The Structural Violence Trap: Disparities in Homicides, Chronic Disease Deaths, and Social Factors Across San Francisco Neighborhoods

ObjectiveTo determine: (1) which biological/lifestyle, psychological and/or social factors are associated with fatigue among children with a chronic disease and (2) how much each of these factors contributes to explaining variance in fatigue.Design and settingThis was a cross-sectional study across two children’s hospitals.PatientsWe included children aged 8–18 years who visited the outpatient clinic with cystic fibrosis, an autoimmune disease or postcancer treatment.Main outcome measuresFatigue was assessed using the PedsQL Multidimensional Fatigue Scale. Generic biological/lifestyle, psychological and social factors were assessed using clinical assessment tools and questionnaires. Multiple linear regression analyses were used to test the associations between these factors and fatigue. Finally, a multivariable regression model was used to determine which factor(s) have the strongest effect on fatigue.ResultsA total of 434 out of 902 children were included (48% participation rate), with a median age of 14.5 years; 42% were male. Among these 434 children, 21.8% were severely fatigued. Together, all biopsychosocial factors explained 74.6% of the variance in fatigue. More fatigue was uniquely associated with poorer physical functioning, more depressive symptoms, more pressure at school, poorer social functioning and older age.ConclusionsFatigue among children with a chronic disease is multidimensional. Multiple generic biological/lifestyle, psychological and social factors were strongly associated with fatigue, explaining 58.4%; 65.8% and 50.0% of the variance in fatigue, respectively. Altogether, almost three-quarters of the variance in fatigue was explained by this biopsychosocial model. Thus, when assessing and treating fatigue, a transdiagnostic approach is preferred, taking into account biological, psychological and social factors.

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A syndemics approach to exercise is medicine

Health An Interdisciplinary Journal for the Social Study of Health Illness and Medicine ◽

10.1177/13634593211021481 ◽

2021 ◽

pp. 136345932110214

Author(s):

Caitlin Vitosky Clarke ◽

Brynn C Adamson

Keyword(s):

Mental Illness ◽

Chronic Disease ◽

Social Factors ◽

Social Conditions ◽

Self Concept ◽

Exercise Interventions ◽

Narrow Scope ◽

The Social ◽

Exercise Promotion ◽

The Impact

This paper offers new insights into the promotion of the Exercise is Medicine (EIM) framework for mental illness and chronic disease. Utilising the Syndemics Framework, which posits mental health conditions as corollaries of social conditions, we argue that medicalized exercise promotion paradigms both ignore the social conditions that can contribute to mental illness and can contribute to mental illness via discrimination and worsening self-concept based on disability. We first address the ways in which the current EIM framework may be too narrow in scope in considering the impact of social factors as determinants of health. We then consider how this narrow scope in combination with the emphasis on independence and individual prescriptions may serve to reinforce stigma and shame associated with both chronic disease and mental illness. We draw on examples from two distinct research projects, one on exercise interventions for depression and one on exercise interventions for multiple sclerosis (MS), in order to consider ways to improve the approach to exercise promotion for these and other, related populations.

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Social factors in the etiology of chronic disease: An overview

Social Science & Medicine ◽

10.1016/0277-9536(82)90046-6 ◽

1982 ◽

Vol 16 (4) ◽

pp. 353-367 ◽

Cited By ~ 52

Author(s):

David V. McQueen ◽

Johannes Siegrist

Keyword(s):

Chronic Disease ◽

Social Factors

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Bioethical Guidelines of 'Extreme Triage' Under Covid: The Question of 'Possible Lives' in Latin America

Bionatura ◽

10.21931/rb/2020.05.04.27 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1434-1437

Author(s):

Abril Saldaña-Tejeda

Keyword(s):

Resource Allocation ◽

Social Factors ◽

Structural Violence ◽

Individual Responsibility ◽

Systemic Racism ◽

Structural Problems ◽

The Social ◽

Genetic Makeup ◽

Obesity Hypertension ◽

Individual Choices

The essay briefly looks into the bioethical guide of extreme triage and resource allocation based on known co-morbidities (i.e., obesity, hypertension, and diabetes). I invite to reflect upon how a focus on individual responsibility under COVID-19 occludes major structural problems while silencing the social factors behind the heath disaster that we are witnessing today. The essay argues that chronic diseases are not merely the result of genetic makeup or individual choices but are instead profoundly linked to poverty, systemic racism, structural violence, and lack of care. Debates on extreme triage guidelines and resource allocation illuminate a series of ethical shortcomings that preexisted COVID-19. Even if guidelines clearly state that criteria such as race, gender, or class will not be taken into account when deciding how to allocate limited medical resources, these categories are deeply linked to health disparities, and therefore, on people’s possibilities of surviving the pandemic.

