Paying for Success: An appraisal of social impact bonds 

Curtis Child, Benjamin G. Gibbs, Kristie J. Rowley

A social impact bond is a type of pay-for-success initiative that shifts the financial risks associated with pursuing public purposes to private investors. Governments throughout the world are hopeful that they can be relied on as a politically feasible policy tool for tackling difficult social problems. Despite the excitement surrounding them, there is very little empirical scholarship on social impact bonds. This article takes stock of this new phenomenon, noting the many reasons for their widespread appeal while also raising some concerns that researchers and practitioners would do well to consider before adopting them. We do so by appraising them through the lens of three dimensions: accountability, measurement, and cost-effectiveness. Throughout, we draw comparisons to conventional government contracting.



communityworkandfamily.JPGWork-family Conflict among Black, White, and Hispanic men and women

Samantha K. Ammons, Eric C. Dahlin, Penny Edgell, Jonathan Bruce Santo

Are there racial/ethnic differences in work–family conflict? Using a nationally representative survey of Americans, we analyze differences in work–family conflict among Blacks, Whites, and Hispanics and then utilize an intersectional approach, disaggregating men and women within each racial/ethnic group. Using structural equation modeling, we find that the usual predictors of conflict – family and work characteristics – have varied effects on work–family conflict among men and women of different racial/ethnic groups. Nonstandard schedules were uniformly linked to increased work-to-family conflict among all respondents, regardless of subgroup. Our findings reveal the merits of intersectional approaches, and suggest the need for theoretical models of the work–family interface that better reflect the experiences of men and women of color.



impact assessment and project appraisal.JPGThe Social Impacts of Products: A Review

Meagan Rainock, Dallin Everett, Andrew Pack, Eric C. Dahlin, Christopher A. Mattson

Many agree that every product has economic, environmental, and social impacts on those who use and produce them. While environmental and economic impacts are well known and measures have been developed, our understanding of social impacts is still developing. While efforts have been made to identify social impacts, academics, and practitioners still disagree on which phenomena should be included, and few have focused on the impacts of products specifically compared with programs, policies, or other projects. The primary contribution of this review essay is to integrate scholarship from a wide array of social science and engineering disciplines that categorizes the social phenomena that are affected by products. Specifically, we identify social impacts and processes including population change, family, gender, education, stratification, employment, health and well-being, human rights, networks and communication, conflict and crime, and cultural identity/heritage. These categories are important because they can be used to inform academics and practitioners alike who are interested in creating products that generate positive social benefits for users.


journalofchildandfamilystudies.jpgSingle Parenthood and Adolescent Sexual Outcomes

Mikaela J. Dufur, John P. Hoffmann, Lance D. Erickson

Research suggests that children of single parents are at heightened risk of precocious sexual behavior, STDs, and other risky sexual outcomes. However, few such studies have addressed the type of single-parent family (single mother or single father), or differences across other-sex parent–child dyads. While gender essentialist models assume differences among youth living only with mothers or with fathers, constructivist models propose more flexible modes of parenting that lead to more similar outcomes. Using data from the National Longitudinal Study of Adolescent to Adult Health (n=2570) on youth between the ages of 15 and 19, we compared sexually-related outcomes among adolescents, both boys and girls, who lived with a single mother or a single father. These outcomes include sexual intercourse and knowledge, use of contraception, attitudes toward intimacy and pregnancy, and diagnosis of sexually-transmitted diseases. The results from linear and logistic regression models indicated few differences between single-mother and single-father families, or between same-sex and opposite-sex parent–child matches, using p values of .05 or smaller. Our results called into question essentialist models that posit higher risks for adolescents living with a particular parent or with an opposite-sex parent.


populationspaceplace.JPGLifetime Stayers in Urban, Rural, and Highly Rural Communities in Montana

