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Background Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction. Methods Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects. Results After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator. Conclusions Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.

Background Schizophrenia and related disorders are highly disabling and create substantial burdens for families, communities, and health care systems. Although pharmacological treatments can often lessen the psychotic symptoms that are a hallmark of schizophrenia, they do not lessen the social and cognitive deficits that create the greatest impediments to community engagement and functional recovery. This study builds on prior research on psychosocial rehabilitation by comparing the effectiveness of two treatments demonstrated as efficacious in improving social and community functioning, Cognitive Enhancement Therapy (CET) and a version of Social Skills Training (HOPES/SST). Methods The study uses a randomized cluster design in which a pair of clinicians at community- and hospital-based mental service centers deliver either CET or HOPES to at least one group of 6-8 eligible clients for 12 months. Clinicians are trained and then supervised weekly, with ongoing process measurement of treatment fidelity, attendance, satisfaction, and retention, and use of other services. Measures administered at baseline and at 6 and 12 months while in treatment, and then at 18 and 24 months after treatment include social adjustment, quality of life, social skills, positive and negative symptoms, and neuro- and social cognition. We hypothesize that CET will be associated with greater improvements than SST in both the primary outcome of community functioning and the secondary outcomes of neuro- and social cognition and social skills. Secondarily, we hypothesize that more cognitive impairment at baseline and younger age will predict more benefit from CET compared to HOPES. Discussion Resource shortages endemic in mental health services and exacerbated by the pandemic highlight the importance of identifying the most effective approach to improving social and community functioning. We aim to improve understanding of the impact of two efficacious psychosocial treatments and to improve clinicians’ ability to refer to both treatments the individuals who are most likely to benefit from them. We expect the result to be programmatic improvements that improve the magnitude and durability of gains in community functioning. Trial registration ClinicalTrial.gov NCT04321759 , registered March 25, 2020.

We combined survey, mobility, and infections data in greater Boston, MA to simulate the effects of racial disparities in the inclination to become vaccinated on continued infection rates and the attainment of herd immunity. The simulation projected marked inequities, with communities of color experiencing infection rates 3 times higher than predominantly White communities and reaching herd immunity 45 days later on average. Persuasion of individuals uncertain about vaccination was crucial to preventing the worst inequities but could only narrow them so far because 1/5th of Black and Latinx individuals said that they would never vaccinate. The results point to a need for well-crafted, compassionate messaging that reaches out to those most resistant to the vaccine.

Differences in health care satisfaction can alter patterns of health care utilization and so affect health outcomes, but little is known about variation in satisfaction in relation to immigration status. Health care satisfaction is analyzed with survey data from state public health program patients. Overall health care satisfaction is higher for first generation Hispanic immigrants and lower among those in the second generation compared to white Americans—consistent with the pattern termed the “healthy migrant effect.” This pattern is more pronounced for Portuguesespeaking immigrants and is not explained by self-reported health, communication ability or acculturation. Satisfaction with specific aspects of health care follows different patterns that may be explained by differences in experiences and culture. As anticipated by segmented assimilation theory, we find variation in cross-generational patterns of health care satisfaction both within and between ethnic groups. This variation indicates the importance of distinguishing Portuguese-speakers from Spanish-speakers and of taking into account differences in the ways they are able to communicate with health care providers as well as differences in their orientations toward health care. Our disparate findings with other immigrant groups also reinforce limiting expectations of a “healthy migrant effect” to Latinos. Finally, the variable influences on different satisfaction measures indicate the importance of considering the relative influence of culturally-based orientations and health care experiences on the specific outcomes measured, with particular sensitivity to acceptance of individualized standards of care.

Despite long-standing prejudices against doing so, it is time for sociology to reconnect with its roots in biological and evolutionary thinking. Sociology emerged as a discipline when the notion of evolution was actively used in biology, geology, and emerging social sciences. Throughout the nineteenth century, many of the most prominent early European sociologists examined the social universe from an evolutionary perspective; and this perspective was borrowed in much of early American sociology in the last decades of the nineteenth century and in the first decades of the twentieth century. By the end of the second decade of the twentieth Century, however, evolutionary analysis was rapidly disappearing in sociology in the United States, and by the 1930s, it was pretty much dead. And for the remainder of the twentieth century, it was viewed with a great suspicion, especially evolutionary approaches that sought to incorporate ideas from biology into the field. Despite the revival of stage models of societal evolution and the emergence of new ecological approaches in the 1960s and 1970s, evolutionary ideas from biology were still rejected by most American sociologists though much of the twentieth century. In this paper, we first present the history of this rejection of evolutionary, with the goal of encouraging sociologists today to recognize the distortions and misrepresentations of Darwinian and Spencerian ideas that fueled intellectual prejudices for so many decades. These prejudices only get in the way of sociology in the twenty-first century, where biological ideas have begun to pervade the social sciences. Thus, American sociologists should now take stock and reconsider how much evolutionary and biological analysis can help sociology and, equally if not more important, how an informed evolutionary sociology can influence those in the other social sciences and even those in the biological sciences.

In sociology’s formative period between 1830 and 1930, evolutionary analysis organized much theorizing and research. This line of work ended abruptly in the 1920s but, over the last decades, has come back into the discipline somewhat piecemeal with the reintroduction of more sophisticated stage models of societal evolution, functional analysis, human ecological analysis, and other new lines of evolutionary inquiry outlined in this paper. Our goal is to demonstrate that revitalized paradigms of the past can still be useful with modest reconceptualization, while at the same time new intellectual movements in the other social sciences, especially economics and psychology, incorporating evolutionary ideas from biology provide sociology with an opportunity to develop its own approach to evolutionary analysis that avoids the problems that let to the demise of this line of inquiry in the 1920s, as well as the problems of other social sciences applying their more narrowly focus models to sociological problems. Indeed, sociology can become a leader in the social sciences in developing more sophisticated theoretical and methodological approaches to incorporating biology and evolutionary analysis into the social sciences. When presented in a new, more sophisticated guise, old approaches like functionalism, stage models of societal evolution, and ecological models can be seen as still having a great deal of explanatory power, while revealing a progressive and future orientation that should appeal to all contemporary sociologists. It is time, then, for sociology to remember its past in order to move into the future.

Abstract Purpose Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients. Methodology/approach A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified. Findings The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs. Research limitations/implications While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation. Practical implications The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill. Originality/value A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.