RESUMO
ASCO's new policy statement on SDOH supports practices that sustain and advance cancer health equity.
Assuntos
Neoplasias , Determinantes Sociais da Saúde , Humanos , Determinantes Sociais da Saúde/normas , Neoplasias/terapia , Neoplasias/epidemiologia , Oncologia/normas , Oncologia/métodos , Política de Saúde , Sociedades Médicas/normasRESUMO
El objetivo de esta Estrategia y plan de acción sobre la promoción de la salud en el contexto de los Objetivos de Desarrollo Sostenible 2019-2030 es renovar la promoción de la salud por medio de acciones sociales, políticas y técnicas que aborden los determinantes sociales de la salud, con el fin de mejorar la salud y reducir las inequidades en el contexto de la Agenda 2030. Este documento está vinculado a la Estrategia para el acceso universal a la salud y la cobertura universal de salud de la OPS y se centra en el trabajo con todos los niveles de gobierno, en particular el nivel local, para empoderar a las personas y comunidades en sus entornos y territorios. Dada su importancia, la intersectorialidad y la participación social se consideran como dos ejes transversales en todo el plan de acción y deberían reflejarse en las actividades para alcanzar cada línea estratégica (véase el anexo A). El compromiso con los principios del respeto de los derechos humanos, la equidad y la inclusión, teniendo en cuenta específicamente las cuestiones de género, la etnicidad, la interculturalidad y las discapacidades entre otros aspectos, es la base de todas las líneas estratégicas de acción. Cada país deberá adaptar la respuesta nacional, subnacional y local a su propia situación, contexto y prioridades. El presente plan de acción se basa en cuatro líneas estratégicas de acción que se refuerzan mutuamente, a saber, fortalecer los entornos saludables clave; facilitar la participación y el empoderamiento de la comunidad, y el compromiso de la sociedad civil; fortalecer la gobernanza y el trabajo intersectorial para mejorar la salud y el bienestar, y abordar los determinantes sociales de la salud, y fortalecer los sistemas y servicios de salud incorporando un enfoque de promoción de la salud.
The goal of this Strategy and Plan of Action on Health Promotion within the Context of the Sustainable Development Goals 2019-2030 is to renew health promotion through social, political, and technical actions, and addressing the sustainable development goals in order to improve health and reduce health inequities within the context of the 2030 Agenda. This document is linked to PAHO's Strategy for Universal Access to Health and Universal Health Coverage and focuses on work with all levels of government, but particularly the local level, to empower people and communities in their settings and territories. Given the importance of intersectoral action and social participation, these are considered as two cross-cutting axes throughout the Plan of Action and should be reflected in actions to achieve each strategic line. Commitment to the principles of respect for human rights, equity, and inclusivity, with specific consideration of gender, ethnicity, interculturality and disabilities, among others, underpins all the strategic lines of action. Each country will need to tailor its national, subnational, and local responses to its own situation, context and priorities. This Plan of Action is based on four mutually reinforcing strategic lines of action: strengthening key healthy settings; enabling community participation and empowerment and civil society engagement; enhancing governance and intersectoral work to improve health and well-being and address the social determinants of health; and strengthening health systems and services by incorporating a health promotion approach. The Strategy and Plan of Action on Health Promotion are aligned with the Universal Access to Health and Health Coverage 2014, the Astana Declaration 2018 and the Sustainable Development Goals.
