Karin V. Rhodes, Genevieve M. Kenney, Ari B. Friedman, Brendan Saloner, Charlotte C. Lawson, David Chearo, Douglas Wissoker, and Daniel Polsky, “Primary Care Access for New Patients on the Eve of Health Care Reform,” JAMA Internal Medicine, 2014


Taking the Pulse of the Primary Care System

A good doctor is hard to find—and for those with Medicaid or without health insurance at all, finding a new primary care doctor is almost impossible. According to an audit study headed by physician Karin Rhodes, the difference in access to primary care is even more extreme than we might expect. New patients with Medicaid were far less likely to obtain a doctor’s appointment than their privately insured peers, and uninsured patients had it hardest of all: only 15.4% could obtain an appointment without paying more than $75 at the time of service.

One reason this disparity has gone undetected until now is that physicians overestimate how many Medicaid patients they treat by up to 40%. In order to get a true read, Rhodes uses an audit study, which is perhaps the most powerful tool social scientists can use to measure discrimination. In Rhodes’ simulated patient study, a team of 10 field staff members was selected for diversity in race and age based on the sound of their voices in a phone audition. After being trained to pose as new patients, they made 11,347 calls to doctors’ offices in 10 states to assess “business as usual”. On each attempt to make an appointment with a primary care physician, a caller was prompted to adopt the persona of a patient with one of three insurance types: private, Medicaid, or no insurance. In this way, two otherwise identical “patients” were presented in the real-world situation of making an appointment, and the only characteristic that varied was their insurance type, which was experimentally manipulated by the researcher. As a result, using the audit method allowed Rhodes’ team to test exactly how much of the difference in outcomes was due solely to insurance type.

Overall, 87.4% of privately insured callers were able to schedule an appointment, compared to 57.9% of Medicaid callers. Among uninsured patients, 78.8% were able to see the doctor, but only if they could pay a fee of $75 or more in full at the time of service. The median out-of-pocket cost for a primary care visit was $120, and fewer than one-fifth of practices allowed flexible payment arrangements.

Rhodes’ study assessed the capacity of the primary care system before the Affordable Care Act’s 2014 coverage expansion. The ACA is projected to cover 25 million formerly uninsured Americans. Because access to primary care is considered vital to improving population health outcomes, system that is already strained may make the ACA’s goals harder to achieve. This means that the system of providers accepting Medicaid needs to be strengthened before coverage increases will translate into gains in access to primary care.


Chinyere Osuji, “Divergence or Convergence in the US and Brazil: Understanding Race Relations Through White Family Reactions to Black-White Interracial Couples,” Qualitative Sociology, 2014


‘Inclusionary Discrimination’: Family Policing of Interracial Couples

Much of the research on race relations in the US and Brazil places the two societies in separate camps. For example, the US is usually understood as a nation with a strict racial hierarchy, where blacks and whites occupy opposite poles. On the contrary, Brazil is conceived of as more of a “racial democracy,” where racial boundaries are blurred and social inequalities are predominantly class-based.

In the most recent issue of Qualitative Sociology, however, Chinyere Osuji adds to the growing body of literature that aims to complicate these simple conceptions of race relations in both countries. Using comparative data from interviews with 87 individuals in black-white relationships, Osuji looks at the lived reality of interracial couples in Rio de Janeiro and Los Angeles, exploring how they negotiate racial boundaries through family interactions. Focusing on couples’ interactions with their families, Osuji finds trends that are emblematic of the prominent racial discourses that exist in either society. In the US, for instance, she discovers that families tend to take a “color-blind” approach upon first hearing of an interracial relationship, and do not show more overt displeasure or discouragement until the relationship becomes serious. Brazilian families differ in that many show immediate and open racist opposition to interracial mixing. Even upon the families’ acceptance of the relationship, overt racism often persists through the use of “humor,” something that Osuji argues is representative of the “inclusionary discrimination” in Brazilian race relations.

But not everything is different. In both sites, families are most oppositional to black men in interracial couples. Moreover, white men are often less questioned by their families than white women about their decisions to date interracially. Most importantly, Osuji’s study illustrates how, in light of their supposed differences, families in the US and Brazil continue to police racial boundaries despite the societal prevalence of “color-blind” and “post-racial” rhetorics.

