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Drawing from social epidemiology literature on structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper uses satire and humor as commentary on mainstream U.S. public health discourse related to the role of "race" (properly understood, racism) in shaping inequities observed via COVID-19. Taking the form of a "RACISM-20" fact sheet, this paper transposes structural racism and COVID-19. In doing so, it accentuates how individualist, ahistoric, and pathologizing "downstream" frames of health risks/solutions curtail productive dialogue and action to advance racial and health equity. In the spirit of "racial emancipatory humor", this work represents a potential pedagogical tool to discuss and critique dominant frames of racial(ized) risks, "vulnerability", and responsibility – both in the context of COVID-19 and within broader discourse of racial health inequities, including as related to racialized police violence. In this capacity, this "fact sheet" serves as an example health promotion product of critical resistance and counternarrative. [ABSTRACT FROM AUTHOR]

Researchers of community health worker (CHW) models in many countries are looking for ways to scale without losing one of their main advantages, their context-sensitivity. This paper looks at one research strategy to make CHW projects scalable, namely by developing a generic notion of culture-sensitivity. Based on in-depth qualitative analysis, we reconstruct how 'culture' has been enshrined in a US-based CHW project and specifically in the artefact of a binder with teaching materials for vulnerable mothers. The inscription of generalized, culture-sensitive spaces into the binder did allow the Project to comply with standards of evidence-based medicine while respecting community self-determination and made space for creative and competent CHW practices. Yet at the same time, it took away from more substantive conceptions of community engagement and from community empowerment through CHWs. Our analysis highlights how the focus on culture can invisibilise and displace the importance of competent CHW practice and processes of community engagement. [ABSTRACT FROM AUTHOR]

The tactics used by the food industry to influence public policy have been well documented, but there is little direct evidence of the rationale behind food industry actions and their level of support from within individual companies. This paper provides an analysis of an email exchange (from 2015) between former senior executives of Coca-Cola to gain insider insight into ways in which the food industry seeks to influence policy-makers as well as scientific evidence and opinion with respect to nutrition and non-communicable disease (NCD) prevention. The results provide direct evidence that senior leaders in the food industry advocate for a deliberate and co-ordinated approach to influencing scientific evidence and expert opinion. The paper reveals industry strategies to use external organisations, including scientific bodies and medical associations, as tools to overcome the global scientific and regulatory challenges they face. This evidence highlights the deliberate approach used by the food industry to influence public policy and opinion in their favour. It also demonstrates the importance of identifying and managing potential conflicts of interest when assessing the evidence base and when making policy decisions related to nutrition and NCD prevention. [ABSTRACT FROM AUTHOR]

Recent interdisciplinary scholarship has drawn increased critical attention to issues related to race, gender, class, and culture within public physical activity (PA) spaces, foregrounding the importance of rethinking dominant narratives of PA and promoting diverse and more inclusive practices within these contexts to address PA disparities. This paper addresses issues related to diversity and inclusion within community fitness spaces by examining the experiences of stakeholders and members involved in 'The Collective' Free Fitness Group (CFFG), a free, open-to-the-public fitness community based in Oakland, Ca (the original name has been changed for purposes of anonymity). This organization has made intentional efforts towards addressing diversity and inclusion across its membership and is located in one of the most ethnoracially diverse regions of the country. Drawing on McGee's (1980) concept of ideographs, we explore the potential limitations and consequences of how the CFFG Oakland community members communicated discourses and lived experiences of and to one another and the broader Oakland community. Specifically, we argue that by emphasizing certain expressions of and while deemphasizing alternative forms, participant responses reflected a 'paradox' of diversity, despite their shared in-group identification around as an important individual moral virtue and their open and community. This study contributes new knowledge to the 'paradox' literature and may inform future physical activity interventions and theoretical directions of study. [ABSTRACT FROM AUTHOR]

Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April to July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18–29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM's responses unveiled tensions between researchers', recruiters', and participants' expectations, particularly regarding eligibility criteria (e.g. age, sex frequency), assumptions about 'risky behaviors,' and the 'target' community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected 'target' community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future research engagement. [ABSTRACT FROM AUTHOR]

This paper presents findings from a qualitative study exploring how students at a university in the southern USA conceptualize, theorize, and attempt to influence the role 'social factors' play in mental illness and well-being. Drawing on models of research co-production and principles of critical pedagogy, a group of 10 university students ('student researchers') worked with a faculty member to develop and conduct the study. The results highlight three ways in which the student interviewees ('student interlocutors') theorize 'the social'. The first two – (1) via the 'social determinants of health' and (2) by means of theories on 'neoliberal subjectivity' – provide a powerful frame for interrogating hierarchical systems of power. However, because neither of these corresponds to our interest in producing knowledge for social change, we used prefigurative and speculative approaches to explore a third notion of the social, that of (3) 'world-making practices'. We conclude by reflecting on the relevance of this project for educators, learners, and researchers seeking to deepen knowledge and theories of the social in mental health. We argue that co-produced research that draws from principles of critical pedagogy can enhance interdisciplinary collaboration and lead to more nuanced, transformative, and innovative analyses. [ABSTRACT FROM AUTHOR]