Le but de la Stratégie et plan d'action sur la promotion de la santé dans le contexte des objectifs de développement durable 2019-2030 est de renouveler la promotion de la santé grâce à des mesures de nature sociale, politique et technique qui agissent sur les déterminants sociaux de la santé, afin d'améliorer la santé et de réduire les iniquités en santé dans le contexte du Programme à l'horizon 2030. Le présent document est lié à la Stratégie pour l'accès universel à la santé et la couverture sanitaire universelle de l'OPS et est axé sur la collaboration avec tous les niveaux de gouvernement, mais en particulier le niveau local, visant à accroître l'autonomie des personnes et des communautés dans leurs milieux et leurs territoires. Étant donné l'importance de l'action intersectorielle et de la participation sociale, ces deux aspects sont considérés comme représentant deux axes transversaux dans l'ensemble du plan d'action et devront se traduire par des mesures destinées à réaliser chaque axe stratégique (voir l'annexe A). L'adhésion aux principes de respect des droits de l'homme, de l'équité et de l'inclusivité, en tenant compte plus particulièrement du sexe, de l'appartenance ethnique, de l'interculturalité et des handicaps, entre autres facteurs, sous-tend tous les axes stratégiques d'intervention. Chaque pays devra adapter les réponses qu'il met en Åuvre aux niveaux national, infranational et local à sa propre situation, à son propre contexte et à ses propres priorités. Ce plan d'action se fonde sur quatre axes stratégiques d'intervention qui se confortent mutuellement : renforcer des milieux sains névralgiques ; permettre la participation et l'autonomisation des communautés et la mobilisation de la société civile ; consolider la gouvernance et l'action intersectorielle en vue d'améliorer la santé et le bien-être et d'agir sur les déterminants sociaux de la santé, et renforcer les systèmes et les services sanitaires par l'intégration d'une approche de promotion de la santé.
Assuntos
Humanos , Estratégias de Saúde Locais , Determinantes Sociais da Saúde/normas , Desenvolvimento Sustentável , Integralidade em Saúde , Promoção da Saúde/normasRESUMO
BACKGROUND: The current Coronavirus disease pandemic reveals political and structural inequities of the world's poorest people who have little or no access to health care and yet the largest burdens of poor health. This is in parallel to a more persistent but silent global health crisis, antimicrobial resistance (AMR). We explore the fundamental challenges of health care in humans and animals in relation to AMR in Tanzania. METHODS: We conducted 57 individual interviews and focus groups with providers and patients in high, middle and lower tier health care facilities and communities across three regions of Tanzania between April 2019 and February 2020. We covered topics from health infrastructure and prescribing practices to health communication and patient experiences. RESULTS: Three interconnected themes emerged about systemic issues impacting health. First, there are challenges around infrastructure and availability of vital resources such as healthcare staff and supplies. Second, health outcomes are predicated on patient and provider access to services as well as social determinants of health. Third, health communication is critical in defining trusted sources of information, and narratives of blame emerge around health outcomes with the onus of responsibility for action falling on individuals. CONCLUSION: Entanglements between infrastructure, access and communication exist while constraints in the health system lead to poor health outcomes even in 'normal' circumstances. These are likely to be relevant across the globe and highly topical for addressing pressing global health challenges. Redressing structural health inequities can better equip countries and their citizens to not only face pandemics but also day-to-day health challenges.
Assuntos
Desigualdades de Saúde , Acessibilidade aos Serviços de Saúde/normas , Pobreza/estatística & dados numéricos , Saúde Pública/normas , Determinantes Sociais da Saúde/normas , Animais , COVID-19/epidemiologia , COVID-19/prevenção & controle , Saúde Global/normas , Saúde Global/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Saúde Pública/estatística & dados numéricos , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/estatística & dados numéricos , Tanzânia/epidemiologiaRESUMO
The "great AIDS patient revolt" had a major impact on the world of health care in Western countries. It is considered to be one of the social factors that led to the emergence of the notion of health democracy at the turn of the century. A look back at a historic struggle.
