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社會學國際頂刊

Social Science & Medicine

（《社會科學與醫學》）

的最新目錄與摘要

Social Science & Medicine provides an international interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers.

The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization.

Journal Metric

Current Issue

Social Science & Medicine 為半月刊，最新一期（Volume 402, August 2026）包括“Review articles”“Regular articles”“Special Issue”三個欄目，共計20篇文章，詳情如下。

Content

Review articles

Equity of financial protection for health care in high-income countries: A systematic scoping review

Edward C. Xie, Diego Proa?o, Shehzad Ali, Sara Allin, ... Beate Sander

[Background]Financial protection is a central objective of health systems and a key mechanism for advancing health equity within universal health coverage. To date, evidence on the equity of financial protection in high-income countries has not been systematically synthesized. [Objective]To summarize the literature on the equity of financial protection for health care in high-income countries. [Methods]We conducted a systematic scoping review based on a published protocol. We searched four academic (Embase, MEDLINE, IBSS, EconLit) and three grey literature (WHO, OECD, World Bank) databases for data addressing four domains: (i) variables used to characterize equity, (ii) financial protection indicators, (iii) observed financial protection distributions, and (iv) conceptualizations of equity. Eligible records were original research published in any language since 2010. Two reviewers independently assessed records for eligibility. Findings were synthesized narratively. [Results]Seventy-five records were included from 4142 screened results, covering data from 48 countries. The largest number of studies focused on the Republic of Korea (n?=?13) and the United States (n?=?11). Inequalities of financial protection were observed for at least one determinant of health in each setting, across diverse indicators and individual or group stratifiers. Most studies insufficiently conceptualized equity, limiting assessment of outcomes as equitable or inequitable. Notable gaps include the underrepresentation of important variables (e.g. migration status, area-level deprivation, and social class), minimal examination of disproportionate advantage, and the inconsistent application of more equity-sensitive analytical methods. [Conclusion]This review provides the first systematic synthesis of evidence on the equity of health system financial protection in high-income countries. Key issues that warrant attention in future research and practice include clearer conceptualization of equity and the analysis of underrepresented determinants of health and disproportionate advantage.

Regular articles

"Why is my body malfunctioning?”: Legitimacy narratives of women experiencing chronic lactation insufficiency

Susanna Foxworthy Scott, Julie Searcy, Izzi Jordan

Despite medical and public health emphasis on breastfeeding, individuals with chronic lactation insufficiency (CLI), which is persistent low milk supply that does not resolve despite adherence to recommended lactation practices, often face clinical dismissal, diagnostic ambiguity, and shame. Drawing on narrative theory and legitimacy narratives, this study examines how women construct and negotiate the legitimacy of their CLI experiences across clinical, cultural, and experiential domains. We conducted in-depth semi-structured interviews with 30 women who self-identified as having experienced CLI, analyzing data using phronetic iterative analysis. Findings reveal that participants engaged in the four forms of legitimacy work: legitimizing suffering, asserting moral legitimacy through effort, seeking medical legitimacy, and pursuing public legitimacy. We extend legitimacy narrative theory through a proposed Triple Bind Framework, and argue that CLI narratives are structurally produced at the intersection of three dominant and mutually reinforcing master narratives: biomedical (“just use formula”), feminist (“trust your body”), and neoliberal (“try harder”). When all three fail to account for the physiological reality of CLI, women construct legitimacy narratives as epistemic resistance. These findings carry implications for patient-provider communication, calling for narrative humility, recognition of physiological risk factors, and dedicated support spaces for individuals with CLI. We argue that a biosocial perspective, one that honors embodied variation and invites women to co-create breastfeeding knowledge, is essential to improving maternal and infant health outcomes.

