Social Structural Factors Research Articles

Does husband\u2019s alcohol consumption increase the risk of domestic violence during the pregnancy and postpartum periods in Nepalese women?

BackgroundDomestic violence against women during pregnancy and the postpartum period not only violates the human rights of women but also harms on the health of both mother and child. Domestic violence is entrenching in social norms, customs and structural factors against women in Nepal. The use of alcohol also exacerbates domestic violence. The objective of this study was to determine the association between domestic violence against women and husband’s drinking behavior across the periods of pregnancy and postpartum.MethodsThis study was a cross-sectional study conducted in the antenatal care and postnatal care clinics of a government hospital in Kathmandu district. Among 660 women (aged 15–49), 165 women were consecutively recruited from each trimester of pregnancy and the postpartum period. Adjusted odds ratios (AOR) were computed from a multivariate logistic regression model to determine the association between domestic violence against women and the husband’s drinking behavior.ResultsWomen whose husbands drank alcohol were twice as likely to suffer from domestic violence, compared to those women whose husbands did not drink (AOR = 2.12; 95% CI: 1.4–3.2), independently of their socio-demographic status. Women suffered from domestic violence in each period of pregnancy and postpartum due to their husband’s drinking habits, but the most affected period was the second trimester of pregnancy. Among women who suffered from physical, psychological and sexual violence during the pregnancy and postpartum periods, 70.2, 67.9, and 64.2% respectively experienced violence due to their husband’s drinking habit. Other associated factors for domestic violence included the ethnic culture of Janjati ethnicity, illiteracy of the women, duration of marriage 2–5 years (compared to one year or less) and a husband who behaved in a controlling manner.ConclusionsHaving a husband who has alcohol drinking behavior is an important risk factor for domestic violence against women in the pregnancy and postpartum periods. Screening of alcohol use in husbands will not prevent domestic violence but could lead to a referral to integrated treatment for alcohol and domestic violence treatment.

Powering and Structuring Intersectionality: Beyond Main and Interactive Associations.

It is exciting to watch intersectionality travel from its roots in Black feminist activism and critical legal studies to increasingly more mainstream research domains such as psychology and psychopathology. We commend Mennies et al. (Journal of Abnormal Child Psychology, 2020) for their application of the intersectionality framework to the study of psychopathology and treatment utilization in youth in the ABCD study. We argue, however, that this application falls short of its intersectional promise. We discuss some conceptual and methodological/analytical issues that evidence the focal article's lack of alignment with intersectionality's core tenets, particularly regarding the central role of power and social-structural factors as drivers of inequities across intersectional positions. Specifically, we discuss our concerns with the testing and flattening of intersectionality, the selection and operationalization of intersectional positions, and the use of conventional regression models as quantitative analytical approach. We end by suggesting ways that intersectionality can help reduce the inequities in psychopathology and treatment utilization identified by Mennies et al. (Journal of Abnormal Child Psychology, 2020).

Global Applications of Culturally Competent Health Care: Guidelines for Practice ed. by Marilyn "Marty" Douglas et al.

