"Healthier Than Just Healthy": Families Transmitting Health as Cultural Capital

Racial, Ethnic, and Gender Differences in the Timing of Initiating the HPV Vaccine in the United States: the Case of Southeast Asian Americans

Despite the availability of the human papillomavirus (HPV) vaccine, non-Latinx (NL) Southeast Asian Americans have the highest incidence of HPV-associated cervical cancer in the US. Little is known about NL-Southeast Asian Americans' HPV vaccination coverage due to being categorized under the "Asian American" monolith. Therefore, this study uses restricted data from the 2011-2018 National Health and Nutrition Examination Survey (NHANES) to disaggregate NL-Southeast Asian Americans and compare this population's age-specific probabilities of initiating HPV vaccinations to two Asian American subgroups (NL-East Asian and NL-South Asian Americans) and NL-White, NL-Black, and Latinx Americans. Multinomial logistic regression models examine the differences in the timing of initiating the HPV vaccine series, late (ages 13-26) or never, relative to on-time vaccination (by age 12). NL-Southeast Asian Americans are significantly more likely to never vaccinate and to vaccinate late than NL-White, NL-Black, and Latinx Americans, relative to on-time vaccination. NL-Southeast Asian American boys/men are significantly more likely to never initiate the HPV vaccine than Latinx boys/men, relative to on-time vaccination. NL-Southeast Asian American girls/women are significantly more likely to never vaccinate and vaccinate late than NL-White, NL-Black, and Latinx girls/women, relative to on-time vaccination. There are significant gender differences in uptake among all racial and ethnic groups, except among NL-Southeast and NL-East Asian Americans. Disaggregated data on NL-Southeast Asian Americans helps scholars and public health officials uncover health disparities and improve health interventions. Targeted HPV vaccine promotion and services for this population are needed to mitigate current and future health disparities and promote health equity.

When the Penny Drops: Understanding how social class influences speciality careers in the UK medical profession

In the UK, the medical profession is socially exclusive and socially stratified as doctors from more advantaged backgrounds are more likely to train for specialities with more competitive entry. However, in research to date the causes and consequences of social stratification have been overlooked. We explore this subject here, drawing on a qualitative study comprising in-depth interviews with 30 medical students and doctors from less advantaged socio-economic backgrounds negotiating medical school and early careers. Using Bourdieu's 'theory of practice' we show how socialisation in the family and at school influences how aspirant medics from less advantaged backgrounds view the world, suggesting some inclination towards more community orientated careers, which may be less competitive. However, these tendencies are encouraged as they lack stocks of social, economic and cultural capital, which are convertible to power and position in the field. While allowing for both choice and constraint our core argument is that speciality outcomes are sometimes inequitable and potentially inefficient, as doctors from more advantaged backgrounds have privileged access to more competitive careers for reasons not solely related to ability or skill. Our main theoretical contribution is to literature in the sociology of medical education where ours is the first study to open-up the 'black box' of causal factors connecting medical students' resources on entering the field of education and training with speciality outcomes, though our findings also have important implications for practitioners, the profession and for patients. We discuss the implications for safe and effective healthcare and how this informs directions for future research.

The formation of classed health lifestyles during youth: A two-generational, longitudinal approach

The topic of this article is the classed formation of health lifestyles in youth. Based on longitudinal interview data (41 youths, 17 of their parents) from two contrasting class contexts in Norway, we investigate how health lifestyles are reproduced across generations and during youth, focussing particularly on diet and physical activity. We find that young people's health lifestyles are powerfully shaped by social class and moulded over time in ways that may impact their further health trajectory. The health practices of upper-class young people are closely monitored; they are practically and emotionally scaffolded by their parents. Developing a rigorous health orientation, they come to view health as an investment for the future, intrinsically linked to achievement, discipline and identity. Working-class parents focus more on the child's autonomy in matters of diet and physical activity. Separating health practices from family life, their children's health orientation becomes more fragile and their children's health lifestyle trajectory more arbitrary and vulnerable to peer influence and marketised body cultures. Combining temporality, youth agency and relationality, it becomes evident that young people internalise their parents' health lifestyle, leaving room for different expressions of youth agency.