Lance D. Erickson, Scott R. Sanders, Michael R. Cope

Modernity can be characterised by a shift from a communal to an individual orientation where social mobility is one of individuals' primary goals. However, for individuals to achieve social mobility, they often must also be geographically mobile. Consequently, geographic immobility or staying in place needs to be theorised and examined directly. In this context, the life course perspective provides a useful framework to understand staying. The role transitions associated with different life stages represent different decision points where choices to stay must be deliberate. We use state‐representative data from Montana (USA) in 2010 to perform an exploratory analysis of stayers. Using a variety of community and individual predictors, we find that high community attachment, low satisfaction with one's community, and/or local services make being a stayer more likely. In separate models of being a stayer by rurality, age group, educational attainment, and having a dependent in the home, the pattern of results suggests that interpretations of high attachment and low satisfaction among stayers as being indicators of being “stuck” may be incorrect. Instead, even in the absence of being satisfied with one's community, community attachment may be indicative of deliberate decisions to stay. We discuss the limitations of addressing staying using cross‐sectional data and suggest future avenues for better understanding those who stay in place throughout their lives.


ijamh.jpgSad and Lonely: body dissatisfaction among adolescent girls

Renata Forste, Marina Potter, Lance D. Erickson

Purpose: To further understand the association between body dissatisfaction and sadness/loneliness among adolescent girls, we examine how this association, as reported by pre-teen and adolescent girls, is mediated or moderated by the quality of peer and family relationships. 

Methods: Our data are from the Health Behavior of School-Aged Children 2009–2010, a nationally representative survey of school-aged children in the US. We analyze a sample of 5658 girls in Grades 5 through 10. We utilize ordinary least squares (OLS) regression techniques and adjust for the complex sampling design. We explore how the link between body dissatisfaction and sadness/loneliness is mediated or moderated by family and peer relationships and also include controls for age, race, media exposure, and physical health. 

Results: We find that body dissatisfaction is predictive of sadness/loneliness for girls at all grade levels and that the quality of peer and family relationships mediates 27%–38% of this association, particularly among early adolescent girls. Positive peer relationships also moderate or help mitigate the association between body dissatisfaction and sadness/loneliness among pre-teens. 

Conclusion: Our findings underscore the association between body dissatisfaction and sadness/loneliness among early adolescent girls. In addition, our results highlight the importance of quality peer and family relationships in terms of how girls think about their bodies and respond emotionally to them. To evaluate feelings of sadness and loneliness among early adolescent girls, health care professionals need toc onsider not only body dissatisfaction but also the context of peer and family relationships.


socialscienceresearch.jpgForeclosure migration and neighborhood outcomes: Moving toward segregation and disadvantage

Matthew Hall, Kyle Crowder, Amy Spring, Ryan Gabriel

The US housing crisis during the late 2000s was arguably the most devastating residential disaster of the last century, sending millions of families into foreclosure and destroying billions in household wealth. An understudied aspect of the crisis was the spike in local migration that followed the foreclosure surge. In this paper, we assess the residential consequences of these moves, by exploring how foreclosure-induced migration affected the racial and socioeconomic composition of affected families’ neighborhoods. To do so, we use the Panel Study of Income Dynamics to track foreclosure, migration, and neighborhood outcomes for samples of white, black, and Hispanic homeowners. Findings from our analysis show clearly that foreclosure was linked to migration to less white and more residentially disadvantaged neighborhoods, with foreclosed Hispanic householders, in particular, tending to move to poorer and more racially isolated neighborhoods.




The Legacy of Lynching? An Empirical Replication and Conceptual Extension

Ryan Gabriel, Stewart Tolnay

Research shows enduring impacts of lynching on a variety of modern outcomes. For instance, Messner, Baller, and Zevenbergen found that lynching is associated with contemporary white-on-black homicide. We propose a model describing how events from the past can have effects on events in the present. Essential to our framework is the notion of social forces of “resistance” that can impede or facilitate the temporal transmission of collective memories. We test “indicators of resistance” that influence the transmission of a collective memory supportive of a “legacy of lynching.” Analyses reveal that the positive and significant association between lynching and white-on-black homicide observed by Messner et al. is attenuated and becomes statistically nonsignificant with the inclusion of these indicators. Our results suggest that the temporal transmission of a racist cultural schema manifested through lynching is more likely where resistance is low. These findings have implications for how researchers can study historical legacies.   