The impossibility problem: When public health policies require what structural conditions prevent

Katelin Albert, Jasmine Padam, Garry C. Gray

“Bubbles” were introduced as a nonpharmacological strategy in 2020 COVID-19 public health guidelines, comparable to social distancing measures. Despite the seemingly clear metaphor of bubbles, public communication and guidelines for bubbling across Canada and globally created a context of ambiguity, confusion, and inconsistency. It was up to individual citizens, households, groups, schools, and workplaces to know what a bubble was and how to implement bubbling practices. In spite of its widespread adoption as a pandemic intervention, little is known about how the public made sense of this guideline and how they attempted to follow this guideline in practice. Drawing on data from 39 semi-structured qualitative interviews with people in British Columbia Canada, between October and December 2020, this research study explains how people understood and responded to the idea of bubbles. Our findings reveal the role of situated trust and compensatory strategies in shaping bubbling practices in the context of multiple unknowns, as well as the disconnect between how people understood bubbles conceptually versus how they enacted them.

Looking through the cracks: vulnerabilities and deprivation in the Brazilian open drug scenes

Alexandra Almeida, Susan M. Kiene, María Luisa Zú?iga, Dan Werb, ... Francisco I. Bastos

[Background]Cocaine use is increasing worldwide, and Brazil, located along major transatlantic trafficking routes, has experienced widespread availability of low-cost crack, which circulates predominantly in open drug scenes (ODS). ODS are public spaces where drug use, purchase, sale, and social interaction converge. While national surveys have identified these settings as central to crack use, their social, structural, and spatial characteristics remain poorly understood. This study offers a nationwide description of Brazilian ODS, providing empirical evidence that can inform targeted, context-sensitive interventions. [Methods]We analyzed 3,787 ethnographic field notes from the 2014 Brazilian Crack Survey, a unique nationwide study describing the lived environments of ODS. Using Structural Topic Modeling with document-level covariates (location, weekday, and shift of observation), we identified recurring social, spatial, and behavioral patterns. Intertopic correlations guided the interpretation of broader thematic domains, and Topic Share statistics measured each topic's prevalence across scenes. [Results]ODS exhibited consistent signs of structural vulnerability, including lack of infrastructure, unstable housing, drug-use patterns, and uneven law enforcement dynamics. High-prevalence topics included crack paraphernalia sharing (TS?=?24.83%) and polydrug use (TS?=?15.95%). Areas marked by blatant poverty (TS?=?15.71%), whether related to favelas and under-bridge sites (TS?=?12.64%) or a significant presence of minors trafficking or using crack (TS?=?3.07%), were typical of the city outskirts. In contrast, ODS in commercial zones (TS?=?14.07%) involved unhoused populations (TS?=?5.13%) and a “cat-and-mouse” dynamic among dealers, people who use crack, and police (TS?=?8.94%). Hidden drug use (TS?=?13.36%) was associated with social stigma (TS?=?7.78%) and fear of law enforcement (TS?=?5.58%). [Conclusion]Brazilian ODS share a foundation of structural deprivation but vary substantially in their socioterritorial configurations. Recognizing this heterogeneity is essential for designing interventions that account for how place-specific infrastructures, stigma gradients, and local regulatory dynamics shape drug-use environments. These findings provide empirical support for public health and social policies that address the diverse realities of ODS across Brazil.

Proximity and positionality: Situating knowledge through the experiences of quantitative air quality data collectors working in participants’ homes

Elara Shurety, Frank J. Kelly, Diana Varaden

Data collection is a vital part of the research process, and those who conduct this work play a foundational role in shaping research. Despite this, the experiences and perspectives of frontline data collectors are often left underexamined by research teams and in wider literature. This paper presents the findings of a reflexive, qualitative study of 10 fieldworkers from a research project examining indoor air quality and childhood asthma in London, where multi-method quantitative data collection was undertaken in the homes of 110 participating households. Throughout, this paper underscores how fieldworkers’ positionalities influence both the emotional intensities of data collections and the production of knowledge. It examines the epistemic opportunities for research teams that can be gained from attuning to fieldworkers’ insights. Through attuning to place, this paper underscores the significance of the research setting, focusing here on the home-based data collection. This is considered with reference to the fields of environmental health, exposure science, and public health, where the growing interest in indoor ecologies and the intersection of housing and health necessitates an appraisal of home-based quantitative data collection.

