health

Prescription Drug Use on the Rise

Caty Taborda on November 11, 2015
Taki Steve, Flickr CC.
Taki Steve, Flickr CC.

A study published earlier this month in the Journal of the American Medical Association (JAMA) reports that over half of adults in the United States use prescription drugs, and as many as 15% of adults report using more than five prescription drugs each month. Recent coverage of these findings at NPR explores how increases in obesity and obesity-related illnesses may contribute to the increase in prescription drug use. Several sociological studies provide other potential explanations, including the increasing influence that pharmaceutical companies have over the doctor-patient relationship.

Though physicians are the ultimate gatekeepers for prescription drugs, the pharmaceutical industry drastically shapes prescription drug use. Through internal research studies and trials, pharmaceutical companies produce new knowledge about illnesses and treatment options. Pharmaceutical companies can even play an increasing role in medicalization—the process of constructing issues as specifically medical problems. By promoting the idea that something is a medical problem, pharmaceutical companies then offer a solution. Pharmaceutical salespeople aggressively promote their wares to clinicians, even promoting the off-label use of drugs to increase distribution.
Direct-to-consumer advertising may also lead to increase prescription drug use. Patients who see such ads may be more likely to self-diagnose and directly request drugs, and patients who request medication (whether a specific drug or just drug treatment in general) are more likely to be prescribed medication. Despite the potential for over-prescribing, direct-to-consumer advertising also encourages positive interactions between patients and physicians by providing patients with more information about current and undiagnosed conditions.

Fantasy Sports and the Culture of Fandom

Evan Stewart and Alex Snidarich on October 29, 2015
Fantasy sports have gained coverage as a sport of their own.
Fantasy sports have gained coverage as a sport of their own.

You’ve probably seen more than an ad or two this fall for DraftKings or FanDuel, two massive online fantasy sports websites valued at over $1 billion each. Since 2009, the number of fantasy sports players has doubled, and, as of August, 56.8 million participated in the United States and Canada (according to the Fantasy Sports Trade Association). It’s not all fun and games, though. The New York Attorney general launched an investigation into these sites, and a recent feature in The New York Times highlights how deep the rabbit hole goes for illegal online gambling on fantasy sports. It is easy to focus on scandalous stories of crime rings, big winnings, and crushing losses, but these sites are not just about gaming the system. Sociologists emphasize that they are also powerful social communities driven by cultures of masculinity and fandom.

Eric Leifer argues that the history of sports fandom in the U.S. is place- and team-based—fans supported the team in their town or region as a marker of community membership. Fantasy leagues and social media challenged this by shifting the focus from entire teams to individual athletes’ performance.
Sociologists, especially, focus on the racialized and gendered nature of sport-based communities. Members often forge strong social ties in male-dominated spaces that emphasize knowledge and expertise, and the groups can privilege racial stereotypes and racialized assumptions about athletic performance.
Fantasy sites (and the betting that ensues on them) are in line with other case studies that show how online socialization is not “less real” or consequential than offline social interaction—both teach everything from harmless play to deviant behavior. We see the power of online interaction in everything from hackers developing their own open-source political theory to online peers teaching others how to download music for free and sport message boards reinforcing racial stereotypes.
Of course, gambling is tied up in these social structures. While American society has “medicalized” compulsive gambling, treating it as an individual and treatable problem, more recent work shows how social environments create what gamblers want most: a chance to be in the “zone” and play for long periods of time. The strong communal aspect of fantasy sports websites makes them a perfect space for sustained play.

#ShoutYourAbortion Shouts Back at Stigma

Amber Powell and Jacqui Frost on October 26, 2015
Twitter screenshot.
Twitter screenshot.

In the ongoing battles around whether to defund Planned Parenthood, Lindy West and Amelia Bonow created the Twitter hashtag #ShoutYourAbortion to encourage women to share their abortion stories, express their experiences, and recognize the stigma that often silences women who have an abortion. Consequently, many have criticized the hashtag and attacked the women involved. Supporters of #ShoutYourAbortion argue that sharing real women’s stories on social media produces cultural change around an issue surrounded by legal rhetoric. Sociological research details why women have generally felt compelled to stay silent about having abortions and the potential benefits of speaking up.

