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Do nudges need a regulatory push? Comparing the effectiveness and implementation of exemplar nudge (size-based) and non-nudge (price-based) dietary interventions 推动需要监管推动吗?比较助推(以规模为基础)和非助推(以价格为基础)饮食干预的有效性和实施情况
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-20 DOI: 10.1016/j.socscimed.2025.118004
Theresa M. Marteau , Eleni Mantzari , Gareth J. Hollands
{"title":"Do nudges need a regulatory push? Comparing the effectiveness and implementation of exemplar nudge (size-based) and non-nudge (price-based) dietary interventions","authors":"Theresa M. Marteau ,&nbsp;Eleni Mantzari ,&nbsp;Gareth J. Hollands","doi":"10.1016/j.socscimed.2025.118004","DOIUrl":"10.1016/j.socscimed.2025.118004","url":null,"abstract":"<div><div>Changing behaviour across populations is key to improving population health and achieving net zero by 2050, including changing diets. We examine the extent to which <em>nudges,</em> with the potential to contribute to such change, are being implemented alongside traditional approaches. We compare the effectiveness and extent of implementation into policy of two interventions to improve diets: size-based interventions that alter portion, package or tableware size, commonly considered a <em>nudge</em>; and, price-based interventions, including food-item taxes, not considered a <em>nudge</em>.</div><div>We conducted four rapid reviews: two for systematic reviews with meta-analyses aimed to determine the effectiveness of size-based and price-based interventions, respectivel<em>y</em>; and two for reports to estimate the extent to which size-based and price-based interventions have been implemented in health or environment policies of governments, public authorities, or private sector organisations, at national or sub-national levels.</div><div>Both sets of interventions were consistently found in research studies to be effective at reducing consumption and purchasing of unhealthy products, but price-based interventions have been implemented in policies far more often than size-based ones. At least 118 countries have implemented taxes on sugar sweetened beverages (SSBs), and 42 countries have implemented taxes on unhealthy foods. In contrast, we identified 20 reports of size-based interventions implemented at sub-national level, of which only one involved regulation.</div><div>Explaining and reversing the lack of implementation of size-based interventions and other effective <em>nudges</em> merits prioritisation to help realise global ambitions to improve population health and achieve net zero by 2050.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 118004"},"PeriodicalIF":4.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725574","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}
引用次数: 0
Impact of the 2009 WIC revision on infant and maternal health: A quasi-experimental multi-state study 2009年WIC修订对母婴健康的影响:一项准实验多州研究
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-20 DOI: 10.1016/j.socscimed.2025.117974
Guangyi Wang , Marianne Bitler , Dean Schillinger , Martin Halla , Steven Stillman , Rita Hamad
{"title":"Impact of the 2009 WIC revision on infant and maternal health: A quasi-experimental multi-state study","authors":"Guangyi Wang ,&nbsp;Marianne Bitler ,&nbsp;Dean Schillinger ,&nbsp;Martin Halla ,&nbsp;Steven Stillman ,&nbsp;Rita Hamad","doi":"10.1016/j.socscimed.2025.117974","DOIUrl":"10.1016/j.socscimed.2025.117974","url":null,"abstract":"<div><div>Improving food security and dietary quality during pregnancy is vital for maternal and infant health. Poor nutrition can lead to adverse fetal development and complications for women. In 2009, the Special Supplemental Nutrition Program for Women, Infant, and Children (WIC), a US safety net program for low-income pregnant, breastfeeding or postpartum women and young children, was revised to improve dietary quality, promoting intake of whole grains, fruits, and vegetables. Prior studies found the revision improved dietary quality, but its impact on downstream health is less understood. We analyzed 2008–2012 national birth certificate data (N = 11,855,417) and employed a quasi-experimental difference-in-differences analysis to examine pre-post trends in outcomes among women predicted to be to be eligible for WIC (treatment group) while “differencing” out pre-post trends among predicted WIC-ineligible women (control group). Outcomes include infant birth weight and size for gestational age, and maternal gestational-diabetes-mellitus (GDM) and gestational-weight gain (GWG). The 2009 WIC revision was associated with small reductions in birth weight (−3.52 g; 95 %CI, −4.75 to −2.30) and small-for-gestational-age (−0.08 % points; 95 %CI, −0.15, −0.01), and GWG (−0.05 pounds; 95 %CI, −0.09, −0.02). While the results were robust to most sensitivity tests, they were not for some and therefore should be interpreted cautiously. Disparities emerged in the impact on GDM and GWG across subgroups. The limited evidence of positive effects on infant and maternal health underscores the need for ongoing research to better understand the impact of the 2019 WIC revision, including implementation factors and program design, on downstream health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 117974"},"PeriodicalIF":4.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143738536","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}