Sense of coherence and the cultural organisation of barriers to healthy eating and active living in socioeconomically disadvantaged neighbourhoods in Uppsala

Martinell, Tove Fall, Meena Daivadanam

Jonas Idevall Hagren, Helle M?lsted Alvesson, Mats

[Objective]In salutogenic theory, sense of coherence (SOC) reflects an individual's capacity to mobilise appropriate resources to prevent barriers from becoming stressors. However, few studies have examined how culture defines the barriers and resources evaluated through SOC. Integrating salutogenesis with cognitive anthropology, we examine how SOC relates to cultural models of barriers to healthy eating and active living (HEAL) in socioeconomically disadvantaged neighbourhoods in Uppsala, Sweden. [Design]We used an iterative mixed-method approach. Qualitative analyses of interviews and observations identified barriers to HEAL. Participants then pile-sorted these barriers; shared structures were analysed using the quadratic assignment procedure and hierarchical cluster analysis. Factor analyses examined whether clusters aligned with participant difficulty ratings and Bayesian multivariate regression examined associations between extracted factors and SOC. Qualitative data were revisited to interpret relationships among SOC-associated factors. Data collection occurred between September 2023 and June 2024. [Results]Participants agreed on how HEAL barriers were organised into cultural subdomains. Seven subdomains yielded single-factor solutions. Four factors (_How Neighbours See Me_ ,_Social Change_ ,_Self-doubt_ ,_Exercise_ Support) covaried negatively with SOC. Qualitative analyses indicated that these factors cohered around themes of strong kinship bonds and mistrust toward outgroup members. [Conclusion]SOC showed selective associations within the cultural models of HEAL barriers. Thematic coherence across SOC-associated subdomains suggests a shared organising logic centred on close-tie interdependence in the setting. This pattern clarifies how SOC is implicated within a culturally organised HEAL domain and provides an exploratory basis for hypotheses about SOC in socioeconomically disadvantaged settings.

“I'm not just a large lady; I'm a large Black lady”: Intersectional stigma and barriers to healthcare access among Black women

Gashaye Melaku Tefera, Virginia Ramseyer Winter, Shelby Varol, Ally Terhaar, ... Kate Trout

Weight stigma in healthcare settings presents serious mental and physical health implications and contributes to disparities in healthcare access and outcomes. Using an intersectionality lens, this study examined how weight stigma experienced by large-bodied, low-income Black women in Missouri healthcare settings affects healthcare quality and access. We used qualitative design and in-depth interviews to collect data. Eligible participants identified as Black women (age ≥35) with BMI ≥30, low income (≤$60,000 for a family of four), Missouri residence, and English proficiency. 21 participants were included in the study using purposive and snowball sampling approaches. One 30–60-min semi-structured interview was completed per participant via Zoom/phone. Data analysis followed a thematic analysis. Six coders iteratively developed a codebook; intercoder reliability was strong (Cohen's κ?=?0.85). Intersectional stigma was pervasive and multifaceted. Participants described (1) weight-first framing that overshadowed other diagnoses, leading to misattribution and missed care; (2) cultural insensitivity and non-inclusive environments (lack of appropriate fitting gowns/equipment, stigmatizing imagery); (3) communication failures and dismissal, producing feelings of being unheard or judged; and (4) heightened medical mistrust rooted in historical and ongoing racism, resulting in delays or avoidance of care. Contextual barriers in low-income neighborhoods (e.g., limited healthy food and safe exercise spaces) were seldom acknowledged in clinical encounters. These results demonstrate that weight stigma cannot be disentangled from race, gender, and socioeconomic status in Black women's healthcare. Interventions should include weight-inclusive, culturally responsive, bias-aware training; increased representation of Black providers; redesigning clinical environments for inclusivity; and workflow changes that prioritize holistic assessment beyond weight. Findings inform practice, policy (e.g., respectful-care quality metrics), and future research to co-design solutions with patients and clinicians.