Stoyan V. Sgourev and Niek Althuizen, “‘Notable’ or ‘Not Able’: When Are Acts of Inconsistency Rewarded?,” American Sociological Review, 2014


Art Goes for Looks, Patrons Go for Status

What makes people like art? We usually think it is something deep in the piece itself—a hidden texture or message that captures a truth about the way we see the world and ourselves (like that scene from Ferris Bueller), but sociology reminds us that the people who make, sell, and show the art shape our tastes just as much as the pieces themselves. Some “brilliant innovations” can be just plain weird (and weirdly expensive).

Sgourev and Althuizen set out to understand how social roles shape the way we appreciate art. They are particularly interested in inconsistent art styles, asking when patrons think a contrasting style is “innovative” and when they think it shows a lack of skill. Using a set of lesser-known works from Pablo Picasso—an artist known for his inconsistency—the authors set up an online experimental survey taken by 183 students at a French business school. They gave respondents either a set of consistent or inconsistent paintings and told them the paintings were done by either Picasso (a high status artist), Braque (a mid-status artist), or Fresnaye (a low-status artist). The respondents rated the paintings’ aesthetic value, market value, and overall creativity.

Respondents were more likely to say inconsistent works were more creative or aesthetically pleasing when told the artist was a well-known painter with high status, and less likely to give such positive reviews to low-status painters. The study’s authors conclude that “inconsistent works by a prominent artist are given the benefit of the doubt and interpreted as a sign of creativity,” while the public may be less forgiving to the lesser-known. So, the next time you go to a museum, it may be worth asking whether the art is great, or the artist is just “hot right now.

Colter Ellis, “Boundary Labor and the Production of Emotionless Commodities: The Case of Beef Production,” The Sociological Quarterly, 2014


Creating the Line Between “Animal” and “Meal”

The United States slaughters approximately 34 million beef cattle annually, yet consumers know very little about beef production. This is largely by design. In a recent article (and podcast), sociologist Colter Ellis exposes the incredible role of emotional boundaries and boundary labor in beef production. Previous research has focused on the detachments necessary between consumers and the exploitation of commodities, ignoring the producers.

For most consumers, our feelings about cows, pigs, chickens, and other animals that we eat are very different from the feelings about our dogs, cats, and other animals that we keep as pets. Ellis demonstrates how this is not the case for cattle ranchers, who often see cattle as sentient, social beings with individual personalities (as illustrated by Pete the social beast and Cupcake the “teaser” steer). Through daily interactions with their cattle, ranchers develop emotional relationships, yet they have also developed narratives and emotional boundaries that allow them to treat these animals as economic assets and, eventually, as commodities.

The labor of cattle ranchers produces more than just beef. Their boundary labor creates a separation between animal-based commodities and the physical bodies these products come from. It creates a separation between consumers and the industrial practices that transforms sentient beings into emotionless commodities. Ultimately, Ellis finds, it allows consumers the privilege to disengage animal from meal.

Francesca Polletta and Zaibu Tufail, “The Moral Obligations of Some Debts,” Sociological Forum, 2014


Indebted: To Creditors and Conscience

Living under the vigilant gaze of creditors is no fun—the nerve of these creditors, expecting us to pay back money loaned to us! Fortunately, not everyone feels guiltless toward credit. In fact, contrition over debt is fairly typical, and our relationships with money are rarely emotion-neutral: money is always moralized.

In fact, in new work, researchers find debt weighs as heavily on our consciences as our wallets. In the most recent issue of Sociological Forum, Franceca Polletta and Zaibu Tufail study the moral relationships between creditors and debtors by accounting for the intervening influence of debt settlement agencies.  Through field observations at two debt settlement agencies and interviews with 17 agents, the researchers aimed to understand whether and why clients are willing to settle certain forms of debt.

Their observations showed that debt settlement agencies were instrumental in shaping what the authors call “equality matching relationships” between creditors and debtors.  Within such relationships, debtors see their relationship with creditors as “reciprocal and ongoing.” Therefore, the receipt of adequate service from a creditor obligated debtors to respond in kind by paying off their debt. Thus decisions about whether debt must be paid back in full or could be settled were made based on perceptions of the moral character of the creditor. Since debtors were most willing to settle credit card debt and least willing to settle medical debt, Polletta and Tufail’s findings suggest that debtors see little integrity in credit card companies, but hold greater trust in the moral worth of medical providers and feel they must pay the entirety of what they are billed by doctors.

