Severe Hardship Research Articles

Returning to fund refugeehood: dispersal and survival between Uganda and South Sudan

ABSTRACT Return movements of refugees, even when gradual or temporary, are typically understood as part of a process of full repatriation or as a ‘strategy’ for leveraging socio-economic opportunities across borders. However, for some refugees, return is neither a step towards repatriation nor an empowering strategy. Drawing on qualitative and quantitative data from Uganda and South Sudan, this article shows how, due to gradual reductions in aid and the lack of livelihood opportunities in Uganda, South Sudanese refugees travel back to their homeland in order to financially support their relatives who remain in exile. These return movements and the phenomenon of split households among South Sudanese are responses to severe hardship and, paradoxically, are deployed to sustain their life in Uganda. While cross-border migration enables refugees to access subsistence opportunities, this article argues that it underscores how refugees must now find their own means to ‘fund’ their refugeehood, given ongoing reductions in international assistance for protracted displacement.

A review on social work and climate change: the need for a transdisciplinary approach

ABSTRACT Climate change is a global emergency due to its social and economic impacts. This comprehensive review examines how climate change affects society and emphasises the role of social work in solving this problem with a multidisciplinary approach. Despite the least responsible, marginalised groups suffer hugely from climate change impacts and the global GDP will plummet, if no action is taken to mitigate its effects causing severe economic hardship for developing nations, and marginalised communities, which already face inequalities, resource shortages, and poor governance. There is a necessity for strategies to lower vulnerable population risks, thus emphasising the role of social work in addressing the inequalities of the climate change impacts. This paper discusses how social work concepts relate to environmental challenges and how they advocate for sustainability during climate change adaptation and mitigation, and promote environmental justice. Furthermore, the review also emphasises the need for transdisciplinary action on climate change. Scopus and Google Scholar databases was used to retrieve literature, based on the review questions, 51 literature items were selected for the evaluation and case examples. The review concludes that transdisciplinary action, including social workers’ role in decision-making and implementation, can create an equitable climate change mitigation plan.

Financial hardship and healthcare utilization among older cancer survivors with comorbidities.

349 Background: Financial burden among older cancer survivors (65y+) is understudied, particularly with regard to how comorbidities may affect financial burden and healthcare utilization despite Medicare eligibility. We assessed the relationship between financial hardship (FH), healthcare utilization, and comorbidities among cancer survivors. Methods: The University of Alabama at Birmingham tumor registry was used to identify patients diagnosed at ≥65y with lymphoma, breast, colorectal, prostate, or lung cancer types and received curative-intent treatment from 2000 to 2019. Patients were surveyed on FH, healthcare utilization, and comorbid conditions. FH was defined as having answered ‘Yes’ to experiencing material, psychological, or behavioral hardship in the past year. Visits to a primary care physician (PCP), oncologist, non-oncology specialist, or emergency department (ED) in the past 2 years were self-reported. A modified Common Terminology Criteria for Adverse Events (CTCAE) grading system captured 45 self-reported comorbidities. A CTCAE of 3 or 4 was considered severe. Multivariable models were used to determine the differences in risk of any FH between severe vs. non-severe CTCAE and to determine differences in healthcare utilization. All models were adjusted for age at survey completion, years from diagnosis to survey, sex, race, income, stage, distance travelled to medical center. Results: Among the 759 survivors included, median age was 77 (IQR=73-82), a majority identified as White (82%), half were female (53%) and a third reported annual income of less than 20,000 (32%). Breast (33%) was the most common cancer type followed by prostate (26%), lung (17%), colorectal (15%), and lymph (9%). Moderate or Severe comorbidities were reported by 46% of participants. FH was most commonly associated with coronary heart disease (18-47%), chronic obstructive pulmonary disease (20-57%), and myocardial infarction (25-60%) across all cancer types. Overall, patients with severe comorbidities had a higher risk of any FH (RR, 1.50; 95%CI, 1.15, 1.97), ED visits (IRR, 2.20; 95%CI, 1.22, 3.95), specialists (IRR, 1.52; 95%CI, 1.25, 1.87), and PCP (IRR 1.15; 95%CI, 1.01, 1.30). Those with severe comorbidities and financial hardship had higher utilization of PCP (p < 0.003), but not other types of utilization. Conclusions: Older patients with severe comorbidities were at increased risk of financial hardship while also utilizing healthcare facilities at a higher rate than those with fewer comorbidities. While those with severe comorbidities and financial hardship utilized their PCP more often, they did not utilize all healthcare facilities more than those with fewer comorbidities. Financial burden and high healthcare utilization remain after entering into cancer survivorship but is exacerbated by additional comorbid conditions.

