Unintended Consequences Research Articles

Intended and unintended effects of cannabis regulation in Uruguay

Ten years after Uruguay legalised cannabis, the country’s experience provides valuable insights regarding the implementation of such a policy. Uruguay’s regulation of cannabis represented an innovative policy based on a state-controlled model that yielded both expected and unexpected effects. To study these effects, we employed a qualitative research design and analysed six key outcome dimensions: accessibility, pharmacies, cannabis social clubs, quantity, prices and quality. The research included 23 interviews with key informants and 25 interviews with frequent cannabis consumers, complemented by secondary data analysis. We propose that the unintended effects of the policy, such as the formation of a ‘grey market’ – the illegal distribution of legally produced cannabis – are attributable to: (1) the novel character of the regulation and, therefore, the lack of an evidence base to guide policy design and implementation; (2) the different preferences and policy dynamics that shaped the three different governments in office during the period; and (3) an implementation gap.

A Framework of Foreseen and Unforeseen Harms in Transformative Service Systems

Transformative service systems (TSSs) are designed to uplift human well-being. Yet, paradoxically, by necessity and in design, TSSs can also generate unintended harms for system actors. Our conceptual paper builds on recent service literature, as well as that on unintended consequences from a range of fields, to advance an integrative framework of harms in TSSs. Through the enabling theory of the doctrine of double effect, our framework organizes harms in the transformative service context, identifying that unintended harms can be both foreseen and unforeseen. Additionally, we find that the mechanism underlying these harms is system emergence. Emergence arises from the relative complexity of the service system and the relative dynamism of the issue the TSS aims to address. Our framework demonstrates that greater service system complexity increases the likelihood of foreseen harms, while greater relative dynamism increases the likelihood of unforeseen harms arising. Furthermore, we show how these two factors combine to promulgate the emergence of harms. We find that in instances where harm arises, greater service system adaption is required to mitigate such harms. However, some TSS harms are an inevitable and unfortunate secondary outcome of doing good, and these harms necessitate acknowledgment and acceptance by service designers.

Myocardial ischaemic syndromes: a new nomenclature to harmonize evolving international clinical practice guidelines.

Since the 1960s, cardiologists have adopted several binary classification systems for acute myocardial infarction (MI) that facilitated improved patient management. Conversely, for chronic stable manifestations of myocardial ischaemia, various classifications have emerged over time, often with conflicting terminology-e.g. 'stable coronary artery disease' (CAD), 'stable ischaemic heart disease', and 'chronic coronary syndromes' (CCS). While the 2019 European guidelines introduced CCS to impart symmetry with 'acute coronary syndromes' (ACS), the 2023 American guidelines endorsed the alternative term 'chronic coronary disease'. An unintended consequence of these competing classifications is perpetuation of the restrictive terms 'coronary' and 'disease', often connoting only a singular obstructive CAD mechanism. It is now important to advance a more broadly inclusive terminology for both obstructive and non-obstructive causes of angina and myocardial ischaemia that fosters conceptual clarity and unifies dyssynchronous nomenclatures across guidelines. We, therefore, propose a new binary classification of 'acute myocardial ischaemic syndromes' and 'non-acute myocardial ischaemic syndromes', which comprises both obstructive epicardial and non-obstructive pathogenetic mechanisms, including microvascular dysfunction, vasospastic disorders, and non-coronary causes. We herein retain accepted categories of ACS, ST-segment elevation MI, and non-ST-segment elevation MI, as important subsets for which revascularization is of proven clinical benefit, as well as new terms like ischaemia and MI with non-obstructive coronary arteries. Overall, such a more encompassing nomenclature better aligns, unifies, and harmonizes different pathophysiologic causes of myocardial ischaemia and should result in more refined diagnostic and therapeutic approaches targeted to the multiple pathobiological precipitants of angina pectoris, ischaemia and infarction.

The unintended consequences of merit-based teacher selection: Evidence from a large-scale reform in Colombia

Teacher quality is a key factor in improving student academic achievement. As such, educational policymakers strive to design systems to hire the most effective teachers. This paper examines the effects of a national policy reform in Colombia that established a merit-based teacher-hiring system intended to enhance teacher quality and improve student learning. Implemented in 2005 for all public schools, the policy ties teacher-hiring decisions to candidates’ performance on an exam evaluating subject-specific knowledge and teaching aptitude. The implementation of the policy led to many experienced contract teachers being replaced by high exam-performing novice teachers. We find that though the policy sharply increased pre-college test scores of teachers, it also decreased the overall stock of teacher experience and led to sharp decreases in students’ exam performance and educational attainment. Using a difference-in-differences strategy to compare the outcomes of students from public and private schools over two decades, we show that the hiring reform decreased students’ performance on high school exit exams by 8 percent of a standard deviation, and reduced the likelihood that students enroll in and graduate from college by more than 10 percent. The results underscore that relying exclusively on specific ex ante measures of teacher quality to screen candidates, particularly at the expense of teacher experience, may unintentionally reduce students’ learning gains.