引用次数: 0
“We do not stop being Indigenous when we are in pain”: An integrative review of the lived experiences of chronic pain among Indigenous peoples “当我们痛苦时,我们不会停止作为土著居民”:对土著人民慢性疼痛生活经历的综合回顾
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-20 DOI: 10.1016/j.socscimed.2025.117991
Lívia Gaspar Fernandes , Cheryl Davies , Chrystal Jaye , Jean Hay-Smith , Hemakumar Devan
{"title":"“We do not stop being Indigenous when we are in pain”: An integrative review of the lived experiences of chronic pain among Indigenous peoples","authors":"Lívia Gaspar Fernandes ,&nbsp;Cheryl Davies ,&nbsp;Chrystal Jaye ,&nbsp;Jean Hay-Smith ,&nbsp;Hemakumar Devan","doi":"10.1016/j.socscimed.2025.117991","DOIUrl":"10.1016/j.socscimed.2025.117991","url":null,"abstract":"<div><h3>Background</h3><div>Chronic non-cancer pain is a major burden worldwide. Indigenous communities experience additional inequities in pain care and management influenced by long-standing impacts of colonization, including systemic racism, oppression, and marginalization. Traditional healing knowledges, practices and methods are valued by Indigenous people when managing their pain. However, mainstream health services often disregard this knowledge and fail to provide culturally safe management strategies.</div></div><div><h3>Aim</h3><div>To understand how Indigenous peoples across the globe make sense of pain when experiencing chronic non-cancer pain.</div></div><div><h3>Methodology and methods</h3><div>This integrative literature review is reported according to the PRISMA checklist and CONSIDER statement. We focused on qualitative data reported by Indigenous adults with chronic non-cancer pain in empirical and theoretical studies. Electronic searches were performed in databases from health and humanities scopes, in addition to grey literature, from 1990 to August 2023. We drew from critical theory approaches to thematically analyze data from the included studies, privileging Indigenous perspectives through a Western intellectual framework (Two-Eyed Seeing epistemology). Data extraction and thematic analysis were managed using NVivo. Primary data were mapped according to geography and theoretical framework.</div></div><div><h3>Results</h3><div>After removal of duplicates, 1352 studies were screened using title and abstract, from which 99 full texts were assessed and 29 studies and 3 dissertations/theses were included. Included studies reported lived experiences of chronic pain among Indigenous peoples from Oceania, North America, and South America. Thematic analysis derived four main themes that indicated pain is entwined with nature, Indigenous identity, historical trauma, and the collective. Our findings suggest that pain is interconnected to a broader scenario of feelings, thoughts, peoples and places.</div></div><div><h3>Conclusion</h3><div>Our findings highlight the layered and complex aspects of the lived experiences of chronic pain among Indigenous people. Indigenous-led alternatives focusing on culturally safe care can guide approaches to clinical pain practice and contribute to achieving health equity.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 117991"},"PeriodicalIF":4.9,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735309","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}
引用次数: 0
Structural stigma and mental health among lesbian, gay, and bisexual adults: Policy protection and cultural acceptance 男女同性恋和双性恋成年人的结构性耻辱和心理健康:政策保护和文化接受
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117985
Haoming Song
{"title":"Structural stigma and mental health among lesbian, gay, and bisexual adults: Policy protection and cultural acceptance","authors":"Haoming Song","doi":"10.1016/j.socscimed.2025.117985","DOIUrl":"10.1016/j.socscimed.2025.117985","url":null,"abstract":"<div><div>Emerging studies link the mental health of lesbian, gay, and bisexual (LGB) adults to structural stigma, focusing on state policies. Limited work considered cultural norms and the time changing nature of culture and policy. In this study, we draw from the structural stigma theory and hypothesize that both policy protection and cultural acceptance will independently promote LGB mental health and explore their interactive roles. Composing a novel state-year longitudinal dataset on policy and culture related to sexual minority people, we link it to a sample of cisgender LGB adults from the large-scale, representative Behavioral Risk Factor Surveillance System (2016–2023). Our multilevel regression models predicted depressive diagnosis and frequent mental distress from varied stigma measures, controlling for state-level and individual-level factors. The results revealed that LGB adults especially bisexual women faced elevated mental health challenges. Models generally showed structural stigma measures in the policy and culture domains were not independent, significant predictors of LGB mental health. Moreover, there was generally no significant and sizable interactions between policy and culture. One exception came from lesbian women, where policy protection was negatively associated with worse mental health, reducing frequent mental distress by around 6 percentage points across policy score ranges. We conclude by discussing the varied findings and encouraging future studies to incorporate the time-changing nature of policy and culture when linking structural stigma to LGB mental health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 117985"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725576","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}