socialscienceresearch.jpgMixed-Race Couples, Residential Mobility, and Neighborhood Poverty

Ryan Gabriel

Despite substantial growth in mixed-race coupling, we know little about their association with neighborhood poverty. To address this gap, I utilize data from the Panel Study of Income Dynamics linked to information from four censuses. With these data, I assess the extent to which mixed-race couples are more likely than monoracial couples to migrate in response to higher percentages of neighborhood poverty; and, once they move, I examine the percentage poverty in their destination neighborhoods. I find that most mixed-race couples are similar to white couples in their out-mobility responses to neighborhood poverty. However, when mixed-race couples with black partners migrate they tend to move to neighborhoods with higher poverty concentrations than couples without a black partner. Mixed-race couples without black partners experience similar percentages of poverty in their destination neighborhoods as whites, providing further evidence of the profound impact of black race on residential stratification.



maternalhealthjournalvol21.jpgBirth Weight and Early Cognitive Skills: Can Parenting Offset the Link

Jamie L. Lynch, Benjamin G. Gibbs

Objectives; There is an enduring negative association between low birth weight (\2500 g) and early childhood cognitive skills. This study examines if parenting practices meaningfully contribute to or offset birth weight disparities in cognitive development prior to formal schooling. 

Methods: This study uses the ECLS-B, a nationally representative sample of live births in the United States in 2001. Unlike studies focused on one or two measures of parenting and investment, this study considers a wide array parenting measures collected at multiple time points, tracked from before birth across 5 years of development. 

Results: Regression results show that nearly 50 % of the low-birth-weight gap in early math and reading ability is associated with family socioeconomic status. Between-family OLS regressions show that parenting practices, including ‘‘parental interaction,’’ ‘‘cognitive stimulation,’’ and ‘‘parent quality’’, are negatively associated with low birth weight and positively associated with improved cognitive skill among all children. After adjustment for family socioeconomic status, parenting practices did little to offset (by mediation or moderation) remaining birth weight disparities in early cognitive development. 

Conclusions: Effective parenting is positively associated with cognitive development, but parenting is not a panacea—the developmental disadvantages associated with poor child health are not linked to parenting practices. We argue that birth weight disparities are rooted in biology and cannot easily be offset by parenting practices.



maternalhealthjournalvol21.jpgBreastfeeding, Parenting, and Infant Attachment Behaviors

Benjamin G. Gibbs, Renata Forste, Emily Lybbert 

Objectives: Infants and toddlers need secure attachments in order to develop the social competence required to successfully navigate later peer and adult relationships. Breastfeeding is a parenting factor that has been associated with child emotional development—specifically the attachment between children and their mothers. Yet, this link may simply be the result of other parenting behaviors that are associated with breastfeeding. Thus, our objective is to examine whether the link between infant attachment behaviors and breastfeeding endures when accounting for a broad array of in-depth measures of parenting.

Methods: We use the Early Childhood Longitudinal Study of children from 9 months to 2 years of age collected by the National Center for Education Statistics. Using Ordinary Least Squares regression, data analyses examine the association between the Toddler Attachment Sort-45 (TAS-45) measures of toddler-parent attachment (infant attachment security and temperamental dependency) and breastfeeding practices. We also examine individual items of the TAS-45 to isolate specific attachment behaviors that have the strongest associations with breastfeeding. 

Results: We find an enduring link between children who are predominantly breastfed for six or more months and infant attachment security. However, we find no evidence that breastfeeding is linked to a child’s temperamental dependency. Of the nine items used to examine infant attachment behaviors, we find that breastfed children are rated as having slightly higher scores on two measures (“warm and cuddly,” “cooperative”) and lower scores on one measure (“demanding/angry”). 

