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Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by ' hesitant adopters', defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context. • Understanding hesitant adoption provides insights into increasing vaccine acceptance • In remote Alaska, Elders may influence the decisions community members make • Images and conversations reinforced narratives of safety and efficacy • Agency in information-seeking increased vaccine confidence [ABSTRACT FROM AUTHOR]

High quality primary care is a foundational element of effective health services. Internationally, primary care physicians (general practitioners (GPs), family doctors) are experiencing significant workload pressures. How non-patient-facing work contributes to these pressures and what constitutes this work is poorly understood and often unrecognised and undervalued by patients, policy makers, and even clinicians engaged in it. This paper examines non-patient-facing work ethnographically, informed by practice theory, the Listening Guide, and empirical ethics. Ethnographic observations (104 h), in-depth interviews (n = 16; 8 with GPs and 8 with other primary care staff) and reflexive workshops were conducted in two general practices in England. Our analysis shows that 'hidden work' was integral to direct patient care, involving diverse clinical practices such as: interpreting test results; crafting referrals; and accepting interruptions from clinical colleagues. We suggest the term 'hidden care work' more accurately reflects the care-ful nature of this work, which was laden with ambiguity and clinical uncertainty. Completing hidden care work outside of expected working hours was normalised, creating feelings of inefficiency, and exacerbating workload pressure. Pushing tasks forward into an imagined future (when conditions might allow its completion) commonly led to overspill into GPs' own time. GPs experienced tension between their desire to provide safe, continuous, 'caring' care and the desire to work a manageable day, in a context of increasing demand and burgeoning complexity. • The non-patient-facing work of general practitioners is often invisible or hidden. • Hidden work is associated with complexity and uncertainty. • Behind-the-scenes work is care work, just as direct work with patients is care work. • Doctors face tensions between completing tasks and working a manageable day. • Combining practice theory with the Listening Guide embraces multi-vocality. [ABSTRACT FROM AUTHOR]

This paper examines the experiences of adolescents from mixed migratory status families affected by deportation. We analyze the impacts on their mental and emotional health when they are separated from one parent in the United States, forcibly displaced with another to Oaxaca, and experience the consequences of their deportation in Mexico. We use a qualitative and ethnographic methodology. This paper focuses on data from semi-structured interviews and focus groups with 15 parents who had been deported from the United States and 53 adolescents who moved with them to Mexico. The data was collected between 2018 and 2020. The main findings show the existence of emotions that are sustained in the transnational flow and acquire new nuances upon return. They also show the emergence of new conditions related to family separation, all of which have an impact on the adolescents' well-being and on important areas of their lives, such as education. The research contributes to knowledge in two main ways: 1) it addresses the impacts of parental deportation on the well-being of adolescents in mixed-status families, which have typically focused on children; 2) it studies how parental deportation affects the mental and emotional health of adolescents de facto deported to Mexico, a field still little studied. • De facto deportation has mental health consequences among adolescents. • The forced nature of de facto deportation produces helplessness, aggression and anger. • The code of silence associated with deportation generates fear, stress, anxiety. • Ambiguous loss is accentuated at important moments in academic and developmental life. • Family separation and de facto deportation affect school performance. [ABSTRACT FROM AUTHOR]

Discrete Choice Experiments (DCEs) are widely employed survey-based methods to assess preferences for healthcare services and products. While they offer an experimental way to represent health-related decisions, the stylized representation of scenarios in DCEs may overlook contextual factors that could influence decision-making. The aim of this paper was to evaluate the predictive validity of preferences elicited through a DCE in decisions likely influenced by a hot-cold empathy gap, and compare it to another commonly used method, a direct-elicitation question. We focused on preferences for pain-relief modalities, especially for an epidural during childbirth - a context where direct-elicitation questions have shown a preference for or intention to have a natural birth (representing the "cold" state), yet individuals often opt for an epidural during labor (representing the "hot" state). Leveraging a unique dataset collected from 248 individuals, we incorporated both the stated preferences collected through a survey administered upon hospital admission for childbirth and the actual pain-relief modality usage data documented in medical records. The DCE allowed for the evaluation of scenarios outside of those expected by respondents to simulate decision-making during childbirth. When we compared the predicted epidural use with the actual epidural use during labor, we observed a choice concordance of 71-60%, depending on the model specification. The concordance rate between the predicted and actual choices increased to 77-76% when accounting for the initial use of other ineffective modalities. In contrast, the direct-elicitation choices, relying solely on respondents' baseline expectations, yielded a lower concordance rate of 58% with actual epidural use. These findings highlight the flexibility of the DCE method in simulating complex decision contexts, including those involving hot-cold empathy gaps. The DCE proves valuable in assessing nuanced preferences, providing a more accurate representation of the decision-making processes in healthcare scenarios. • The concordance between the predicted and actual epidural use was 71%-60. • Concordance increased to 77-76% when accounting for prior use of ineffective options. • Direct-elicitation choices resulted in a concordance of 58% with actual epidural use. • DCE proved to be more flexible in predicting decisions with hot-cold empathy gaps. [ABSTRACT FROM AUTHOR]

Many Latinx and Indigenous Mexican populations in the United States Southwest live in unincorporated communities in the US-Mexico borderlands called colonias. These environmental justice communities often lack basic infrastructure, including healthcare services, prompting many to seek services across the border. However, due to geopolitical factors more vulnerable caregivers are limited to utilize healthcare services in the US. This paper reports the experiences and healthcare decision-making of caregivers living in colonias in the US-Mexico border region who care for children with respiratory health conditions. This study was carried out from September to December 2020. Focus groups and interviews were conducted with Latinx and Indigenous Mexican caregivers of children with asthma or respiratory distress. Qualitative interviews elicited caregivers' perspectives on the environmental factors affecting children's chronic health conditions and use of healthcare services. The analysis employed the concept of structure vulnerability to theorize geography as a structural determinant of health for caregivers faced with making healthcare decisions for their suffering from respiratory health conditions. A survey was administered to collect basic sociodemographic information. A total of 36 caregivers participated in the study. Structural factors including unincorporated community status and government inaction intersected with social determinants of health to prompt caregivers to cross the US-Mexico border to access healthcare services in Mexico for their children. Yet, more vulnerable caregivers (i.e., those without documentation status in the US) and their children, accessing healthcare services in the US was not an option limiting caregivers' ability to meet their children's healthcare needs. In such cases, geography acts as a structural determinant of health. This study shows the importance of geography in health. Rural unincorporated colonias located in the borderlands are precariously located and lack basic critical infrastructure including healthcare access. Within such places, historically and socially marginalized populations become invisible, are subject to the health effects of environmental hazards, and are limited depending on their positionality and thus vulnerability to healthcare services. • Municipal unincorporation contributes to health disparities among Latinx families in US-Mexico borderlands. • Latinx children in colonias are disproportionately exposed to environmental toxins. • Geography acts as a structural determinant of health for Latinx families in colonias. • A binational approach to health services should be prioritized for families in the borderlands. [ABSTRACT FROM AUTHOR]

Health insurance is one of the main financing mechanisms currently being used in low and middle-income countries to improve access to quality services. Tanzania has been running its National Health Insurance Fund (NHIF) since 2001 and has recently undergone significant reforms. However, there is limited attention to the causal mechanisms through which NHIF improves service coverage and quality of care. This paper aims to use a system dynamics (qualitative) approach to understand NHIF causal pathways and feedback loops for improving service coverage and quality of care at the primary healthcare level in Tanzania. We used qualitative interviews with 32 stakeholders from national, regional, district, and health facility levels conducted between May to July 2021. Based on the main findings and themes generated from the interviews, causal mechanisms, and feedback loops were created. The majority of feedback loops in the CLDs were reinforcing cycles for improving service coverage among beneficiaries and the quality of care by providers, with different external factors affecting these two actions. Our main feedback loop shows that the NHIF plays a crucial role in providing additional financial resources to facilities to purchase essential medical commodities to deliver care. However, this cycle is often interrupted by reimbursement delays. Additionally, beneficiaries' perception that lower-level facilities have poorer quality of care has reinforced care seeking at higher-levels. This has decreased lower level facilities' ability to benefit from the insurance and improve their capacity to deliver quality care. Another key finding was that the NHIF funding has resulted in better services for insured populations compared to the uninsured. To increase quality of care, the NHIF may benefit from improving its reimbursement administrative processes, increasing the capacity of lower levels of care to benefit from the insurance and appropriately incentivizing providers for continuity of care. • The NHIF influences service coverage and quality in complex ways. • NHIF reimbursement is crucial for facilities and its delay affects inputs for quality. • Lower levels of care benefit less from NHIF. • Need to improve reimbursement process to enhance quality of care. [ABSTRACT FROM AUTHOR]