The paper explores how paid and unpaid labor history over the life course influence women's cardiovascular disease. U.S. women comprise about 50% of the paid workforce and perform the majority of unpaid labor. However, the influence of women's work on their health is under-researched. Our sample was drawn from the Women's Health Initiative Observational Study, a cohort of post-menopausal women in the U.S. aged 50–79 at recruitment. Women were categorized into five groups according to paid labor history: worked in paid jobs consistently throughout adult life; left the workforce early; entered the workforce later; discontinuous work history; never worked outside the home. Live birth history (none, at least one, missing) served as a proxy for unpaid labor in prime age. Cox proportional hazard models were used to estimate the hazard ratio of CVD associated with different paid work histories. We then assessed the effect of unpaid labor on the relation between paid labor and CVD. Paid labor participation was not associated with CVD risk among women without unpaid labor after adjusting for age, education, and birth cohort. Among those with unpaid demands, leaving the workforce early or having discontinuous work history was protective. In this U.S. sample, the association between paid work participation history and CVD risk depends on the presence of unpaid labor. Our results demonstrate the necessity of including work – paid and unpaid – in consideration of women's health. [ABSTRACT FROM AUTHOR]

There is a growing effort from a range of professionals and institutions to develop comprehensive integrated prison-to-community healthcare, discharge planning, and community re-entry support for inmates living with HIV. This paper draws from ethnographic data to explore the 'lived experience' of HIV-positive inmates in a US State prison system offering an integrated case management support programme. In the US, incarceration is critical for connecting socially marginalised people and those with health needs to certain rights and resources. We present the ways in which imprisonment enables a claims-making process against the state by allowing this group access to resources and rights connected to imprisonment, healthcare, and associated social welfare support. Offenders identified incentives underpinning their expressed desire or 'intention' to return to prison over time. Our findings suggest that this group of inmates has increased opportunity to access material, medical, and welfare resources when compared to the general inmate population and those outside the prison system. Multiple gaps remain in this group's sense of security in the community, ability to cope with the stress of everyday life, sustained support with substance dependency and, most importantly, consistent access to medical and welfare resources that enable them to live independently. Ironically, for many inmates living with HIV, incarceration offers a better chance of accessing public health services than living in the community. [ABSTRACT FROM AUTHOR]

America faces an obesity epidemic affecting both children and adults – one broadly tied to increased consumption of sugar-sweetened beverages (SSBs). Since 2012, taxes have been proposed as an effective means of reducing SSB consumption and raising revenue. Such taxes have been the subject of voter referendums and have elicited persuasion campaigns by stakeholder groups interested in their passage or failure. This paper provides a picture of the evolution of tactics used to address the public on the subject of SSB taxes, and the persuasive setting of voter referendums as a whole. This study gathered and analyzed pro- and anti-tax messaging from all US SSB tax referendums from 2012 through 2018. The methods and strategies used in each campaign are identified. Common themes and arguments are distinguished and a set of decisions that appeared to heavily influence referendum outcomes are discussed. In summary: (1) Tax proponents must offer a cohesive justification of a new tax, while opponents can sow doubt about it from a number of contradictory directions. (2) The overt politicization of tax debates is an effective anti-tax method. (3) Associating anti-tax messages with the SSB industry can provide a stronger pro-tax framing than the direct public health or tax revenue arguments. (4) Anti-tax messages framing an SSB tax as a 'grocery tax' may be effective, but only if the claim not subjected to strong media or legal scrutiny. [ABSTRACT FROM AUTHOR]

The health and ecological harms created and spread by firms active in many unhealthy commodity industries (UCIs) have received considerable attention from the public health community. However, less focus has been paid to analysing the distribution of wealth and income – important social and economic determinants of health – by these industries. This study aimed to examine long-term trends in wealth and income distribution by publicly listed corporations active in four UCIs: fossil fuels; tobacco; ultra-processed foods; and alcohol. Quantitative analysis of a range of data was conducted for firms listed on stock exchanges in the United States (US). Wealth and income distribution metrics were analysed at the industry level, including effective corporate tax rates and shareholder value ratios. The equity ownership structures and investor location of 20 of the largest firms were also explored. Since the 1980s, US-listed firms in the examined UCIs have distributed much less of their wealth and income to governments and much more to shareholders and investors mostly based in high-income countries. The study provides evidence that firms active in UCIs create a 'double burden of maldistribution': their externalised social and ecological harms disproportionately affect disadvantaged population groups and governments in low- and middle-income countries; whilst, simultaneously, they are increasingly transferring wealth and income to a group over-represented by a small and privileged elite. The identified distributive injustice warrants increased policy attention. [ABSTRACT FROM AUTHOR]