Cross-sector collaboration to reduce health inequalities: a qualitative study of local collaboration between health care, social services, and other sectors under health system reforms in England

BackgroundPolicymakers across countries promote cross-sector collaboration as a route to improving health and health equity. In England, major health system reforms in 2022 established 42 integrated care systems (ICSs)—area-based partnerships between health care, social care, public health, and other sectors—to plan and coordinate local services. ICSs cover the whole of England and have been given explicit policy objectives to reduce health inequalities, alongside other national priorities.MethodsWe used qualitative methods to understand how local health care and social services organizations are collaborating to reduce health inequalities under England’s reforms. We conducted in-depth interviews between August and December 2022—soon after the reforms were implemented—with 32 senior leaders from NHS, social care, public health, and community-based organizations in three ICSs experiencing high levels of socioeconomic deprivation. We used a framework based on international evidence on cross-sector collaboration to help analyse the data.ResultsLeaders described strong commitment to working together to reduce health inequalities, but faced a combination of conceptual, cultural, capacity, and other challenges in doing so. A mix of factors shaped local collaboration—from how national policy aims are defined and understood, to the resources and relationships among local organizations to deliver them. These factors interact and have varying influence. The national policy context played a dominant role in shaping local collaboration experiences—frequently making it harder not easier. Organizational restructuring to establish ICSs also caused major disruption, with unintended effects on the partnership working it aimed to promote.ConclusionsThe major influences on cross-sector collaboration in England mirror key areas identified in international research, offering opportunities for learning between countries. But our data highlight the pervasive—frequently perverse—influence of national policy on local collaboration in England. National policymakers risked undermining their own reforms. Closer alignment between policy, process, and resources to reduce health inequalities is likely needed to avoid policy failure as ICSs evolve.

Investigating Pregnant Women's Attitudes toward Herbal Remedies: A Cross-Sectional Study.

Herbal remedies play a significant role in daily life, regardless of region or ethnicity. While they offer various health benefits, they may also pose risks, including toxicity and undesirable side effects. Pregnant women, one of the most vulnerable populations, frequently use herbal remedies, often without informing their healthcare providers, which can lead to unforeseen consequences for both the mother and the fetus. A total of 590 women participated in an online survey designed to assess demographic factors, awareness of herbal remedies during pregnancy, and the potential impact of these remedies on maternal and fetal health. The survey revealed that 35.8% of the participants used herbal remedies during pregnancy. The most common reasons for their use were beliefs in their safety and family recommendations. Anise (Pimpinella anisum L.) was the most frequently used herb. The findings indicate that pregnant women generally have limited knowledge about herbal remedies and their potential risks. To mitigate this, it is essential to develop and disseminate comprehensive safety and efficacy guidelines. Both physicians and pregnant women should be well-informed to ensure the protection of maternal and fetal health.

A Pandemic of Mental Health: Evidence from the U.S.

The direct impact of the COVID-19 pandemic and the indirect impact of the ensuing economic and political response have affected the United States on a large scale. We document a substantial surge in anxiety and depression symptoms from 2019 to 2020 driven by the young adult population, indicating a disproportional indirect impact on the young. Multivariate regression analysis was utilized to quantify the stringency of state responses’ indirect effect on the changes in anxiety or depression symptoms during the pandemic. While we observe a slight decline in the share of the adult population experiencing anxiety and depression through July 2021- June 2022, such decline does not compensate for the large surge of mental health issues among young adults in 2020. Overall, our results indicate that the effects of the stringency of the mitigation measures on different areas of health are complex and vary by state, with a wide variation of mental health-related issues by age group and a higher prevalence in younger adult age categories. After discussing inequities in the accessibility of mental health treatment, lack of health insurance, and implications for quality of life among young adults, this paper adds to the breadth of ongoing COVID-19 research and emphasizes the importance of considering the overall health of the population in a large-scale health crisis as well as discussing the potential unintended consequences of the mitigation measures put in place.