This paper examines the impact of residence-based ethnic networks on mental health; such networks are defined as the concentration of residents from the same country of origin in a neighborhood. To estimate the effect, we utilize administrative registry data, together with data on quasi-random assignment of apartments to non-Western households with housing needs to various neighborhoods. After controlling for individual characteristics, time-invariant neighborhood characteristics, and general practitioners (GP) fixed effects, we find that a 1–percentage-point increase in the concentration of residence-based co-ethnics (RBCEs) increases the probability of being treated with psychiatric medications by 0.7-percentage point over a 5-year period after the assignment. With 19% of the population being treated with psychiatric medications the year before assignment, the result translates into an effect size of 3.7%. The results indicate that relatively high concentrations of co-ethnics treated with psychiatric medications increase the probability of being treated with psychiatric medications. The positive impact on treatment with psychiatric medication reflects an increase in the demand for these drugs when moving into a neighborhood with neighbors of the same ethnicity. If new residents are in good mental health condition when moving, these results suggest that moving into a neighborhood with a high co-ethic concentration worsens mental health status. However, as the population in this study is a vulnerable group an increase in treatment with psychiatric medications likely reflects that untreated mental health problems are treated, and the mental health status improved. The group of non-Western immigrants in this study differs significantly from the population in general, thus, results may not be generalized to all non-Western immigrants. • We study the impact of residence-based ethnic networks on mental health. • We utilize quasi-random assignment of immigrants in urgent housing needs. • Residence-based ethnic networks increase the use of psychiatric medication. • The characteristics of co-ethnic neighbors impact significantly mental health. [ABSTRACT FROM AUTHOR]

This paper examined the relationship between social identity and health-related behavior, exploring whether social identities are associated with multiple health-related behaviors or only specific ones, and whether this association varies on the type of social identity, the type of social identity measures or the expected relationship between identity and behavior. In a systematic review and meta-analysis we assessed whether the pattern of findings can be explained by the social identity approach. An extensive literature search was conducted in several databases including EBSCO-host and PubMed, using elaborate search terms related to social identity and health-related behavior. This resulted in 10728 potential articles, with 115 articles (with 248 effect sizes from 133 independent samples, N = 112.112) included in the meta-analysis. We found a small but positive overall association between social identification and health-related behavior, which was present for actual behavior, as well as for intention and attitudes. This association was stronger for health-related social identities, positive health-related behaviors, when the expected relationship was positive and when indirect social identity measures were used. However, not all findings could be explained by the social identity approach, indicating a need for further research to better understand the relationship between social identity and health-related behavior, in order to more effectively incorporate social identity into health interventions. • There's a positive association between social identity and health-related behavior. • This effect is present for actual behavior, intention and attitudes. • This effect is stronger for some social identities and health-related behavior. • These results can partly be explained by social identity approach. [ABSTRACT FROM AUTHOR]

A recent national survey of bereaved partners found high levels of complicated grief and psychological distress, with evidence that loneliness and isolation may contribute to these outcomes. However, the mechanisms of action for this have not been explored. To advance grief theory this paper reports analysis of the survey free-text data to examine the relationship between social support and emotional responses to bereavement. Individuals bereaved of a civil partner or spouse 6–10 months previously were identified through death registration data. 569/1945 (29 %) completed surveys were received. Of those, 311 participants (55 %) provided responses to two free-text questions which asked about their 'feelings since the death of their partner or spouse', and 'about the support around' them. Data were analysed using corpus-assisted discourse analysis and the discourse dynamics approach for figurative language. Participants described diverse emotional responses to the bereavement (e.g. sadness, anger, denial, acceptance), and the value of formal and informal bereavement support. Although many of the experiences described are accounted for in existing grief theory, some participants described a liminal experience not recognised within these theories. They felt trapped, unable to engage with loss or restoration, and unable to move forward as their planned future no longer existed. They sought out 'communitas' (solidarity in experiences), but often found support from their social networks had diminished. Metaphors were used to describe this liminality, with partner grief expressed as a dark agentic force, a monster, an abyss, and as water. The findings of this study offer original insights into experiences and trajectories of bereavement, and our understandings of prolonged or complicated grief. A novel model 'Between Loss and Restoration' is presented to include these experiences. Recognition of the place for liminality within the spectrum of grief experiences could enhance grief literacy and improve formal and informal bereavement support provision. • Bereaved partners exhibit a range of intense emotions 6–10 months after the loss. • Some bereaved partners describe feeling trapped between loss and restoration. • This liminal experience is characterised by a feeling of 'not being anywhere'. • Metaphors are used to construct the liminal state as a monster, an abyss and water. • 'Between Loss and Restoration' advances grief theory to include this liminal state. [ABSTRACT FROM AUTHOR]

This paper explores the impact of school food policy from the perspective of school food workers to offer an alternative account of why school food may not be having the desired impact on child health or food choices. Drawing upon the findings from an institutional ethnography carried out in three UK primary schools, we argue that school food is being asked to perform an unrealistic task of luring children and families away from more unhealthy food options, without being given adequate resources or powers to do this job effectively. We theorise that the narrative depicting school food as a hero, combatting the harms of poor dietary choices and poor health outcomes, is inappropriate as a countermeasure to mitigate the effects of wider food industry forces. We revisit the narrative to consider the power imbalances within society that structure dietary choices, presenting our findings and the wider policy review in the form of a story about the evolution of school food set against a shifting food environment. We conclude with recommendations for policy makers who want to see school food have a greater impact in improving child health. • We report on an Institutional Ethnography of 3 UK schools to explore the issue of low meal uptake. • Semi-structured interviews with food workers, observations, and text analysis were used. • A significant barrier to meal uptake was an unfamiliarity with the healthy food offered in schools. • We discuss the evolution of the UK school meal service alongside changes in the wider food system. • We propose policy changes that would strengthen the protected food space offered by schools. [ABSTRACT FROM AUTHOR]

This paper presents a critical analysis of newspaper articles (N = 60) published in a leading vernacular newspaper about violence against doctors in India. Adopting a theoretical perspective that considers 'news as a cultural practice,' a qualitative content analysis was conducted to examine how the phenomenon is framed and presented in the news, i.e., what is problematized, what causal links are drawn or hinted at, what moral stance is taken or alluded to, and what solutions are proffered and why, to arrive at a nuanced understanding of various aspects of this social phenomenon. Three overlapping key themes emerged from the analysis, namely the narrative of victimization, the changing doctor-patient relationship, and the crisis facing the 'noble profession' of medicine. It reveals how the media shapes public opinion and attitudes towards the state of the medical profession while in turn, reflecting existing opinions, attitudes, and cultural values; the analysis also reveals missing perspectives such as the voices of the patients and the public. We highlight how the findings are not merely the dominant ways in which the rise in incidents of violence against doctors is reported and is understood in society, but how media might have shaped the popular discourse around the issue and why. We reflect on what the reportage says about the state of the medical profession and its standing in society in India. • The rise in violence against doctors in India has received much media coverage. • The coverage suggests that the doctor-patient relationship is under stress. • Doctors feel that they are being unfairly targeted and being treated unjustly. • A re-configuration of the social contract between doctors and society is needed. • Such reconfiguration is underway in some form in many countries across the world. [ABSTRACT FROM AUTHOR]

Since the approvals of several vaccines against COVID-19 by the World Health Organization, a large body of research has studied the determinants of individuals' intention to be vaccinated against COVID-19 in a variety of societies. Vaccine intention is a complex construct rooted in the social context that informs the decision-making process. The underlying reasons for older adults' intention to receive the vaccination is even more important to health authorities in societies with large proportions of older adults. In this paper, we interview 27 women over age 55 in Singapore about their COVID-19 vaccine decision-making. Using a social-ecological framework of trust, we identify factors at both individual and institutional levels that build or undermine trust and underlie older women's decisions to receive COVID-19 vaccinations in an authoritarian regime. Findings show that both interpersonal trust and institutional trust contribute to vaccine uptake, however, trust can also contribute to delays in vaccination. Moreover, a sizable minority of respondents report that they were vaccinated not because of institutional trust, but because they felt compelled to do so. The results shed light on directions for future vaccination campaigns. • We focus on older women in an authoritarian state. • We adopt a social-ecological framework of trust. • Both interpersonal trust and institutional trust contribute to vaccine uptake as well as delays in vaccination. • This study provides policy implications for future vaccination campaigns. [ABSTRACT FROM AUTHOR]

In the context of the escalating burden of diabetes in low and middle-income countries (LMICs), there is a pressing concern about the widening disparities in care and outcomes across socioeconomic groups. This paper estimates health poverty measures among individuals with type 2 diabetes mellitus (T2DM) in Malaysia. Using data from the National Diabetes Registry between 2009 and 2018, the study linked 932,855 people with T2DM aged 40–75 to death records. Cox proportional hazards models were used to estimate the 5-year survival probabilities for each patient, stratified by age and sex, while controlling for comorbidities and area-based indicators of socio-economic status (SES), such as district-level asset-based indices and night-time luminosity. Measures of health poverty, based on the Foster-Greer-Thorbecke (FGT) measures, were employed to capture excessive risk of premature mortality. Two poverty line thresholds were used, namely a 5% and 10% reduction in survival probability compared to age and sex-adjusted survival probability of the general population. Counterfactual simulations estimated the extent to which comorbidities contribute to health poverty. 43.5% of the sample experienced health poverty using the 5% threshold, and 8.9% were health poor using the 10% threshold. Comorbidities contribute 2.9% for males and 5.4% for females, at the 5% threshold. At the 10% threshold, they contribute 7.4% for males and 3.4% for females. If all patients lived in areas of highest night-light intensity, poverty would fall by 5.8% for males and 4.6% for females at the 5% threshold, and 4.1% for males and 0.8% for females at the 10% threshold. In Malaysia, there is a high incidence of health poverty among people with diabetes, and it is strongly associated with comorbidities and area-based measures of SES. Expanding the application of health poverty measurement, through a combination of clinical registries and open spatial data, can facilitate simulations for health poverty alleviation. • Novel health poverty measures applied to T2DM in Malaysia using early mortality risk. • Administrative dataset comprising 1M adults combined with death records and SES. • Male gender, older age and area deprivation drive health poverty. • Nighttime luminosity reveals regional patterns in health poverty. • Combining luminosity data and medical datasets enhances risk stratification in LMICs. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45–75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option. • Survey on how provider communication contributes to mt-sDNA screening intention. • "Why" information from providers improves perceived effectiveness of screening. • "How" information from providers improves perceived ease of use of screening. • "Why" information contributes to screening intention via perceived effectiveness. • "How" information contributes to screening intention via perceived ease of use. [ABSTRACT FROM AUTHOR]