This paper addresses the relevance of medical folklore for vaccine policy intended to increase vaccination uptake. There are two primary claims of this paper: First, that dominant approaches to increasing US vaccination uptake have largely been based on deficient understandings of the root causes of anti-vaccination behavior; and second, that superior approaches to evidence-based policy must enlarge the scope of that evidence base to include crucial findings on belief formation, technical, and risk communication, and the folklore of vaccination. The failure to attend to this evidence results in interventions that are disconnected from the factors actually driving vaccination refusal. The paper describes the deficiencies in dominant approaches, and based on its analysis of the root causes of anti-vaccination behavior recommends superior evidence-based policies that emphasize upstream structural determinants of health behaviors. [ABSTRACT FROM AUTHOR]

Dental pain reduces a person's quality of life and constrains the ability to perform routine day-to-day activities, yet its distribution in society is inequitable and significantly shaped by the social determinants of health. This paper explores this social phenomenon of dental pain using John Rawls' conception of justice as fairness. Several key concepts in Rawls' framework are examined, including the implications for: a person's right to fair equality of opportunity; a person's sense of self-respect; and, the dental profession's social contract. We conclude that the current distribution of dental pain in Canada and the United States breaks with the principles set out in Rawls' conception of a just society. [ABSTRACT FROM AUTHOR]

Despite improvements in access to transition-related medical care, many transgender people still face numerous barriers to paying for gender-affirming procedures. Crowdfunding websites have gained immense popularity as a strategy for trans people to raise money for transition-related healthcare expenses. Using descriptive statistics and thematic content analysis, this paper illustrates how fundraising campaigns for medical gender transition both reveal and reinforce health and social inequalities. Although trans people crowdfund for a variety of transition-related needs, the majority of online campaigns are used to fund chest surgeries among young, white, binary-identified trans men in the United States. Most campaigns fall dramatically short of their fundraising goals. In addition, campaigns use medicalized, normatively gendered transition narratives that privatize inequality in marginalized communities. The article concludes with a consideration of how to incorporate a 'revolutionary etiquette' in crowdfunding for transition healthcare. [ABSTRACT FROM AUTHOR]

One of the most serious, but least examined, issues arising at the intersection of the 'new' genetics and public health is the relationship between social class and genetic burden. In the USA, concerns in ethics, policy and public discourses about genetic medicine and class structure have frequently been expressed in the notion of a potential 'genetic underclass'. The paper explores the usefulness of the genetic underclass metaphor for framing intersections of genetics and social disadvantage. Data are drawn from preliminary analysis of in-depth interviews with mothers of children affected with a genetic condition or illness, as part of a broader study of the state-funded Genetic Outreach Program serving rural Kentucky. The first section of the paper briefly considers the notion of the genetic underclass as it has appeared in medical ethics and policy literatures. It is argued that the mechanisms of access and discrimination to which the genetic underclass concept is attached are not likely to be those through which the new genetics significantly reinforces or exacerbates social disadvantage. Little direct evidence currently exists to substantiate the notion of a genetically unemployable or uninsurable underclass. However, theoretical dimensions associated with the underclass as it appears in social stratification literature do suggest ways of examining dynamics of genetic conditions and social disadvantage. In the second section of the paper, drawing from these dimensions and through cases analyses, issues and processes are identified that will be of importance to understanding relationships between social disadvantage and public health genetics. [ABSTRACT FROM AUTHOR]

This paper builds on the work of critical health scholars and practitioners who have examined the ‘securitization’ of public health in the US during the post-9/11 period. Adopting a critical race perspective, I delve more deeply into the racialized dimensions of this securitization, analyzing how the emergence of a bioterror-framed view of disease has mobilized a disease-terror imaginary comprised of longstanding suspicion towards bodies of color coupled with more recent anti-Arab and anti-Muslim sentiment. I demonstrate that the incorporation of the central figure of this imaginary – the bioterrorist – into US public health discourse has reconfigured ideas about disease carriers as potentially violent and malicious, in turn reconfiguring approaches to disease control that rely on suspicion and securitized health surveillance. US public health adoption of this orientation towards disease control has, I argue, the potential to exacerbate targeting, stigma, and exclusionary practices towards individuals and populations deemed suspicious vis-à-vis this imaginary. My work, in examining the racial discourses of bioterror that shape ‘securitization’, aims to expand the analytical tools that US public health administrators and practitioners draw on to remain vigilant in ensuring that it serves all of its publics in an equitable manner. [ABSTRACT FROM PUBLISHER]