All debts being equal—in dollars—does nothing to equalize our perceptions of moral obligation. In other words, when we choose whether to pay off or settle outstanding debt, we are not only making good with creditors, but with our consciences.



Kristin Turney, Rebecca Kissane, and Kathryn Edin, “After Moving to Opportunity: How Moving to a Low-poverty Neighborhood Improves Mental Health among African American Women,” Social and Mental Health, 2013


Moving to Mental Health Opportunities

According to a popular real estate saying, “Three things matter for property: location, location, location.” Turns out, location can be as important to mental health as it is to property value. In a recent study, Kristin Turney, Rebecca Kissane, and Kathryn Edin demonstrate that mental health benefits abound for African American women who move into low-poverty neighborhoods as compared to others who remain living in disadvantaged neighborhoods.

The authors analyze data from interviews with 67 Baltimore adults participating in the Moving-to-Opportunity social experiment, a project that randomly gave 4,608 families living in public housing developments the chance to move into low-poverty neighborhoods. Of those interviewed, 33 received MTO’s move to low-poverty neighborhoods, while 34 had not been selected. All interviewed were female and the head of their household; 66 were African American and one was multiracial.

The authors found that both groups reported experiencing traumatic and stressful life experiences and mental health challenges. Many who moved endured additional challenges in transitioning from public to private housing, managing utility bills, securing transportation, and living farther from friends and family. However, the stresses of relocation were counteracted by improvements in neighborhood and home aesthetics, neighborhood collective efficacy and pride, lower violence and criminal activity, and better environments for raising children. On the whole, the improvements in physical and social environments positively impacted mental health of those who moved. The link between location and opportunity remains tenuous, but the link with quality of mental health is now better understood.

Douglas S. Massey and Jayanti Owens, “Mediators of Stereotype Threat among Black College Students,” Ethnic and Racial Studies, 2014

The Personal Mediators of Stereotype Threat

Since the term stereotype threat was coined by psychologist Claude Steele, its effects on stigmatized groups have been studied and confirmed by numerous researchers across the social sciences. Stereotype threat contributes to lower academic achievement among students from stigmatized groups because they fear perpetuating negative group stereotypes. If this anxiety is heightened enough, it can lead to a psychological process called “disidentification,” in which an individual will drop the stress-inducing act (say, an advanced placement class) to raise self-esteem. Repeat disidentification enough, and it leads to decreased levels of interest, effort, and ultimately, underperformance.

In a recent journal article, sociologists Douglas S. Massey and Jayanti Owens expand on the concept of stereotype threat by exploring how its impact on individuals varies by social context (in this case, by the contexts of specific schools, like whether they’re public or private, highly selective, or emphasize diversity) and personal characteristics (such as the student’s skin color, immigrant background, parental education, etc.). Using data from the National Longitudinal Survey of Freshmen (NLSF), the authors test to see how the variables affect the GPAs of black students over their undergraduate careers.

The authors find that while institutional factors are surprisingly insignificant in inducing stereotype threat among black students, personal characteristics are significant. Individuals whose “blackness” was in question (for example, because they’d been educated in integrated schools, had a light skin tone, or had a non-black parent) were more likely to be negatively influenced by stereotype threat and to practice disinvestment. The opposite was true for students with stronger markers of “blackness,” who were less likely to practice disinvestment. Massey and Owens conclude that the effects of stereotype threat aren’t consistent across a stigmatized group; they vary systematically by individual traits. In particular, black students with stronger connections to their race/ethnicity are better able to skirt the harmful effects of negative stereotypes.

Hiroshi Ono and Kristen Schultz Lee, “Welfare States and the Redistribution of Happiness,” Social Forces, 2013


Closing the Happiness Gap

If money can’t buy happiness, can redistributive social policies do the trick? In their research on state intervention in various socially democratic welfare states, Hiroshi Ono and Kristen Schultz Lee examine how welfare expenditures and taxes affect the happiness of citizens. Writing in Social Forces, Ono and Schultz not only report that money does buy happiness, but also that using public social expenditures to protect populations from social risk is a wise investment.