Although operating an emergency department (ED) can influence general admission activity of hospitals, most articles that analyze hospital care ignore the potential spillover of emergency activity. In this paper, we examine the consequences of a French reform that encouraged the creation of EDs within private-for-profit (PFP) hospitals in order to decrease congestion in EDs. We use administrative panel data on 365 French PFP hospitals observed between 2002 and 2012. Specifications including hospital fixed-effects are estimated to examine the impact of an ED opening on private hospitals' admission activity, namely inpatient and day-care admissions (ED visits are excluded, but patients admitted following an ED visit are included). We control for shocks that can impact demand for care in hospitals, and we estimate yearly changes before and after the opening. We find that an ED opening is followed by an increase in the number and proportion of inpatient admissions, and by an increase in the length of inpatient stays. A transitory increase in the bed occupancy rate is also observed. In many countries, public and private hospitals compete to some extent. The former provide a public service, while the latter are profit-maximizers that are allowed to specialize in profitable activities. They generally focus on day-care admissions. We provide empirical evidence that private hospitals experience a significant change in the composition of their admissions when they start providing emergency care. Opening an ED creates a new non-selective entryway to private hospitals, resulting in admissions of inpatients with health problems that are more severe. Hence, involving PFP hospitals in the provision of emergency care is likely to make the structure of admissions of private hospitals closer to that of public hospitals. • Financial incentives encouraged the creation of EDs among French private hospitals. • Starting up emergency care spills over to private hospital admissions. • ED opening increases hospital's proportion and length of inpatient admissions. • Results suggest higher severity of patients' conditions after opening. • Structure of stays in private and public hospitals gets more similar after ED opening. [ABSTRACT FROM AUTHOR]

Socioeconomic status (SES) is a robust correlate of mental health, and emerging research indicates that life course trajectories of SES (i.e., social mobility) may be more predictive for health outcomes than point-in-time SES assessments. This paper presents five primary meta-analyses to determine how mental health differs between social mobility groups. We conducted a systematic review of PsycINFO, Web of Science, and PubMed for studies of social mobility and mental health. We used random-effects multilevel meta-analyses to compare mental health problems between individuals who experienced upward mobility, downward mobility, stable high SES, and stable low SES. We included data from 21 studies and 157,763 unique participants yielding 105 effect sizes. Upwardly mobile participants experienced more mental health problems than stable high SES participants (d = 0.11), fewer mental health problems than stable low SES participants (d = −0.24), and fewer mental health problems than downwardly mobile participants (d = −0.17). Downwardly mobile individuals experienced more mental health problems than stable high SES participants (d = 0.26) and fewer mental health problems than stable low SES participants (d = −0.10). Subgroup analyses revealed that the magnitude of effects did not differ by continent of study, type of generational mobility (intergenerational vs. intragenerational), or SES indicator. Meta-regressions with continuous moderators (age, gender, race, study quality) were also non-significant. Taken together, these results indicate that both upwardly and downwardly mobile individuals experience more mental health problems than those who are persistently advantaged, and they both experience fewer mental health problems than those who are persistently disadvantaged. Our findings suggest that while current SES has a stronger association with adult mental health than childhood SES, it is important to also consider the impact of early life and prior generation SES to account for lingering effects of early disadvantage. • Social mobility has small but significant effects on subsequent mental health. • The socially mobile have more mental health problems than the always-advantaged. • The socially mobile have fewer mental health problems than the always-disadvantaged. • Current social class influences mental health more than early life social class. • Early life social class still has some lingering consequences for mental health. [ABSTRACT FROM AUTHOR]

A rising emphasis on patient involvement in clinical research and healthcare improvement has led to the steady incorporation of patients and caregivers into this work. However, interactional factors shaping recruitment processes are not well understood. In this paper, we present a qualitative analysis of interviews with twenty-six patients, family members, engagement staff and healthcare providers who are engaged in healthcare improvement work in the United States. We focus on how stakeholders account for recruitment decisions to participate in healthcare improvement work. We find that expressions of and judgments about patients' and caregivers' cultural health capital shape providers' decisions to extend invitations to participate in healthcare improvement work. These findings extend current conceptualizations of cultural health capital beyond the clinical encounter to reveal factors shaping patient recruitment into healthcare improvement work. In theorizing how cultural health capital shapes action in this new setting, we found that healthcare providers, engagement staff, and patients/caregivers attended to different aspects of cultural health capital when accounting for why they extended or received a recruitment pitch. We further found that participating in healthcare improvement work led to a boost in cultural health capital for patients and caregivers, which they could use to develop transmissible forms of cultural health capital for less centrally involved patients and caregivers. Finally, we describe how participants in healthcare improvement collaboratives account for a lack of diversity among partners. These findings help us hypothesize the consequences of recruitment processes that rely on displays and judgments of cultural health capital and identify possibilities for change. Using the case of healthcare improvement work in Collaborative Learning Health Systems, our findings advance past work on cultural health capital in medical sociology by theorizing the role of cultural health capital in recruitment processes. • Providers recruit patients for healthcare improvement work with subjective criteria. • Providers often recruit high-resourced, privileged patients that they "vibe" with. • Partners build cultural health capital from doing healthcare improvement work. • Recruiting for cultural health capital may exclude patients from diverse backgrounds. • The role of recruitment should be considered to improve partner representation. [ABSTRACT FROM AUTHOR]

The aim of this paper is to track the whereabouts of basic old-age insurance (BOI) contribution subsidies. Little research has paid attention to the misalignment between the implementation objects of subsidy policies and the actual beneficiaries. In recent years, local governments in China have followed a contribution subsidy policy to help persons with disabilities (PWDs) with lower life expectancies. This study applied an actuarial model to calculate the leakage rate of the BOI contribution subsidy. The primary data are from the life tables of the entire population and PWDs in K province in China in 2015. It was found that, under different booking interest rates, 35.27%–61.26% of the contribution subsidy for PWDs in the individual account will be inherited by their heirs, and under different discount rates, 18.21%–68.74% in the pooling account will be enjoyed by non-disabled participants. The policy of BOI contribution subsidy for PWDs failed to account for the shorter average life expectancy and the lower average income of PWDs and would result in a welfare loss for PWDs. Therefore, it was suggested that it should be replaced by a non-contributory pension policy for PWDs. • Track the whereabouts of basic old-age insurance (BOI) contribution subsidies. • Built an actuarial model to calculate the leakage rate of contribution subsidy. • 35%–61% of the contribution subsidy for PWDs will be inherited by their heirs. • 18%–69% in the pooling account will be enjoyed by non-disabled participants. [ABSTRACT FROM AUTHOR]

Drawing on village-based data from Nepal, this paper explores the transferability of the Integrated Behavioural Model for Water, Sanitation and Hygiene (IBM-WASH) to the clean cooking sector and its potential to elucidate how barriers to improved cookstove adoption and sustained use intersect at different scales. The paper also explores the potential of IBM-WASH, behaviour settings theory and domestication analysis to collectively inform effective behaviour change techniques and interventions that promote both adoption and sustained use of health-promoting technologies. Information on cookstove use in the community since 2012 enables valuable insights to be gained on how kitchen settings and associated cooking behaviour were re-configured as homes and stoves were re-built following the April 2015 earthquake. The methodological approach comprised of semi-structured interviews, focus group discussions, direct observation and household surveys. The findings indicated that the IBM-WASH framework translated well to the improved cookstove sector, capturing key influences on clean cooking transitions across the model's three dimensions (context, psychosocial and technology) at all five levels. Understandings gained from utilising IBM-WASH were enhanced – especially at the individual and habitual levels – by domestication analysis and settings theory which elucidated how different cooking technologies were incorporated (or not) within physical structures, everyday lives and routine behaviour. The paper concludes that this combination of approaches has potential applicability for initiatives seeking to promote improved environmental health at community-wide scales. • Transferability of IBM-WASH to the cookstove sector is explored for the first time. • Data from post-earthquake Nepal is used to test this transferability. • We demonstrate that the framework translates well to the cookstove sector. • Findings from IBM-WASH are enhanced by domestication analysis and settings theory. • This combination of approaches has broader applicability for health initiatives. [ABSTRACT FROM AUTHOR]