Many women believe that disclosing their abortion experiences will lead to negative responses from relatives and friends, due to widely held norms of femininity and motherhood that assert women are “natural nurturers” and the idea that having an abortion negates those qualities. In a classic study of pro-life and pro-choice activists, Kristin Luker notes that abortion is often seen as a “referendum on the place and meaning of motherhood.” For pro-life activists, terminating a pregnancy may be the ultimate example of being a “bad mother.” Rather than face anticipated judgment and condemnation around moral codes of appropriate feminine behavior, women then choose to conceal their procedures.
A major source of stress and frustration women experience centers on the gendered imbalance of responsibility for contraception and abortion decisions. Research finds that women are often expected be responsible for providing or taking contraception, but are heavily criticized when they take responsibility by choosing to have an abortion. Thus, Sally Brown argues, where women are held responsible for reproductive decisions, “decision making, if ‘decisions’ happen at all, is bound up with notions of hegemonic masculine and feminine roles.”
Stigma, however, does not reduce the likelihood that a woman will have an abortion. Cockrill and Nack write that even women who “believe abortion is morally wrong and that women who have abortions are careless and irresponsible will still have abortions.” Instead, the primary consequences of abortion stigma are decreased mental and physical health, strained relationships, and loss of social status. Spaces of affirmation and support like the #ShoutYourAbortion campaign allow women to engage in “collective stigma management,” offering a supportive network where their public presence can work to change social attitudes and shatter the silence surrounding abortion experiences.

Mass Incarceration’s Challenges for Black America: Ta-Nehisi Coates’ Edition

Amber Joy Powell on October 19, 2015
Coates' latest book reflects on race and the justice system. Click for publisher site.
Coates’ latest book reflects on race and the justice system. Click for publisher site.

In The Atlantic, Ta-Nehisi Coates’ “The Black Family in the Age of Mass Incarceration” details the historical development of the carceral state, its consequences on current and formerly imprisoned black Americans, and the unique challenges families face during their absences and returns. Coates cites and interviews several prominent sociologists for their insight into the carceral state’s repercussions for black Americans specifically. We rounded up some of their best work on the topic.

The 1970s saw increasing unemployment and concentrated poverty. Legislators developed “tough on crime” policies that resulted in the start of a massive increase in the number of incarcerated individuals in jails and prisons. Increases in incarceration, however, do not appear to have had a significant effect on decreasing crime rates.
Mass imprisonment has a wide range of collateral consequences. Those who serve time face health risks, familial struggles, and barriers to employment before and after they are released.

The Social Life of Autism and ASD

Sarah Catherine Billups on September 21, 2015
Hepingting, Flickr CC
Hepingting, Flickr CC

Autism and Autism Spectrum Disorder (ASD) are the umbrella terms for a broad range of complex disorders of brain development. They have been the center of national concern and even political debate as diagnoses become more frequent. Since the symptoms of autism and ASD are based on a range of behavioral indicators, diagnosis is not straightforward. Instead, ASD is a clear example of how social factors shape the way we understand disease and medicine. The cause of autism remains unknown, but diagnosis has risen with changes in diagnostic criteria, increased awareness, and more reliance on families for treatment.

Gil Eyal argues that autism was a rare disorder in the era of mental institutions, where children were simply deemed “mentally retarded” and separated from families. Changes since the ‘70s have meant mental healthcare is no longer mostly addressed in large, hospital-like institutions, but through a network of local therapeutic services that have created new opportunities for parents to interact with therapists and take part in diagnosis and treatment. This new social arrangement has increased practitioners’ trust in parents’ experiences and helped create a new category of mental illness.
Increased visibility and information about autism comes with more and more diagnosed cases. Parents have become “experts” at identifying symptoms of autism in their own children when they see other kids with a diagnosis. Thus children living in wealthy communities or very close to a child diagnosed with autism are more likely to be diagnosed with autism or ASD. Children can’t “catch” autism, but the diffusion of information about symptoms through social networks increases the chances of diagnosis.
The ambiguity of identifying, diagnosing, and treating autism often takes a toll on parents. As if on a perpetual rollercoaster, they feel stressed not knowing what to expect from a child’s day-to-day behavior. Mothers sometimes blame themselves for their child’s disorder.

