented digital intervention for type 2 diabetes self-management: Analysis of usage data","authors":"Rhiannon E. Hawkes ,&nbsp;Antonia M. Marsden ,&nbsp;Sarah Cotterill ,&nbsp;Jack S. Benton ,&nbsp;David P. French","doi":"10.1016/j.socscimed.2025.117858","DOIUrl":"10.1016/j.socscimed.2025.117858","url":null,"abstract":"<div><h3>Background</h3><div>‘Healthy Living’ is an online self-management intervention for people living with type 2 diabetes rolled out across England from 2019. It was based on the ‘HeLP-Diabetes’ intervention which demonstrated effectiveness in a randomised controlled trial. However, it is unclear how much people are exposed to intervention content outside of a trial setting.</div></div><div><h3>Purpose</h3><div>To analyse exposure to behaviour change techniques and self-management content in routine usage.</div></div><div><h3>Methods</h3><div>Anonymous usage data was obtained for all registered Healthy Living users between May 2020 and September 2023, and linked with previously coded behaviour change technique and self-management content of 895 Healthy Living webpages.</div></div><div><h3>Results</h3><div>N = 42,689 users registered for a Healthy Living account, of whom n = 27,422 activated it, and n = 19,137 (69.8%) accessed some intervention content. The median number of times users (n = 19,137) were exposed to self-regulatory behaviour change techniques across the intervention was 0 (IQR: 0,0), apart from ‘Self-monitoring of outcome(s) of behaviour’ (median: 1, IQR: 0,1). Fewer than 30% of users were exposed to behaviour change techniques present after the first section of the curriculum. The median frequency of user (n = 19,137) exposure to medical self-management tasks was 11 (IQR: 4,32), emotional self-management tasks was 4 (IQR: 1,7), and role self-management tasks was 0 (IQR: 0,1).</div></div><div><h3>Conclusions</h3><div>This is the first analysis to quantify engagement with behaviour change techniques and self-management tasks in a ‘real-world’ digital type 2 diabetes self-management programme. Future work needs to identify how to encourage usage of key material in online interventions, for example, by allowing users greater flexibility to access content they wish to engage with.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117858"},"PeriodicalIF":4.9,"publicationDate":"2025-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143479781","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":"Medical uncertainty in the shadow of Dobbs: Treating obstetric complications in a new reproductive frontier","authors":"Mara Buchbinder ,&nbsp;Kavita S. Arora ,&nbsp;Samantha M. McKetchnie ,&nbsp;Erika L. Sabbath","doi":"10.1016/j.socscimed.2025.117856","DOIUrl":"10.1016/j.socscimed.2025.117856","url":null,"abstract":"<div><div>Recent changes to United States medical practice following the U.S. Supreme Court's decision in <em>Dobbs v Jackson Woman's Health Organization</em> have led to new forms of medical uncertainty arising from the interpretation and implementation of state law. Post-<em>Dobbs</em> legal restrictions are particularly challenging because they entail multiple forms of uncertainty that intensify when combined, with risks to pregnant patients and to the clinicians who care for them. In this article, we identify and describe three distinct types of uncertainty that obstetrician-gynecologists (OB-GYNs) in states with abortion bans encounter when caring for patients with an obstetric complication known as preterm prelabor (or premature) rupture of membranes (PPROM, i.e., ‘water breaking’). PPROM represents a paradigmatic case in which prognostic, legal, and existential uncertainty coalesce, leading to stress and discomfort for both patients and the clinicians caring for them. Focusing on OB-GYNs, we describe each of these forms of medical uncertainty in turn, and then elaborate a case study to show how they operate in tandem over time. In doing so, we add to a growing body of literature highlighting the relationship between structural conditions shaping medicine and uncertainty in practice. Whereas evidence-based medicine is organized around the logic of reducing uncertainty, we find that doing so is far more difficult when the uncertainty arises from politics as opposed to clinical factors.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"369 ","pages":"Article 117856"},"PeriodicalIF":4.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430092","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":"Care in an opioid substitution therapy daycentre","authors":"Esben Houborg ,&nbsp;Sif Ingibergsdottir Mogensen ,&nbsp;Mette Kronbæk ,&nbsp;Kristian Relsted Fahnøe ,&nbsp;Nanna Kappel ,&nbsp;Katrine Schepelern Johansen","doi":"10.1016/j.socscimed.2025.117857","DOIUrl":"10.1016/j.socscimed.2025.117857","url":null,"abstract":"<div><div>Care is getting increasing attention as important for harm reduction for people who use drugs (PWUD). As a contribution to the literature about the role that care can play in harm reduction, this article presents a study of the care provided at a daycentre for PWUD. Based on semi-structured interviews with PWUD and staff at the daycentre and field notes from researchers, the article shows how care is enacted through the social interaction between staff and users and how the daycentre is constituted as an enabling place. However, the article also shows how care involves power. Analytical tools from feminist care research and Collins' interaction ritual theory are used to investigate how care practices can generate social, material and affective resources for PWUD. The article emphasises the important role that interaction rituals can play in mobilising social and affective resources. It also shows that it is important to be attentive to the ‘politics of care’ when care is provided.