In an era of considerable uncertainty about future prospects for development assistance to fund major health programmes in Sub-Saharan Africa, social health insurance is increasingly being considered as an alternative mechanism for increasing financing health. However, empirical support for social health insurance in sub-Saharan Africa remains sparse. The main aim of this study was to examine the viability of increasing health financing through social health insurance in Zambia. The paper uses a large nationally representative household survey to estimate the expected mean and total willingness to pay for social health insurance. The revenue potential of social health insurance for health sector funding is assessed. The results show that despite a high level of public support for social health insurance, with 80% willing to join a social insurance scheme, the estimated mean monthly willingness-to-pay is relatively low at Zambian Kwacha 55 (US$8.8 in 2014 dollars) per household. The evidence presented in this paper suggests that the revenue potential of social health insurance would not be sufficient to fund major improvements in quality of care for insured members, let alone cross-subsidize benefits to non-members. • Despite the high level of public support for SHI, the level of WTP is low. • WTP declines steeply with a decrease in income and is lower among informal sector workers. • High coverage of the population would only be feasible if premiums are set very low. • Estimated revenue of SHI is insufficient to finance major improvements in quality. [ABSTRACT FROM AUTHOR]

Universal health coverage (UHC) has become an influential global health policy. This study asked whether and to what extent UHC became a "hegemonic" health policy. The article consists of three parts: a historical timeline of UHC's rise, a bibliometric analysis of UHC in the literature, and a qualitative thematic analysis of how UHC is defined and the thematic content of those definitions. The roots of UHC can be traced to policies enacted by international financial institutions (IFIs) such as the World Bank and International Monetary Fund (IMF) during the latter half of the twentieth century. These policies caused the debt of low- and middle-income countries (LMICs) to rise precipitously and led the same IFIs and other institutions like the World Health Organization to become involved in the development and restructuring of health systems. UHC was presented as the leading method for financing development of health systems. As the bibliometric analysis shows, UHC has come to predominate in the literature around health system reforms. The thematic analysis based on a random selection of papers obtained in the bibliometric component of the study shows that often the term is not defined or only poorly defined. There is wide variation in the definitions, with many papers mentioning concepts such as quality, access, and equity without further clarification. Usually, papers define UHC to include tiering of benefits, with discussions of financing that focus on preventing "catastrophic [individual] expenditures" rather than discussing universal budgeting of a national health care system or national health insurance. We conclude that UHC has become hegemonic within global health policy, to the exclusion of discussions about other approaches to the transformation of health systems that are not predominately based on insurance coverage such as Health Care for All system, a system which provides equal services for the entire population. • Universal health coverage (UHC) has become hegemonic in global health policy. • UHC emerged largely as an initiative of international financial institutions. • UHC predominates in the literature and is often poorly defined or not defined. • Discussions of finances focus on individual spending instead of global budgeting. • UHC's hegemony diverts attention from other policies such as Health Care for All. [ABSTRACT FROM AUTHOR]

Medical students with chronic health conditions are an underrepresented and often overlooked population in medical education. Previous research describes the dual roles they hold as both healthcare recipients and providers and details challenges they face related to accommodations and accessibility. However, less is known about how having a chronic health condition shapes the day-to-day aspects of medical education. To address this gap in knowledge, I conducted semi-structured interviews with eighteen medical students with chronic conditions and examined data using reflexive thematic analysis. Findings revealed the competing demands students face between medical school expectations and the need to manage their health. They work to reconcile these demands using tools like accommodations and strategic communication and by reconstructing narratives to re-assess self-imposed expectations. These participants understand having a chronic health condition as just one piece of their larger sense of self. Participants approach this understanding in individualized and nuanced ways, yet all share a cohesive view that their experiences having chronic health conditions inform their medical practice for the better through the development of genuine empathy for patients. This paper concludes with recommendations drawn from participant interviews of how medical schools can better support students with chronic health conditions. • Chronic condition management and medical training compete for time and energy. • Demands are reconciled at structural, interpersonal, and intrapersonal levels. • Having a chronic condition influences but does not define medical training. • First-hand healthcare experiences build genuine empathy and improve patient care. [ABSTRACT FROM AUTHOR]

Obesity remains a significant public health concern globally with over one billion adults projected to be obese by 2025. To better understand the drivers of obesity and to inform policy, it is important to explore the factors that influence obesity. The objective of this paper to examine if the crime rates in the neighbourhood or local area in which a person lives influences their likelihood of being obese. Thus, we seek to contribute to the literature on the determinants of obesity by asking the question: what is the effect of neighbourhood (i.e., postcode) crime on obesity? We also examine the pathways through which neighbourhood crime influences obesity with a focus on the role of social capital, physical activity and sleep quality. Using 14 waves of longitudinal data from the Household, Income and Labour Dynamics in Australia (HILDA) survey merged with official police statistics on crime rates at the postcode level, we apply identification strategies that address endogeneity arising from endogenous sorting and omitted variable bias. We find that an increase in neighbourhood crime rates is associated with an increase in body mass index (BMI) and the likelihood of being obese. Exploring the pathways through which neighbourhood crime influences obesity, we find that social capital and physical activity are important channels, while sleep quality is not. The evidence also suggests that the effects of violent crime are more pronounced compared to property crime. Our findings suggest that targeting crime, and in particular violent crime, which seems to be driving the findings, is a core mechanism for reducing BMI and maintaining healthy body weight. The mediating role of physical activity and social capital also suggest that public policy can specifically target these areas by providing interventions that promote social capital and physical activity even amidst high crime rates. • We examine the impact of neighbourhood crime on obesity. • We use 14 waves of longitudinal data from Australia. • Neighbourhood crime increases obesity. • Social capital and physical activity are important channels. • Effects are stronger for females than males. [ABSTRACT FROM AUTHOR]

Gun sales spike after mass shooting incidents. As firearm presence is associated with numerous health and safety risks, it is imperative to understand what catalyzes gun ownership. Despite evidence that Americans' fear of mass shootings is increasing at a pace that exceeds their likelihood of victimization, the relationship between fear of mass shootings and gun ownership has received minimal attention. The current study examines group differences in fear of mass shootings and openness to gun ownership. Specifically, it is hypothesized that (1) fear of mass shootings will increase openness to future firearm ownership among non-owners, (2) gun owners will be more afraid of mass shootings than non-owners, and (3) protective owners will be more afraid than non-protective owners. This paper uses Wave 26 of Pew Research Center's nationally representative American Trends Panel (n = 1968). Binary logistic regression analyses indicate that among non-gun-owners, fear of mass shootings decreases openness to ownership. Ordinal logistic regression analyses indicate that while fear of mass shootings does not differ between gun owners and non-owners, protective gun owners are more afraid than non-protective owners. Combined with prior research, these findings suggest that protective gun owners, non-protective gun owners, and non-owners have distinct views of the relationship between guns and mass shootings and are motivated to acquire firearms by different processes. Additional longitudinal work is needed to confirm these findings and clarify the role of causal attributions. • Americans' fear of mass shootings outweighs their risk of mass shooting victimization. • Gun sales increase after mass shooting incidents. • Gun owners and non-gun owners diverge in the ways that firearms impact their fear of mass shootings. • Non-gun owners with high fear of mass shootings are less open to future gun ownership. • Protective gun owners are more afraid of mass shootings than non-protective owners. [ABSTRACT FROM AUTHOR]

Advance care planning is premised on concepts of individual autonomy and self-determination. The standardisation of this individualist approach to decision-making erases the diverse cultural sensibilities and vocabularies that shape trajectories of care. In attempting to redress this exclusion, this paper foregrounds previously overlooked vernaculars and practices for understanding how care for the aged and those approaching the end of life is understood and enacted in Australia's culturally diverse society. Drawing on ethnographic interviews and participant-observation with ageing Chinese migrants and their families in Adelaide, South Australia, it examines the multiple enactments of 'face' in end-of-life care. In so doing, the paper extends Goffman's theorisation of 'face', opening up the 'front' of the bounded individual to reveal how persons are mutually implicated in relational contexts. Attending to cultural contours of face and their intersections with filial piety, this paper unsettles the imperative of self-determination in advance care planning and reveals how intergenerational shifts from older to younger generations can reorient care at the end of life. • Face provides a critical context for understanding aged and end-of-life care in Chinese families. • Face and filial piety are enacted differently in different contexts. • Diverse cultural vocabularies and practices are needed in care settings. • Care at the end-of-life is always relational and nuanced. [ABSTRACT FROM AUTHOR]

The low rate of help-seeking and high rate of suicide completion among men has prompted public health officials to create suicide prevention campaigns that specifically target men. Drawing from data collected as part of a larger study of fire recovery in a rural county in Northern California, this paper utilizes 68 interviews with fire survivors (24 men and 44 women) and 40 interviews with mental health service providers to examine how rural residents interpret this type of campaign. To track patterns of help-seeking over time, I also draw upon 26 follow-up interviews – 20 with fire survivors (7 men and 13 women) and 6 with service providers – conducted one year after the first wave of interviews. In total, 134 in-depth interviews were conducted. This paper also draws on a secondary data source; I conducted content analysis of an internal Health and Human Services Agency focus group report used in the development of a local male-targeted suicide prevention campaign, Captain Awesome. As I show, male-targeted suicide prevention efforts have little salience in rural communities in which treatment resources are limited and stigma abounds. Perceptions about material conditions – i.e., treatment resources being few and far between – contribute to residents establishing a norm of not seeking help. Rural culture which emphasizes self-sufficiency and independence contributes to a pattern of both men and women repeating a narrative that frames men who seek help as weak. While research has identified women as key drivers for men's physical health maintenance, my research suggests that the same pattern might not hold around mental health maintenance in rural settings. In sum, I argue that male-targeted campaigns have limited resonance and efficacy in rural communities where material conditions and cultural narratives create physical and psychological barriers to accessing to treatment. • Male-targeted suicide prevention campaigns have little salience in rural areas. • Perceptions of limited treatment resources contribute to low rates of help-seeking in rural places. • A rural ethos emphasizing self-sufficiency contributes to low help-seeking. • Both men and women residents of rural places reinforce stigma against help-seeking. • Suicide prevention campaigns need to be developed with regional specificity. [ABSTRACT FROM AUTHOR]