Informal Foreign Currency Market Rate Coordination and Remittance Flows

ABSTRACT An unintended consequence of remittance flows to economically troubled countries may be the exacerbation of parallel foreign currency market activities. Studying clandestine markets is often hobbled by a lack of data on informal market coordination mechanisms. This paper examines the impact of the sudden cessation of an informal foreign currency exchange reference rate in Zimbabwe on inward remittance flows and public attention to money transfer operators. While the reference rate existed, there was bi-directional feedback between black market currency rates and retail diaspora remittance flows, but not with the flows of non-governmental organizations (NGOs). The abolition of the informal reference rate did not stall retail diaspora remittance flows. NGO remittances reacted negatively to the ban, suggesting concerns with government policy. Online attention on money transfer operators increased after the reference rate’s cessation suggesting remitters shifted to formal channels. Accordingly, remittance costs reduced significantly.

Working less for longer: unintended effects of longevity adjustment of retirement age

AbstractUsing a standard macro model with overlapping generations in the manner of Blanchard–Yaari, we show that by broadening the labour supply on the extensive margin through longevity adjustment of the statutory retirement age, labour supply is likely to decrease on the intensive margin. However, this backlash effect depends on the specific design of the pension system. It is significantly higher under a pay-as-you-go scheme with fixed benefits compared to a pay-as-you-go scheme with fixed contributions and a fully funded scheme based on voluntary savings. The findings have implications for responses to the fiscal and macroeconomic challenges raised by an ageing population.

Subordinated service environments: how branding can create unintentional service exclusion

Purpose This study aims to explore unintended effects of branding in a healthcare environment. Children’s hospitals often treat both women and children. The current research examines the implications of sub-branding women’s services and its potential impact on how patients and providers perceive these services. Design/methodology/approach A multi-actor qualitative method is used, incorporating in-depth interviews, focus groups and observations. This approach allowed for a comprehensive understanding of how hospital administrators, physicians, staff and patients perceive service exclusion when women’s services are located within a children’s hospital. Findings The findings suggest that sub-branding can have negative effects on both patients and providers. The data show that this can lead to service exclusion due to perceptions of confusion and a lack of belonging. As a result, sub-branding women’s services in a children’s hospital may unintentionally create a subordinated service environment for adult patients and their providers, which has important implications for policy and other service settings. Originality/value The authors introduce the concept of a subordinated service environment and explore how patients and providers perceive sub-branded women’s services in children’s hospitals. The study contributes to service theory by showing how and why branding efforts can unintentionally lead to service exclusion.

Power imbalance in hospital dual management system and its impact on turnover.

With the deepening of the healthcare reform in China, the competition in the sector is becoming fiercer leading to several unintended consequences such as talent turnover, which highly affect hospital development. Taking the case of a specialized university-affiliated stomatology hospital in Guangzhou, this thesis aims to analyze the main factors that contribute to talent turnover in this type of hospitals. The loss of talents in the field of stomatology is not unique to China and represents a significant problem in both developed and developing countries. The data for the study were collected from post facto live interviews conducted with 21 resigners to understand their feelings and motivations after the passage of time. The data were coded and concepts refined using MAXQDA software to form 18 sub-categories and six aggregate dimensions leading to the construction of two theoretical models. The balance of power embedded in the dual leadership system characteristic of Chinese organizations and corresponding leadership style and behavior, deeply affect the turnover of talents. The more unbalanced the power, the greater the impact on turnover. Based on the situation studied, a power imbalance allowed for individual behaviors that determined the development of the hospital and directly affected institutional fairness, culture, working atmosphere and ultimately led to turnover.

Confirmation dialog box in the physical world: design strategies on tangible confirmation behavior in human-machine interaction

In tangible irreversible human-machine interactions (HMIs), erroneous inputs resulting from users’ unfamiliarity, inattention, or ingrained habits can lead to unintended consequences. Although some design measures like buttons with protective shells or safety switches before critical actions have been implemented to minimize human errors in both everyday products and industrial interfaces, a cohesive guiding strategy on when, where, and how to prevent unintended consequences is lacking. Inspired by the confirmation dialog boxes commonly utilized in graphical user interfaces, this study proposes design strategies for effective tangible confirmation behaviors in HMIs. Initially, a workshop was conducted to gather design cases and explore potential design opportunities in future scenarios. By analysing the outcomes, we propose an evaluation method for assessing the necessity and complexity requirements of confirmation design and introduce a design library considering complexity levels graded by users’ time, effort, and cognitive load expenditure. Subsequently, a user behavior experiment was conducted to validate the feasibility and efficacy of the proposed strategies. Our strategies offer valuable references for designers, highlighting the significance of confirmation design in preventing human errors. Following these strategies, designers and engineers can integrate more Kansai engineering principles into HMIs to ensure user safety, protect property, and enhance interaction efficiency.