Conclusions for Practice: Breastfeeding has an important link to the child’s use of their caregiver as a secure base for exploration and a place of comfort when distressed (infant attachment security). Yet, breastfeeding does not appear to reduce a child’s temperamental dependency or level of clinginess as measured by how demanding, fussy or distressed the child becomes when separated. 



plosone.pngThe relative age effect reversal among National Hockey League elite

Luca Fumarco, Benjamin G. Gibbs, Jonathan A. Jarvis, Giambattista Rossi

Like many sports in adolescence, junior hockey is organized by age groups. Typically, players born after December 31st are placed in the subsequent age cohort and as a result, will have an age advantage over those players born closer to the end of the year. While this relative age effect (RAE) has been well-established in junior hockey and other professional sports, the long-term impact of this phenomenon is not well understood. Using roster data on North American National Hockey League (NHL) players from the 2008–2009 season to the 2015–2016 season, we document a RAE reversal—players born in the last quarter of the year (October-December) score more and command higher salaries than those born in the first quarter of the year. This reversal is even more pronounced among the NHL “elite.” We find that among players in the 90th percentile of scoring, those born in the last quarter of the year score about 9 more points per season than those born in the first quarter. Likewise, elite players in the 90th percentile of salary who are born in the last quarter of the year earn 51% more pay than players born at the start of the year. Surprisingly, compared to players at the lower end of the performance distribution, the RAE reversal is about three to four times greater among elite players.



sociologyperspectives.pngThe Asian American Advantage in Math among Young Children: The Complex Role of Parenting

Benjamin G. Gibbs, Priyank G. Shah, Douglas B. Downey, Jonathan A. Jarvis

Asian American children exhibit stronger math and reading skills than white children at school entry, a pattern that has motivated scholars to examine early childhood to determine when and why these gaps form. Yet, to date, it has been unclear what parenting practices might explain this “Asian Advantage.” Analyzing more than 4,100 children from the Early Childhood Longitudinal Study–Birth Cohort, we find that the role of parenting is complex. Asian American parents have high educational expectations compared with whites but are less engaged in traditional measures of parenting (e.g., reading to the child, maternal warmth, parent-child relationship), and these differences matter for understanding the Asian American/white math advantage in early childhood. Thus, even by age four, Asian American parents (across ethnic subgroups) play an important but complex role in the development of a child’s cognitive skills in the first few years of life.



americanbehavioralscientist.pngFamily Social Capital, Family Social Bonds, and Juvenile Delinquency

John P. Hoffmann, Mikaela Dufur

There is a long history in criminology of examining the effects of social bonds on criminal behavior. A similar conceptual framework that developed in sociology is social capital theory. Studies using these models have addressed the effects of parent–child relationships on adolescent behavior. However, social bond theory tends to predominate as an explanation of juvenile delinquency. We developed a comparative analysis of measures of family social bonds and family social capital using nationally representative data on youth (N = 6,432). Measurement models suggested that family social capital is a more parsimonious latent construct than family social bonds. Moreover, it is a more efficient predictor of delinquent behavior. Thus, we encourage criminologists to adopt family social capital as a promising concept and empirical variable in their quest to understand delinquent behavior.



youthandsociety.jpgAcademic Underachievement and Delinquent Behavior

John P. Hoffmann

Considerable research has addressed whether various academic factors affect involvement in delinquent behavior among youth. Yet few studies have assessed the association between academic underachievement and delinquency. Academic underachievement is defined as school performance, such as measured by grades, that falls below what is predicted by standardized tests of mental/cognitive ability. Using two waves of longitudinal data (n = 11,223), this study aimed to evaluate this association and determine if it is affected by school attachment, family relations, parental education, or self-control. The results of the empirical model suggested a modest association between academic underachievement and delinquent behavior, but it was partially attenuated by attention deficits, an indicator of low self-control. Additional analyses indicated that attention deficits were associated with both underachievement and delinquent behavior.



womenandcriminaljustice.jpgBroken Hearts and Bettered Lives: Adverse and Abusive Life Histories and Externalized Responses to Anger as Pathways to Illicit Drug Use Among Incarcerated Women