This paper reconsiders the Ebola response in the US as a panic that was both predictable and problematic. Public health professionals and policy-makers have historically drawn attention to and prepared for emerging infectious diseases by raising the specter of catastrophe, generating fears that the media and politicians are often willing to amplify. Although this approach can increase awareness of and funding for global health threats, it also sows the seeds of panic, stigmatizing people associated with the disease, and compromising an effective, evidence-based response. We offer lessons for public health leaders as they review the US Ebola response in order to prepare more responsibly for future disease scares such as that posed by the Zika virus. [ABSTRACT FROM PUBLISHER]

Informed by the theory of the social construction of reality, this paper examines media framing of the tobacco issue in the United States over time. A comparative analysis reveals that both the New York Times and the Wall Street Journal defined the situation in the same manner-that smoking was associated with cancer and other illnesses, and that smokers should assume responsibility for smoking. However, although the New York Times coverage became less supportive of the tobacco industry over time, the Wall Street Journal supported the tobacco industry both over the 1964 Surgeon General's report and during the 1998 Minnesota trial. This suggests that ideology may play a role in the framing of reality. [ABSTRACT FROM AUTHOR]

This paper critically reviews the literature on access to healthcare for people with HIV/AIDS. It takes as its starting point studies that show both the effectiveness of combination medical therapy in reducing AIDS related morbidity and mortality and studies which show that a high percentage (upwards of 66%) of people with HIV/AIDS are receiving neither life-prolonging therapy nor adequate healthcare. It argues that despite the availability of social programs designed to enhance the availability of AIDS-related medical services, such as Medicaid, Medicare and the Ryan White CARE Act Program, social and structural barriers impede patient access to these programs and services. These barriers include poverty, differential application of social programs across state and local lines, and the influences of the social factors of race and gender on healthcare utilization. Such barriers may also preclude access to clinical trials. [ABSTRACT FROM AUTHOR]

In the early 1990s, breast cancer activists in the United States challenged the scientific establishment to include lay activists in the inner circles of science policy making. Within a few years, activists' demands extended beyond policy to inclusion in the everyday practices of science, that is, in the formulation of research questions, the design of scientific studies and the review of scientific grant proposals. While some activists refer to themselves as consumers, their participation in the practices of science has taken them beyond the narrow framework of consumption and cast them as producers, rather than simply consumers, of scientific knowledge. This paper describes a science education program organized by breast cancer activists to prepare them for involvement in the scientific arena. The specific goals of this educational program are to teach basic concepts of biology and epidemiology and critical appraisal of scientific literature and research studies, as well as to examine the institutional practices of science. By simultaneously engaging with the content and the politics of science in Project LEAD, breast cancer activists acquire tools that allow them not only to influence science policy but to evaluate the truth claims of science. In the process, they take a more active and direct role in determining the nature of knowledge produced about breast cancer. [ABSTRACT FROM AUTHOR]

How food security is defined and implemented impacts on public health. The authors argue that the potential to improve food security policy and practice lies foremost in the capacity of a populace to define and demand change rather than in a bureaucracy's readiness to change. This paper introduces a dialogue on food security and rights at two levels, the international and the US community scales, and discusses how they are contingent. The international situation is marked by tension between conflicting post-Second World War trends: on the one hand, to actualize a United Nations (UN) covenant on the human right to food into food security programs and policy that have been decentralized to more local scales and, on the other hand, to centralize—or globalize—the economic markets that manipulate food production, distribution and access. Since the mid-1990s, US activists and researchers have organized at the community level to challenge food policies in the state and marketplace. This diverse collective, from ranchers to soup kitchen volunteers, and nutritionists to restaurateurs, are developing a common frame of reference about the structural constraints to economic security and the necessary organizing goals to leverage policy changes. The authors maintain that global-scale food security debates influence local actors. International human rights covenants, for example, buoy local visions for social justice and enhanced public health. [ABSTRACT FROM AUTHOR]

This paper addresses public health and access to care for the urban poor in the context of US urban, economic, and industrial policy. The pathogenic deterioration of 'inner city' neighbourhoods is a direct result of political and economic strategies to facilitate capital accumulation and consolidation, manifested in geographic patterns of uneven development that mirror the relationship between First and Third World countries. The deleterious public health effects of these trends include reduced access to care; medical indigence in the wake of deindustrialization and the restructuring of the blue-collar workforce; and the spread of social epidemics such as AIDS, violence, and substance abuse. Contemporary health policy and 'reform' debates, however, have virtually ignored the pathogenic role played by economic and social inequality in the etiology and dispersion patterns of disease. To confront the health crisis that currently threatens poor and minority communities in the US, economic justice must be explicitly acknowledged as a public health issue, alongside more traditional concerns such as access to care, immunization, vector control, and behaviour modification. It will be necessary to challenge political and economic policies that shore up corporate power at the expense of community development; spur capital accumulation at the expense of social programs and economic opportunity for the poor and politically disenfranchised; and actively facilitate the continued exploitation of, and withdrawal of resources from, the nation's most vulnerable citizens and their communities. [ABSTRACT FROM AUTHOR]