Community-based care for people with dementia is mainly provided by family carers, many of whom experience decreased mental, physical and financial well-being due to their caring role. Many countries are now implementing ageing-in-place policies that have increased pressure on family carers as care-work is redistributed from residential to community-based settings. Family caring responsibilities for people with dementia are made even more complicated by the economic, social and cultural expectations that underpin existing provision. Support for family carers is, therefore, an important policy topic across many countries. The focus of this paper is on the propensity of citizens to support enhanced care for family carers in Ireland, as demonstrated by their willingness-to-pay additional taxation to fund different combinations of carer support measures, developed through careful and sustained dialogue with multiple stakeholders, especially family carers themselves. We carried out a discrete choice experiment (DCE) with 509 members of the general public in Ireland between January and February 2021. Using mixed logit models, our findings show that citizens value four key attributes: regular caring breaks for family carers (day-care and long-break respite); financial compensation (carer's allowance); and emotional support (carer peer support groups). We also estimated the welfare impact of moving from current provision to enhanced support packages for family carers of people with dementia. The welfare gains accumulate to €1035.80 for the most complete levels of provision across the four support attributes. Overall, respondents in this paper showed empathy and understanding towards family carers of people with dementia through their willingness to contribute to funding additional services and supports. • We present findings of a DCE with 509 members of the general public in Ireland. • We estimate public preferences for supporting family carers of people with dementia. • Citizens are willing-to-pay increased taxation to support family carers. • These findings suggest strong public support for increased provision of services. [ABSTRACT FROM AUTHOR]

This paper examines the role of perceived disease risk in vaccination behavior. Using health insurance claims data, I estimate the effect of local measles outbreaks in Germany on first- and second-dose measles vaccinations in children as well as catch-up vaccinations in adults. In my analytic strategy, I exploit the variation in timing and location of regional disease outbreaks and estimate a two-way fixed effects model with birth cohort and region fixed effects. The basic underlying assumption is that measles outbreaks alter perceptions regarding the disease risk. The robustness of this approach concerning possible bias due to heterogeneous treatment effects under differential treatment timing is assessed through the use of alternative estimators. Measles outbreaks within a region increase the share of children who receive their vaccination on time by 0.8 percentage points for both the first and second vaccination. This corresponds to a reduction in the share of not timely vaccinated children of about 1.0% and 1.6% for the first and second doses, respectively. Results further show an increase in the rate of monthly catch-up vaccinations in adults by about 10% for the age group 20–30 to up to 46% for those at ages 40–50 in the first six months after an outbreak. One important finding is that regional outbreaks do not lead to increases in vaccinations in other regions even if public attention extends beyond the affected region. These results suggest that behavioral responses are driven by affective rather than deliberative risk perception. Also, vaccination effects can be observed only in the few months following the outbreak, which indicates that changes in the perceived disease risk due to a local measles outbreak are short-lived and fade away quickly once the disease outbreak is over. • Measles outbreaks increase the share of children with on-time measles vaccination. • Outbreaks affect the timing, though not the overall long-term vaccination coverage. • Measles outbreaks also increase the rate of monthly catch-up vaccinations in adults. • Vaccination effects are observed only in the few months following an outbreak. [ABSTRACT FROM AUTHOR]

Scholars have suggested that direct-to-consumer advertising (DTCA) of prescription drugs may discourage or encourage changes in lifestyle to improve health. The current paper informs this debate by examining associations between estimated exposure to DTCA for drugs focused on heart disease/cholesterol and diabetes and self-reported exercise and consumption of a variety of unhealthy foods (candy, sugary drinks, alcohol, and fast food). We estimated exposure to DTCA by combining data from Kantar Media Intelligence (Kantar) on televised pharmaceutical DTCA airings in the U.S. from January 2003 to August 2016 (n = 7,696,851 airings) with thirteen years of data from the Simmons National Consumer Survey (Simmons), a mailed survey on television viewing patterns. We estimated associations between exposure to advertising (both overall and for advertisements with specific content) and self-reported physical activity and dietary behavior using Simmons data from January 2004 to December 2016 (n = 288,483 respondents from n = 157,621 unique households in the U.S.). Our analysis controls for many potential confounders including respondent demographics, temporal trends, and program placement to account for purposeful ad targeting to higher-risk adults. Higher estimated exposure to DTCA for heart disease and diabetes drugs were not consistently associated with meaningful differences in the frequency of engaging in regular physical activity. Greater estimated exposure to DTCA for both diseases were, linked to small but consistently higher volume of consumption of candy, sugar-sweetened beverages, alcohol, and fast food. Specific DTCA message content about diet and exercise explained very little of the observed association between overall DTCA exposure volume and study outcomes. Many Americans were regularly exposed to pharmaceutical DTCA for heart disease and diabetes from 2003 to 2016. Widespread exposure to such DTCA is associated with higher levels (though small in magnitude) of consuming alcohol, fast food, candy, and sugar-sweetened beverages. • Exposure to DTCA was not consistently associated with levels of physical activity. • Exposure to DTCA was associated with higher consumption of unhealthy foods. • Specific DTCA message content explained very little of the observed associations. [ABSTRACT FROM AUTHOR]

Marked ethnic inequalities in COVID-19 infection and its consequences have been documented. The aim of this paper is to identify the range and nature of evidence on potential pathways which lead to ethnic inequalities in COVID-19 related health outcomes in the United Kingdom (UK). We searched six bibliographic and five grey literature databases from 1st December 2019 to 23rd February 2022 for research on pathways to ethnic inequalities in COVID-19 health outcomes in the UK. Meta-data were extracted and coded, using a framework informed by a logic model. Open Science Framework Registration: DOI 10.17605/OSF.IO/HZRB7. The search returned 10,728 records after excluding duplicates, with 123 included (83% peer-reviewed). Mortality was the most common outcome investigated (N = 79), followed by infection (N = 52). The majority of studies were quantitative (N = 93, 75%), with four qualitative studies (3%), seven academic narrative reviews (6%), nine third sector reports (7%) and five government reports (4%), and four systematic reviews or meta-analyses (3%). There were 78 studies which examined comorbidities as a pathway to mortality, infection, and severe disease. Socioeconomic inequalities (N = 67) were also commonly investigated, with considerable research into neighbourhood infrastructure (N = 38) and occupational risk (N = 28). Few studies examined barriers to healthcare (N = 6) and consequences of infection control measures (N = 10). Only 11% of eligible studies theorised racism to be a driver of inequalities and 10% (typically government/third sector reports and qualitative studies) explored this as a pathway. This systematic map identified knowledge clusters that may be amenable to subsequent systematic reviews, and critical gaps in the evidence-base requiring additional primary research. Most studies do not incorporate or conceptualise racism as the fundamental cause of ethnic inequalities and therefore the contribution to literature and policy is limited. • 123 UK studies examined pathways to ethnic inequalities in COVID-19 outcomes. • Socioeconomic inequalities and comorbidities were commonly explored as pathways. • 30% of studies aggregated ethnic groups into one broad category (e.g., non-White). • Only 11% studies considered racism as a driver of ethnic inequalities. • We provide recommendations for future research into ethnic inequalities in health. [ABSTRACT FROM AUTHOR]

Following the successful development of vaccines for COVID-19, attention turned to the problem of vaccine access. However, in contexts where vaccines are available, hesitancy remains a major problem. Informed theoretically by the scholarship on vaccine anxiety, this paper uses a qualitative research approach that included 144 semi-structured interviews to investigate how social and political dynamics shaped people's perspectives in particular environments in Ghana, Cameroon, and Malawi about COVID-19's viral spread and COVID-19 vaccines. Vaccines and the viral spread of COVID-19 are related to political tensions and class-related fractures in particular contexts, and how the public interprets COVID-19's viral spread and engages with vaccination is based on people's social and political environment and their experience. Subjectivities are also rooted in coloniality. Vaccine confidence goes beyond clinical and regulatory authority approvals, and encompasses forces that are economic, social, and political in nature. Thus, an exclusive focus on technical prescriptions for enhancing vaccine uptake will not achieve significant positive results. • Vaccines are related to political tensions and class-related fractures in particular settings. • Political context shapes how people view mandatory vaccination. • The body is a mirror of socio-political context. • Worries about getting COVID-19 vaccines cut across professional and income-related categories. • Distrust in vaccines has national and international dimensions. [ABSTRACT FROM AUTHOR]