Melissa S. Jones, Susan F. Sharp, Meredith G. F. Worthen

Most incarcerated women suffer from adverse and abusive life histories, including adverse childhood experiences (ACEs), such as sexual, physical, emotional abuse, and neglect, and intimate partner violence (IPV). In addition, many have difficulties regulating their anger expression and most participate in illicit drug use. Although many have offered explanations for these relationships, the current study is among the first to utilize an integrated feminist pathways and general strain theory (GST) approach to explain them. Using data from a stratified random sample of all incarcerated women in Oklahoma (N = 441), we explore the linkages between ACEs, IPV, the externalized expression of anger, and heavy illicit drug use. Our findings indicate that childhood physical and sexual abuse are significantly associated with externalized responses to anger. However, the effects of childhood adversities, particularly sexual abuse, on heavy illicit drug use are mediated by externalized responses to anger suggesting that anger plays a significant role in women’s pathways to illicit drug use. In contrast, and somewhat surprisingly, being a victim of IPV was negatively related to externalized responses to anger and not significantly related to illicit drug use. Implications for the importance of utilizing an integrated feminist pathways and GST approach in future research are offered.



currentperspectives.jpgWeber and Levinas on Modernity and the Problem of Suffering: Reconstructing Social Theory as Ethically Framed Rather than Epistemologically Framed

Stan J. Knapp

Purpose: This paper argues that the quest for meaning and the problem of suffering are in an irresolvable state of tension and that this tension remains of central importance in modernity and a prominent issue in the reconstruction of contemporary social theory and social science. 

Methodology/approach: The approach focuses on an examination of the work of Max Weber and Emmanuel Levinas on issues of rationality and suffering bringing them into a productive dialogue and juxtaposition.

Findings: The work of Max Weber shows how practices of rationality in modernity are still haunted by the ethical call to responsibility that suffering incurs. The work of Emmanuel Levinas complements and reconfigures Weber’s framing of the issues involved and deepens the general point that a reconstructed social theory would incorporate the implications of suffering more deeply into its practices. 

Implications: A social science and social theory oriented by an epistemological framework is inadequate to the ethical responsibility the presence of suffering invokes. A reconstructed social theory in an ethical framework calls for the best knowledge capable of being produced. As such, a nihilistic or disengaged pluralism, as well as a social science framed primarily by methodological concerns, is inadequate. What will be required is both critical examination of explicit and implicit assumptions of theory and research as well as active, engaged dialogical practices with alternative perspectives. 

Originality/value: An engagement between Weber and Levinas is almost unprecedented, especially on issues rationality and suffering despite their shared perspectives. What Levinas offers the reconstruction of social theory today is explored.



migrationandhumansecurity.jpgRedefining American Families: The Disparate Effects of IIRIRA's Automatic Bars to Reentry and Sponsorship Requirements on Mixed-Race Couples

Jane Lilly Lopez

With passage of the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA), the goal of discouraging illegal immigration and the legal immigration of the poor triumphed over the longstanding goal of family unity in US immigration policy. This shift resulted in policy changes that prevent some mixed-citizenship families from accessing family reunification benefits for the immigrant relatives of US citizens. Two specific elements of IIRIRA — (1) the three- and 10-year bars to reentry, and (2) the minimum income thresholds for citizen sponsors of immigrants — have created a hierarchy of mixed-citizenship families, enabling some to access all the citizenship benefits of family preservation and reunification, while excluding other, similar families from those same benefits. This article details these two key policy changes imposed by IIRIRA and describes their impact on mixed-citizenship couples seeking family reunification benefits in the United States. Mixed-citizenship couples seeking family reunification benefits do not bear the negative impacts of these two policies evenly. Rather, these policies disproportionately limit specific subgroups of immigrants and citizens from accessing family reunification. Low-income, non-White (particularly Latino), and less-educated American families bear the overwhelming brunt of IIRIRA’s narrowing of family reunification benefits. As a result, these policy changes have altered the composition of American society and modified broader notions of American national identity and who truly “belongs.” Most of the disparate impact between mixed-citizenship couples created by the IIRIRA would be corrected by enacting minor policy changes to (1) allow the undocumented spouses of US citizens to adjust their legal status from within the United States, and (2) include the noncitizen spouse’s income earning potential toward satisfying minimum income requirements.