Snakebite incidence and healthcare-seeking behaviors in Eastern Province, Rwanda: A cross-sectional study.

Snakebite envenoming (SBE) is a potentially life-threatening event that can lead to severe physical, mental, and economic hardships, particularly in under-resourced regions like sub-Saharan Africa. In Rwanda, there have been no epidemiological assessments of SBE to guide the Ministry of Health in its efforts to reduce the burden. This study had two main objectives: first, to estimate the incidence of snakebites across districts, and second, to describe formal versus informal healthcare seeking behaviors among snakebite victims in Eastern Province, Rwanda in 2020. This cross-sectional study utilized a cluster sampling approach, involving Community Health Workers (CHWs) who recorded snakebite cases across seven districts. The descriptive analysis considered sampling weights, and healthcare seeking behavior was assessed based on the type of care sought as the first point of treatment. The study surveyed 390,546 individuals across 763 villages and estimated a provincial annual incidence rate of 4.3 cases per 1,000 individuals. Incidence estimates ranged from 1.1 cases per 1,000 in Nyagatare to 9.1 cases per 1,000 individuals in Bugesera and Ngoma districts. Among the 2,545 cases recorded by CHWs, three resulted in deaths. Regarding healthcare-seeking behavior, 13% of snakebite victims (143 out of 1,098) initially consulted formal care providers (CHWs, health post/center, or hospital), while 87% sought informal care (family/friends, pharmacist, or traditional healer). Approximately half of the victims (583, 53.1%) reported severe symptoms. Unsafe practices included skin cutting/burning, tourniquet application, use of black stones, and venom extraction; only 24 cases (2.2%) received anti-venom. This large-scale community-based assessment highlights variations in snakebite incidence between districts and confirms frequent involvement of traditional healers in management. Improving access to anti-venom and community education on the risks of ineffective practices, along with timely use of formal healthcare, are crucial. Collaboration between healthcare providers, traditional healers, community leaders, and policymakers is essential to implement targeted interventions for enhancing snakebite prevention and management strategies.

Impact of COVID-19 Lockdown: Stratified Livelihoods in Nepal a Sociological Analysis

Purpose: The COVID-19 pandemic prompted the government of Nepal to institute a series of lockdowns from March 24, 2020, significantly affecting the livelihoods of its citizens. This study explores stratified livelihoods during Pandemic lockdowns in Nepal and of these measures, uncovering nuanced and diverse experiences across different strata of Nepali society. Design/Methodology/Approach: Therefore, utilizing a qualitative research approach, the study employs primary and secondary data collection methods, such as observations and case studies, and analyses the data through content analysis techniques. Findings/Results: The findings reveal a spectrum of impacts, ranging from individuals finding solace and familial bonding during the lockdown—equating it to a period of celebration to those experiencing severe hardships. These hardships included undertaking long-distance travel on foot without adequate sustenance and facing limited access to medical care. The diverse experiences observed align, to some extent, with the theoretical frameworks of Marx and Weber, showcasing the varied socio-economic repercussions of the lockdown measures. Originality/Value: This research sheds light on the complex dynamics of pandemic interventions on livelihoods within the Nepali context. It provides valuable insights to understand and mitigate the multifaceted impacts of such measures on various societal layers.

Guardian of society: Civil society in Nigeria's response to COVID-19 pandemic.

