Search

Known as the "Black-White mental health paradox," Black Americans typically report better mental health than White Americans, despite chronic exposure to the psychologically harmful effects of racism and discrimination. Yet, researchers rarely examine how mental health is experienced across racial groups in economically distressed rural regions where all residents have disproportionately less access to mental healthcare resources. The purpose of this study was to explore how the racialized social system potentially contributes to the mental health beliefs and attitudes of racially majoritized and minoritized rural residents. We conducted a secondary analysis of 29 health-focused oral history interviews from Black American (n = 16) and White American (n = 13) adults in rural North Carolina. Through critical discourse analysis, we found nuanced discourses linked to three mental-health-related topics: mental illness, stressors, and coping. White rural residents' condemning discourses illustrated how their beliefs about mental illnesses were rooted in meritocratic notions of individual choice and personal responsibility. Conversely, Black rural residents offered compassionate discourses toward those who experience mental illness, and they described how macro-level mechanisms can affect individual well-being. Stressors also differed along racial lines, such that White residents were primarily concerned about perceived social changes, and Black residents referenced experiences of interpersonal and structural racism. Related to coping, Black and White rural residents characterized the mental health benefits of social support from involvement in their respective religious organizations. Only Black residents signified that a personal relationship with a higher power was an essential positive coping mechanism. Our findings suggest that belief (or disbelief) in meritocratic ideology and specific religious components could be important factors to probe with Black-White patterning in mental health outcomes. This research also suggests that sociocultural factors can disparately contribute to mental health beliefs and attitudes among diverse rural populations. • Black and White rural adults received social support from religious organizations • Black rural adults articulated compassion for people who experience mental illness • White adults' beliefs about mental illness were rooted in meritocratic ideology • Perceived sociocultural changes were a source of stress for White rural adults • A relationship with a higher power was a positive coping mechanism for Black adults [ABSTRACT FROM AUTHOR]

Reduced social support among parents is a well-established risk factor for child removal by child protective services. There has been relatively little attention, however, to mothers' social networks following child removal, including how stigma and additional strain of living apart from children may influence mothers' social ties. Foregrounding the rarely heard perspectives of mothers who use drugs, a group disproportionately intervened upon by child protective services, this study examines social relationships and social support among mothers in the aftermath of child removal. We conducted in-depth interviews with 19 women who use drugs and conducted thematic analysis to examine social relationships and patterns of social support. Women reported severely disadvantaged social networks following child removal, with network ties commonly cited as providing low support, most often attributed to poverty-related adversities, lack of acknowledgment of the traumatic nature of women's losses, and pronounced stigmatization. Findings highlight how unmet social support needs and stigma can act to deepen social blame and marginalization of mothers following child removal, impeding efforts toward family reunification and foreclosing other life opportunities. More mutually supportive, peer-to-peer spaces are needed to provide support to parents currently involved in the system and to challenge processes of stigmatization. [ABSTRACT FROM AUTHOR]

Extensive research documents that social network characteristics affect health, but knowledge of peer networks of youth in Malawi and sub-Saharan Africa is limited. We examine the networks and social participation of youth living in extreme poverty in rural Malawi, using in-depth interviews with 32 youth and caregivers. We describe youth's peer networks and assess how gender and the context of extreme poverty influence their networks and participation, and how their networks influence health. In-school youth had larger, more interactive, and more supportive networks than out-of-school youth, and girls described less social participation and more isolation than boys. Youth exchanged social support and influence within their networks that helped cope with poverty-induced stress and sadness, and encouraged protective sexual health practices. However, poverty hampered their involvement in school, religious schools, and community organizations, directly by denying them required material means, and indirectly by reducing time and emotional resources and creating shame and stigma. Poverty alleviation policy holds promise for improving youth's social wellbeing and mental and physical health by increasing their opportunities to form networks, receive social support, and experience positive influence. [ABSTRACT FROM AUTHOR]