Reviewed by: Global Applications of Culturally Competent Health Care: Guidelines for Practice ed. by Marilyn "Marty" Douglas et al. Fung Kei Cheng, PhD (bio) Global Applications of Culturally Competent Health Care: Guidelines for Practice. Marilyn "Marty" Douglas, Dula Pacquiao, & Larry Purnell (Eds.). Cham, Switzerland: Springer International Publishing AG (2018). doi:10.1007/978-3-319-69332-3. pp. 386. ISBN 978-3-319-69331-6, ISBN 978-3-030-09883-4, ISBN 978-3-319-69332-3 (eBook). Population diversity characterizes many countries, and diversified workforces have become noticeable on the managerial level, which affects the medical field. However, there is limited discussion of this issue from a health care perspective. This compilation, Global Applications of Culturally Competent Health Care: Guidelines for Practice, complies with the Guidelines for Culturally Competent Health Care endorsed by International Councils of Nurses to advance reductions in social inequality and the maintenance of health equity, and shares practical and clinical experiences in putting guidelines into practice. One set of goals of culturally competent care are to achieve decreases in hospital readmissions, length of stays in hospital, and revisits to the emergency department, as well as eventual improvements in health outcomes. Widely covering the Guidelines in its 10 parts (totalling 43 chapters), this book comprehensively elucidates the sophisticated skills used by health care professionals pertaining to their cultural knowledge, multicultural communication abilities, critical reflection capability, cross-cultural leadership manifestation, culturally competent health care implementation, allowance of patient empowerment, and sufficient training connected to these guidelines. It also articulates the importance of organizational resources and multicultural manpower in assessing the success of this health care model. Additionally, advocating research on culturally competent interventions, it promotes evidence-based studies that support the applicability of the Guidelines. The structure in each part contains a theory chapter and three or four case studies that exemplify cultural and social-structural factors, and subsequently propose culturally competent strategies for individual, organizational, and community-level interventions. In some cases, they also specify the role of human rights within a culturally competent health care system. This compilation highlights marginalisation within health care systems related to underserved (such as ethnic minorities and immigrants) and underprivileged (for example, the poor, sexual minorities, and victims of abuse) groups. In order to ensure extensive coverage, the authors of this book hail from North America, Asia, Europe, and the Middle East, enabling the editors to unveil the afflictions and hurdles caused [End Page 1083] by health inequalities that exist commonly across different continents. In particular, one autobiography (chapter 37) narrated the experience of a girl born in Sierra Leone, and how difficult it was to become educated in the nursing service in a country where females are normally excluded from schools. Summarizing suggestions from the authors, this compilation elaborates on collective wisdom from various dimensions. A macro view associated with environmental factors contributes by not only providing a culturally safe context that reduces patient fear, but also providing culturally responsive community resources that ensure adequate patient supplies. Equally important, micro domains emphasise practitioner attributes and empowerment. The former requires a compassionate mindset and multifaceted skills such as humour, respect, empathetic understanding, interactive patient-practitioner relationships, cross-cultural leadership, cultural congruence, and psychoeducation. The latter allows for patient autonomy and informed decisions, as well as fostering collaborative engagement. In addition, alternative rapport is inseparable from supportive services such as peer groups and the buddy system, traditional medicine and healing measures such as adjunctive therapy, religious coping or spirituality, health advocacy, and financial assistance. All these aim at approaching an individual comfort level and generating solutions that fit individual needs (that is, individualized patent care). With its macro and micro analyses of social and personal factors, this book sheds light on the importance of cultural sensitivity in modern medical organisations. Awareness of cultural diversity reaches professional quality when it helps the practitioner serve patients best, both physiologically and emotionally. It is necessary for health care specialists to enrich their conscious and unconscious cultural competence as an integral part of their practice, and to be well trained in counselling techniques. Although this book attempts to embrace diverse cultures, it seemingly inclines more towards Muslim cultures and pays limited attention to Western and...

With their children placed in kinship care, did parents get the services they needed?

This secondary analysis involved exclusively parents with children placed in kinship care by a child welfare agency. It examined associations between parents’ receipt of needed services and 6 sets of variables measuring parents’ needs, access to service providers, social structural factors, demographic factors, family resources, and child welfare interventions experienced. The sample of 731 parents was extracted from the National Survey of Child and Adolescent Well-Being II. Data were analyzed using generalized least squares random-effects modeling. Analysis showed an association in positive direction between the percentage of needed services parents received and 4 measures: Medicaid coverage, education, case plan’s specification of needed services, and racial/ethnic homogeneity of parent and child welfare caseworker. Association in negative direction was observed between the outcome and unavailability of services, difficulty accessing services, refusal of services, caseworker engagement perceived by parent, and physical maltreatment. Implications of results include the necessity that caseworkers list in case plans the accurately identified needs of parents for services, along with mandates for those services. Implications also include need for adequate training in building caseworker–parent working alliance and need for sustained focus on reunification.