The rapid breakout and dissemination of the coronavirus disease 2019 (COVID-19) infection from the city of Wuhan, China, to the rest of the countries of the world in December 2019 triggered a situation that led the World Health Organization to report it as a global public health emergency. The pandemic resulted in abrupt and significant loss of lives, disruption of economies, loss of livelihoods, and severe hardship across the nations of the world. Nigeria encountered the COVID-19 reality following the discovery of the first case of the infection in the country on February 27, 2020, prompting the government to swing into action to contain its spread. However, the government's response to the pandemic benefited from the support of nonstate actors from the profit and nonprofit sectors. This study, thus, specifically examined the role of civil society organizations (CSOs) in Nigeria's response to the coronavirus crisis. Using data obtained through secondary sources and analysis of thematic and descriptive-interpretive methods, the study found that CSOs impressively contributed to the government's fight against COVID-19, particularly in view of their roles in creating awareness about the virus and rebutting disinformation regarding the disease, among others. Yet, CSOs encountered some problems while undertaking these roles, prominently the closure of the civic space, noninclusion of CSOs in government's pandemic response architecture, and loss of funding. The study recommends, among other things, that in the case of any future public health emergencies of COVID-19 magnitude, the Nigerian Government should make CSOs an integral part of its response structure, while concluding that the application of these measures would incentivize better contributions from CSOs.

Exploring fidelity of enactment in a cluster randomised controlled trial testing the effectiveness of ‘gatekeeper’ training for pesticide vendors in reducing self-poisoning in rural Sri Lanka: protocol for a multimethod qualitative study

IntroductionPesticide self-poisoning causes severe health and socioeconomic hardship in low- and middle-income countries, including Sri Lanka. A stepped-wedge cluster randomised controlled trial (cRCT) has been designed to test whether ‘gatekeeper’...

Prediction and Mechanisms of Spontaneous Resorption in Lumbar Disc Herniation: Narrative Review.

The major symptoms of lumbar disc herniation (LDH) are low back pain, radiative lower extremity pain, and lower limb movement disorder. Patients with LDH suffer from great distress in their daily life accompanied by severe economic hardship and difficulty in self-care, with an increasing tendency in the aging population. PubMed and the Cochrane Central Register of Controlled Trials were searched for relevant studies of spontaneous resorption or regression in LDH after conservative treatment and for other potential studies, which included those from inception to June 30, 2023. The objective of this narrative review is to summarize previous literatures about spontaneous resorption in LDH and to discuss the mechanisms and influencing factors in order to assess the probability of spontaneous resorption by conservative treatment. Spontaneous resorption without surgical treatment is influenced by the types and sizes of the LDH, inflammatory responses, and therapeutic factors. If the lumbar disc herniated tissue comprises a higher percentage of cartilage or modic changes have been shown on magnetic resonance imaging (MRI), resorption in LDH is prevented. The bull's eye sign on enhanced MRI, which is a ring enhancement around a protruding disc, is a vital indicator for easy reabsorption. In addition, the type of extrusion and sequestration in LDH could forecast the higher feasibility of natural reabsorption. Moreover, the higher the proportion of protrusion on the intervertebral disc tissue within the spinal canal, the greater the likelihood of reabsorption. Therefore, which illustrates the feasibility of conservative treatments for LDH. Nonsurgical management of LDH with clinical symptoms is recommended by the authors.

Persistent Food Insecurity and Material Hardships: A Latent Class Analysis of Experiences among Venezuelan Refugees and Migrants in Urban Colombia.