Fuelling injustice? Safeguarding equity in anti‐fossil fuel norms

AbstractThis article explores anti‐fossil fuel norms (AFFNs), which set behavioral standards for phasing out practices and processes across the fossil fuel supply chain. In recent years, AFFNs have emerged and become increasingly institutionalized in global climate governance. However, they remain contested and have not yet achieved widespread acceptance. Much of the contestation concerns the perceived equity of these norms. Drawing on insights from the literature on AFFNs and expert interviews, this article investigates equity‐related issues that arise in the context of four key AFFNs: phasing out coal‐fired power, phasing out oil and gas, ending public financing for fossil fuels, and reforming fossil fuel subsidies. We find that each of these norms is well placed to contribute to a shift away from a fossil fuel‐based economy. However, these norms are often framed in ways that do not account for the distributional impacts of this shift, which may lead to unintended and inequitable consequences. We conclude that AFFNs need to be developed and deployed to actively consider the needs of marginalized communities. Policymakers and non‐governmental organizations can work together to develop norms that prioritize addressing equity and distributional justice concerns in the transition away from fossil fuels.

Prenatal testing technologies in Australia: Unintended clinical and emotional complexities in underprepared systems

The past decade has seen technological advances in prenatal screening technologies rapidly integrated into clinical practice. These technologies have revolutionised healthcare and raised complex socio-ethical issues such as equitable access, medical commercialisation, and new eugenics. However, the important issue of the impact of these technologies on healthcare professionals is receiving less attention. Exploring this issue in the Australian context, we conducted a survey from August to November 2022, targeting health and allied health professionals who work with parents in the perinatal period who have received a fetal diagnosis. We received 75 substantive responses from a diversity of professionals, including sonographers, midwives, genetic counsellors and medical providers.In this article, we consider the unintended impacts of prenatal screening technologies on healthcare workers, drawing from Ziebland et al., ’s 2021 unintended consequences framework. Our reflexive thematic analysis produced three key themes: “Unintended Clinical Complexities”, “Adapting Work Practices to Keep Up in Systems that Lack”, and “Unintended Intensification of Emotional Labour”. Prenatal testing technologies have intentionally increased early testing and fetal information, offering veiled promises of increased certainty in pregnancy. However, our analysis highlights that these advancing technologies also generate more ambiguous results, creating unintended clinical and emotional complexities for healthcare providers. Workers must manage increased clinical uncertainty and constant change, creating intensified emotional labour in under-prepared systems. We conclude by identifying the need to recognise the impacts of advancing prenatal screening technologies on healthcare workers and for targeted professional training to prepare healthcare professionals for the complexities introduced by these new technologies.

Public Perception of the Tobacco 21 Amendment on Twitter in the United States: Observational Study.

Following the signing of the Tobacco 21 Amendment (T21) in December 2019 to raise the minimum legal age for the sale of tobacco products from 18 to 21 years in the United States, there is a need to monitor public responses and potential unintended consequences. Social media platforms, such as Twitter (subsequently rebranded as X), can provide rich data on public perceptions. This study contributes to the literature using Twitter data to assess the knowledge and beliefs of T21. Twitter data were collected from November 2019 to February 2021 using the Twitter streaming application programming interface with keywords related to vaping or e-cigarettes, such as "vape," "ecig," etc. The temporal trend of the T21 discussion on Twitter was examined using the mean number of daily T21-related tweets. Inductive methods were used to manually code the tweets into different sentiment groups (positive, neutral, and negative) based on the attitude expressed toward the policy by 3 coders with high interrater reliability. Topics discussed were examined within each sentiment group through theme analyses. Among the collected 3197 tweets, 2169 tweets were related to T21, of which 444 tweets (20.5%) showed a positive attitude, 736 (33.9%) showed a negative attitude, and 989 (45.6%) showed a neutral attitude. The temporal trend showed a clear peak in the number of tweets around January 2020, following the enactment of this legislation. For positive tweets, the most frequent topics were "avoidance of further regulation" (120/444, 27%), "Enforce T21" (110/444, 24.8%), and "health benefits" (81/444, 18.2%). For negative tweets, the most frequent topics were "general disagreement or frustration" (207/736, 28.1%) and "will still use tobacco" (188/736, 25.5%). Neutral tweets were primarily "public service announcements (PSA) or news posts" (782/989, 79.1%). Overall, we find that one-third of tweets displayed a negative attitude toward T21 during the study period. Many were frustrated with T21 and reported that underage consumers could still obtain products. Social media data provide a timely opportunity to monitor public perceptions and responses to regulatory actions. Continued monitoring can inform enforcement efforts and potential unintended consequences of T21.