Social relationships are important in bolstering health and well-being for everyone in the general population. For transgender people, strong supportive social relationships may be paramount to their overall health and well-being due to their marginalised status in society. This review aimed to investigate what is currently known about the social relationship experiences of transgender people and their relational partners (e.g., family members, romantic partners). Thirty-nine qualitative papers were extracted from Web of Science, Scopus, Cochrane, and PubMed that related to social relationships of transgender people. These papers were analysed via a qualitative meta-synthesis. Forty-nine second-order themes were identified, initially organised into relational partner clusters (e.g., family, friends, work colleagues) for specific phenomena, then these were synthesized into five overarching conceptual themes: (1) Development of relationships through transition and beyond , (2) Coping strategies of transgender people and their relational partners , (3) Reciprocal support in social relationships , (4) Stigma enacted and ameliorated interpersonally , and (5) Influence of stigma on social health and well-being. These overarching themes show the potential characteristics that assist in the health-buffering role of social relationships for transgender people and their relational partners. Of particular note, stigma was reported as a common negative experience by transgender people and their relational partners, and open communicative social relationships had positive effects on self-conceptualisations of identity, which were inferred to protect against the damaging effects of stigma. We discuss the various implications and applications of this meta-synthesis to future research and clinical settings as well as how it can inform healthcare policy to support transgender people. • Synthesizes literature related to transgender people and their relational partners. • Five overarching conceptual themes emerged concerning these relationships. • The themes had an overarching focus on identity, support, and stigma. • Overall, building stable relationships improves health and well-being for all. • Themes have several implications for relationships as well as policy and practice. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has introduced dramatic adversities for public health around the world, especially in low and middle-income countries. While research has shown the pandemic to have direct effects on a variety of major economic and health crises, its impact on health-related behaviors is not clear. In this paper, I examine how exposure to the pandemic affects alcohol use and smoking in Peru, which experienced one of the highest COVID-related death rates albeit implementing one of the strictest lockdown policies in the world. I find that post pandemic consumption of alcohol and smoking in the last 30 days decreases by 41.3% and 44.1% respectively when compared to pre-pandemic rates. I also conclude that the intensity of engaging in these behaviors change such that the frequency of consuming alcohol in the last 30 days, binge drinking and the probability of smoking daily falls. While drinking behavior returns to pre-pandemic levels, the negative effect on smoking weakens but remains for almost two years preceding the pandemic. • Estimates changes in alcohol consumption and smoking due to the pandemic in Peru. • Alcohol use and smoking decreases at both the extensive and intensive margins. • The largest fall in drinking and smoking was immediately after the lockdown. • Alcohol consumption returns to the pre-pandemic level by the end of 2021. • The reduction in smoking weakens but perdures by the end of 2021. [ABSTRACT FROM AUTHOR]

Ex post moral hazard, the additional healthcare utilization induced by health insurance, can be decomposed into an efficient portion generated by the income effect and an inefficient portion caused by the substitution effect, which has been discussed theoretically, but few studies have provided evidence of the efficient moral hazard. In 2016, the Chinese government launched the consolidation of urban and rural resident health insurance at the national level. After the consolidation, insurance benefits for nearly 800 million rural residents got improved. This paper uses a nationally-representative sample of 30,972 individuals from the China Health and Retirement Longitudinal Study (2011–2018) and adopts a 2-step empirical approach with the difference-in-differences method and the fuzzy regression discontinuity design to estimate the efficient moral hazard in the consolidation among rural residents. We find that the price shock contained in the consolidation increases inpatient care utilization, and the corresponding price elasticity is between −0.68 and −0.62. Further analysis shows that the efficient moral hazard resulting in welfare gains accounts for 43.33%–66.36% of the additional healthcare utilization. These findings highlight the necessity of evaluating the efficient moral hazard when analyzing the cost-benefit of health insurance reform. • We provide rare evidence of the efficient moral hazard effect in health insurance. • We focus on low-income groups from developing countries. • We use a 2-step empirical approach to estimate the efficient moral hazard effect. • The efficient moral hazard generated by income effect accounts for 43.33%–66.36%. [ABSTRACT FROM AUTHOR]

While the overall impact of the COVID-19 pandemic on U.S. population health has been devastating, it has not affected everyone equally. The risks of hospitalization and death from the disease are relatively low for the population as a whole, but much higher for specific subpopulations defined by age, health status, and race or ethnicity. The extent to which Americans perceive these disparities is an open question, with potentially important political implications. Recognition of unequal impacts may prime concerns about justice and fairness, making Americans more concerned and willing to support government intervention. On the other hand, belief that the pandemic primarily threatens "other people" or out-groups may reduce, rather than increase, a person's concern. Partisanship and media consumption habits are also likely to play a role in these perceptions, as they do in most issues related to COVID-19. In this paper, we use original survey data from the Cooperative Election Study (N = 1000) to explore Americans' perceptions of which groups are most harmed by the pandemic, the demographic and political determinants of these perceptions, and the relationship of these perceptions with their opinions about COVID-related mitigation policy. We find that, on average, people perceived accurately that certain groups (e.g., Black Americans, older people) were more affected, but these group perceptions varied by demographic and political characteristics of respondents. We find, in contrast with recent experimental evidence, that the perception that populations of color were harmed was associated with more support for pandemic mitigation strategies. More research should investigate the relationships among pandemic politics and the racial dynamics of the target populations most affected. • In fall 2020, survey participants recognized groups harmed by COVID based on age. • They had lower recognition of racial groups harmed, lowest for Native Americans. • Perceptions of groups harmed varies by information exposure and politics. • Perceiving group disparities was associated with more support for pandemic policy. • The racial dynamics surrounding the politics of COVID-19 requires more attention. [ABSTRACT FROM AUTHOR]

Since 2016, around seven in 10 adults in the United States (U.S.) actively use Facebook. While much Facebook data is publicly available for research, many users may not understand how their data are being used. We sought to examine to what extent research ethical practices were employed and the research methods being used with Facebook data in public health research. We conducted a systematic review (PROSPERO registration CRD42020148170) of social media-based public health research focused on Facebook published in peer-reviewed journals in English between January 1, 2006 and October 31, 2019. We extracted data on ethical practices, methodology, and data analytic approaches. For studies that included verbatim user content, we attempted to locate users/posts within a timed 10-min period. Sixty-one studies met eligibility criteria. Just under half (48%, n = 29) sought IRB approval and six (10%) sought and obtained informed consent from Facebook users. Users' written content appeared in 39 (64%) papers, of which 36 presented verbatim quotes. We were able to locate users/posts within 10 min for half (50%, n = 18) of the 36 studies containing verbatim content. Identifiable posts included content about sensitive health topics. We identified six categories of analytic approaches to using these data: network analysis, utility (i.e., usefulness of Facebook as a tool for surveillance, public health dissemination, or attitudes), associational studies of users' behavior and health outcomes, predictive model development, and two types of content analysis (thematic analysis and sentiment analysis). Associational studies were the most likely to seek IRB review (5/6, 83%), while those of utility (0/4, 0%) and prediction (1/4, 25%) were the least likely to do so. Stronger guidance on research ethics for using Facebook data, especially the use of personal identifiers, is needed. • We present a systematic review of studies using Facebook data in health research. • We found variability in IRB review, consent, and use of identifying information. • We could identify individual users in half of the studies with verbatim quotes. • Greater ethical guidance is needed for research involving social media data. • Considerations around sampling and analytic approaches are also discussed. [ABSTRACT FROM AUTHOR]

Socioeconomic inequalities in childhood Body Mass Index (BMI) are becoming increasingly more pronounced across the world. Although countries differ in the direction and strength of these inequalities, cross-national comparative research on this topic is rare. This paper draws on harmonized longitudinal cohort data from four wealthy countries—Germany, the Netherlands, the United Kingdom (UK), and the United States (US)—to 1) map cross-country differences in the magnitude of socioeconomic inequalities in childhood BMI, and 2) to examine cross-country differences in the role of three energy-balance-related behaviors—physical activity, screen time, and breakfast consumption—in explaining these inequalities. Children were aged 5–7 at our first timepoint and were followed up at age 8–11. We used data from the German National Educational Panel Study, the Dutch Generation R study, the UK Millennium Cohort Study and the US Early Childhood Longitudinal-Kindergarten Study. All countries revealed significant inequalities in childhood BMI. The US stood out in having the largest inequalities. Overall, inequalities between children with low versus medium educated parents were smaller than those between children with high versus medium educated parents. The role of energy-balance-related behaviors in explaining inequalities in BMI was surprisingly consistent. Across countries, physical activity did not, while screen time and breakfast consumption did play a role. The only exception was that breakfast consumption did not play a role in the US. Cross-country differences emerged in the relative contribution of each behavior in explaining inequalities in BMI: Breakfast consumption was most important in the UK, screen time explained most in Germany and the US, and breakfast consumption and screen time were equally important in the Netherlands. Our findings suggest that what constitutes the most effective policy intervention differs across countries and that these should target both children from medium as well as low educated families. • All countries showed substantial socioeconomic inequalities in childhood BMI. • In all countries, inequalities in BMI steepen over course of primary school. • Protective factors among the most advantaged seem to mainly drive inequalities. • Across most countries, underlying mechanisms for inequalities in BMI are similar. • The relative contribution of each mechanism to BMI inequalities differs per country. [ABSTRACT FROM AUTHOR]