populationresearchandpolicyreview.jpgCaregiver Decision-Making: Household Response to Child Illness in Sub-Saharan Africa

Hayley Pierce, Ashley Larsen Gibby, Renata Forste

We draw upon a framework outlining household recognition and response to child illness proposed by Colvin et al. (Soc Sci Med 86:66–78, 2013) to examine factors predictive of treatment sought for a recent child illness. In particular, we model whether no treatment, middle layer treatment (traditional healer, pharmacy, community health worker, etc.), or biomedical treatment was sought for recent episodes of diarrhea, fever, or cough. Based on multinomial, multi-level analyses of Demographic and Health Surveys from 19 countries in sub-Saharan Africa, we determine that if women have no say in their own healthcare, they are unlikely to seek treatment in response to child illness. We find that women in sub-Saharan Africa need healthcare knowledge, the ability to make healthcare decisions, as well as resources to negotiate cost and travel, in order to access biomedical treatment. Past experience with medical services such as prenatal care and a skilled birth attendant also increases the odds that biomedical treatment for child illness is sought. We conclude that caregiver decision-making in response to child illness within households is critical to reducing child morbidity and mortality in sub-Saharan Africa.



sociological science.pngDeporting the American Dream: Immigration Enforcement and Latino Foreclosures

Jacob S. Rugh, Matthew Hall

Over the past decade, Latinos have been buffeted by two major forces: a record number of immigrant deportations and the housing foreclosure crisis. Yet, prior work has not assessed the link between the two. We hypothesize that deportations exacerbate rates of foreclosure among Latinos by removing income earners from owner-occupied households. We employ a quasi-experimental approach that leverages variation in county applications for 287(g) immigration enforcement agreements with Immigration and Customs Enforcement and data on foreclosure filings from 2005–2012. These models uncover a substantial association of enforcement with Hispanic foreclosure rates. The association is stronger in counties with more immigrant detentions and a larger share of undocumented persons in owner-occupied homes. The results imply that local immigration enforcement plays an important role in understanding why Latinos experienced foreclosures most often. The reduced homeownership and wealth that result illustrate how legal status and deportation perpetuate the racial stratification of Latinos. 



populationresearchandpolicyreview.jpgMilitary Veterans and Neighborhood Racial Integration: VA Mortgage Lending Across Three Eras

Mary J. Fischer, Jacob S. Rugh

The military has long been seen as an avenue for increasing racial equality for minorities, especially black Americans. In this article, we examine to what extent military veterans also experience residential integration by looking at neighborhood residential outcomes for black and white men utilizing the popular Veterans Affairs (VA) loan program to purchase a home. We draw on data from the Home Mortgage Disclosure Act (HMDA) to examine residential integration among white and black veteran homebuyers compared to homebuyers utilizing conventional loans over three major lending eras: 1990s, 2000–2007, and 2008–2015. By 2015, a quarter of all home purchase mortgages loans to black men were VA loans even though veterans made up only a tenth of the adult black male population. In our multivariate analyses, we uncover a sizeable combined swing toward neighborhood minority-white integration, 14.4% points, among black and white veterans who use VA loans. Compared to those with conventional loans, black veterans live in neighborhoods with 10% points fewer minorities and, white veterans, 4.4% points fewer whites. Our results illustrate how racial integration in the US military has the potential to foster lasting housing integration among veterans.



JMF cover.jpgDoes Adherence to Masculine Norms Shape Fathering Behavior?