引用次数: 0
A syndemic perspective on food insecurity, gestational diabetes, and mental health disorders during pregnancy 对粮食不安全、妊娠期糖尿病和妊娠期精神健康障碍的综合看法
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117994
Sarah Oresnik , Tina Moffat , Luseadra McKerracher , Deborah M. Sloboda
{"title":"A syndemic perspective on food insecurity, gestational diabetes, and mental health disorders during pregnancy","authors":"Sarah Oresnik ,&nbsp;Tina Moffat ,&nbsp;Luseadra McKerracher ,&nbsp;Deborah M. Sloboda","doi":"10.1016/j.socscimed.2025.117994","DOIUrl":"10.1016/j.socscimed.2025.117994","url":null,"abstract":"<div><div>Pregnancy brings numerous physiological and psychosocial changes and conditions that may include gestational diabetes mellitus (GDM) and anxiety and mood disorders. Household food insecurity (HFI)—not having access to food that meets dietary needs and preferences—may put pregnant people at risk for developing pregnancy complications like GDM. This study used qualitative and quantitative methods to understand, from a syndemic perspective, the intersections among these conditions in Canada. Using the Canadian Community Health Survey cycles from 2009 to 2018, we fit multivariable and multivariate logistic regressions to these data to understand interactions among food insecurity, anxiety and mood disorders, and GDM. We also conducted four focus group discussions (FGDs) and six one-on-one interviews with pregnant and postpartum people living in Hamilton, Ontario. Analyses of the survey data show that pregnant individuals who reported an anxiety and/or mood disorder were more likely to experience HFI. Those who experienced HFI were also more likely to be diagnosed with GDM during pregnancy or report an anxiety and/or mood disorder. Major themes identified from interviews and FGDs revealed that structural variables impact access to food, that a GDM diagnosis increased anxiety, and that experiencing HFI exacerbates the management of these conditions during pregnancy. The potential interactions among HFI, GDM, and anxiety and/or mood disorders indicate that addressing rising HFI alongside prevention and treatment of GDM and anxiety and mood disorders are critical to improving the health and well-being of pregnant people in Canada.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 117994"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143725577","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}
引用次数: 0
Corrigendum to “Do high school experiences shape midlife body weight?” [Soc. Sci. Med. Volume 367, February 2025, 117693] “高中经历会影响中年体重吗?”的勘误表(Soc。科学。Med.卷367,二月2025,117693]。
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117961
Michelle L. Frisco , Emily A. Lybbert , Chandra Muller , Eric Grodsky , J. Robert Warren
{"title":"Corrigendum to “Do high school experiences shape midlife body weight?” [Soc. Sci. Med. Volume 367, February 2025, 117693]","authors":"Michelle L. Frisco ,&nbsp;Emily A. Lybbert ,&nbsp;Chandra Muller ,&nbsp;Eric Grodsky ,&nbsp;J. Robert Warren","doi":"10.1016/j.socscimed.2025.117961","DOIUrl":"10.1016/j.socscimed.2025.117961","url":null,"abstract":"","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117961"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671688","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}
引用次数: 0
Tensions of time at the end (of life) (生命结束时)紧张的时间
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117995
Alex Broom , Katherine Kenny , Nadine Ehlers , Henrietta Byrne , Phillip Good
{"title":"Tensions of time at the end (of life)","authors":"Alex Broom ,&nbsp;Katherine Kenny ,&nbsp;Nadine Ehlers ,&nbsp;Henrietta Byrne ,&nbsp;Phillip Good","doi":"10.1016/j.socscimed.2025.117995","DOIUrl":"10.1016/j.socscimed.2025.117995","url":null,"abstract":"<div><div>Perhaps the most valuable asset in our cultural imaginary is time. Yet, this notion of time-as-asset intensifies, is contested, and is often derailed at the end of life. When faced with death, time can become many things, including both personal and interpersonal asset and liability. Bringing the concept of time and dying into focus, this paper draws on qualitative interviews with 15 people nearing death in an Australian specialist palliative care unit. We examine the normative expectations of time and its unravellings in their lived experiences, findings which are critical given time near death has not been extensively