Topic territoriality and the cost of civility: examining the impact of IP address disclosure on Weibo

Abstract This article introduces the concept of “topic territoriality,” a mechanism that governs participation in conversational spaces. When a discussion becomes prone to territorialization, individuals are more likely to claim topics (participating in discussions about topics they own as “stakeholders”) and defer (reducing participation in topics owned by others). They are also more likely to patrol topic boundaries (monitoring who is participating and confronting topic “intruders”). We document the operation of topic territoriality by analyzing 112,278 conversational turns on Weibo before and after a policy that reveals users’ broad geographic locations. We find that revealing these locations increased territorial behaviors, leading to more homogenous participation in conversations. Although the display of locations has improved the overall civility in language, the confrontations between stakeholders and intruders became more toxic. Our research emphasizes the impact of topic territoriality in online conversations and sheds light on the unintended consequences of social media policies.

PACMHCI, VI, MHCI, September 2024 Editorial

Welcome to this issue of the Proceedings of the ACM on Human-Computer Interaction, which brings together contributions from the Mobile Human-Computer Interaction (MHCI) community. This issue showcases innovations in research focused on mobile, wearable, and personal devices. Research in MHCI encompasses both technical innovations and social considerations. Mobile technologies accompany us throughout our daily lives: at home, at work, in traffic, and out in the wild. However, while mobile technologies provide the capacity for constant connectivity, they also pose risks of harm and unintended consequences. There has never been a more pressing time to debate and explore the meaning of digital culture, and to understand how mobile technologies can and should be used to connect us, our data, and mobile applications and services in meaningful ways - true to the conference theme of 'Connecting Cultures'.

The role of asset-based pedagogy in an interactive view of reading

In this paper, we present an Asset-Based Interactive View of Reading that builds on the Active View of Reading, Self-Determination Theory, and Asset-Based Pedagogy to consider the role of students’ individual, linguistic, and cultural resources in understanding reading processes. We begin by discussing some of the limitations with the ways Science of Reading has been narrowly conceived, which includes the (perhaps unintended) consequences of reliance on the Simple View of Reading. We then elaborate on each of the three components of our proposed framework to address assumptions of cultural neutrality and universal application in educational psychology. We conclude with implications for research, policy, and practice.

Co-exposure to microplastics and soil pollutants significantly exacerbates toxicity to crops: Insights from a global meta and machine-learning analysis

Environmental contamination of microplastics (MPs) is ubiquitous worldwide, and co-contamination of arable soils with MPs and other pollutants is of increasing concern, and may lead to unexpected consequences on crop production. However, the overall implications of this combined effect, whether beneficial or detrimental, remain a subject of current debate. Here, we conducted a global meta and machine-learning analysis to evaluate the effects of co-exposure to MPs and other pollutants on crops, utilizing 3346 biological endpoints derived from 68 different studies. Overall, compared with control groups that only exposure to conventional soil contaminants, co-exposure significantly exacerbated toxicity to crops, particularly with MPs intensifying adverse effects on crop morphology, oxidative damage, and photosynthetic efficiency. Interestingly, our analysis demonstrated a significant reduction in the accumulation of pollutants in the crop due to the presence of MPs. In addition, the results revealed that potential adverse effects were primarily associated with crop species, MPs mass concentration, and exposure duration. Our study reaffirms the substantial consequences of MPs as emerging pollutants on crops within the context of integrated pollution, providing novel insights into improving sustainability in agro-ecosystems.

Vertical and lateral dynamics of middle managers’ strategizing for institutional complexity

Abstract Research suggests that institutional complexity is of strategic importance and recent calls have been made to investigate organizational strategizing in such a situation of multiple institutional logics. We therefore investigate middle managers’ strategizing for institutional complexity. In doing so, we follow theoretical suggestions of a renewed practice-based view on strategizing as a broad social accomplishment beyond top management activities. Based on a qualitative field study in a company under influence of substantive financial reform, findings show that middle managers re-strategize institutional complexity at the vertical interstices of top management strategies and the distributed agency of their followers. Furthermore, the study highlights the character and effects of lateral dynamics of middle managers’ competing strategizing. We explain how these vertical and lateral dynamics provide insight into strategizing for institutional complexity as a distributed, situated, and emergent social accomplishment. Such strategizing practices have unintended organizational consequences beyond both top and middle management control.