Assuntos
Síndrome da Imunodeficiência Adquirida , Acessibilidade aos Serviços de Saúde , Ativismo Político , Humanos , Síndrome da Imunodeficiência Adquirida/história , Síndrome da Imunodeficiência Adquirida/terapia , Democracia , Desigualdades de Saúde , Acessibilidade aos Serviços de Saúde/história , Acessibilidade aos Serviços de Saúde/normas , Infecções por HIV/história , Infecções por HIV/terapia , Determinantes Sociais da Saúde/história , Determinantes Sociais da Saúde/normas , História do Século XX , História do Século XXIAssuntos
Ensaios Clínicos como Assunto , Saúde das Minorias , Seleção de Pacientes , Hipertensão Arterial Pulmonar , Doenças Raras , Ensaios Clínicos como Assunto/métodos , Ensaios Clínicos como Assunto/organização & administração , Ensaios Clínicos como Assunto/normas , Acessibilidade aos Serviços de Saúde , Humanos , Saúde das Minorias/etnologia , Saúde das Minorias/normas , Avaliação das Necessidades , Hipertensão Arterial Pulmonar/etnologia , Hipertensão Arterial Pulmonar/terapia , Doenças Raras/etnologia , Doenças Raras/terapia , Sistema de Registros/normas , Sistema de Registros/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/normas , Populações Vulneráveis/estatística & dados numéricosRESUMO
Socioeconomic disparities in cardiovascular risk factors and outcomes exist among women, particularly those of minority racial or ethnic backgrounds. Barriers to optimal cardiovascular health begin early in life-with inadequate access to effective contraception, postpartum follow-up, and maternity leave-and result in excess rates of myocardial infarction, stroke, and cardiovascular death in at-risk populations. Contributing factors include reduced access to care, low levels of income and social support, and lack of diversity among cardiology clinicians and within clinical trials. These barriers can be mitigated by optimizing care access via policy change and improving physical access to care in women with geographic or transportation limitations. Addressing structural racism through policy change and bolstering structured community support systems will be key to reducing adverse cardiovascular outcomes among women of racial and ethnic minorities. Diversification of the cardiology workforce to more closely represent the patients we serve will be beneficial to all women.
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Doenças Cardiovasculares , Determinantes Sociais da Saúde , Saúde da Mulher , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Feminino , Humanos , Saúde das Minorias , Saúde da População Rural , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/normasRESUMO
Importance: Quality of care of young adults with acute myocardial infarction (AMI) may depend on health care systems in addition to individual-level factors such as biological sex and social determinants of health (SDOH). Objective: To examine whether the quality of in-hospital and postacute care among young adults with AMI differs between the US and Canada and whether female sex and adverse SDOH are associated with a low quality of care. Design, Setting, and Participants: This retrospective cohort analysis used data from 2 large cohorts of young adults (aged ≤55 years) receiving in-hospital and outpatient care for AMI at 127 centers in the US and Canada. Data were collected from August 21, 2008, to April 30, 2013, and analyzed from July 12, 2019, to March 10, 2021. Exposures: Sex, SDOH, and health care system. Main Outcomes and Measures: Opportunity-based quality-of-care score (QCS), determined by dividing the total number of quality indicators of care received by the total number for which the patient was eligible, with low quality of care defined as the lowest tertile of the QCS. Results: A total of 4048 adults with AMI (2345 women [57.9%]; median age, 49 [interquartile range, 44-52] years; 3004 [74.2%] in the US) were included in the analysis. Of 3416 patients with in-hospital QCS available, 1061 (31.1%) received a low QCS, including more women compared with men (725 of 2007 [36.1%] vs 336 of 1409 [23.8%]; P < .001) and more patients treated in the US vs Canada (962 of 2646 [36.4%] vs 99 of 770 [12.9%]; P < .001). Conversely, low quality of post-AMI care (748 of 2938 [25.5%]) was similarly observed for both sexes, with a higher prevalence in the US (678 of 2346 [28.9%] vs 70 of 592 [11.8%]). In adjusted analyses, female sex was not associated with low QCS for in-hospital (odds ratio [OR], 1.05; 95% CI, 0.87-1.28) and post-AMI (OR, 1.07; 95% CI, 0.88-1.30) care. Conversely, being treated in the US was associated with low in-hospital (OR, 2.93; 95% CI, 2.16-3.99) and post-AMI (OR, 2.67; 95% CI, 1.97-3.63) QCS, regardless of sex. Of all SDOH, only employment was associated with higher quality of in-hospital care (OR, 0.72; 95% CI, 0.59-0.88). Finally, only in the US, low quality of in-hospital care was associated with a higher 1-year cardiac readmissions rate (234 of 962 [24.3%]). Conclusions and Relevance: These findings suggest that beyond sex, health care systems and SDOH that depict social vulnerability are associated with quality of AMI care. Taking into account SDOH among young adults with AMI may improve quality of care and reduce readmissions, especially in the US.