The causes and conditions of displacement often increase the vulnerability of migrant and refugee populations to food insecurity, alongside other material hardships. We aimed to examine the multidimensional aspects and patterns of food insecurity and other material hardships in a cross-sectional sample of 6221 Venezuelan refugees and migrants in urban Colombia using a latent class analysis. Using multinomial and logistic regression models, we investigated the demographic and migratory experiences associated with identified classes and how class membership is associated with multiple health outcomes among Venezuelan refugees and migrants, respectively. Approximately two thirds of the sample was comprised cisgender women, and the participants had a median age of 32 years (IQR: 26-41). Four heterogeneous classes of food insecurity and material hardships emerged: Class 1-low food insecurity and material hardship; Class 2-high food insecurity and material hardship; Class 3-high income hardship with insufficient food intake; and Class 4-income hardship with food affordability challenges. Class 2 reflected the most severe food insecurity and material hardships and had the highest class membership; Venezuelans with an irregular migration status were almost 1.5 times more likely to belong to this class. Food insecurity and material hardship class membership was independently associated with self-rated health, mental health symptoms, and recent violence victimization and marginally associated with infectious disease outcomes (laboratory-confirmed HIV and/or syphilis infection). Social safety nets, social protection, and other interventions that reduce and prevent material hardships and food insecurity among refugees and migrants, alongside the host community, may improve public health, support development, and reduce healthcare costs. In the long term, regularization and social policies for migrants aimed at enhancing refugees' and migrants' social and economic inclusion may contribute to improving food security in this population.

Social work students in Aotearoa New Zealand: the impacts of financial hardship on mental and social wellbeing

ABSTRACT In Aotearoa New Zealand, approximately 3000 people are enrolled in a recognized social work education programme at any one time. A collaboration between researchers at two social work education providers sought to understand the experiences of student financial hardship, and its impact on wellbeing, amongst current social work students and recent graduates. In total, 346 students and recent graduates participated in a survey that gathered information Glossary of te reo Māori terms regarding financial circumstances, caring responsibilities, mental health and social wellbeing. As social work qualifications require a significant component of unpaid field education, this study reflects growing interest in the financial impact of studying for a social work qualification. This article explores some of the findings with particular focus on the impact of financial hardship on mental and social wellbeing. In particular, the study found that nearly one in four respondents reported experiencing moderate or severe financial hardship while studying, and that this had a significant impact on their mental and social wellbeing. In addition, those with caring responsibilities, especially accumulative caring responsibilities for children and others, were more likely to experience financial hardship. These results add weight to the call for greater support for those preparing to enter the social work workforce.

Resilience and Loyalty in the Face of Adversity: A Case of Local Employees in Kerala’s Backwater Tourism

Summary This case study reports on Kerala’s backwater tourism and the associated experiences of houseboat employees in the sector. Kerala’s backwater tourism is a significant facet of the state’s tourism industry, drawing both foreign and domestic tourists. Houseboats, referred to as ‘kettuvallam,’ play a central role in backwater tourism, harmonizing tradition with modernity. Despite gaining global recognition, challenges such as escalating costs and external crises, including the COVID-19 pandemic, have impacted Kerala’s backwater tourism sector, leading to severe hardship and job insecurity among employees. Despite these adversities, interviews conducted as part of the case study reveal remarkable levels of ongoing resilience and loyalty on the part of houseboat employees, most of whom are local residents. Their resilience and loyalty are rooted in affective commitment and intrinsic motivation, wherein houseboat employees see themselves as custodians of tradition and ambassadors of the backwater region. In turn, their unwavering dedication may be seen as being a vital factor that can contribute to the ongoing adaptability and resilience of the backwater tourism sector as a whole. Information © The Authors 2024

"As I Grew Older, My Life Got Better": Conceptions of Successful Aging among Older Women Living with or at Risk of HIV.

Successful aging (SA) is an important target for HIV care. However, we have insufficient understanding of how older women living with HIV (OWLH) in the US define SA. We explored conceptions of SA by OWLH and older women at risk of HIV and examined whether SA conceptions differed by (1) HIV serostatus, and (2) participation in the Women's Interagency HIV Study (WIHS). These analyses were part of a larger mixed-methods study with a sequential design. Participants were recruited at two clinical WIHS sites. We enrolled both WIHS participants and non-WIHS clinic patients. Our sample was 84% Black and included 29 OWLH and 15 older women at risk of HIV. We conducted 21 semi-structured interviews and four focus groups. The dataset was analyzed using descriptive, comparative, and relational analysis. We found four interlinked themes: life course perspective, accepting and celebrating aging, taking care of yourself, and looking good. The life course perspective was a core theme: participants assessed their aging in comparison to their earlier life hardships. These themes were similarly present among OWLH and older women at risk of HIV, although OWLH emphasized taking care of HIV. SA conceptualizations by OWLH did not differ whether or not they participated in the WIHS. Women living with or at risk of HIV may experience severe hardships throughout their lives. Overcoming these hardships may be linked to SA. Assessing the needs and connecting women to resources and programs are critical for SA promotion.