Richard J. Petts, Kevin M. Shafer, Lee Essig

Research suggests that many fathers struggle balancing hegemonic masculine norms with new fatherhood ideals. This study uses data on 2,194 fathers from a national study on fathers of children aged 2 to 18 and incorporates a comprehensive assessment of masculine norms to examine whether adherence to masculine norms is associated with father involvement and whether this relationship is mediated by fathers' adherence to the new fatherhood ideal that promotes engaged, nurturing parenting. Results suggest that fathers who more closely adhere to masculine norms are less involved in instrumental and expressive parenting and are more likely to engage in harsh discipline than fathers who are less masculine. Adherence to masculine norms also reduces the likelihood of embracing the new fatherhood ideal, and adherence to the new fatherhood ideal at least partially mediates the relationship between masculinity and father involvement. Overall, despite changing expectations for fathers, hegemonic masculine norms continue to shape fathers' behavior.




children and youthservices.jpgDoes Family Reunification from Residential Care Facilities Serve Children's Best Interest? A Propensity-score Matching Approach in Ghana

Spencer L. James, Jini L. Roby, Lindsay J. Powell, Bryan A. Teuscher, Kelsey L. Hamstead, Kevin Shafer

The U.N. Convention on the Rights of the Child declares that children are entitled to grow up in a family environment with love, happiness and understanding. Governments and international child welfare agencies have promoted the reintegration of children currently in residential care facilities with family or other caregivers. We assess whether 157 children who spent time in a Ghanaian residential care facility but who have been reunified with their families scored differently on a battery of standardized child wellbeing measures than 204 children still living in residential care facilities using propensity score matching models. Results suggest that outcomes, including overall hope (as well as hope pathways and hope agency) and access to basic resources as measured on the Child Status Index, differ between children who were and were not reunified. These results underline the importance of supporting children's physical and psychosocial developmental needs. Children who were reunified with family members or other kin may require additional support regarding access to basic resources whereas interventions designed to increase hope in the future may benefit children in residential care. We urge a redoubling of efforts to care for children under carefully designed national schemes providing resources, trained personnel, and sustained case management.



rural sociology.jpgIntersecting Contexts: Understanding Rural Utah Veterans Experiences with Accessing VA Health Care

Carol J. Ward, Matthew Stearmer, Michael R. Cope

 Since the passage of the Rural Veterans Care Act of 2006 research has focused on health care provider issues with less attention given to individual and contextual factors that contribute to the remaining service gap. Adopting the health care user’s viewpoint, we focus on two questions: How do health care users perceive access to health care, and which contextual factors are relevant to explaining the failure of recent efforts to increase access by rural veterans? We collected detailed data through focus groups and individual interviews involving veterans and knowledgeable community members in four rural areas of Utah. Framing the analysis of interview data using the sociospatial approach reveals key dimensions of several contexts that affect rural veterans’ access to health care: the historical period of military service that influences attitudes toward use of Veterans Administration health care and access to specialists, regulations of regionally and locally organized insurance coverage that affects access to and coordination of health care, and local social aspects of rural communities that inform use of specific health care sources. These dimensions provide new insights into the conditions that contribute to variations in the vulnerability of rural Utah veterans.

Carol J. Ward, Michael R. Cope, Lindsey Elmont

As a growing segment of the military, Native Americans are expected to increase enrollment in Department of Veterans Affairs (VA) healthcare. Currently, 20% of Native American veterans are aged 65–74, which means they served during the Vietnam era. This study explores the experiences of rural American Indian veterans from two Montana reservations with accessing VA health services. Utilizing detailed data obtained in focus group and individual interviews, we examine the experiences, attitudes, barriers and needs of rural Vietnam-era veterans. Analyses indicate that while Native American Vietnam-era veterans experienced a poor reception returning to the US after military service, they had more positive receptions in their home reservation communities. However, reintegration was often impeded by poor local opportunity structures and limited resources. As they have aged and turned to the VA for healthcare, these veterans have encountered barriers such as lack of information regarding eligibility and services, qualifying for care, excessive distances to health services, the cost of travel, and poor quality of assistance from VA personnel. Despite variations in their resources, tribal community efforts to honor veterans have begun to facilitate better access to healthcare. Focusing on the roles and importance of place–based resources, this study clarifies challenges and obstacles that Native American Vietnam-era veterans experience with accessing VA health services in rural, reservation communities. Additionally, findings show how tribal efforts are facilitating access as they begin to implement the 2010 agreement between the VA and Indian Health Services to better serve Native veterans.