This commentary reflects upon power-knowledge dynamics and matters of epistemic, procedural, and distributive justice that undergird epidemiological knowledge production related to racial health inequities in the U.S. Grounded in Foucault's power-knowledge concepts—"objects", "ritual", and "the privileged"—and guided by Black feminist philosopher Kristie Dotson's conceptualization of epistemic violence, it critiques the dominant positivist, reductionist, and extractivist paradigm of epidemiology, interrogating the settler-colonial and racial-capitalist nature of the knowledge production/curation enterprise. The commentary challenges epidemiology's affinity for epistemological, procedural, and methodological norms that effectively silence/erase community knowledge(s) and nuance in favor of reductionist empirical representations/re-presentations produced by researchers who, often, have never stepped foot inside the communities they aver to model. It also expressly names the structurally racist reality of a "colorblind" knowledge production/curation system controlled by White scholars working from/for an invisibilized White scientific gaze. In this spirit, this commentary engages the public health critical race praxis principle of "disciplinary self-critique", illuminating the inherent contradictions of a racial health equity discourse that fails to interrogate the racialized power dynamics underlying its knowledge production enterprise. In doing so, this commentary seeks to (re)frame and invite discourse regarding matters of epistemic violence and (re)colonization as manifest/legible within epidemiology research, suggesting that the structural racism embedded within – and perpetuated through – our collective work must be addressed to advance antiracist and decolonial public health futures. In this regard, I suggest the value of engaging poetry as praxis—as mode of knowledge production/expression to "center the margins" and offer counternarratives to epidemiology's epistemic violence. [ABSTRACT FROM AUTHOR]

E-cigarettes are believed to be less harmful than combustible tobacco. However, e-cigarettes have created divisions in public health: within and between academia, policy and practice. As e-cigarettes proliferate, and public health debates intensify, the best interests of those most at risk of smoking related illness can be lost in the furore. This article draws on 183 open-ended responses to a 2019–2020 questionnaire posted to various online vaping discussion forums to argue that emotion needs to become part of this discussion – particularly the emotional perspectives of vapers. The findings indicated that for many vapers, e-cigarettes are not just another potential harm reduction or alternative nicotine product. For many of the respondents, vaping is a social practice, but also more than this: an affective economy. In this economy, emotions do things, specifically they indicate the boundaries of a vaping community. This community is based on shared experiences of e-cigarettes creating positive new lifeworlds and changes to everyday life. However, it is also based on fears that these new lifeworlds are under threat. The aim of this article is to encourage more acknowledgment of this affective economy in the interests of reducing division and increasing reflexivity. [ABSTRACT FROM AUTHOR]

This article addresses the challenges solidarity poses for the development of Precision Medicine (PM). Solidarity is invoked in calls for a new 'social contract' for PM, seeking to promote participation in PM by emphasizing reciprocity between contributions to and benefits from this new branch of medicine. In this context, there is a need for further conceptualization with regard to what qualifies as solidarity and how solidarity is performed in Precision Medicine initiatives. We address these conceptual gaps that have important practical implications for PM's development, most notably for agendas of public engagement and trust. We argue that solidarity does not only represent a value but also takes on infrastructural forms, shaping how PM is practiced in, for example, healthcare delivery systems. Next, we empirically probe how solidarity is invoked in PM initiatives in the United States ('All of Us'-Program) and Europe (the UK 100,000 Genomes Project and the French 2025 Genomics Plan). Based on this analysis, we argue that the infrastructural dimension of solidarity forms a vital precondition to build trust in PM. Echoing the famous motto of The Three Musketeers, 'One for all, all for one', PM policies cannot just proclaim solidarity for the gathering of data alone ('One for all') without caring about delivery of benefits of PM ('All for one'). We conclude by proposing an empirical research agenda for studying infrastructural formations to secure solidarity in the implementation of PM practices across national contexts. [ABSTRACT FROM AUTHOR]

In a resource limited environment, universities may increasingly need to conceive themselves as 'brands' and to mobilize capitalist marketing strategies to enhance institutional reputations. Between 1994 and July 2018, 24% of accredited United States public health schools were renamed for private donors. We suggest branding public health schools with private names carries ethical risks, including threats to stated school values, public health practice, and community accountability and trust. These interrelated harms implicitly redefine the 'public' in public health, promoting the perception that public health should ultimately serve and celebrate private profit. Public health schools offering branding in exchange for private donations should critically consider the unique harms of private branding, beyond those of private donations alone, when pursuing the mission of public health. [ABSTRACT FROM AUTHOR]