studied. We consider five key themes, ‘agency and physical decline across time’, ‘negotiating the time of death’, ‘the relational affordances of waiting’, ‘resisting prognostic time’, and ‘the cost of waiting’, all relations to and in time, that were variously woven through people's accounts of the end of life. These themes highlight connections between time and agency, juxtapositions of swiftness and sometimes interminable slowness, and how busyness and paralysis play crucial roles in the practices of dying. Sitting in stark contrast to the rather typical representation of time as a ‘good’ to be protected or used ‘well’, especially close to death, more nuanced accounts of dying-in-time emerge, highlighting tensions, troubles, and vitalities as we all collectively confront the end (of life/time).</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117995"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143695926","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}
引用次数: 0
Horizontal equity in primary care financing: An assessment of payments to general practices in England, 2014–2022 初级保健融资中的横向公平:2014-2022年英格兰全科医疗支付评估
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117996
Charlene Lo , Laura Anselmi , Matt Sutton
{"title":"Horizontal equity in primary care financing: An assessment of payments to general practices in England, 2014–2022","authors":"Charlene Lo ,&nbsp;Laura Anselmi ,&nbsp;Matt Sutton","doi":"10.1016/j.socscimed.2025.117996","DOIUrl":"10.1016/j.socscimed.2025.117996","url":null,"abstract":"<div><h3>Objectives</h3><div>Previous studies of equity in primary care financing have only considered deprivation as the benchmark for need and focused on specific funding streams. We assessed inequity in payments to primary care providers in England, considering alternative definitions of need and comparing different schemes and changes over time.</div></div><div><h3>Methods</h3><div>We used data on annual payments to 7765 general practices between 2014 and 2022, linked to patient characteristics. We measured need as: (i) demand for care, based on patient appointment attempts; (ii) expected utilisation based on a primary care needs index; (iii) diagnosed morbidity, based on prevalence of 20 chronic conditions; and (iv) expected care burden from diagnosed morbidity, based on a hospital care needs index. We ranked practices by average patient neighbourhood income in 2019, and calculated concentration indices of need and need-standardized payments. We then decomposed the concentration index into need, socioeconomic (income, education, ethnicity, economic activity, rurality), and supply-side factors (practice region, dispensing status, contract type).</div></div><div><h3>Results</h3><div>Need was concentrated among poorer populations for most measures: expected utilisation (concentration index (CI) = −0.0169), demand for care (CI = −0.0102) and expected burden from diagnosed morbidity (CI = −0.0097). The concentration of diagnosed morbidity varied across conditions. Total payments were consistently pro-rich, with the highest inequity when defining need by expected utilisation (horizontal inequity index (HI) = 0.0224), followed by diagnosed morbidity (HI = 0.0039). Inequity varied substantially across payment schemes, from pro-rich (HI = 0.03993) for the Minimum Practice Income Guarantee to pro-poor (HI = −0.0938) for the Personal Medical Services expenditure. Socioeconomic and supply-side factors contributed to pro-rich inequalities in payments in all years.</div></div><div><h3>Discussion</h3><div>Payments to NHS primary care providers do not fully reflect healthcare need. Clear objectives for resource distribution should be defined and harmonized across different schemes to reduce horizontal inequities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"373 ","pages":"Article 117996"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143768943","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}
引用次数: 0
Do type, timing and duration of life course non-employment differentially predict dementia risk? An application of sequence analysis 非就业的类型、时间和持续时间对痴呆风险的预测有差异吗?序列分析的一个应用
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117976
Lucia Pacca , S. Amina Gaye , Willa D. Brenowitz , Kaori Fujishiro , M. Maria Glymour , Amal Harrati , Anusha M. Vable
{"title":"Do type, timing and duration of life course non-employment differentially predict dementia risk? An application of sequence analysis","authors":"Lucia Pacca ,&nbsp;S. Amina Gaye ,&nbsp;Willa D. Brenowitz ,&nbsp;Kaori Fujishiro ,&nbsp;M. Maria Glymour ,&nbsp;Amal Harrati ,&nbsp;Anusha M. Vable","doi":"10.1016/j.socscimed.2025.117976","DOIUrl":"10.1016/j.socscimed.2025.117976","url":null,"abstract":"<div><div>Periods out of employment may influence dementia, but characterizing lifecourse employment is difficult and prior research is sparse. This study used sequence and cluster analysis to characterize type, timing, and duration of lifecourse work gaps and estimate associations with dementia risk.