Assuntos
Infarto do Miocárdio/psicologia , Qualidade da Assistência à Saúde/normas , Fatores Sexuais , Determinantes Sociais da Saúde/normas , Adulto , Canadá/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Determinantes Sociais da Saúde/estatística & dados numéricos , Estados Unidos/epidemiologiaAssuntos
COVID-19 , Desenvolvimento Infantil , Determinantes Sociais da Saúde/normas , Estresse Psicológico , Adaptação Fisiológica , Adaptação Psicológica , Adolescente , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Saúde da Criança , Humanos , Saúde Mental , Responsabilidade Social , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Estresse Psicológico/prevenção & controle , Estresse Psicológico/psicologiaRESUMO
OBJECTIVE: To describe MiPATH (the Michigan Plan for Appropriate Tailored Healthcare in pregnancy) panel process and key recommendations for prenatal care delivery. METHODS: We conducted an appropriateness study using the RAND Corporation and University of California Los Angeles Appropriateness Method, a modified e-Delphi process, to develop MiPATH recommendations using sequential steps: 1) definition and scope of key terms, 2) literature review and data synthesis, 3) case scenario development, 4) panel selection and scenario revisions, and 5) two rounds of panel appropriateness ratings with deliberation. Recommendations were developed for average-risk pregnant individuals (eg, individuals not requiring care by maternal-fetal medicine specialists). Because prenatal services (eg, laboratory tests, vaccinations) have robust evidence, panelists considered only how services are delivered (eg, visit frequency, telemedicine). RESULTS: The appropriateness of key aspects of prenatal care delivery across individuals with and without common medical and pregnancy complications, as well as social and structural determinants of health, was determined by the panel. Panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for: 1) prenatal visit schedules (care initiation, visit timing and frequency, routine pregnancy assessments), 2) integration of telemedicine (virtual visits and home devices), and 3) care individualization. Panelists recognized significant gaps in existing evidence and the need for policy changes to support equitable care with changing practices. CONCLUSION: The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.
Assuntos
Atenção à Saúde/normas , Cuidado Pré-Natal/normas , Atenção à Saúde/métodos , Técnica Delphi , Feminino , Humanos , Recém-Nascido , Michigan , Gravidez , Complicações na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Medição de Risco , Fatores de Risco , Determinantes Sociais da Saúde/normas , Telemedicina/normas , Ultrassonografia Pré-Natal/normasAssuntos
Doenças Cardiovasculares , Dietoterapia/tendências , Saúde Pública , Comportamento de Redução do Risco , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Guias como Assunto , Humanos , Prevenção Primária , Saúde Pública/normas , Saúde Pública/tendências , Determinantes Sociais da Saúde/normasRESUMO
PURPOSE: Recent national events, including the COVID-19 pandemic and protests of racial inequities, have drawn attention to the role of physicians in advocating for improvements in the social, economic, and political factors that affect health. Characterizing the current state of advocacy training in U.S. medical schools may help set expectations for physician advocacy and predict future curricular needs. METHOD: Using the member school directory provided by the Association of American Medical Colleges, the authors compiled a list of 154 MD-granting medical schools in the United States in 2019-2020. They used multiple search strategies to identify online course catalogues and advocacy-related curricula using variations of the terms "advocacy," "policy," "equity," and "social determinants of health." They used an iterative process to generate a preliminary coding schema and to code all course descriptions, conducting content analysis to describe the structure of courses and topics covered. RESULTS: Of 134 medical schools with any online course catalogue available, 103 (76.9%) offered at least 1 advocacy course. Required courses were typically survey courses focused on general content in health policy, population health, or public health/epidemiology, whereas elective courses were more likely to focus specifically on advocacy skills building and to feature field experiences. Of 352 advocacy-specific courses, 93 (26.4%) concentrated on a specific population (e.g., children or persons with low socioeconomic status). Few courses (n = 8) focused on racial/ethnic minorities and racial inequities. CONCLUSIONS: Findings suggest that while most U.S. medical schools offer at least 1 advocacy course, the majority are elective rather than required, and the structure and content of advocacy-related courses vary substantially. Given the urgency to address social, economic, and political factors affecting health and health equity, this study provides an important and timely overview of the prevalence and content of advocacy curricula at U.S. medical schools.