Research demonstrates a causal link between increased exposure to racial discrimination and adverse health outcomes among diverse racial and ethnic populations in the U.S. However, most research on Latinx communities overlooks how discrimination varies according to individual accounts of how their race is perceived by others. To address this gap, our study draws from critical race theory to analyze a new multi-dimensional measure of racial status – 'street race' and its association with discrimination experiences. We analyzed data from the 2015 Latino National Health and Immigration Survey (n = 1,493). Our main dependent variables are experiences of everyday discrimination and our explanatory variables are five mutually exclusive categories of 'street race.' We estimated a series of logistic regression models, which disaggregated the 'street race' measure, to better understand everyday discrimination experiences across street race categories. We found that Latinxs who are racialized on the street as Black or as Arab/Middle-Eastern relative to White were more likely to have experienced discrimination because of their race/ethnicity. They were also more likely to have experienced discrimination in the employment domain, by police, in the housing market, as consumers in shops or restaurants, and while receiving medical care. Employing a critical race approach, our study expands the conceptual measurement of discrimination to incorporate a more nuanced approach that captures interpersonal racism based on 'street race.' Further research will benefit from employing our 'Critical Street-Race' theory for developing equity-focused multi-level interventions at the interpersonal, community, and policy levels. [ABSTRACT FROM AUTHOR]

While enormous strides have been made in the representation of women in clinical trials, the percentage of women enrolling in Phase I trials still remains low, which both raises public health concerns about the safety of new drugs and social justice concerns regarding their inclusion in research. As part of a longitudinal study of healthy volunteers in the United States, our inquiry aimed to examine impediments to women enrolling in Phase I trials as well as their experiences participating in these studies at residential research clinics. We analyzed 111 semi-structured interviews conducted with 47 women who had enrolled in at least one Phase I trial. Our study indicates that women face discrimination during all stages of their participation in Phase I trials from their ability to qualify for studies, the treatment they receive in the clinic facilities, and a lack of social support. Specifically, we found that (1) study designs disadvantage participants of childbearing potential, (2) women feel vulnerable in the clinic space when outnumbered by men, and (3) heterosexual women are often discouraged from participation by their husbands or significant others. Placing these findings within the scholarly literature on barriers to women's clinical trial participation, we argue that diverse strategies attending both to physiological and social factors are needed to combat inequalities in U.S. Phase I trial participation. [ABSTRACT FROM AUTHOR]

Like many rural and suburban counties in the Midwestern United States, George County, Indiana is facing increased rates of heroin use, drug-related overdose, and hepatitis C. Following an outbreak of HIV in 2015 in a nearby county, the George County department of health launched an effort to open a needle exchange despite considerable opposition from the community, including ambivalent stances among current and former users of opiates. This article examines these conflicted perspectives noting their grounding in a moral approach to addiction and seeks to explain opposition to the needle exchange program by examining locals' depictions of the religious and moral landscape of the county. This analysis is based on 29 qualitative interviews conducted with 20 people who have experience using heroin or prescription opioid painkillers and 13 other community members involved in local efforts to address addiction. Ethnographic observation of public events was undertaken. Examining the contours of the local moral economy and its links to religious spirituality and practice reveals that the moral model of addiction both mitigates and produces social exclusion and begets conflicted stances towards the presence of an initiative to open a modest needle exchange program. Interviewees expressed a variety of stances towards the initiative feeling that it might decrease the spread of disease, but may not be used effectively. Though it is situated on morally contested terrain, it may be a step towards social inclusion and empowerment for addicted individuals who stake their right to health and a place in the community. [ABSTRACT FROM AUTHOR]

This study explores whether population-level measures of income inequality and poverty rates are associated with mass shootings in the United States. We test these potential connections by examining the incidence rate of mass shootings using random effects negative binomial regressions for a panel data-set that included 3144 counties for the years 1990-2015. According to the adjusted models, income inequality is significantly associated with the three or more victim-related injuries (incidence rate ratio [IRR] = 1.39; 95% confidence interval [CI] = 1.11, 1.67; P < .001) and four or more victim-related deaths definition of mass shootings (IRR = 1.36; 95% CI = 1.08, 1.64; P < .01). However, poverty rates lack a reliable association with the three or more injuries (IRR = 1.07; 95% CI = .75, 1.39) and four or more deaths definition (IRR = .95; 95% CI = .71, 1.19). When considered in conjunction with the literature on inequality and crime, these results indicate that counties with high inequality may foster an environment of anger and resentment that ultimately leads to mass shootings. [ABSTRACT FROM AUTHOR]