A tale of two discriminations: Examining social network pathways between healthcare and everyday discrimination and type 2 diabetes self-management among Black/African American men

Tyler Prochnow, Jeong-Hui Park, Meg S. Patterson, Ledric D. Sherman, Matthew Lee Smith

[Objective]Type 2 diabetes (T2D) disproportionately affects Black/African American men, with discrimination emerging as a critical factor influencing health outcomes through complex social pathways. This study examines how healthcare and everyday discrimination are differentially associated with diabetes self-management through social network mechanisms among this population. [Methods]A cross-sectional survey was conducted with 1225 Black/African American men using measures of perceived discrimination, four social networks (i.e., general communication frequency, diabetes-specific conversations, mean social support, and presence of highly supportive network members), and T2D self-care activities. Eight separate simple mediation models were estimated to examine each pathway independently, addressing multicollinearity concerns and providing interpretable estimates of individual associations. [Results]Healthcare discrimination and everyday discrimination demonstrated opposite associations with diabetes-specific conversations. Healthcare discrimination showed a negative association with diabetes-specific conversations (β?=?-0.21,p?<?.001), while everyday discrimination showed a positive association (β?=?0.15,p?<?.001). Both discrimination types showed negative associations with social support quality measures. Diabetes-specific conversations demonstrated the strongest association with self-care activities (β?=?0.24,p?<?.001). Healthcare discrimination operated through predominantly negative indirect pathways. Everyday discrimination showed competing pathways with positive indirect effects through communication dimensions and negative effects through support quality measures. Direct effects became non-significant after accounting for mediators. [Conclusion]Healthcare discrimination was negatively associated with health-focused conversations critical for disease management, while everyday discrimination was positively associated with communication while negatively associated with support quality. These findings suggest discrimination types require differentiated intervention approaches, with healthcare discrimination necessitating restoration of health information networks and everyday discrimination requiring enhanced support quality alongside existing communication mobilization.

Serial associations of depressive symptoms and functional impairment in the social isolation-cognitive function relationship: Findings from the Hubei Memory and Aging Cohort Study

Heqianxi Dong, Gui-Rong Cheng, Hua Meng, Yuan-Yuan Peng, ... Yan Zeng

[Background]Depressive symptoms and functional impairment link social isolation to poor cognitive function in older adults, though their serial indirect associations are unquantified. [Objective]To examine the association between social isolation and domain-specific cognitive function, and to hypothesize “depressive symptoms → functional impairment → cognitive domains” as a theoretically derived serial association model for statistical decomposition of correlations. [Methods]We conducted a cross-sectional analysis of 4,987 baseline participants (mean age 73.01?±?5.55; 57.0% female) from the Hubei Memory and Aging Cohort Study. We examined the indirect association between social isolation and cognitive domains via depressive symptoms and functional impairment using structural equation modeling (R Lavaan) with 5,000 bootstrap resamples, treating this analysis as a theory-based statistical decomposition of correlations among variables rather than a causal mediation analysis. [Results]The prevalence of social isolation was 34.5% among community-dwelling older adults. Depressive symptoms showed indirect associations with language (_β_ =??0.003; 3.19%) and attention (_β_ =??0.002; 2.25%). Functional impairment was associated with all cognitive domains: memory (_β_ =??0.012; 12.77%), language (_β_ =??0.014; 11.02%), attention (_β_ =??0.008; 8.99%), and executive function (_β_ =??0.017; 10.43%). The serial indirect association showed small coefficients across domains (_β_ =??0.002 to ?0.003; 1.84%–2.36%). Subgroup analyses indicated significance among rural residents and males. Joint analysis showed a stronger association in socially isolated individuals with low socioeconomic status. [Conclusions]Social isolation, depressive symptoms, and functional impairment correlate with domain-specific cognitive function, yet the serial structure implies no causality. Interventions should prioritize rural, male, and socioeconomically disadvantaged older adults.