Assuntos
Equidade em Saúde/normas , Defesa do Paciente/educação , Racismo/etnologia , Faculdades de Medicina/estatística & dados numéricos , American Medical Association/organização & administração , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/virologia , Criança , Currículo/estatística & dados numéricos , Educação a Distância/organização & administração , Feminino , Humanos , Masculino , Papel do Médico , Política , Prevalência , Racismo/estatística & dados numéricos , SARS-CoV-2/genética , Faculdades de Medicina/organização & administração , Minorias Sexuais e de Gênero/psicologia , Determinantes Sociais da Saúde/normas , Inquéritos e Questionários , Estados Unidos/epidemiologiaRESUMO
The Covid-19 pandemic has revealed myriad social, economic, and health inequities that disproportionately burden populations that have been made medically or socially vulnerable. Inspired by state and local governments that declared racism a public health crisis or emergency, the Anti-Racism in Public Health Act of 2020 reflects a shifting paradigm in which racism is considered a social determinant of health. Indeed, health inequities fundamentally rooted in structural racism have been exacerbated by the Covid-19 pandemic, which calls for the integration of antiracist praxis to promote ethical public health research processes. This commentary describes ways in which antiracist praxis-which emphasizes empowerment of traditionally marginalized populations-offers strategies to explicitly address power imbalance, stigmatization, and other consequences of structural racism in public health research.
Assuntos
COVID-19/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/tendências , Saúde Pública , Racismo , Determinantes Sociais da Saúde , Códigos de Ética , Humanos , Saúde Pública/ética , Saúde Pública/métodos , Saúde Pública/normas , Racismo/prevenção & controle , Racismo/tendências , Determinantes Sociais da Saúde/ética , Determinantes Sociais da Saúde/normas , Discriminação Social/prevenção & controle , Marginalização Social , Estados UnidosRESUMO
AIMS: To examine factors associated with undiagnosed diabetes in Namibia and South Africa. METHODS: This study used the most recent Demographic and Health Surveys (DHS) from Namibia (2013) and South Africa (2016). This study focused on adults at 35-64 years old. Using Andersen's Behavioral Model, potential contributing factors were categorized into predisposing factors (sex and education), enabling factors (wealth, health insurance, and residence), and a need factor (age, BMI, and high blood pressure). Separate multivariable logistic regression models were used to examine factors associated with undiagnosed diabetes in Namibia (N = 242) and South Africa (N = 525). RESULTS: In Namibia, higher odds of having undiagnosed diabetes were associated with rural residence (adjusted odds ratio (aOR) = 2.21) and age younger than 45 years old (aOR = 3.20). In South Africa, odds of having undiagnosed diabetes were higher among the poorest-to-poorer group than it was in the richer-to-richest group (aOR = 2.33). In both countries, having high blood pressure was associated with lower odds of having undiagnosed diabetes (aOR = 0.31 in Namibia; aOR = 0.21 in South Africa). DISCUSSION: Different enabling and need factors were associated with undiagnosed diabetes in these two countries, which implies potentially-different mechanisms driving the high prevalence of undiagnosed diabetes, as well as the needs for different solutions.
Assuntos
Diabetes Mellitus/epidemiologia , Serviços de Saúde/normas , Determinantes Sociais da Saúde/normas , Feminino , Humanos , Masculino , Namíbia/epidemiologia , África do Sul/epidemiologiaAssuntos
COVID-19 , Erradicação de Doenças , Saúde Global , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/organização & administração , Tuberculose , COVID-19/epidemiologia , COVID-19/prevenção & controle , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Erradicação de Doenças/tendências , Saúde Global/economia , Saúde Global/normas , Saúde Global/tendências , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Humanos , Melhoria de Qualidade , SARS-CoV-2 , Determinantes Sociais da Saúde/economia , Determinantes Sociais da Saúde/etnologia , Determinantes Sociais da Saúde/normas , Tuberculose/economia , Tuberculose/epidemiologia , Tuberculose/terapia , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/terapiaRESUMO
BACKGROUND: Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA. METHODS: We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates. RESULTS: The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa. CONCLUSION: The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.