Maternal height is associated with mortality and anthropometry in low-and-middle-income countries. This paper explored residual associations and potential underlying mechanisms linking maternal height to several child outcomes using regression models with neighborhood and half-sibling fixed effects and Gelbach decomposition on 108 Demographic and Health Surveys from 37 sub-Saharan African countries. When adjusting for time of birth, twinning, sex, and survey, a single z-score (6.5 cm) increase in mother's height was associated with a 22% reduction in the average deficit in height-for-age among children under five (according to the WHO 2006 growth standard), 16% lower neonatal mortality (age <1 month) , 10% lower postneonatal mortality (age 1–11 months), 11% lower child mortality (age 12–59 months) , and 2% increase in school attendance among 7–16-year-olds. Adjusting further for maternal education, household living standards, maternal fertility and birth related factors, and neighborhood reduced the coefficients for maternal height by 22% for child height-for-age, 26% for neonatal mortality, 46% for postneonatal mortality, 56% for child mortality, and 90% for school attendance. The decomposition showed that adjusting for neighborhood had a substantial impact on the association of maternal height with all outcomes, especially child mortality. Adjusting for unobserved father and household factors also had a particularly large impact on the association with child mortality. The robustness of the relationship with neonatal mortality suggests that pregnancy and perinatal factors are an important link between maternal height and child outcomes. Adult living standards and socioeconomic and related behavioral factors likely play a small role. Genetics may also play a large role in linking maternal height and child height-for-age, especially for educated mothers, whose height was presumably impacted less by early life adversity. • Neonatal deaths and height-for-age had a strong and direct link to mother's height. • Links with postneonatal and child mortality and school attendance were weaker. • Pregnancy and perinatal factors appeared to link mother's height and child outcomes. • Genetics were likely to mostly link mother's and child's height. [ABSTRACT FROM AUTHOR]

Poverty is known to be associated with poorer child mental wellbeing. Relatedly, the security and quality of employment are reported to affect adult wellbeing. Less is known about how both poverty and parental employment affect children's mental wellbeing. This paper uses nine waves (2005/06–2017/18) of the Growing Up in Scotland (GUS) study to examine how the longitudinal trajectories of poverty and work intensity are associated with the longitudinal trajectories of mental wellbeing in a nationally representative sample of 3994 children (ages 0 to 12). This analysis was conducted via a bivariate multilevel non-linear growth curve model for the widely used Strengths and Difficulties Questionnaire (SDQ) subscales of conduct problems and emotional symptoms. Results show that unstable work intensity and poverty trajectories arising from the 2008 financial crisis are associated with substantial changes in the trajectories of conduct and emotional problems, but with key differences between the individual outcomes: increasing work intensity is associated with around a fifth of a standard deviation increase in conduct problems; decreasing work intensity over time is associated with around a fifth of a standard deviation increase in emotional problems; material deprivation is associated with an increase in both conduct and emotional problems, at around a tenth of a standard deviation; and longitudinal income poverty trajectories are associated with up to around a fifth of a standard deviation increase in conduct problems, but not emotional symptoms. These findings are discussed with the purpose of informing policies to tackle the effects of unstable and/or changing socioeconomic circumstances on children's mental health wellbeing in the context of an economic crisis, as well as its implications for the contemporary socioeconomic landscape and the devastating effects expected of the COVID-19 crisis. • Children's conduct problems naturally attenuate over time as they grow older. • Children's emotional problems intensify and swing towards the extremes over time. • Unstable parental work is linked to raised children's conduct and emotional problems. • Poverty trajectories are associated with conduct but not emotional problems. • Children continue to be affected by the 2008 economic crisis many years later. [ABSTRACT FROM AUTHOR]

Peer relations inform consumption practices that shape both alcohol use and prescription drug misuse. Integrating studies on pharmaceutical cognitive enhancement with research on consumptive based edgework, this paper examines the role of psychostimulant medications in resolving contradictory aspects of contemporary peer building processes. Drawing on qualitative interviews (n = 162) from a U.S. based study on the context of young adult prescription drug misuse, we demonstrate how medical resources are incorporated into peer bonding rituals in order to enhance consumptive capacity, reduce social risks, and facilitate the accumulation of relational capital. These findings highlight the paradoxical and problematic health ramifications of consumptive based peer bonding practices as well as how psycho-stimulant medications may compound those issues in unintended ways. • Explores how peer bonding and accumulation of relational capital shape substance use. • Examines medicines role in resolving paradoxical aspects of over-consumption. • Expands contextual understandings of pharmaceutical based cognitive enhancement. • Offers insight into unintended consequences of psychostimulant prescribing practices. [ABSTRACT FROM AUTHOR]

Medicalization is a central topic of concern in the sociology of disability and of health and illness. In this paper, I examine how medicalization is inequitably applied and circulates in the context of schools, specifically in serving students with educational disabilities. My aim is to advance understandings of medicalization through this case. Using a mixed-methods design, I first show, descriptively, how race and gender intersectionally predict educational disability status in a dataset of all Wisconsin public school students. Next, I examine how racial and gender disparities in disability status are produced at the micro level, using interviews with 27 Wisconsin teachers, including in-depth discussions of 73 individual students that were struggling academically or behaviorally. My quantitative findings show variation by race, gender, and disability category: White children have higher probability of special education receipt than comparable children of color for academic difficulties, but lower probability for behavioral difficulties, and girls have lower probability than comparable boys overall. My interview data suggest that these disparate outcomes reflect stratified medicalization processes, in which institutional constraints, status beliefs, and cultural discourses of race and gender shape both stratified noticing of schooling difficulties and stratified interpretation of those difficulties as medicalized conditions. • White children and boys are more likely than comparable peers to receive special education for higher-status disabilities. • Children of color and boys are more likely than comparable peers to receive special education for lower-status disabilities. • These inequalities are explained by stratified definitional processes of medicalization by teachers. • Institutional constraints and cultural discourses of race and gender shape stratified medicalization processes. • These processes include stratified noticing and stratified interpretation of students' difficulties. [ABSTRACT FROM AUTHOR]

This study analyzed the relationship between parents' son preference in a person's childhood and their health when they become older, and tested whether childhood educational opportunities, health level, and care resources play mediating roles in this relationship. China has entered a stage of aging population. The health of the elderly determines whether the government can successfully cope with the challenges brought about by the aging of the population. Chinese people are deeply influenced by Confucianism. The concept of "son preference" is related to residents' parenting strategies. Then, if one's parents exhibit a son preference in their childhood, will it affect one's health in old age? Based on the data of China Health and Retirement Longitudinal Study collected in 2014, this paper uses the least square method to analyze the impact of parents' preference in childhood for boys on the health of the elderly, and uses Karlson-Holm-Breen (KHB) to analyze the mediating effects of childhood educational opportunities, health level and care resources. This study found that parents' preference for boys had a positive impact on the health of male children when they became elderly but had a negative impact on the health of female children when they became elderly. Childhood educational opportunities, health level, and care resources mediated this relationship. It is necessary to analyze the impact of parents' preference for sons in one's childhood on the health of elderly, and intervene the adverse factors affecting the health, to improve the health level and quality of life of the elderly. • Parents' preference for boys had a significant impact on older people's health. • The effect relies on the mediating role of childhood education, health, and care resources. • The idea of prioritizing boys over girls be changed, to improve the health level of the elderly. [ABSTRACT FROM AUTHOR]

Research in several countries shows higher Covid-19 vaccination willingness and uptake among physicians than nurses. Our paper aims to characterize and explain this difference. In early 2021, we surveyed 1047 U.S. primary care professionals who served adolescents, ages 11–17. The national sample included physicians (71%) as well as nurses and advanced practice providers. The survey assessed the three domains of the Increasing Vaccination Model: thinking and feeling , social processes , and direct behavior change. Covid-19 vaccine uptake was higher among physicians than among nurses and advanced practice providers (91% vs. 76%, p <.05). Overall, in the thinking and feeling domain, higher confidence in Covid-19 vaccination, higher perceived susceptibility to the disease, and stronger anticipated regret were associated with higher vaccine uptake (all p <.05). In the social processes domain, perceiving more positive social norms for Covid-19 vaccination, receiving recommendations to get the vaccine, and wanting to help others were associated with higher vaccine uptake (all p <.05). In the direct behavior change domain, receiving an invitation to get the vaccine and better access to vaccination were associated with higher uptake (both p <.05). Of these variables, most of the thinking and feeling and social processes variables mediated the association of training with vaccine uptake. Physicians had higher Covid-19 vaccine uptake than nurses and advanced practice providers, corresponding with their more supportive vaccine beliefs and social experiences. Efforts to reach the remaining unvaccinated cohort can build on these findings. • Covid-19 vaccine uptake among advanced practice providers and nurses was lower than in physicians. • Vaccine confidence and social norms explained the difference in Covid-19 vaccine uptake. • Recommendations from employers and providers suppressed some differences in vaccination. • Behavioral nudges – invitation and incentives – were associated with more vaccine uptake. • Offers directions and contexts for future vaccination interventions and programs in the U.S. [ABSTRACT FROM AUTHOR]