Health migrations: How pre-migration healthcare experiences and US healthcare challenges shape immigrants’ transnational healthcare practices

Tiffany D. Joseph, Vibhustuti Thapa

Research examining immigrants' healthcare experiences in host countries have found that various structural and socio-cultural challenges impede their healthcare access. In response, migrants address unmet medical needs by engaging in what we call “transnational healthcare practices” (THCPs). But less research has explored how migrants' pre-migration healthcare experiences influence their negotiation of care across transnational contexts. This paper aims to fill that gap by addressing four questions: 1) How do pre-migration healthcare experiences at home shape immigrants' orientation to transnational healthcare practices (THCPs)?; 2) What structural and socio-cultural healthcare challenges facilitate migrants' THCPs?; 3) What THCPs do immigrants engage in?; and 4) How do providers' views of THCPs differ from migrants' perceptions? Data comes from 132 interviews conducted with Latin American immigrants and healthcare providers in Boston from 2012 to 2019. Findings indicate that: 1) pre-migration healthcare experiences generate “here” and “there” comparisons that facilitate migrants' THCPs in the US; 2) the complex and costly US healthcare system poses challenges that push migrants' THCP engagement; 3) migrants engage in THCPs like receiving medication from home, having transnational telehealth consultations, and traveling home for care; and 4) providers caution against THCPs because of health consequences, although migrants view them positively. Ultimately, THCPs represent migrants' agency to meet healthcare needs amid structural and socio-cultural challenges in the US healthcare system. Through highlighting the role of pre-migration healthcare practices at home as central to migrants’ THCPs, this article contributes to scholarship on transnationalism, immigration, and health care.

Ethics of transference care: Navigating personhood, data, and the dead in corneal donation

Ronja Tammi

This article examines how ethics is enacted in everyday corneal donation practices in a Finnish eye bank, focusing on the socio-technical and affective work of tissue coordinators. Drawing on two months of ethnographic fieldwork in 2024 at a Finnish university hospital eye bank, including participant observation and interviews, I introduce the concept of ethics of transference care to describe how ethical practices unfold across transition between life and death, data and bodies, and objectification and personhood. Building on scholarship on emotional labour, ethical labour, and ontological multiplicity, the analysis shows how coordinators navigate ethical ambiguity through repertoire switching and relational practices. By foregrounding the role of patient data and embodied encounters with the dead, the article advances practice-based understandings of ethics beyond formal ethical guidelines and protocols.

Migrant access to emergency health care: The significance of emotions

Simran Sandhu, Raelene Wilding, Sabrina Gupta

Migrant utilisation of emergency services is typically framed as either premature or delayed, positioning temporal responsiveness as central to patient outcomes and system efficiency. While these studies acknowledge structural barriers, such as system navigation, affordability and access, they pay less attention to the role that emotional and cultural processes might play in shaping how migrants recognise, interpret, and act upon health crisis. Building on recent attention to emotions in healthcare, this study interrogates the role of emotions in the emergency healthcare practices of older Indian migrants (aged 50+) living in Melbourne, Australia. Reflecting on qualitative interview and focus group data, we examine how emotions such as fear, shame, hesitation, and uncertainty shape emergency health practices. Our findings indicate that emotional responses are not incidental but rather emerge as central to the way care is navigated, delayed, or resisted. These emotions emerge from culturally specific understandings of illness and family responsibility and are further shaped by the challenges of adapting to unfamiliar healthcare systems. By centring emotion as both socially and culturally embedded, this study contributes to understandings of how health decisions are shaped not only by structural issues such as access, but also by being deeply situated in moral and emotional worlds.