Food and beverage product reformulation is a public health nutrition policy of recent prominence; it is a so-called ‘win-win’ policy, as unlike other nutrition policies, it has the potential to also benefit the food and beverage industry. However, reformulation has also been criticized as being driven by industry interests. In order to inform future policy debates about reformulation, we sought to investigate how and why reformulation became a public health initiative by conducting a framing analysis on 278 US newspaper articles from 1980 to 2015. Frames are aspects of text emphasizing a particular definition of a problem or solution, and they help shape policy discourses and the public policy agenda. Three primary frames of reformulation were identified: business, health, and political. Having multiple frames enables reformulation to assume different meanings in different contexts, which helps to explain how it has garnered broad support from multiple sectors. The political frame of reformulation, however, only grew in importance after 2001, to describe reformulations occurring in response to public health policy initiatives aimed at obesity and noncommunicable diseases. The increasing use of a political frame, and the events described in the articles, suggests that voluntary reformulation followed a growing threat of policy change and litigation facing the industry, a finding that provides important context to debates about voluntary reformulation initiatives. Future reformulation initiatives will need to reconcile and negotiate the varying frames and aims of reformulation in order to ensure they are a success from the public health perspective. [ABSTRACT FROM AUTHOR]

In the past decade, enthusiasm for intrauterine devices (IUDs) has rapidly grown in the United States. Messages from health care providers, pharmaceutical advertisements, and public health campaigns extol the freedom that women can experience using a long-term, internal, highly effective contraceptive method. Little research has investigated how young women conceptualize IUDs in terms of freedom and control. We conducted a thematic analysis of in-depth, individual interviews with 37 young Black and Latina women and explored their perspectives on IUDs as promoting and constraining freedom. Participants with favorable views of the IUD (n = 13) appreciated that it would allow them to live their day-to-day lives ‘normally’ without thinking about contraception and with minimal side effects. Four current IUD users found the method empowering because they could pursue their goals without fear of unintended pregnancy. In contrast, nearly two-thirds of participants (n = 24) had predominantly negative views and focused on temporal and physical features of IUD use. They expressed concern that IUDs would impinge on their personal agency by restricting their bodily autonomy since they would not be able to discontinue use without a health care provider; found the idea of a contraceptive method inside their body for years unsettling; and/or desired flexibility over their pregnancy plans. These results highlight a contradiction between IUD promotion discourses and some women’s views about the method and their approaches to pregnancy. Discursive and clinical practices that encourage the use of long-acting contraceptive methods like IUDs over other methods may unintentionally infringe upon reproductive autonomy. [ABSTRACT FROM PUBLISHER]

Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the first approach to categorical and the second to anti-categorical intersectionality. Here, we juxtapose the categorical approach with traditional between-group risk calculations (e.g. odds ratios) and the anti-categorical approach with the statistical concept of discriminatory accuracy (DA), which is routinely used to evaluate disease markers in epidemiology. To demonstrate the salience of this distinction, we use the example of racial/ethnic identification and its value for predicting influenza vaccine uptake compared to other conceivable ways of organizing attention to social differentiation. We analyzed data on 56,434 adults who responded to the NHFS. We performed logistic regressions to estimate odds ratios and computed the area under the receiver operating characteristic curve (AU-ROC) to measure DA. Above age, the most informative variables were education and household poverty status, with race/ethnicity providing minor additional information. Our results show that the practical value of standard racial/ethnic categories for making inferences about vaccination status is questionable, because of the high degree of outcome variability within, and overlap between, categories. We argue that, reminiscent of potential tension between categorical and anti-categorical perspectives, between-group risk should be placed and understood in relationship to measures of DA, to avoid the lure of misguided individual-level interventions. [ABSTRACT FROM AUTHOR]

A growing body of social science research has focused on the negative public health consequences of criminalizing the sexual transmission of HIV. I examine the criminalization of contagion in West and Central Africa and address a significant research gap:How do legislative environments that enable harmful laws to be applied become created in the first place?With stated aims of promoting human rights and public health objectives, HIV/AIDS-related laws have been created transnationally though the use of an omnibus model law. A group of legislative actors have problematized this United States Agency for International Development (USAID) funded model law, known as the USAID/Action for West African Region model law, or N'Djamena model law. This ‘harmonizing’ text led to the rapid spread of HIV/AIDS laws, including the criminalization of HIV transmission, across at least 15 countries in West and Central Africa between 2005 and 2010. The HIV model law was packaged and ‘sold’ to developing countries through the strategic use of best practice discourse. Best practice replications are enabled though a set of social and technological relations of use including the availability of mobile, standardizing texts. Although best practice standardization has been a key feature of global health institutions work activities in the HIV response over the past two decades, recent replications related to the criminalization of HIV transmission illustrate the potential public health dangers of ‘don’t reinvent the wheel’ thinking. I offer a normative critique of the transnational, text-mediated process that has produced highly problematic laws. [ABSTRACT FROM PUBLISHER]