Communication-related vulnerability to disasters: A heuristic framework

The concept of social vulnerability has been increasingly applied in disaster literature, but its communicative drivers have remained understudied. In this article, we put forward a heuristic framework for explaining how communication-related factors may adversely affect people's capacity to prepare for and respond to disasters. This will help researchers, policy makers, and practitioners in the field of disasters and crises to systematically identify individual, social-structural, and situational factors of vulnerability that shape how people access, understand, and act upon information about hazards. We integrate ideas from recent literature on information disorders – various forms and effects of false or harmful information that are characteristic to modern communication ecosystems – to improve our understanding of how the new media environments may transform the ways people learn about hazards and cope with disasters.

Punishments and the dominance identity in networks

In this study, we examine the effects of the structure of a network, the dominance identity of the actors, and the actors' ability to reward or punish on the use of punishment and the development of social bonds in a network. As expected, we find that peripheral rather than central actors in a network use punishment more, as do those with a high dominance identity. We also find that persons use punishment to increase or decrease their perceived level of dominance when their dominance identity is not verified. However, the patterns of interaction that develop in the network are an interactive function of network position, actor's dominance identity, and punishment use. We discuss how the social psychological drive to control one's identity interacts with social structural factors in the network to create different cultures of dyadic interaction.

The relationship between housing instability and intimate partner violence: A retrospective study.

To examine the relationship between housing instability (HI) and intimate partner violence (IPV) over time, controlling for individual, situational, and social structural factors among women and to determine whether race/ethnicity modifies these relationships. The study was a retrospective secondary data analysis from the Fragile Families and Child Well-Being Study. The sample included women who reported their housing status at year 5, yielding 4,000 women. Housing instability was our main independent variable. Our dependent variable of IPV was divided into two categories: no IPV or IPV overtime (IPV reported at baseline, year 1 and year 5). Women were more likely to report HI if they were between the ages of 20-24 (36%), Black (53.2%), did not graduate from high school (48.6%), and were employed with an income of less than $10,000 USD (69%). Race/ethnicity was not found to influence the association between HI and IPV overtime. Women in their early to mid-twenties, with a low level of education and are employed at low-wage jobs have an increased risk for HI and experiencing IPV. Therefore, nurses need to move beyond traditional assessments and screening to elicit information that will help determine increased risk for HI.

Meta-synthesis of Qualitative Research of Pre-exposure Prophylaxis (PrEP) Adherence Among Men Who Have Sex With Men (MSM).

The aim of the study was to consolidate evidence on barriers and facilitators to PrEP adherence among men who have sex with men. PubMed, Science Direct, and EBSCO host were utilized to search for relevant articles. Six articles from PubMed, published between 2010 and 2018, were reviewed. Thematic analysis was employed to synthesize findings. At the individual level, HIV susceptibility, knowledge of PrEP, and individual lifestyle affected PrEP adherence. At the organizational level, cost of PrEP and quality of PrEP services influenced adherence to PrEP. At the societal level, social stigma, financial assistance or medical insurance, and family and peer support were determinants of PrEP adherence. Facilitators included perceived high risk of HIV infection and payment assistance, while barriers included social stigma and high cost of PrEP. Social stigma and structural level factors such as payment assistance and cost of PrEP need to be examined to ensure optimal adherence to PrEP.