…mothers were experiencing feelings associated with ambiguous loss [which] revealed frequent expressions of conflicting or contradictory emotions and ideas about the child and about ASDs, confusion about the child’s and their own future, and alterations between hope and hopelessness, feeling in control and feeling helpless. (O’Brien 140)

Although genetic studies of autism are inconclusive, genetic testing for autism in embryos is often framed as essential for responsible parenting. As a result, mothers carry great responsibility for birthing children with autism and risk considering their children “disabled” before they even enter the world. Much of the autism and ASD advocacy revolves around curing autism, rather than promoting the well-being of affected families and children, and this marginalizes autistic individuals by presuming that genetic material measures a person’s potential value to society by indicating whether they are “normal” or “disabled.” Not all people with autism appreciate the framing of autism as a disease that needs a cure, and instead these people advocate for respect of neurodiversity.

For more, see “Learning to See the Spectrum,” about Eyal’s AJS article and Girl w/ Pen’s “Autism and Neurodiversity.”

The Time Trials of Good Parents

Anne Kaduk on April 27, 2015

WaPo graphic

 

A recent scholarly article in the Journal of Marriage and Family by Melissa Milkie, Kei Nomaguchi, and Kathleen Denny (first covered in the Washington Post) has sparked a plethora of commentary in the news media, including several critiques by Justin Wolfers of The Upshot, and a convincing response by the authors in the Washington Post. Using high-quality time use data from a national panel study, Milkie, Nomaguchi, and Denny found that the overall amount of time mothers spend with either adolescents or younger children does not matter for their children’s behaviors, emotions, or academics. What do sociologists know about the impact of parenting time on children’s wellbeing?

First, the kind of parenting time matters. Time mothers spend engaging with children makes more of a difference than the time mothers are available to or are supervising their children. So being long on love but short on time isn’t a bad thing. Engaged maternal time is related to fewer delinquent behaviors among adolescents, and engaged time with both parents was related to better outcomes for adolescents. Other studies show too much “unstructured” parental time, such as watching TV together, may actually be worse for some children under age 6, and that the quality of parent-child relationships factors in. Family dinners contribute to fewer depressive symptoms and less delinquency among adolescents, but only when parent-child relationships are strong.
Why did this finding spark such a media response? In part, it’s because society believes ideal mothering means spending lots of time with children. Many parents strive to attain this ideal, but many working mothers who cannot attain it must redefine their definition of a “good mother” to fit with work responsibilities. Still, working mothers today spend more time with their children than employed mothers in the past.

 

 

For more on the original article and the critiques, see Sociological Images.

Vexed by Vaccination Refusals

Caty Taborda on February 9, 2015

As the outbreak of measles in Southern California continues its spread, public health officials have turned their attention toward the rising number of parents forgoing vaccinations for their children. Once based on the now discredited study linking vaccines to autism, the choice not to vaccinate is now considered an issue of individual choice, albeit one made at the expense of public health.

Vaccinating has become highly politicized. With conflicting information about potential side effects and the increase in mandated vaccines, some parents have grown anxious and distrustful—they are now known as “anti-vaxxers.”
Social networks and institutions help distrust spread. For instance, you can’t “catch” autism from other people, but as parents near each other share information and experiences, the chances that a child will be diagnosed with autism increases.
When parents who distrust medical advice about vaccines consider other parenting practices, such as breastfeeding and nutrition, they also seek out institutions like private schools, which are more friendly to alternative choices. The parents’ networks are thus made smaller.
Although anti-vaxxers are not necessarily motivated by religious values, sociologists study how multiple sources of authority, such as religious and political affiliations, impact scientific distrust and result in deeply held personal beliefs that may place facts and values at odds.