Distinction through distancing: Norm formation and enforcement during the COVID-19 pandemic

The unequal spread of COVID-19 was accompanied by disparities in adherence to social distancing. Research is needed on social processes that facilitated widespread adherence to distancing, how they connected with existing resource access and belief systems, and how they potentially strengthened intergroup boundaries. We integrated insights from research on social norms and cultural capital to analyze early pandemic (April-August 2020) qualitative interviews with parents and their teenage children in two higher-resource communities in the United States. Our findings uncovered four interrelated processes that facilitated the rapid establishment of norms around distancing, concurrently strengthening group boundaries. Community members: 1) drew on existing cultural capital to smooth the establishment of new social norms, 2) associated social distancing with individual moral worth and community identity, 3) applied double standards that granted certain exceptions to ingroup members to maintain social cohesion, and 4) drew strong distinctions between their own and outsiders' social distancing behaviors and moral worth. Our findings articulate social processes that allowed for rapid cohesion around distancing and show how these mechanisms strengthened existing community social boundaries.

How theory can help to understand the potential impact of food environment policies on socioeconomic inequalities in diet: an application of Bourdieu's capital theory and the scarcity theory

Government policies that promote healthy food environments are considered promising to reduce socioeconomic inequalities in diet. Empirical evidence of effects on these inequalities, however, is relatively scarce and, with a few exceptions, tends to be inconclusive. We use two contemporary theories that help to understand socioeconomic inequalities in health and health-related behaviours (Bourdieu's capital theory and Mullainathan and Shafir's scarcity theory) to reason how policies influencing food environments may differentially impact lower and higher socioeconomic groups. In essence, these theories enable us to understand how specific elements of broader daily living conditions (e.g. social practices that lead to habitus formation, material conditions that shape experiences of scarcity) may lead to a greater benefit of certain food environment policies for the healthfulness of diets of lower or higher socioeconomic groups. We conclude that the application of theories on the mechanisms underlying socioeconomic inequalities in health can help to guide future empirical studies in testing theory-based hypotheses on differential effects of policies, and thereby enhance the development of effective policies tackling socioeconomic inequalities in dietary intakes.

Family Socioeconomic Status and Children's Screen Time

OBJECTIVE

This mixed-methods study examined whether higher-SES children's digital technology use adhered to contemporaneous pediatric guidelines, how it compared to lower-SES children, and why, as analyses showed, higher-SES children's technology use far exceeded pediatric recommendations.

BACKGROUND

2013 American Academy of Pediatrics (AAP) guidelines recommended limited "screen time" for children. Higher socioeconomic status (SES) families tend to follow guidelines, but digital technology use-simultaneously a health behavior and a pathway for building human capital-has complex implications.

METHOD

Quantitative analyses provide new nationally representative estimates of the relationship between social class and 9- to 13-year-old children's technology time (including television), device access, and parenting rules (2014 PSID Child Development Supplement, N=427). Qualitative analyses of 77 longitudinal higher-SES parent interviews articulated explanatory processes.

RESULTS

Higher-SES children used technology as frequently as others and in excess of recommendations. Their device access, activities, and agency in adhering to rules, however, differed from others. Qualitative analysis uncovered processes that helped explain these findings: parents' ambivalence about technology and perception that expert guidance is absent or unrealistic, and children's exercise of agency to use technology facilitated by "concerted cultivation" parenting styles, led to higher-SES individualistic parenting practices that supported children's increased non-television technology use.

CONCLUSION

Cultures and structures related to children's technology use are in flux, and classed norms and understandings are emerging to construct relevant class-based distinctions around parenting.