Informal payment for medical services is a common phenomenon in China. Patients make informal payments, in cash or in kind, to physicians in addition to official charges billed for medical services. This paper assesses the associations between patients' perceptions of the physician as an agent for the patient's interests (physician agency problem) and informal payment behavior. Using data of 24,000 and 6700 rural households respectively from the Health Development of Rural China Program database (collected in 2008) and Ningxia data source (collected in 2015), we find that patients' concern about physician agency problems is significantly associated with informal payments. The data shows that patients are more likely to make informal payments when they show low trust towards their physicians. For example, in the surgical cases, among patients who strongly distrusted the physicians, 17.9% (95% confidence interval [CI]:]: 13.5, 22.3) initiated informal payments, compared to 8.0% (95% CI: 5.1, 10.9) who expressed "strong trust" in their physicians. Poor communication was also significantly associated with an increase in the informal payment rate. For example, in the non-surgical setting, among the patients who rated the physicians' explaining skills as "poor," 5.9% (95% CI: 5.0, 6.9) of them made informal payments, significantly higher than the patients who rated "excellent" (of whom 1.8% made informal payments 95% CI, 0.9, 2.7). In this study, we provide an explanation for this finding: patients may initiate informal payments to physicians in order to mitigate the physician agency problem. It suggests that to mitigate informal payments, improving alignment between doctors' incentives and patients' interests would be essential. • Informal payments were directly related to patients' concerns about physicians' behavior. • Patients were more likely to make informal payments when they showed low trust towards their physicians. • Poor communication between patients and physicians was related to informal payment rate. • Informal payment might be viewed as an effort by the patients to align the physicians. [ABSTRACT FROM AUTHOR]

Men whose sexual behaviors place them at risk of HIV often exhibit a "cluster" of behaviors, including alcohol misuse and violence against women. Called the "Substance Abuse, Violence and AIDS (SAVA) syndemic," this intersecting set of issues is poorly understood among heterosexual men in sub-Saharan Africa. We aim to determine cross-sectional associations between men's use of alcohol, violence, and HIV risk behaviors using a gendered syndemics lens. We conducted a baseline survey with men in an informal, peri-urban settlement near Johannesburg (Jan–Aug 2016). Audio-assisted, self-completed questionnaires measured an index of risky sex (inconsistent condom use, multiple partnerships, transactional sex), recent violence against women (Multicountry Study instrument), alcohol misuse (Alcohol Use Disorders Tool), and gender attitudes (Gender Equitable Men's Scale). We used logistic regression to test for syndemic interaction on multiplicative and additive scales and structural equation modeling to test assumptions around serially causal epidemics. Of 2454 men, 91.8% reported one or more types of risky sex. A majority of participants reported one or more SAVA conditions (1783, 71.6%). After controlling for socio-demographics, higher scores on the risky sex index were independently predicted by men's recent violence use, problem drinking, and inequitable gender views. Those men reporting all three SAVA conditions had more than 12-fold greater odds of risky sex compared to counterparts reporting no syndemic conditions. Each two-way interaction of alcohol use, gender inequitable views, and IPV perpetration was associated with a relative increase in risky sex on either a multiplicative or additive scale. A structural equation model illustrated that gender norms predict violence, which in turn predict alcohol misuse, increasing both IPV perpetration and risky sex. These data are consistent with a syndemic model of HIV risk among heterosexual men. Targeting intersections between syndemic conditions may help prevent HIV among heterosexual men in peri-urban African settings. • Heterosexual men's risky sex overlaps with alcohol and violence against women. • We used a "gendered syndemic" lens to explore substance use, violence, and HIV/AIDS. • We found gender norms predict violence, which leads to alcohol and risky sex. • Targeting syndemics among heterosexual men may ensure health in peri-urban settings. • This is among the first papers to offer quantitative support for syndemic theory. [ABSTRACT FROM AUTHOR]

For sociological and anthropological scholars alike, the body is both a physical and social entity as well as a project to be worked on by the self and by others (Tamari, 2020). However, scholars' conceptual work in organ transplantation and the body has tended to overlook the resultant surgical scars, yet these are borne by all transplantation recipients. For example, in understanding biomedicine's intervention in the body through the skin Shildrick (2008) uses the term 'corporeal cut' conceptually rather than focus on the flesh that is cut and the scar that subsequently forms. In this way body flesh has become abstract; cut but unmarked, with transplantation scars being an 'absent presence' in these disciplines' thinking. In this paper we attempt to develop a more nuanced understanding of how organ transplantation shapes both the corporeality of the body and the embodiment of the self through considering the concept of a transplant scar in three ways. First, through transplantation scars' dynamic physical appearance across their lifecourse and their symbolic meaning for their bearer. Second, how scars' coded messages are framed for 'stranger' audiences in the context of their little experience of organ transplantation; and third, through the scars' display and storytelling in the context of more intimate relationships. Interview data from 27 adult survivors of childhood liver transplantation, who bear either 'Lexus' or 'Mercedes' transplantation scars, are drawn upon to illustrate these concepts. Awareness of the meanings associated with the scar as well as others' reactions, imputed or not, to the physicality of the scar point to the significance of the body as a corporeal marker of personal narratives and negotiations. It also indicates the polysemic nature of the scarring and the way in which inventive narratives can play a positive as well as negative role in the lives of organ transplant recipients. • Sociology and anthropology of the body rarely consider surgical scars. • Scars have both social and personal significance that is conveyed through stories. • The meaning of transplantation scars are polysemous and change over the lifecourse. • Surgical scarring is increasingly significant as new cohorts require intervention. [ABSTRACT FROM AUTHOR]

Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the "hospice gaze". We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services. • Ethnographic research develops Foucault's medical gaze in contemporary settings. • A Foucauldian inspired hospice gaze provides ethical approaches to palliative care. • The hospice gaze offers patients more agency than the medical gaze. • The hospice gaze slows care, and adapts the environment to patients. • The hospice gaze attunes staff to patients and helps expression of patient needs. [ABSTRACT FROM AUTHOR]

According to the global Multidimensional Poverty Index (MPI), an internationally comparable measure, poverty in developing countries has fallen substantially over the last 15 years. The COVID-19 pandemic and associated economic contraction are negatively impacting multiple dimensions of poverty and jeopardising this progress. This paper uses recent assessments of food insecurity and school closures made by UN agencies to inform microsimulations of potential short-term impacts of the pandemic under alternative scenarios. These simulations use the nationally representative datasets underlying the 2020 update of the global MPI. Because these datasets were collected in various years before the pandemic, we develop models to translate the simulated impacts to 2020. Our approach accounts for the country-specific joint distribution of deprivations in the simulations, recent poverty reduction trends, and resulting differences in the responsiveness of the global MPI to the scenarios. Aggregating results across 70 countries that account for 89% of the global poor according to the 2020 global MPI, we find that the potential setback to multidimensional poverty reduction is between 3.6 and 9.9 years under the alternative scenarios. We argue that the extent to which such disruptions result in persistent increases of poverty and deprivations may be attenuated by appropriate policy responses. • We evaluate the potential impact of COVID-19 and policy responses on global poverty. • We use 70 microdata sets underlying the global multidimensional poverty index. • Our simulations are informed by assessments of UN agencies (WFP and UNESCO). • Our results suggest a potential global setback to poverty reduction of around 9 years. • Appropriate policy measures may prevent deprivations from becoming persistent. [ABSTRACT FROM AUTHOR]

While there is considerable evidence that therapeutic landscapes have a positive impact on wellbeing, we know little about the mechanisms through which this impact occurs. In this paper we go some way toward addressing this gap. Drawing on in-depth interviews with 12 people aged between 52 and 75 years of age, who are engaged in nature-adventure activity in the UK, we focus on what they understand by 'wilderness'; their experiences of nature-adventure in wilderness settings; and the impact of these experiences on their wellbeing. Moving beyond the largely behavioural focus of laboratory-based studies prevalent within environmental psychology, we highlight the importance of understanding the role of the contextual in the therapeutic relationship. That is, how relational, embodied, social, lifecourse and/or cultural factors that are constitutive of wilderness environments impact wellbeing for those engaged in nature-adventure activity in later life. In doing so, we map out a working model of the mechanisms that impact wellbeing within this context. Our data suggest that there is no one single mechanism, rather we need to think about a range of mechanisms, often operating across a series of spectra (active/passive; safety/risk; alone/socially etc) and importantly, each are connected to place. Hence, we suggest, that where that activity takes place is instrumental for wellbeing. • Addresses critiques of Therapeutic Landscapes. • Maps out mechanisms that underpin how Therapeutic Landscapes impact wellbeing. • Explores the impact of nature-adventure activity in wilderness. • Addresses how people adapt nature-adventure activity for wellbeing in later life. • Where nature-activity takes place is instrumental for wellbeing in later life. [ABSTRACT FROM AUTHOR]

This article examines the relationship between childhood mortality experienced within families and the height of surviving male children. Sibling mortality, controlled by different socioeconomic and environmental variables, is used as an approximation of the hygienic and epidemiological context and practices within the family. The analysis is based on a sample of 2783 individuals born between 1835 and 1977 in 14 villages in north-eastern Spain. The mortality data were obtained from the parish archives of the reference villages, and the height data from military service records of conscriptions at 21 years of age. The data were linked according to nominative criteria using family reconstitution methods. The results suggest the existence of a strong negative relationship between height and the childhood mortality experienced within families. Children born in families in which 50% of the children died before the age of five were up to 2.3 cm shorter than those of families with childhood mortality of less than 25%. General socioeconomic, hygienic and health improvements reduced childhood mortality, causing this link to gradually disappear between the 1940s and 1970s. • This paper discusses the effects on height of mortality experienced within the family. • It is based on a very rich and unique (micro) database. • It analyses the relationship between heights and parental care in the very long-term. • Regression analyses provide new evidence on the determinants of biological well-being. • We found a negative correlation between the percentage of deceased siblings and height. [ABSTRACT FROM AUTHOR]