Testing the sociocultural model of eating disorders: A cross-national analysis of income inequality, gender equality, and eating disorder rates

E.A. Harris, F.K. Barlow, A. Wu, D. Russo-Batterham, ... K.R. Blake

[Objective]We present the first study to examine associations between national income inequality, gender equality, and eating disorder rates. These factors have been linked with other health outcomes (e.g., depression) and relevant psychological outcomes (e.g., comparison, objectification). [Method]We use estimates of eating disorder DALY rates from the Global Burden of Disease Study (Study 1,_N_ =?204 nations) and eating disorder tweeter rates (Study 2,_N_ =?104 nations). We measure income inequality using the Gini index and gender equality using five measures: gender equality in education, paid work, and parliament, the Hill/Karim Index, and the Gender and Social Norms Index. We group countries into regions, reporting within- and between-region associations controlling for national development. [Results]Within-region, we find limited evidence that income inequality and gender equality are associated with eating disorder DALYs or tweeter rates. Between-region, income inequality was associated with higher eating disorder DALYs and tweeter rates; findings for gender equality were mixed in Study 1, and in Study 2, gender equality was associated with higher eating disorder tweeter rates. [Discussion]Within-region null findings may reflect limited statistical power and regional homogeneity. Between-region, income inequality was associated with higher eating disorder burden and online discussion, consistent with previous research linking income inequality with poorer health. Between-region results for gender equality were mixed; however, we found almost no evidence that gender equality was correlated with fewer eating disorders. Between-region analyses should be interpreted with caution due to low statistical power. We discuss implications for theory and measurement.

“They don't care”: The implications of systemic racism on Black women's help-seeking during the COVID-19 pandemic

Anna Pirsch, Lucy Mkandawire-Valhmu, Hanan Abusbaitan, Alexa A. Lopez, ... Jeneile Luebke

[Objectives]Black women in the United States experience disproportionately high rates of intimate partner violence (IPV) and persistent barriers to care. Guided by decolonial frameworks, this study examines how systemic racism shaped Black women's help-seeking during the COVID-19 pandemic. [Methods]This qualitative inquiry is part of a mixed-methods R01 study conducted in the Upper Midwest. Between 2021 and 2023, we conducted semi-structured interviews with 28 urban Black women who experienced IPV during the pandemic. Participants were recruited through community agencies using purposive and snowball sampling. Interviews examined help-seeking, system interactions, and perceptions of safety. Data were thematically analyzed using an interpretive approach informed by Black feminist thought. [Results]Three interrelated themes shaped help-seeking: (1) mistrust rooted in racialized harm; (2) mistrust reinforced through harmful interactions with institutions; and (3) conditions that supported trust. Help-seeking was shaped by individual histories, community context, and perceived safety. [Conclusions]Systemic racism shapes Black women's help-seeking following IPV. Public health responses must address structural drivers of mistrust, strengthen culturally responsive and trauma-informed care, and center lived experiences to advance trust, cultural safety, and accountability in policy and practice.

Silence as a discourse regime in professional interactions within hospitals

Antoine Glauzy, Jean-Philippe Bouilloud

In social science and medicine, silence is frequently mentioned in studies of interprofessional interactions or physician–patient relationships, yet it is most often treated as a secondary phenomenon or a deficit in communication. Consequently, the interactional norms governing silence and its role in organizing professional interactions remain underexplored. This study addresses this gap by examining silence as an object of analysis in professional activities. Based on ethnographic observations and semi-structured interviews conducted in a hospital specializing in severe liver and pancreatic diseases, the study analyses how silence is produced, regulated, and enacted within situated professional interactions. Drawing on Foucault's theory of the order of discourse combined with an interactional perspective, we show that silence in hospital settings is not an absence of communication but a codified, context-dependent mode of regulation shaping how speech circulates between professionals. Our findings show that silence operates differently across interactional settings. During medical staff meetings, it regulates turn-taking and filters contributions according to their relevance for therapeutic decision-making. In the operating room, silence is tied to the spatio-temporal organization of surgical activity, functioning as an interactional resource supporting coordination, concentration, and the management of clinical risk. By conceptualizing silence as an interactionally accomplished discursive regime rather than an individual failure to speak up, this study extends research on voice and psychological safety by showing that silence is not only shaped by social and organizational dynamics but also by discursive regimes that structure the circulation of speech, professional authority, and expertise in hospital work.