Peer Network Processes in Adolescents' Health Lifestyles

Combining theories of health lifestyles-interrelated health behaviors arising from group-based identities-with those of network and behavior change, we investigated network characteristics of health lifestyles and the role of influence and selection processes underlying these characteristics. We examined these questions in two high schools using longitudinal, complete friendship network data from the National Longitudinal Study of Adolescent to Adult Health. Latent class analyses characterized each school's predominant health lifestyles using several health behavior domains. School-specific stochastic actor-based models evaluated the bidirectional relationship between friendship networks and health lifestyles. Predominant lifestyles remained stable within schools over time, even as individuals transitioned between lifestyles. Friends displayed greater similarity in health lifestyles than nonfriend dyads. Similarities resulted primarily from teens' selection of friends with similar lifestyles but also from teens influencing their peers' lifestyles. This study demonstrates the salience of health lifestyles for adolescent development and friendship networks.

"Dedicated to being healthy": Young adults' deployments of health-focused cultural capital

Performances of "health" through diet, exercise, and body size are an increasingly important form of cultural capital transmitted to children. Yet less is known about how socioeconomically privileged young people internalize and deploy that capital or how those less privileged manage their relative lack of capital. How does health-focused cultural capital acquired in childhood shape socioeconomic inequalities, health behaviors, and understandings of health in young adulthood? Our analysis of 113 interviews found that health-focused cultural capital acquired in early life reinforced young adults' socioeconomic and health advantages by helping them claim discipline and morality on the basis of their health behaviors and body size. Two key phenomena tended to be present among our many socioeconomically privileged but not our fewer less privileged participants: family socialization into classed diet- and exercise-related health behaviors resulting in a classed appearance of health (despite less-than-ideal behaviors), and cohesive life course narratives linking these behaviors to hard work and moral worth. Less socioeconomically privileged participants' understandings of health and healthy behaviors were different, rarely linking health to worthiness and discipline. To understand the intergenerational transmission of socioeconomic attainment and health in US society, we must consider how behaviors and group-based norms, identities, and understandings of health coalesce in classed health lifestyles that convey cultural capital.

"Everything is Connected": Health Lifestyles and Teenagers' Social Distancing Behaviors in the COVID-19 Pandemic

Social distancing during the COVID-19 pandemic requires people to engage in new health behaviors that are public, monitored, and often contested. Parents are typically considered responsible for controlling their children's behavior and instilling norms. We investigated how parents and teens managed teenagers' social distancing behaviors. Analyzing 100 longitudinal (2015-2020), dyadic qualitative interviews with teenagers and their parents in 20 families from two middle-class communities in which social distancing was normative, we found that preexisting health lifestyles were used to link social distancing behaviors to specific identities, norms, and understandings of health. The pandemic presented challenges resulting from contradictory threats to health, differing preferences, and conflicting social judgments. Parents responded to challenges by adhering to community norms and enforcing teens' social distancing behaviors. They drew on preexisting, individualized health lifestyles as cultural tools to justify social distancing messages, emphasizing group distinctions, morality, and worth in ways that perpetuated inequalities.

Contributions and Challenges in Health Lifestyles Research

The concept of health lifestyles is moving scholarship beyond individual health behaviors to integrated bundles of behaviors undergirded by group-based identities and norms. Health lifestyles research merges structure with agency, individual-level processes with group-level processes, and multifaceted behaviors with norms and identities, shedding light on why health behaviors persist or change and on the reproduction of health disparities and other social inequalities. Recent contributions have applied new methods and life course perspectives, articulating health lifestyles's dynamic relationships to social contexts and demonstrating their implications for health and development. Culturally focused work has shown how health lifestyles function as signals for status and identity and perpetuate inequalities. We synthesize literature to articulate recent advances and challenges and demonstrate how health lifestyles research can strengthen health policies and inform scholarship on inequalities. Future work emphasizing health lifestyles's collective nature and attending to upstream social structures will further elucidate complex social processes.