Pediatric Chronic Illness Management: A Qualitative Dyadic Analysis of Adolescent Patient and Parent Illness Narratives

In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self-management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self-management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.     

Income Inequality across the Rural-Urban Continuum in the United States, 1970–2016*

The growth in macro-level income inequality in the United States is well established, but less is known about patterns of inequality at subnational scales and how they vary between and within rural and urban localities. Using data from the Decennial Census and American Community Survey, we produce estimates of within-county income inequality from 1970 to 2016 and analyze differences in inequality levels, the persistence of high (low) inequality, and populations' exposure to high (low) inequality across the rural-urban continuum. We find that income inequality has historically been higher in non-metropolitan than metropolitan counties, but inequality levels converged by 2016 due to growing inequality in metropolitan counties. Additionally, levels of inequality were generally persistent within counties over time, except that counties characterized by low inequality in 1970 were unlikely to remain as such in 2016. Third, non-trivial shares of the metropolitan population resided in low-inequality contexts in 1970, but virtually none of the U.S. population resided in such places by 2016. Residence in high-inequality counties is normative in rural and urban America. This statistical analysis provides an updated portrait of income inequality across the rural-urban continuum, and should spur additional research on stratification in rural America during an era of growing inequality.     

Couple-Level Patterns of Disclosure Process Beliefs and Their Association with Marital Satisfaction

Abstract

Grounded in symbolic interaction theory, we used latent class analysis (LCA) to investigate the preexisting patterns of belief surrounding the disclosure process in married relationships. With a sample of 131 heterosexual married dyads from the U.S., we found four classes: two classes represented similarity of spouses’ beliefs (Both High Beliefs and Neither High Beliefs), and two classes represented dissimilarity of spouses’ beliefs (where only the wife endorsed high beliefs, Wife High Beliefs, and where only the husband did, Husband High Beliefs). Husbands’ satisfaction was positively associated with membership in the Both High Beliefs class. An interaction between spouses’ satisfaction was found: the impact of wives’ satisfaction on class membership is dependent on husbands’ satisfaction. Implications for research and practice are discussed.     

Cross‐Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika Transmission

Perceptions of infectious diseases are important predictors of whether people engage in disease‐specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and self‐efficacy (i.e., control). The 2015–2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved cross‐sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (March–May 2016) and one just after the first cases of local transmission (July–August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and self‐efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.     

Young people,social media and connective action: from organisational maintenance to everyday political talk

Social media is pervasive in the lives of young people, and this paper critically analyses how politically engaged young people integrate social media use into their existing organisations and political communications. This qualitative research project studied how young people from a broad range of existing political and civic groups use social media for sharing information, mobilisation and, increasingly, as a means to redefine political action and political spaces. Twelve in-person focus groups were conducted in Australia, the USA and the UK with matched affinity groups based on university campuses. The groups were of four types: party political group, issue-based group, identity-based group and social group. Our focus group findings suggest that this in-depth approach to understanding young people's political engagement reveals important group-based differences emerging in young people's citizenship norms: between the dutiful allegiance to formal politics and a more personalised, self-actualising preference for online, discursive forms of political engagement and organising. The ways in which political information is broadcast, shared and talked about on social media by engaged young people demonstrate the importance of communicative forms of action for the future of political engagement and connective action.     

Back to Hegel? On Gillian Rose's critique of sociological reason

Thirty‐five years ago, Gillian Rose articulated a significant critique of classical sociological reason, emphasizing its relationship to its philosophical forebears. In a series of works, but most significantly in her Hegel contra Sociology, Rose worked to specify the implications of sociology's failure, both in its critical Marxist and its ‘scientific’ forms, to move beyond Kant and to fully come to terms with the thought of Hegel. In this article, I unpack and explain the substance of her criticisms, developing the necessary Hegelian philosophical background on which she founded them. I argue that Rose's attempted recuperation of ‘speculative reason’ for social theory remains little understood, despite its continued relevance to contemporary debates concerning the nature and scope of sociological reason. As an illustration, I employ Rose to critique Chernilo's recent call for a more philosophically sophisticated sociology. From the vantage point of Rose, this particular account of a ‘philosophical sociology’ remains abstract and rooted in the neo‐Kantian contradictions that continue to characterize sociology.     

Estimation of the cumulative incidence function under multiple dependent and independent censoring mechanisms

Competing risks occur in a time-to-event analysis in which a patient can experience one of several types of events. Traditional methods for handling competing risks data presuppose one censoring process, which is assumed to be independent. In a controlled clinical trial, censoring can occur for several reasons: some independent, others dependent. We propose an estimator of the cumulative incidence function in the presence of both independent and dependent censoring mechanisms. We rely on semi-parametric theory to derive an augmented inverse probability of censoring weighted (AIPCW) estimator. We demonstrate the efficiency gained when using the AIPCW estimator compared to a non-augmented estimator via simulations. We then apply our method to evaluate the safety and efficacy of three anti-HIV regimens in a randomized trial conducted by the AIDS Clinical Trial Group, ACTG A5095.     

Health Care innovation and children in poverty: lived experiences of caregivers of children with disabilities in a medicaid-serving ACO

This paper reports the results of a qualitative study of caregivers of children with disabilities enrolled in a Medicaid-serving accountable care organization (ACO). The state of Ohio mandated ACO enrollment for Medicaid-eligible children with disabilities in 34 of 88 counties effective July 2013. Research participants were queried in focus groups and individual interviews about their children’s care experiences and care coordination after enrollment. Most told researchers that they themselves are their children’s care coordinators, and many indicated that resource scarcity is a more pressing problem than fragmented care. Data analysis identified a theme of scarcity and four categories of insufficiency that made caregiver efforts on behalf of their children more difficult: a lack of health services under managed care, resource constraints on other agencies and programs for which families were eligible, a lack of financial support, and a lack of family support. A conceptual framework places ACO care coordination among more upstream factors and identifies ways in which ACOs serving Medicaid populations may wish to address the social determinants of the well-being of children with disabilities. Implications for future research are discussed.