Reducing tobacco supplier profits and pricing power: Modelling the impact of a tobacco price cap and tax increase on socioeconomic inequalities in England

Duncan Gillespie, Damon Morris, Ryan Kai Le Chen, Alan Brennan, J. Robert Branston

[Background]The tobacco industry generates substantial profits from products causing significant health and societal costs. These profits enable the industry to use pricing as a flexible marketing tool. Consequently, calls exist for a scheme to cap wholesale tobacco prices and offset this with higher taxation, reducing price variation and potentially raising revenue. This study models the health and economic impact of such a scheme in England. [Methods]We used the Sheffield Tobacco and Alcohol Policy Model, an individual-level microsimulation, to project tobacco consumption, spending, and health outcomes for adults in England aged 18–89 from 2025 to 2044. We investigated six scenarios for a wholesale price cap and concomitant tax rises, comparing outcomes against a business-as-usual scenario. [Results]Outcomes varied with the price cap level; lower caps and higher tax rises yielded larger behavioural effects, particularly for the most disadvantaged quintile. All scenarios showed a narrower market price range, lower smoking prevalence, higher tax revenue, reduced mortality, and fewer hospital admissions. Industry revenues declined, while consumer expenditure remained largely unchanged. An immediate hard cap could generate ￡4.9 billion by 2029 and, by 2044, 1,636 fewer deaths, 43,987 fewer years of life lost, and 10,073 fewer hospital admissions. Sensitivity analyses show health benefits are robust, although stronger consumer responses slightly reduce tax revenue while increasing health gains. [Conclusions]A tobacco wholesale price cap and tax increase scheme could raise substantial tax revenue, improve health, and reduce health inequalities, whilst limiting the scope to use price as a marketing tool.

Special Issue

Life course socio-economic effects in later life cognitive functioning by cohort, gender and origin

Liili Abuladze, Luule Sakkeus

Later life cognitive health depends on both individual as well as broader structural characteristics, with health inequalities rooted in the long-term organisation of social life. This paper examines a context of social transformation into and out of state socialism, affecting the distribution and accumulation of resources differently across population groups. We analyse later life cognitive health by cohort, gender, and migrant origin, including respondents aged 50 and over from SHARE Estonia (2010-2022), who report information on variables of interest (N?=?5170). The roles of childhood and adulthood socio-economic positions (SEP) are analysed separately in a restricted sample (N?=?2907). Using hybrid and correlated random-effects models, we distinguish within- and between-person effects in verbal recall change for two cohorts – those born in 1930-44 and 1945-59. We find steeper individual verbal recall decline in general for men, but not for migrants, in both cohorts. Gendered cognitive trajectories were not origin- or cohort-specific. Regarding the role of life course socio-economic factors in later life health, we find support for the sensitive period model, the pathway model and the accumulation model.

Critical model of resilience in children and youth from a Latin American polycrisis context based on a mixed-methods study

Felipe Agudelo-Hernández, Yulissa Mosquera-Cetre, Helena Vélez-Botero

This study proposes a critical resilience model for children and youth in Latin American polycrisis contexts, marked by overlapping adversities including poverty, environmental degradation, armed conflict, and institutional abandonment. In this cross-sectional, sequential mixed-methods study, we combined standardized instruments with culturally grounded focusgroups in Indigenous and Afro-descendant communities in Colombia's Chocó region (n?=?187, aged 7-29). Quantitative findings reveal a paradox: high resilience scores despite severe structural deprivation—food insecurity, coercive parenting, violence exposure. Regression analysis identified both risk and protective factors, highlighting complex relationships between adversity and adaptive responses. Narratives emphasized resilience not as passive adjustment but as collective resistance, spiritual balance, and political agency, what participants termed “to live is to resist.” We therefore distinguish resilience from resistance, political agency, and habituated endurance. Rather than rejecting resilience per se, we critique its depoliticized use: in contexts of polycrisis, standardized resilience scores may register persistence under structural harm without adequately differentiating flourishing from normalized suffering. This convergence challenges dominant individualistic resilience conceptions and supports a relational, culturally situated framework informed by Latin American critical theory. Together, the findings support a relational, culturally situated, and justice-oriented understanding of resilience and call for mental health strategies that strengthen collective life while addressing the structural roots of suffering.