In 2008, the world experienced the worst financial crisis since the Great Depression. The crisis is often described in relation to its proximal risk factors such as the proliferation of risky loans and mortgage-based securities, but the root causes of the Great Recession include distal risk factors such as indiscriminate capital flow, excessive financial deregulation, and high concentration of wealth in the top distribution. Ultimately, the crisis is a byproduct of neoliberal policies and the ‘self-correcting market’ ideology that guided national and global macroeconomic reforms since the 1970s. Evidence indicates that the Great Recession led to increases in unemployment and suicides, especially in Europe and in the US. Estimates based on the effects of previous economic downturns suggest that the crisis produced negative health and nutritional outcomes in developing countries. Data, however, also show that recessions can be characterized by increases in life expectancy at birth. These favorable trends seem associated with policy regimes favoring a more egalitarian distribution of income and stronger social protections that can decouple the link between unemployment and suicides during crises (‘healthy de-growth’.). New rules and regulations at the national and global level are needed to prevent future financial crises. The crisis also provides an opportunity to challenge neoliberalism, the ideology of the ‘self-correcting market’ and envision a new model of economic development where GDP growth is longer the main national policy priority. Governments can achieve a regime of ‘healthy de-growth’ if they step in with appropriate policy interventions toward a more egalitarian distribution of income and stronger social protections. [ABSTRACT FROM PUBLISHER]

Although the rate of adolescent childbearing in the USA continues to decline, and its consequences increasingly found to be equivocal, a persistent discourse of teen pregnancy as pathology structures public health responses. Foucault’s concepts of biopower and governmentality are useful to understand and critically analyze the operation of power in discourses related to adolescent childbearing; specifically, how power over life is simultaneously exercised at the level of the body and the population through self-governance. By conducting a situational analysis using health promotion materials and policy documents from a national, non-governmental teen pregnancy prevention organization, I identify two strategies through which the management of bodies and populations emerges in relation to teen pregnancy: the production of risky bodies and subjectivities and the deployment of a regulatory regime of heterosexuality. While the pregnant teenage subject is produced through public health discourses of normalizing judgment, risk, and deference to experts, the pregnant teen body is regulated through abjection and rites of redemption. At the same time, the expansive scope of the teen pregnancy ‘problem’ requires increasing forms of self-governance and rational behaviors from across diverse populations. This analysis enables us to challenge deeply entrenched assumptions guiding teen pregnancy prevention efforts and explore the possibility that the stigmatization and regulation of young women’s reproduction reinforce and reproduce existing health and social inequalities. [ABSTRACT FROM PUBLISHER]

This study explores the social determinants of diabetes in a low-income, Latino, and immigrant neighborhood in a Californian city, emphasizing food environments. We conducted focus groups and semi-structured interviews of a convenience sample of staff and clients at a local non-governmental organization. Eight themes emerged as key barriers to healthy eating: (1) cost of food vis-à-vis income; (2) transportation; (3) language; (4) stigma; (5) immigration status; (6) insufficient formal/informal food assistance; (7) work conditions; and (8) competing basic needs/constraints of poverty. We conclude that the public health and health education rhetoric of ‘individual choice’ is a barrier in itself to understanding the diabetes epidemic, and that without the recognition and understanding of, and intervention upon, socioeconomic, policy, and political barriers to healthy lifestyles, the prevention of diabetes will remain out of reach. [ABSTRACT FROM PUBLISHER]

Informed by the theories of social construction of reality and social movement, this study examined how medical journals, the publications of social movement organizations, and newspapers portrayed Jack Kevorkian in the physician-assisted suicide (PAS) and euthanasia debate. The views of core general medical journals from the United Kingdom and the United States, newsletters of pro- and anti-PAS/euthanasia groups, and local and national American newspaper coverage of Kevorkian were explored. Overall, the findings show that the voices of these different communities converged in some areas of their coverage of Kevorkian. The British medical journals (the British Medical Journal and The Lancet) and a pro-PAS/euthanasia group (the Hemlock Society) shared themes mainly with the New York Times, whereas the American journals (the Journal of the American Medical Association and New England Journal of Medicine) and an anti-PAS/euthanasia group (the International Anti-Euthanasia Task Force) shared themes mainly with the Detroit News. [ABSTRACT FROM AUTHOR]

Features the organization Spirit of 1848 which is composed of U.S. public health activists and researchers. Goal of making and strengthening connections among progressive public health workers; Significance of the group's name; Creation of committees to address critical public health issues; Organization of sessions at the annual American Public Health Association meetings.