The Effect of Parental Educational Background on Child Health: Focusing on Comparison between the Low-income and Non-low-income Groups

In recent years, the issue of health inequality has emerged as an important social problem in Korean society. Recent empirical studies show that social structural factors have more impact on an individual’s health than personal factors. Based on this point, this study examined how parental educational background affects child health. The study compared and analyzed the differences between low-income and non-low-income groups, in particular, based on whether they benefited from public welfare. This study conducted a simple frequency analysis, a descriptive statistical analysis, a correlation analysis, and a multiple regression analysis using the 5th’s year data of the Seoul Panel Study of Children (SPSC). The analysis results show that low-income children were affected by their parents’ educational background, while non-low-income children were not. Especially for low-income children, the higher a mother’s educational background, the worse her child’s self-rated health. This is due to the ‘care deficit’ created by the economic difficulties of low-income families, as mothers, the main caregivers, are forced to make a living, and by the patriarchal family culture in Korea that says, “Children are raised by their mothers.” In order to solve these problems, this study argues that a gender-equal care culture should be established, while at the same time arguing that a delicate policy approach is needed. For example, this study argues that it is necessary to expand community-based social services for primary care (e.g. Woori-dongne-kium Centers launched by the Seoul Metropolitan Government) for low-income families that are in desperate need of support for primary care.

Mapping disparities in homicide trends across Brazil: 2000\u20132014

BackgroundHomicides are a major problem in Brazil. Drugs and arms trafficking, and land conflicts are three of the many factors driving homicide rates in Brazil. Understanding long-term spatiotemporal trends and social structural factors associated with homicides in Brazil would be useful for designing policies aimed at reducing homicide rates.MethodsWe obtained data from 2000 to 2014 from the Brazil Ministry of Health (MOH) Mortality Information System and sociodemographic data from the Brazil Institute of Geography and Statistics (IBGE). First, we quantified the rate of change in homicides at the municipality and state levels. Second, we used principal component regression and k-medoids clustering to examine differences in temporal trends across municipalities. Lastly, we used Bayesian hierarchical space-time models to describe spatio-temporal patterns and to assess the contribution of structural factors.ResultsThere were significant variations in homicide rates across states and municipalities. We noted the largest decrease in homicide rates in the western and southeastern states of Sao Paulo, Rio de Janeiro and Espirito Santo, which coincided with an increase in homicide rates in the northeastern states of Ceará, Alagoas, Paraiba, Rio Grande Norte, Sergipe and Bahia during the fifteen-year period. The decrease in homicides in municipalities with populations of at least 250,000 coincided with an increase in municipalities with 25,000 people or less. Structural factors that predicted municipality-level homicide rates included crude domestic product, urbanization, border with neighboring countries and proportion of population aged fifteen to twenty-nine.ConclusionsOur findings support both a dissemination hypothesis and an interiorization hypothesis. These findings should be considered when designing interventions to curb homicide rates.

Normativity and the Aging Self: “Active Longevity” Media Discourse in Contemporary Russia

This article explores the normative understandings of older adults, old age, and aging as they are articulated in the mainstream media’s discourse on “successful aging” and “active longevity” in contemporary Russia. I draw on critical gerontological approach and critical discourse analysis to examine the articles published in 2016–2018 in one of the most popular Russian weekly newspapers, Argumenty i Fakty (Arguments and Facts), which actively engages in discussions of “activity,” “longevity,” and “success” in later life. This article traces the consumerist logic behind the “successful aging” discourse, which takes the notion of “success” as a matter of lifestyle that can be maintained through individual’s voluntary reflexive participation in consumerist practices and, thus, ignores the social-structural factors affecting this process. The aging subject is invited to engage with the “successful aging” ideal and express their “reflexive” self through the practices of “managing” health and longevity, appearance and embodiment, and manifestations of sexuality. However, this “successful” management suggests a correlation with the conventional perceptions of femininity, masculinity, and sexuality, subjectivity buttressed with neoliberal values, and familial life in which the aging subject must remain a resource for younger generations. This analysis indicates that such standards exclude those life trajectories that do not comply with the norms of the discourses on aging in an “active” and “successful” way. Article in English DOI: 10.25285/2078-1938-2020-12-2-45-67

Digital contact-tracing and pandemics: Institutional and technological preparedness in Africa.