Early life adversity and cardiometabolic risk in adolescents: Comparison of dimensional and cumulative approaches to adversity

Leah Cha, DaiJa Moorehead, Katie A. McLaughlin, Jennifer A. Sumner

[Background]Early life adversity (ELA) is associated with cardiometabolic risk over the lifespan. While cumulative risk models of ELA have provided insights into those most vulnerable, emerging evidence suggests that ELA dimensions of threat and deprivation have distinct consequences for neurodevelopment. However, these dimensions remain understudied in relation to cardiometabolic risk. [Methods]We assessed associations between ELA—comparing cumulative risk and dimensional approaches—with a cardiometabolic risk composite in youth aged 9-19 (_n=_ 117). Using a multi-method approach, youth and caregivers reported on youths’ ELA experiences at baseline and 2-year follow-up visits; reports were aggregated to reflect lifetime experiences of threat and deprivation at follow-up. In addition to threat and deprivation composites, a cumulative ELA composite was calculated by summing the number of threat- and deprivation-related experiences. At follow-up, youth provided measures of blood pressure, body mass index, and waist circumference; indicators were standardized and summed. [Results]Regression models revealed that the cumulative ELA composite was not significantly associated with cardiometabolic risk. However, threat-related ELA, but not deprivation-related ELA, was associated with greater cardiometabolic risk, adjusting for age and sex. Furthermore, age moderated the deprivation-cardiometabolic risk association, such that greater deprivation was linked to lower cardiometabolic risk in late childhood/early adolescence, but not in middle or late adolescence. [Conclusion]Results indicate that dimensional models of ELA may offer more nuanced understanding of biological embedding of adversity and its relevance for cardiometabolic risk, with stronger risk associations observed for threat-related experiences in youth.

Precision medicine ‘versus’ or ‘for’ public health? Different configurations of precision medicine in relation to the social determinants of health

Ilaria Galasso, Martyn Pickersgill, Giuseppe Testa

The relationship between precision medicine (PM) and public health (PH) is far from straightforward. On the one hand, some scientific experts envision PM as helping to advance PH interventions and the health of populations. This is argued to be realisable through a framework that they term ‘precision public health’ (PPH). On the other hand, a range of PH and other scholars question whether PM is a ‘distraction’ from population-wide health urgencies; in particular, inequalities relating to the social determinants of health (SDH). Consequently, individualized PM is framed as coming at the expense of the population. This paper examines these two poles and other positions in-between, and vis-à-vis major national PM initiatives, to investigate how PM is configured in relation to the SDH. Specifically, we analysed documents relevant to, and conducted qualitative interviews in the context of, the USA Precision Medicine Initiative (PMI) and the UK 100,000 Genomes Project (100KGP). Through these data, we characterise three principal configurations of PM that enact particular relationships with PH that have varying implications for health and societies. We conclude by re-examining the potential contributions of PM to generating knowledge and policy in relation to the SDH, and by calling for PM to more reflexively intervene within the health of populations through - and with - the sociopolitical domain.

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《中國社會學學刊》（The Journal of Chinese Sociology）于2014年10月由中國社會科學院社會學研究所創辦。作為中國大陸第一本英文社會學學術期刊，JCS致力于為中國社會學者與國外同行的學術交流和合作打造國際一流的學術平臺。JCS由全球最大科技期刊出版集團施普林格·自然(Springer Nature)出版發行，由國內外頂尖社會學家組成強大編委會隊伍，采用雙向匿名評審方式和“開放獲取”(open access)出版模式。JCS已于2021年5月被ESCI收錄。2022年，JCS的CiteScore分值為2.0（Q2），在社科類別的262種期刊中排名第94位，位列同類期刊前36%。2023年，JCS在科睿唯安發布的2023年度《期刊引證報告》（JCR）中首次獲得影響因子并達到1.5（Q3）。2025年JCS的CiteScore分值為3.4，在社科類別的286本期刊中排名第75位，位列同類期刊前27%（Q2）。

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