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"369 ","pages":"Article 117857"},"PeriodicalIF":4.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143430093","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":"Social media influencers and the Papageno effect: Experimental evidence for the suicide-preventive impact of social media posts on hope, healing, and recovery","authors":"Florian Arendt ,&nbsp;Benedikt Till ,&nbsp;Armin Gutsch ,&nbsp;Thomas Niederkrotenthaler","doi":"10.1016/j.socscimed.2025.117852","DOIUrl":"10.1016/j.socscimed.2025.117852","url":null,"abstract":"<div><div>The media can elicit detrimental and beneficial effects on suicide-related outcomes. Although the bulk of the available evidence focuses on detrimental imitative effects, more recent studies have also investigated the media's preventive potential, especially when focusing on stories of hope, healing, and recovery. Previous studies on this suicide-protective impact, termed the Papageno effect, have often focused on legacy media, such as newspapers, broadcast television, and films. Acknowledging the increasingly important role played by modern digital media environments, the present study investigated the possible suicide-preventive impact of social media posts. Utilizing an experimental design (<em>N</em> = 354) with pre- and post-measurements of suicidal thoughts, the findings revealed that exposure to social media posts on hope, healing, and recovery by an influencer with lived experience of a suicide attempt elicited a significant reduction in suicidal thoughts in a convenience sample of the general population. The reduction was stronger in individuals with comparatively higher scores for suicidal thoughts at baseline. Social media posts on hope, healing, and recovery also increased the intention to seek help when experiencing suicidal thoughts. The evidence is consistent with the idea that social media influencers can contribute to reducing suicidal thoughts and promoting help-seeking intentions. Given that social media plays an increasingly important role, especially for youth, we discuss the important implications of our findings for suicide prevention in the digital age.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117852"},"PeriodicalIF":4.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488352","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":"Trading-off outcomes and policy characteristics of a Universal Basic Income and a Minimum Income Guarantee: Evidence from an exploratory mixed-method preference-based study","authors":"Neil McHugh ,&nbsp;David Bomark ,&nbsp;Rachel Baker ,&nbsp;Verity Watson ,&nbsp;Neil Craig ,&nbsp;Cam Donaldson","doi":"10.1016/j.socscimed.2025.117855","DOIUrl":"10.1016/j.socscimed.2025.117855","url":null,"abstract":"<div><div>What policies should we introduce to tackle the UK's worsening population health trends? From an economic perspective, the concern is with achieving the greatest health outcomes from available resources. This reflects economics preoccupation with outcome-based utility. However, evidence from within health economics suggests that <em>how</em> outcomes are achieved matters as well as <em>what</em> outcomes are achieved, reflecting a concern for process utility. This issue has received much less attention in public health perhaps because of the greater complexity. For example, upstream, non-health policies affect both health and non-health outcomes and policy characteristics, such as universality versus targeting, can generate much debate. In this mixed-method exploratory preference-based study we examined whether and why 50 members of the general public from across Glasgow and Newcastle traded-off the policy characteristics and health and non-health outcomes of a Universal Basic Income and a Minimum Income Guarantee using Benefit Trade-Off and qualitative questions in one-to-one face-to-face interviews. For a majority of respondents, choices were driven by outcomes over policies characteristics, although for a substantial minority it was policy characteristics and not outcomes that influenced preferences. Qualitative data provide support for the different choices. As respondents trade-off policy characteristics and policy outcomes reflecting different preferences for each, studies looking at either in isolation may under- and over-state preferences. Similarly, failure to account for process utility in policymaking may result not only in the misallocation of resources but a lack of social acceptability, which could jeopardise the chances of a policy being implemented in the first place.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"370 ","pages":"Article 117855"},"PeriodicalIF":4.9,"publicationDate":"2025-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143511312","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}