The Second Sex and Second-Class Citizenship

Anne Kaduk on January 14, 2015

The U.S. Supreme Court recently heard arguments in Young v. United Parcel Service. The outcome will affect many American women’s ability to financially support their families and even have children.

Pregnancy discrimination, while widely illegal, happens when some employers illegally terminate their female workers. They are not explicitly fired for being pregnant, but instead branded “bad workers” by managers. The organizations then use run-of-the-mill meritocratic policies to fire the women.

Reginald A. Byron and Vincent J. Roscigno. 2014. “Relational Power, Legitimation, and Pregnancy Discrimination,” Gender & Society 28(3):435–62.

Pregnancy is a particularly vulnerable time for women; it holds health, legal, and employment risks. A systematic examination of arrests of and forced interventions in the lives of pregnant women in the U.S. shows a variety of concerns about their health, dignity, and autonomy.

Lynn M. Paltrow and Jeanne Flavin. 2013. “Arrests of and Forced Interventions on Pregnant Women in the United States, 1973–2005: Implications for Women’s Legal Status and Public Health,” Journal of Health Politics, Policy and Law.

A variety of laws and their sometimes-selective enforcement affect women’s ability to be healthy and valued members of society.

Jeanne Flavin. 2009. Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America. New York: NYU Press.

Beyond pregnancy discrimination, mothers are paid less than childless women. A portion of this motherhood wage penalty is due to discrimination.

Stephen Benard and Shelley J. Correll. 2010. “Normative Discrimination and the Motherhood Penalty,” Gender & Society 24(5):616–46.

Veterans Day and the Challenges of Civilian Life

Evan Stewart on November 11, 2014

With more troops coming home from Iraq and Afghanistan, this Veterans Day sees a unique push for public awareness about the challenges that accompany a return to civilian life. Starbucks CEO Howard Schultz has a new book and A&E a new reality show, and the social science shows why we want to pay attention to veterans after they return from service. We have a few previous TROT posts on issues within the military, but unique problems arise in a civilian world which can often be less hospitable than the regiment.

Military service provides a number of social benefits upon returning home. The positive image of having served can even overcome negative stereotypes in civilian life and help advance veterans who have a history of delinquency.
After service, however, institutional problems in civilian life mean veterans don’t all face the same challenges when they return home. For example, the G.I. Bill offered a wide range of education and housing benefits, but historic racial inequality in civilian institutions often made it harder for vets of color to collect those benefits. Today, female vets are more likely to face unemployment than males. However, those with only a high school degree often do earn more than non-vets with only a high school degree, and they are more likely to be enrolled in college.
We can still do a lot of work to improve the military, particularly in leadership and adjudication, but it also has a history of positive institutional changes to address issues like racial inequality and reduce the risks of service for certain minority groups.

 

Foraging in the Urban Jungle: Food Security and Homelessness

Matt Gunther on October 28, 2014

According to a new report making headlines this week, 21 American cities have passed laws designed to stop residents from sharing food with homeless people since 2013. The finding, which comes from the National Coalition for the Homeless, highlights an increasingly popular belief that hunger motivates troubled individuals to make lifestyle changes. Food aid, in this view, keeps the homeless complacent. In an interview with NPR, one consultant argued that “Street feeding is one of the worst things to do… it’s very unproductive, very enabling, and it keeps people out of recovery programs.” Many city officials quoted in the report have extended this line of thinking to community soup kitchens and food pantries as well. They see those offerings as well-intentioned, but ultimately misguided attempts to help. One, a police captain from Cincinnati, remarked “If you want the bears to go away, don’t feed the bears.” Research shows this isn’t the case, and these attitudes may actually harm people experiencing homelessness.

Social scientists have amassed a great deal of knowledge about the connection between homelessness and hunger. Over and over, they’ve shown that people with stable food access tend to fare better in other aspects of life.
More importantly, these people aren’t animals and homelessness is no mere matter of individual laziness or poor choice. A number of well known structural factors cause and sustain homelessness, including social stigma, poor access to affordable housing, limited employment opportunities, mental health factors, and physical disabilities.

For more on homelessness, check out TROT posts on last year’s polar vortex and this year’s VMAs.