A growing body of research in West Africa and globally shows that cash transfers can decrease intimate partner violence (IPV). The purpose of this study was to explore how the government of Ghana's Livelihood Empowerment Against Poverty (LEAP) 1000 program, an unconditional cash transfer plus health insurance premium waiver targeted at pregnant women and women with young children, influenced IPV experiences. Existing program theory hypothesizes three pathways through which cash transfers influence IPV, including: 1) increased economic security and emotional wellbeing; 2) reduced intra-household conflict; and 3) increased women's empowerment. Informed by this theory, we conducted qualitative in-depth interviews with women in northern Ghana (n = 30) who were or had been beneficiaries of LEAP 1000 and had reported declines in IPV in an earlier impact evaluation. We used narrative and thematic analytic techniques to examine these pathways in the context of gender norms and household dynamics, as well as a fourth potential pathway focused on interactions with healthcare providers. Overall, the most prominent narrative was that poverty is the main determinant of physical IPV and that by reducing poverty, LEAP 1000 reduced conflict and violence in households and communities and improved emotional wellbeing. Participant narratives also supported pathways of reduced intra-household conflict and increased empowerment, as well as interplay between these three pathways. However, participants also reflected that cash transfers did not fundamentally change gender norms or reduce gender-role strain in a context of ongoing economic insecurity, which could limit the gender transformative potential and sustainability of IPV reductions. Finally, while health insurance increased access to healthcare, local norms, shame, fear, and minimal provider screening deterred IPV disclosure to healthcare providers. Additional research is needed to explore interplay between pathways of impact across programs with different design features and implementation contexts to continue informing effective programming to maximize impact. • There is limited understanding of pathways from cash transfers to IPV reduction. • We examined mechanisms linking Ghana's cash plus program to IPV. • Poverty reduction and women's empowerment are evidenced pathways. • There were no fundamental changes to gender norms, limiting sustainability. • Limited disclosure and IPV screening reduced impact of complementary programming. [ABSTRACT FROM AUTHOR]

Male partners of female sex workers are rarely targeted by HIV prevention interventions in the commercial sex industry, despite recognition of their central role and power in condom use negotiation. Social networks offer a naturally existing social structure to increase male participation in preventing HIV. The purpose of this study was to explore the relationship between social network norms and condom use among male partners of female sex workers in La Romana, Dominican Republic. Male partners (N =318) were recruited from 36 sex establishments to participate in a personal network survey. Measures of social network norms included 1) perceived condom use by male social network members and 2) encouragement to use condoms from social network members. Other social network characteristics included composition, density, social support, and communication. The primary behavioral outcome was consistent condom use by male partners with their most recent female sex worker partner during the last 3 months. In general, men reported small, dense networks with high levels of communication about condoms and consistent condom use. Multivariate logistic regression revealed consistent condom use was significantly more likely among male partners who perceived that some or all of their male social network members used condoms consistently. Perceived condom use was, in turn, significantly associated with dense networks, expressing dislike for condoms, and encouragement to use condoms from social network members. Findings suggest that the tight social networks of male partners may help to explain the high level of condom use and could provide an entry point for HIV prevention efforts with men. Such efforts should tap into existing social dynamics and patterns of communication to promote pro-condom norms and reduce HIV-related vulnerability among men and their sexual partners. [Copyright &y& Elsevier]

• To our knowledge, the first mixed-methods study on the impact of cash transfers on instrumental and emotional social support of women. • Quantitative findings show increases in perceived overall, instrumental and emotional social support. • Qualitative findings indicate increased access to social support, decreased reliance on economic support, and more given support to others. • This study shows a potential for crowding-in social support, which can strengthen the effect of cash transfer programs. Social protection programs are not introduced in a vacuum and it is important to understand what effects such programs have on existing informal support networks of family, friends and community members. A social cash transfer may reduce receipt of informal financial support, which can water down part of the program's impact. However, cash transfers can also reduce barriers to social participation and enable participants to engage in reciprocal support systems. We use data from the quasi-experimental mixed method impact evaluation of Ghana's Livelihood Empowerment Against Poverty (LEAP) 1000 program, a social cash transfer program for pregnant women and mothers of children under one year living in poverty, to estimate program effects on social support and participation. Using a difference-in-differences approach we find that LEAP 1000 increases overall social support, as well as both emotional and instrumental support. In addition, program beneficiaries are more likely to participate in community groups. In in-depth interviews, participants confirmed increased support with descriptions of improved access to financial markets, such as borrowing money or contributing to local savings schemes, and strengthening of social participation in local groups and gatherings. Beneficiary women also highlighted reduced need for economic support and new opportunities to support others. By creating opportunities for additional social support within the household and community, LEAP 1000 crowded-in support, rather than reducing existing sources of support or crowding-out support. [ABSTRACT FROM AUTHOR]