Several countries in Africa have either deployed or considering using digital contact-tracing (DCT) as part of their Covid-19 containment strategy, amidst calls for the use of technology to improve the efficiency of traditional contact-tracing. We discuss some of the complexities entailed in using DCT in Africa. Adopting a socio-technical perspective, we argue that if DCT design and deployment are not well thought out, it can lead to unintended consequences, particularly in a continent like Africa with disproportionate levels of digital divides and other structural inequalities. We suggest that any adoption of DCT by African countries must take account of their compatibility with local resources, values, social structure, and domestic political factors. Accordingly, we propose a process of translation whereby DCT adaptation is made to accommodate the unique institutional and technological characteristics of African countries by leveraging local practices learned from previous pandemics like Ebola to develop a blended epidemiological approach to (digital) contact-tracing.

Not what the doctor ordered: Motivations for nonmedical prescription drug use among people who use illegal drugs

BackgroundNonmedical Prescription Drug Use (NMPDU) is common among people who use illegal drugs. NMPDU is particularly problematic among this population however, as medications such as benzodiazepines and gabapentinoids can potentiate the harmful effects of opioids. Despite these harms, there is some evidence that NMPDU can have harm reducing and therapeutic potential for some people who use illegal drugs. This study provides further evidence of the harm reducing motives for NMPDU among people who use illegal drugs in community and prison settings in Wales, UK. MethodsIn depth, semi-structured interviews were conducted with 60 interviewees recruited from statutory and third sector drug treatment providers operating in five towns and cities in Wales, and from two Welsh prisons. Eligibility was based primarily on whether the person was currently (or previously) a user of illegal drugs and had recent experience of NMPDU. ResultsNMPDU was found to be largely driven by insufficient access to certain prescription medications and treatment. In this context, NMPDU played an important role in alleviating legitimate medical concerns and overcoming logistical and regulatory barriers associated with Opioid Substitution Therapy. NMPDU also had everyday practicality and mitigated many of the everyday harms experienced by people who use drugs, including opioid withdrawal and stimulant comedowns. ConclusionResults suggest that NMPDU has the potential to mitigate a number of legitimate medical concerns in the absence of treatment. Finding nuanced ways of responding to patient need whilst reducing the potential for NMPDU are therefore needed, and harm reduction strategies that harness the knowledge and expertise of people who use drugs should be encouraged. Additional policy measures that attend to the inequities and social-structural factors that produce and maintain the need to consume prescription medications in ways that are not intended are also required.

Utilizing a Life Course Approach to Examine HIV Risk for Black Adolescent Girls and Young Adult Women in the United States: A Systematic Review of Recent Literature.

Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this population during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key developmental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psychosocial, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women. Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States. In total, 21 studies met the inclusion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies assessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities. Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledgment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed.

Consensus Organizing and Community-Based Participatory Research to Address Social-Structural Disparities and Promote Health Equity

This case study illustrates the process of integrating community-based participatory research and consensus organizing in an effort to deconstruct social-structural risk factors and markers of health disparities, and build positive relationships between members of the criminal justice system and the community. Community residents, law enforcement, and other cross-sector partners engaged in an extensive planning initiative to address crime and social-structural risk factors in a majority African American community. Community-based participatory research and consensus organizing can be integrated as an effective approach to engaging and empowering communities to take action to dismantle social-structural disparities and promote a culture of health and well-being.

Factors Influencing National Identity and Intergenerational Differences: Based on Data from the 2013 China Social Survey

On the basis of the 2013 Chinese Social Survey (CSS) data, this paper makes an in-depth analysis of the influence of social, economic and cultural factors on the national identity of the population, with a focus on the differences between the younger and the older generation. Our findings show that the sense of national identity of the younger generation is weaker than that of the older generation, and this is even more marked among the tertiary-educated younger generation. The sense of national identity of the older generation is more influenced by social structural factors, especially by their position in the social hierarchy, while that of the younger generation is more affected by cultural and economic factors. In addition, we find that in China, the sense of national identity of the privileged stratum is stronger than that of the middle and base-level strata. These findings, which run counter to Huntington and Inglehart’s view of “the weakening of elite national identity,” may be due to the different roles of the state in globalization and economic growth.