Assuntos
Acessibilidade aos Serviços de Saúde/normas , Serviços de Saúde Materna , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal , Determinantes Sociais da Saúde , África Subsaariana/epidemiologia , Fatores Epidemiológicos , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Cuidado Pré-Natal/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , População Rural , Determinantes Sociais da Saúde/normas , Determinantes Sociais da Saúde/estatística & dados numéricos , Saúde da Mulher/normasAssuntos
Concussão Encefálica/diagnóstico , Concussão Encefálica/psicologia , Futebol Americano/psicologia , Testes de Estado Mental e Demência/normas , Fatores Raciais/normas , Determinantes Sociais da Saúde/normas , Concussão Encefálica/etnologia , Futebol Americano/lesões , Humanos , Masculino , Fatores Raciais/métodos , Análise de RegressãoRESUMO
This study investigated the influence of illness on sexual risk behavior in adolescence and the transition to adulthood, both directly and through moderation of the impact of social disadvantage. We hypothesized positive effects for social disadvantages and illness on sexual risk behavior, consistent with the development of faster life history strategies among young people facing greater life adversity. Using the first two waves of the National Longitudinal Study of Adolescent to Adult Health, we developed a mixed-effects multinomial logistic regression model predicting sexual risk behavior in three comparisons: risky nonmonogamous sex versus safer nonmonogamous sex, versus monogamous sex, and versus being sexually inactive, by social characteristics, illness, interactions thereof, and control covariates. Multiple imputation was used to address a modest amount of missing data. Subjects reporting higher levels of illness had lower odds of having safer nonmonogamous sex (OR = 0.84, p < .001), monogamous sex (OR = 0.82, p < .001), and being sexually inactive (OR = 0.74, p < .001) versus risky nonmonogamous sex, relative to subjects in better health. Illness significantly moderated the sex (OR = 0.88, p < .01), race/ethnicity (e.g., OR = 1.21, p < .001), and childhood SES (OR = 0.94; p < .01) effects for the sexually inactive versus risky nonmonogamous sex comparison. Substantive findings were generally robust across waves and in sensitivity analyses. These findings offer general support for the predictions of life history theory. Illness and various social disadvantages are associated with increased sexual risk behavior in adolescence and the transition to adulthood. Further, analyses indicate that the buffering effects of several protective social statuses against sexual risk-taking are substantially eroded by illness.
Assuntos
Comportamento do Adolescente/psicologia , Comportamento de Doença/fisiologia , Assunção de Riscos , Comportamento Sexual/psicologia , Determinantes Sociais da Saúde/normas , Adolescente , Adulto , Criança , Feminino , Humanos , Estudos Longitudinais , Masculino , Adulto JovemRESUMO
The health threat posed by the novel coronavirus that caused the COVID-19 pandemic has particular implications for people with disabilities, including vulnerability to exposure and complications, and concerns about the role of ableism in access to treatment and medical rationing decisions. Shortages of necessary medical equipment to treat COVID-19 have prompted triage guidelines outlining the ways in which lifesaving equipment, such as mechanical ventilators and intensive care unit beds, may need to be rationed among affected individuals. In this article, we explore the realities of medical rationing, and various approaches to triage and prioritization. We discuss the psychology of ableism, perceptions about quality of life, social determinants of health, and how attitudes toward disability can affect rationing decisions and access to care. In addition to the grassroots advocacy and activism undertaken by the disability community, psychology is rich in its contributions to the role of attitudes, prejudice, and discriminatory behavior on the social fabric of society. We call on psychologists to advocate for social justice in pandemic preparedness, promote disability justice in health care settings, call for transparency and accountability in rationing approaches, and support policy changes for macro- and microallocation strategies to proactively reduce the need for rationing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).