Toddler milk products are ultraprocessed milk-based beverages promoted for children aged 9 through 36 months. They often contain added sugars, which may contribute to unhealthy dietary habits. Aggressive promotion of toddler milk, particularly to the Latinx population, has likely led to rapid rises in sales. The study aims were to qualitatively explore caregivers' experiences with, beliefs about, and attitudes toward toddler milk; to explore caregivers' reactions to health claims and product warnings on toddler milk packaging; and explore whether perceptions of toddler milk differ by Latinx ethnicity. Focus group discussions and in-depth interviews were conducted. Fifteen online in-depth interviews and 4 online focus groups with US caregivers of children aged 9 through 36 months who reported serving toddler milk to their children were conducted in 2021. Audio files were transcribed, coded, and analyzed in NVivo. A thematic analysis with a hybrid analytical approach of deductive and inductive coding was conducted. Caregivers struggled to discern toddler milk from infant formula and perceived formula as a larger term that included toddler milk. Participants described offering toddler milk to their children for its convenience, nutritional profile, and perceived benefits tied to health claims present on the labels. Participants reported that health claims on toddler milk packaging attracted their attention; most participants did not express skepticism about the veracity of the claims. An "added sugar" warning increased understanding of the presence of added sugar in a toddler milk product. Latinx and non-Latinx participants largely reported similar perceptions, beliefs, and patterns of provision of toddler milk. Health claims may lead caregivers to perceive toddler milk as a nutritionally adequate product. Research is needed to investigate caregiver-directed interventions for informing caregivers about the distinction between infant formula and toddler milk. [ABSTRACT FROM AUTHOR]

Access to maternal health services has increased in Ethiopia during the past decades. However, increasing the demand for government birthing facility use remains challenging. In Ethiopia's Afar Region, these challenges are amplified given the poorly developed infrastructure, pastoral nature of communities, distinct cultural traditions, and the more nascent health system. This paper features semi-structured interviews with 22 women who were purposively sampled to explore their experiences giving birth in government health facilities in Afar. We used thematic analysis informed by a cultural safety framework to interpret findings. Our findings highlight how women understand, wield, and relinquish power and agency in the delivery room in government health facilities in Afar, Ethiopia. We found that Afari women are treated as 'others', that they manipulate their care as they negotiate 'cultural safety' in the health system, and that they use trust as a pathway towards more cultural safety. As the cultural safety framework calls for recognizing and navigating the diverse and fluid power dynamics of healthcare settings, the onus of negotiating power dynamics cannot be placed on Afari women, who are already multiply marginalized due to their ethnicity and gender. Health systems must adopt cultural safety in order to ensure health quality. Providers, particularly in regions with rich cultural diversity, must be trained in the cultural safety framework in order to be aware of and challenge the multidimensional power dynamics present in health encounters. • Cultural safety is a powerful framework to interpret and contextualize minority women's experiences in birth. • Afari women are treated as 'others' in their health system. • Afari women manipulate their care to enhance their own safety during childbirth. • Health systems, and their providers, must adopt cultural safety to ensure health quality. [ABSTRACT FROM AUTHOR]

Transnationalism explores social, economic and political processes that occur beyond national borders and has been widely used in migration studies. We conducted a systematic review to explore if and how transnationalism has been used to study migrants' health and what a transnational perspective contributes to understanding health practices and behaviors of transnational migrants. We identified 26 empirical studies published in peer-reviewed journals that included a transnational perspective to study migrants’ health practices and behaviors. The studies describe the ways in which migrants travel back and forth between countries of destination to countries of origin to receive health care, for reasons related to cost, language, and perceptions of service quality. In addition, the use of services in countries of origin is related to processes of social class transformation and reclaiming of social rights. For those migrants who cannot travel, active participation in transnational networks is a crucial way to remotely access services through phone or email, and to acquire medical supplies and other health-related goods (traditional medicine, home remedies). We conclude with recommendations for future research in this area. [ABSTRACT FROM AUTHOR]