Playing the Bullshit Game: How Empty and Misleading Communication Takes Over Organizations

Why is bullshit so common in some organizations? Existing explanations focus on the characteristics of bullshitters, the nature of the audience, and social structural factors which encourage bullshitting. In this paper, I offer an alternative explanation: bullshitting is a social practice that organizational members engage with to become part of a speech community, to get things done in that community, and to reinforce their identity. When the practice of bullshitting works, it can gradually expand from a small group to take over an entire organization and industry. When bullshitting backfires, previously sacred concepts can become seen as empty and misleading talk.

Socioeconomic inequality and adjustments in children’s perceptions of their agency as they age in South Korea

AbstractThis paper explores how children's perceptions of their agency, as something that is closely associated with its exercise, appear in relation to social structural factors, especially their socioeconomic positions, as they age. Using data from 862 10–18 years old in South Korea, we examine how children's expressed optimism about their ability to achieve their occupational choices can conceal the impact of structural factors on their ‘choices’ and dispositions for (non‐)action over time. Based on the findings, we argue for a more careful interpretation of children's sense of agency that recognises its propensity to continuously adjust in contexts of structural inequality.

Structural Competency: Curriculum for Medical Students, Residents, and Interprofessional Teams on the Structural Factors That Produce Health Disparities.

Research on disparities in health and health care has demonstrated that social, economic, and political factors are key drivers of poor health outcomes. Yet the role of such structural forces on health and health care has been incorporated unevenly into medical training. The framework of structural competency offers a paradigm for training health professionals to recognize and respond to the impact of upstream, structural factors on patient health and health care. We report on a brief, interprofessional structural competency curriculum implemented in 32 distinct instances between 2015 and 2017 throughout the San Francisco Bay Area. In consultation with medical and interprofessional education experts, we developed open-ended, written-response surveys to qualitatively evaluate this curriculum's impact on participants. Qualitative data from 15 iterations were analyzed via directed thematic analysis, coding language, and concepts to identify key themes. Three core themes emerged from analysis of participants' comments. First, participants valued the curriculum's focus on the application of the structural competency framework in real-world clinical, community, and policy contexts. Second, participants with clinical experience (residents, fellows, and faculty) reported that the curriculum helped them reframe how they thought about patients. Third, participants reported feeling reconnected to their original motivations for entering the health professions. This structural competency curriculum fills a gap in health professional education by equipping learners to understand and respond to the role that social, economic, and political structural factors play in patient and community health.

Violence and other social structural factors linked to incarceration for women living with HIV in Metro Vancouver: need for trauma-informed HIV care in prisons and post-Release

ABSTRACT Despite women living with HIV (WLWH) being disproportionately criminalized and overrepresented within correctional facilities, there remains limited longitudinal research with WLWH examining factors that make WLWH vulnerable to incarceration. Data are drawn from SHAWNA (Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research cohort with cisgender and transgender WLWH in Metro Vancouver, Canada. Multivariable logistic regression using generalized estimating equations (GEE) and an exchangeable working correlation matrix was used to prospectively model correlates of recent incarceration exposure over a seven-year period. Amongst 289 WLWH, 76% had been incarcerated in their lifetime, and 17% had experienced recent incarceration. In multivariable GEE analysis, younger age (AOR: 0.92 per year older, 95% CI: 0.89–0.96), recent homelessness (AOR: 2.81, 95% CI: 1.46–5.41), recent gender-based (physical and/or sexual) violence (AOR: 2.26, 95% CI: 1.20–4.22) and recent opioid use (AOR: 1.83, 95% CI: 1.00–3.36), were significantly associated with recent incarceration. Lifetime exposure to gender-based violence by police (AOR: 1.97, CI: 0.97–4.02) was marginally associated with increased odds of recent incarceration. This research suggests a critical need for trauma-informed interventions for WLWH during and following incarceration. Interventions must be gender specific, include housing and substance use supports, and address the impact of gender-based violence.