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Determinants of voluntary early retirement for older workers with and without chronic diseases: A Danish prospective study

Scandinavian Journal of Public Health ◽

10.1177/1403494819852787 ◽

2019 ◽

Vol 48 (2) ◽

pp. 190-199 ◽

Cited By ~ 1

Author(s):

Ranu Sewdas ◽

Sannie Vester Thorsen ◽

Cécile R.L. Boot ◽

Jakob Bue Bjørner ◽

Allard J. Van der Beek

Keyword(s):

Chronic Disease ◽

Chronic Diseases ◽

Social Factors ◽

Older Workers ◽

Early Retirement ◽

Cox Regression ◽

Working Environment ◽

Physical Workload ◽

Work Related ◽

Health Related

Aims: This study explored differences in determinants (i.e. health-related, work-related and social factors) of voluntary early retirement between older workers with and without chronic diseases in Denmark. Methods: Workers aged 56–64 years who were members of a voluntary early retirement scheme were selected from the Danish National Working Environment Survey (2008–2009) and were followed in a public register for four years. Cox regression analyses were performed separately for older workers with and without chronic disease to identify the associations between determinants and voluntary early retirement. To explore the differences between groups, an interaction term between the determinant and having a chronic disease was included in the analyses for the total population. Results: Among 1861 eligible older workers, determinants associated with a higher risk of voluntary early retirement included poorer self-rated health, more depressive symptoms, a higher physical workload, lower job satisfaction and lower influence at work. For older workers with a chronic disease ( n=1185), the presence of work–family conflict was also associated with a higher risk of voluntary early retirement, whereas for those with no chronic disease ( n=676), a poorer relationship with colleagues was an additional determinant. Higher emotional demands, a higher work pace and higher quantitative demands were not significantly associated with voluntary early retirement for either group. None of the interaction terms was found to be statistically significant ( p>0.05). Conclusions: Determinants associated with voluntary early retirement did not significantly differ between older workers with or without a chronic disease in Denmark. We conclude that several health-related, work-related and social factors are important for prolonged labour force participation of older workers (with and without a chronic disease).

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Geographic and Social Factors Associated With Chronic Disease Self-Management Program Participation: Going the “Extra-Mile” for Disease Prevention

Preventing Chronic Disease ◽

10.5888/pcd16.180385 ◽

2019 ◽

Vol 16 ◽

Cited By ~ 2

Author(s):

Julie Bobitt ◽

Liliana Aguayo ◽

Laura Payne ◽

Taylor Jansen ◽

Andiara Schwingel

Keyword(s):

Chronic Disease ◽

Disease Prevention ◽

Social Factors ◽

Management Program ◽

Self Management ◽

Program Participation ◽

Factors Associated

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Social Processes That Can Facilitate and Sustain Individual Self-Management for People with Chronic Conditions

Nursing Research and Practice ◽

10.1155/2012/282671 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Elizabeth Kendall ◽

Michele M. Foster ◽

Carolyn Ehrlich ◽

Wendy Chaboyer

Keyword(s):

Chronic Disease ◽

Collective Identity ◽

Social Factors ◽

Social Engagement ◽

Chronic Conditions ◽

Ecological Model ◽

Medical Model ◽

Self Management ◽

Coping Capacity ◽

Policy Direction

Recent shifts in health policy direction in several countries have, on the whole, translated into self-management initiatives in the hope that this approach will address the growing impact of chronic disease. Dominant approaches to self-management tend to reinforce the current medical model of chronic disease and fail to adequately address the social factors that impact on the lives of people with chronic conditions. As part of a larger study focused on outcomes following a chronic disease, this paper explores the processes by which a chronic disease self-management (CDSM) course impacted on participants. Five focus groups were conducted with participants and peer leaders of the course in both urban and rural regions of Queensland, Australia. The findings suggested that outcomes following CDSM courses depended on the complex interplay of four social factors, namely, social engagement, the development of a collective identity, the process of building collaborative coping capacity, and the establishment of exchange relationships. This study highlights the need for an approach to self-management that actively engages consumers in social relationships and addresses the context within which their lives (and diseases) are enacted. This approach extends beyond the psychoeducational skills-based approach to self-management into a more ecological model for disease prevention.

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