Change in screen time and overuse, and their association with psychological well-being among US-wide school-age children during the COVID-19 pandemic: analysis of the National Survey of Children’s Health (NSCH) years 2018–21

BackgroundPrevious studies on screen use and children’s mental health during the Coronavirus Disease 2019 (COVID-19) pandemic focused only on the timeframe during the pandemic, on children between narrow age ranges, only among a subset of children who have previously reported COVID-related severe family economic hardship or worries, or did not distinguish between instructive versus recreational device usage. Thus, in this study, we analyzed trends, specifically related to recreational screen use, and associations with psychological well-being (PWB) in the years before versus during the COVID-19 pandemic, among a wide range of school-aged children, widely across the nation.MethodsUsing the National Survey of Children’s Health (NSCH) years 2018–21, we analyzed a large random sample of school-aged children (6–17 years old) across the US (n = 88,823). We developed PWB issue scores (PWBIS) using self-reported measures relevant to this age group, and constructed regression models to assess the magnitude of the contribution of the pandemic on recreational screen use and PWB.ResultsThe prevalence of recreational screen overuse and PWBIS increased significantly during the pandemic, compared to prior years. We also detected a notable effect of the pandemic on increased PWBIS, as well as its interaction term finding that it strengthened the association between screen time and PWBIS (p < 0.01 across all regression models).ConclusionsAccordingly, our results demonstrate the importance of the pandemic itself as an independent adverse factor and effect measure modifier for screen overuse and PWB more generally among all school-age children widely across the US. Our study used the most current data available, and future studies to evaluate whether these effects are persistent in the years after the pandemic are important.

A qualitative system review: To lead public policy advancement for workplace psychological violence injury

This article presents a qualitative system analysis informing public policy advancement for workplace psychological violence injury. It is a unique look into how a jurisdiction responds to the injury caused by workplace psychological violence (workplace bullying, harassment, and discrimination campaigns). First ever provincial legislation addressing this harm was passed into law. This study found that the legislation has yet to be implemented into the medical response systems dealing with this workplace injury. Severe hardships and consequences are experienced by workers in attempting recovery. Some never get there. The Canadian Institute for Workplace Bullying Resources, a specialist with this injury, received this study's recommendations for system change to assist in closing gaps and reduce the harm experienced by workers in Alberta, Canada. This study found some causal factors to these system barriers to be common globally. Methods to map and lead advocacy system change through qualitative research for this workplace violence and caused injury are provided herein. This is a call to researchers and professionals globally who deal with both workplace psychological violence and injury, to use and build on this study's methods, tools, and outcomes to lead further needed system change.

ДЕПОРТИРОВАННЫЕ ПЕРЕСЕЛЕНЦЫ В ЛИЦЕ КАЗАХСТАНА ОБРЕЛИ СВОЮ ВТОРУЮ РОДИНУ

The author of the article uses various sources to depict the reception and settlement of deported ethnic groups in the Zhambyl region. The article highlights that, despite some local resistance, the inherent kindness and hospitality of the Kazakhs generally prevailed, overshadowing the regime's ideological dictates. This occurred in a context where local collective farmers often did not receive adequate food for their labor, and their children faced starvation. The conclusion of the article underscores that, despite enduring severe hardships, the deported peoples managed to overcome these challenges. With the support of the Kazakh community's tolerance, they not only secured an education but also improved their social and economic status, ultimately finding a new homeland in Kazakhstan.