Using data from the 2002 International Social Survey Program’s (ISSP) “Family and Changing Gender Roles” module, the authors use individual-level factors including gender, marital status, and income to predict reports of happiness in Eastern European countries.  Countries are classified as either low- or high-PSE (Public Social Expenditure) depending on levels of social welfare funding.

Among their findings, women and men are equally happy regardless of the size of the welfare state. The happiness gap between married couples and non-married persons is greater in high-PSE countries, suggesting that countries with higher social expenditures are home to happier marriages. Cohabiters, too, are also nearly three times happier than non-married, non-cohabiting individuals in high-PSE countries. And even low-income people are happier in high-PSE countries compared to their counterparts in low-PSE countries.  Social welfare programs seem to help both the economic security and the subjective wellbeing of the poor. Still, the authors emphasize that public social expenditures do not invoke happiness among all citizens.

The redistribution of income reduces the happiness gap between the rich and the poor:  The happiness of the poor is lifted, and the happiness of the rich is lowered.

Countries attempting to mitigate various forms of “happiness inequality” through investments in safety nets may learn that achieving a state of happiness may not be as expensive as they thought. It just might lead to a few grumpy 1%’ers.



Jason N. Houle, “Disparities in Debt: Parents’ Socioeconomic Resources and Young Adult Student Loan Debt,” Sociology of Education, 2014


College “Credit”

Unless there is a trust fund involved, paying for college is becoming increasingly difficult for families at all levels of the socioeconomic spectrum. As college tuition costs have risen and average wages have remained stagnant, young adults and their families are forced to turn to loans to fund higher education. With aggregate student loan debt well past $1 trillion, many young adults are mortgaging their futures to pay for college now.

In a recent Sociology of Education article, Jason Houle takes a closer look at how parents’ income and education levels are linked with students’ risk for and levels of debt. He finds, perhaps unsurprisingly, that wealthier parents and college-educated parents, regardless of income level, contribute more to their children’s college education, thus buffering them from large debt burdens.

Students from middle-class backgrounds are most at risk for taking on debt to pay for college. Many of these students are prepared for and expected to attend college yet are ineligible for most of the need-based grants and scholarships, making them more likely to take on student loans. However, while “young adults from low-income backgrounds may be more debt adverse,” it is these students from the lowest income bracket that take on the highest debt burdens.

Houle also finds racial discrepancies in student loan debt, with African American young adults more likely to take on educational debt than their white counterparts. Houle speculates that “disparities in student loan debt may reproduce racial gaps in wealth among the college educated.”




Rose McDermott, James H. Fowler, and Nicholas A. Christakis, “Breaking Up Is Hard to Do, Unless Everyone Else Is Doing it Too: Social Network Effects on Divorce in a Longitudinal Sample,” Social Forces, 2013


Divorce is Contagious: Social Networks in Splitsville

The study of social networks is a powerful tool for understanding how behaviors spread across groups. Researchers are using a large networked dataset originally designed to study heart disease to ask a different question: Is divorce contagious? Rose McDermott, James Fowler, and Nicholas Christakis used the Framingham Heart Study to look at how breakups flow across social ties. The study of nearly 5,000 residents in a single town began in 1948, spans several generations, and includes information on how individual residents know one another (e.g., “spouse,” “sibling,” “coworker”) and how closely they are connected.

Within the network, divorce appeared in clusters and spread across friends, extending to two degrees of separation. In other words, a person’s tendency to divorce depends not just on his friends’ divorce, but also his friends’ friends’ divorce. The full network shows that participants are 75% more likely to be divorced if a person they are directly connected to is divorced.

Divorce patterns affect other qualities of the network, too. People who go through divorce experience a small drop in the number of people who name them as friends in the study, and divorcees are more likely to immerse themselves in denser social groups with fewer ties outside their groups. If they remarry, those who are divorced are very likely to partner with another divorcee.

The beauty of network analysis is that it can reveal how our social ties might shape our individual decisions. This study shows that the most “popular” people in the network (those most oft named as a friend by other study participants) were the least likely to divorce. The researchers think having this strong social support system points to other qualities that might help a marriage: good social skills, friends to rely on, and people other than one’s spouse to vent to. Though divorce is an intensely personal process, it seems the people around us shape our ability to make a marriage work and our embrace of alternatives.