</div><div>Life History Mail Survey supplement to the U.S. Health Retirement Study participants (N = 5,945, 13.6 % of the Health and Retirement Study sample) reported lifecourse employment (full time or part time) and reasons and age of work gaps (unemployment, schooling, caregiving, or disability). Our exposure was gender-stratified employment trajectories from age 18–65, characterized using sequence analysis and cluster analysis. Our outcomes were algorithmically defined dementia probability scores and memory scores. We estimated the association between employment trajectories and dementia risk using generalized estimating equations and memory decline using linear mixed effect models, adjusted for age, gender, birthplace, and childhood socioeconomic status.</div><div>We identified 11 employment trajectories for women (including predominant work, disability, unemployment, caregiving, retirement) and 10 for men (similar, but no caregiving). Compared to “predominant work”, “disability” and “unemployment” trajectories were associated with higher dementia risk for men and women (e.g., disability among women: OR = 3.62; 95 % CI = 2.25, 5.81). Among women who cared for family, those who did not re-enter the labor force full-time had higher dementia risk (e.g. “family gap, go back part time”: OR = 1.79; 95 % CI = 1.15, 2.79) compared to the predominant work cluster. Women who cared for family and returned to full-time work had similar cognitive outcomes to those in the predominant work cluster. Men who had long spells of part-time work also had elevated dementia risk (e.g. part time earlier: OR = 1.64; 95 % CI = 1.16, 2.57). Finally, women and men with long periods of unreported employment status had higher dementia risk than those in the predominant work trajectory.</div><div>Results suggest the type, timing and duration of work gaps are differentially associated with dementia risk. Work gaps due to disability, unemployment or unreported employment status predicted higher dementia risk. Permanently leaving full-time work for caregiving predicted worse cognitive outcomes but temporary caregiving-related work interruptions did not.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117976"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704421","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}
引用次数: 0
Identifying Indigenous strengths for health and wellbeing: Targeting the legacy of colonial masculinities in Peru 确定土著居民促进健康和福祉的力量:针对秘鲁殖民时期男性主义的遗留问题
IF 4.9 2区 医学
Social Science & Medicine Pub Date : 2025-03-19 DOI: 10.1016/j.socscimed.2025.117993
Reshmi Mukerji , Jenevieve Mannell , Hattie Lowe , Maria Calderón , Blenda Milagros Abarca Diaz , Renan Espezua , Laura J. Brown , Jennie Gamlin
{"title":"Identifying Indigenous strengths for health and wellbeing: Targeting the legacy of colonial masculinities in Peru","authors":"Reshmi Mukerji ,&nbsp;Jenevieve Mannell ,&nbsp;Hattie Lowe ,&nbsp;Maria Calderón ,&nbsp;Blenda Milagros Abarca Diaz ,&nbsp;Renan Espezua ,&nbsp;Laura J. Brown ,&nbsp;Jennie Gamlin","doi":"10.1016/j.socscimed.2025.117993","DOIUrl":"10.1016/j.socscimed.2025.117993","url":null,"abstract":"<div><div>Indigenous communities often have poor health outcomes due to a combination of structural factors such as poverty, low education and employment, and gender inequality. For these communities, colonization and racism, have played a role in reinforcing the patriarchal social order. The imposition of patriarchal social norms by colonial powers worsened existing inequalities and brought poorer health outcomes for women, including increased violence from men. In this paper, we explore the interplay between gender, culture, and wellbeing drawing on a framework of Coloniality of Gender to understand how communities can be appropriately supported to improve women's health and wellbeing. This has been done through 18 in-depth interviews with women and men of the Quechua speaking communities of a remote island in the Peruvian Highlands. We use a framework of <em>Buen vivir</em>, a uniquely Andean concept, that refers to living in harmony with nature and others, to identify community strengths that could be used to improve women's health and wellbeing in this setting. Three strengths were identified: (1) challenging racism and discrimination, (2) ensuring livelihoods in the face of crisis, and (3) healing from nature and land. Dismantling colonial masculinities and re-defining how men view themselves within society might be a step to improving women's health and wellbeing. Strengths identified in this study may allow communities to reconnect with their cultural traditions, nature and the land while also allowing men to communicate and construct economic wellbeing together with women. Such strengths disrupt ideas of colonial masculinity and foster a sense of pride in communal living and the Indigenous way of life, which can help improve the health and wellbeing of all people in this setting.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"372 ","pages":"Article 117993"},"PeriodicalIF":4.9,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143704495","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}
引用次数: 0
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