Housing hardship and maternal mental health among renter households with young children

Maternal mental health is crucial to healthy family functioning and child well-being. Housing hardship may increase risk for mood disorders among mothers of young children in renter households. The present study used latent class analysis to investigate manifestations of housing hardship during the postpartum year in a sample of renter mothers in the United States (N = 2,329), as well as whether housing hardship types were associated with subsequent maternal depression and anxiety. The majority of mothers were relatively stably housed (“Stable”), one in six made do with governmental rental assistance (“Rent-Assisted”), and more than one in ten struggled to afford or maintain stable housing (“Cost-Burdened” or “Housing Insecure”). The most severe housing hardship was associated with the greatest depression risk, whereas the best determinant of anxiety risk was whether rent was paid each month; mothers whose rent was paid with government assistance did not differ on anxiety risk compared to those who paid their rent independently. Findings suggest that different types of housing hardship are linked with distinct mental health sequelae. Widely available housing assistance may reduce cost burden and prevent displacement, with the potential to reduce mental disorder among low-income mothers of young children.

Abstract A093: Implementation of a financial hardship screening among Native American patients with cancer

Abstract Introduction: Financial hardship and financial hardship screening are emerging concerns in oncology. Native American patients may be at increased risk of financial hardship due to factors including poverty, medical comorbidities, and lack of private health insurance coverage. Financial hardship for Native American patients with cancer has only rarely been studied, and implementation of screening for financial hardship for these patients has never been reported. Methods: Guided by input from a stakeholder advisory board consisting of patient, provider, and staff members at a single cancer center in Oklahoma, we implemented a financial hardship screening tool, the COmprehensive Score for financial Toxicity (COST) – Functional Assessment of Chronic Illness Therapy (FACIT) among 42 Native American patients with cancer. We conducted key informant interviews with ten of these patients and four clinical staff involved in the implementation process. Patient interviews included questions about current financial hardship, experiences in discussing financial hardship with the cancer care and primary care team, and acceptability of the COST-FACIT tool. Clinician interviews focused on their experience with the project, including implementation of the COST-FACIT tool, barriers to implementation, and sustainability. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. COST-FACIT tool data were analyzed using SAS v. 9.4 Results: Three-quarters (76%, n=32) of participants who completed the COST-FACIT tool reported moderate or severe financial hardship (Score &amp;lt;25 out of max 44, with lower scores indicating more hardship). A higher percentage of patients experiencing financial hardship were younger, covered by Medicaid, unemployed, not married/cohabiting, had lower income, and lower education compared to those with no/mild hardship (Scores ≥25). Among patients and clinicians, we identified themes of 1) financial hardship screening perception and intervention experiences, 2) screening efficacy and opportunities for improvement, and 3) systematic and patient related themes of Native American health systems and culture. Conclusions: Financial hardship was reported by the majority of Native American patients with cancer included in our study. Patients expressed a positive experience with the screening tool, including identification of financial challenges though timing of the tool in regards to their cancer diagnosis varied across patients. Clinicians experienced challenges in implementation of the COST-FACIT tool related to logistics, the COVID-19 pandemic, and concerns for sustainability. However, clinicians reported a positive experience with the tool and interactions with patients and referrals that resulted from the screening. Citation Format: Amanda E. Janitz, Amber S. Anderson-Buettner, Stefani D. Madison, Mark P. Doescher, Dorothy A. Rhoades. Implementation of a financial hardship screening among Native American patients with cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A093.

Financial Hardship and Age-Related Decrements in Kidney Function Among Black and White Adults in the Midlife in the United States Study.

This analysis examined if financial hardship was associated with age-related decrements in kidney function using a material-psychosocial-behavioral framework. We also tested if this association was mediated by comorbidity of cardiometabolic risk factors (obesity, elevated blood pressure, and insulin resistance). Data from 1361 non-Hispanic Black and White adults (ages 26-94 years; non-Hispanic Black = 258) were obtained from the Wave 3 and Refresher phases of the Midlife in the United States project. Kidney function was based on serum creatinine-based estimated glomerular filtration rate (eGFR; Chronic Kidney Disease Epidemiology Collaboration formula without race adjustment). Financial hardship was evaluated in three domains: material (income to poverty line ratio, health insurance coverage, and public/government financial assistance), psychological (perceived financial status, control over financial status, and perceived financial strains), and behavioral responses (financial adjustment/coping such as sold possessions and cutting back on spending). More severe financial hardship (overall score and in each domain) was associated with age-related decrements in eGFR, even after adjusting for sociodemographic, education, and health-related covariates. The association between financial hardship and age-related decrements in eGFR was conditional on sex but not race. Finally, cardiometabolic risk factors mediated the association between financial hardship and age-related decrements in eGFR. These findings affirm the negative effects of financial hardship on age-related decrements in renal clearance. In addition to incorporating traditionally used indicators of SES, such as education and income, future research on social hallmarks of aging should also consider the role of financial hardship on the aging process and age-related diseases.

Southern European press challenges in a time of crisis: A cross-national study of Bulgaria, Cyprus, Greece and Malta

The implications of the COVID-19 pandemic for newsrooms across the world range from severe economic hardship to increased threats to press freedom. The “perfect storm” that engulfed the media and journalists globally has threatened and continues to challenge their existence, and the core of their mission to serve the public interest. This study maps the impact of external political, economic, legal and societal factors on journalistic freedom and the way(s) news organizations and journalists operate in times of global crisis in four Southern European countries. It provides a fuller cross-national perspective on the complex relationship between media, journalism and politics in countries with existing democratic deficits. Findings are based on 32 semi-structured interviews with journalists working in four Southern European countries, namely Bulgaria, Greece, Cyprus and Malta, conducted in 2022. We find increased economic challenges to their fragile media markets, high level of state intervention, political parallelism in coverage of the pandemic and beyond, and numerous threats to the autonomy of journalists that hamper journalism and question its development in the future. The study’s implications are relevant to different contexts, particularly in countries where journalism and media face similar challenges.

“I felt super lucky:” Luck and administrative burden in cancer-related financial hardship.

198 Background: Financial hardship after cancer diagnosis is common and leads to earlier mortality and worse quality of life. This qualitative study sought to identify causal and protective factors for financial hardship as part of a larger study to refine a theoretical model and measure of financial hardship. Methods: We recruited female breast cancer survivors at a large comprehensive cancer center. Participants completed a semi-structured interview focused on their reflections of cancer diagnosis and active treatment. Interviews assessed multiple dimensions of financial hardship (coping, impacts, worry/anxiety, depression) and contributing, protective, and contextual factors. We conducted framework qualitative analysis of interview transcripts. Results: We interviewed eighteen women with breast cancer (100% early or regional stage; 77% White; mean age 57; time since diagnosis 3-24 years). Participants reported varying levels of financial hardship during diagnosis and treatment. Financial coping behaviors ranged from minor rebudgeting, to skipping or delaying healthcare, to major decisions about family structure (e.g. having children; marriage or divorce). Even successful financial coping induced stress (“it was just really painful”) because of administrative and time burden: hypervigilance to bills and finances; waiting in phone queues; negotiating with insurance companies and employers; liaising between employer, insurance company, and care team; and learning about, gathering documents, and applying for benefits (e.g. FMLA; disability). Employment and generous health insurance were protective, but out-of-network care and coverage denials tempered this protection and introduced stress. Worry about employment or insurance loss and the administrative burdens required to financially cope also created stress. Other protective factors were largely described as good luck, such as understanding bosses, flexible work arrangements, multiple household incomes, assistance from family and friends, or avoidance of more severe hardship (“we were fortunate we didn't lose our home"). Easily accessible health insurance was also described as good luck. Conclusions: Administrative and time burden required for financial coping behaviors can induce distress for women with breast cancer, even if successful in mitigating financial hardship. Luck emerged as a prominent protective factor. Luck and its relationship to structural factors that generate inequity may have ethical and policy implications for addressing cancer-related financial hardship and is worthy of further study.