WEBVTT 1 00:00:00.001 --> 00:00:00.020 Kate Jaffe: Yes. 2 00:00:00.210 --> 00:00:01.560 Zhe CHEN: Oh, okay. 3 00:00:05.070 --> 00:00:19.430 Zhe CHEN: So good morning. A one or good evening. It depends on where you are, and I'm very happy to make my presentation this time as this session of the twenties. World Congress of Sociology, and 4 00:00:19.570 --> 00:00:29.969 Zhe CHEN: about my study. That is the political and allergy and health status in the East Asian contest evidence farming and China, Japan and South Korea and Taiwan. 5 00:00:30.040 --> 00:00:39.169 Zhe CHEN: and my name is Joe Chen. I am currently a research assistant and the school of public policy and management at Shima University. 6 00:00:39.310 --> 00:00:40.850 Zhe CHEN: Beijing, China. 7 00:00:41.060 --> 00:00:51.700 Zhe CHEN: So in my presentation I will first issue the k findings. From this study, the then I will give a introduction of of the study, still repeated 8 00:00:51.730 --> 00:01:04.479 Zhe CHEN: the A real estate data and the methods using study, followed by the statistical results. And finally, I will make a short discussion. This, based on this, results from this study. 9 00:01:06.850 --> 00:01:15.700 Zhe CHEN: so this that aims to explore the decision between individuals, political and allergy and health status in East Asian contest. 10 00:01:15.960 --> 00:01:23.979 Zhe CHEN: and namely, in in China, South Korea, Japan, and Taiwan. So here are some key findings from this study. 11 00:01:24.100 --> 00:01:36.600 Zhe CHEN: So, firstly, respond respondents who positioned themselves on the left side of the and allergy spectrum have been held, had bad health status compared to those on the west side in South Korea. 12 00:01:36.700 --> 00:01:45.370 Zhe CHEN: and higher levels of competence in government will positively associated with better health status in meaning, and China, Japan and Taiwan. 13 00:01:45.480 --> 00:01:56.440 Zhe CHEN: and the and the view that individuals have more responsibility than garments was significantly associated with band health status in China and Japan. 14 00:01:56.510 --> 00:02:14.819 Zhe CHEN: and the belief that this Government should have the right to conduct civilians on society was significantly associated with bad health status in Japan. and high levels of satisfaction with the government was significantly associated with ban health status in England, China, Japan, and Taiwan. 15 00:02:16.680 --> 00:02:26.990 Zhe CHEN: So now I'm going to introduce the serial basis for this study. So there are various sociological series to explain the social determinants of health. 16 00:02:27.130 --> 00:02:43.379 Zhe CHEN: So in the 1,900 and Ninetys League and Finland they proposed the fundamental cottage theory. This theory persists that risk factors for diseases or embedded with an individual social conditions which are referred to as the fundamental causes. 17 00:02:43.460 --> 00:02:52.340 Zhe CHEN: So the term fundamental implies that the association between social conditions and diseases for this, even after improvements are made in general. 18 00:02:52.480 --> 00:03:06.280 Zhe CHEN: Erez agmoni, so individuals who are socio-economically disadvantaged, still lacking the necessary resources to access health resources, even when the overall availability of such resources improves for a civil society one. 19 00:03:06.450 --> 00:03:07.450 Zhe CHEN: Oh, Emma. 20 00:03:07.580 --> 00:03:19.899 Zhe CHEN: the fundamental code theory may somewhat underestimate the role of counter factors in agency structural relationship to explain. For the reproduction of health behaviors. 21 00:03:20.920 --> 00:03:28.850 Zhe CHEN: So late in the solace intern to San Antonio she composed the Catherine House capital theory. 22 00:03:28.900 --> 00:03:38.469 Zhe CHEN: So Catholic health capital refers to the cattle skills, antitudes, and behaviors that individuals can utilize in the count. In the clinical contest 23 00:03:38.490 --> 00:03:42.809 Zhe CHEN: which automatically impacts their treatment and health outcomes. 24 00:03:43.110 --> 00:03:45.259 Zhe CHEN: And in everyday practices 25 00:03:45.300 --> 00:03:52.910 Zhe CHEN: country has capital is exemplifying to repeated health-related behaviors, such as self-svenience and risk reduction. 26 00:03:53.630 --> 00:04:01.839 Zhe CHEN: So the cat health capital theory differs from the fundamental theory in that individuals exhibit the 27 00:04:02.010 --> 00:04:09.710 Zhe CHEN: exhibit. Their health related behaviors more unconsciously, just like reduced concept of the habiters. 28 00:04:12.130 --> 00:04:42.130 Zhe CHEN: and some studies have have already demonstrated the relationship between an individual's political analogy and their health or health behaviors. For example, main evidence during the COVID-19 from West Societies showed that divisive political ideologies lead to varying health beliefs, including risk perceptions of COVID-19, and trust in this information as well as health behaviors like Max, wearing isolation and adherence to social distancing matters. One. 29 00:04:42.240 --> 00:04:46.290 Zhe CHEN: however, most of these studies are based in Western societies. 30 00:04:46.450 --> 00:04:57.810 Zhe CHEN: and there could be differences across countries in the relationship between political and allergy and the individuals house and in pre-cal studies for mal Western societies are still rare. 31 00:04:59.910 --> 00:05:20.969 Zhe CHEN: and they're helping studies, discussing the political, the political determinants of the house, the many focus out of the upstream political factors that influence publishing house in gloomy inactions and allergies of parties and policies. However, so Charlotte's scholars also need to focus on the downstream political determinism helps 32 00:05:21.120 --> 00:05:33.130 Zhe CHEN: and catch house and couch house chemical theory offers a theoretical framework for analyzing and integrating the into play between political and allergy and individual health. 33 00:05:33.500 --> 00:05:43.229 Zhe CHEN: And this study focuses on focuses on the association between political and allergy and health status. In in China, Japan, South Korea, and Taiwan. 34 00:05:43.380 --> 00:05:47.300 Zhe CHEN: These societies are commonly influenced by the profusion tradition. 35 00:05:47.520 --> 00:05:55.459 Zhe CHEN: but they are very different in across democratic and austerity parties nowadays. 36 00:05:55.810 --> 00:05:59.070 Zhe CHEN: So I propose my research hypothesis here 37 00:05:59.470 --> 00:06:11.419 Zhe CHEN: that is, political ideology is associated with health, with health as the individual level in East Asian contest, namely, in mainland, China, Japan, South Korea, and Taiwan. 38 00:06:13.430 --> 00:06:21.750 Zhe CHEN: And my study used data of the World Value Survey Group 7, which is a comprehensive and representative comparative study. 39 00:06:21.810 --> 00:06:34.549 Zhe CHEN: comparative suit study conducted every five-year school body, and it is the largest non-commercial course national imperial investigation of human beliefs and values conducted faith. 40 00:06:34.720 --> 00:06:53.759 Zhe CHEN: and this and this area in compassed in compass about 80 countries worldwide, and employed a multi-stage assembly mastered in the in the 7. I extracted each substance from Surrey, conducted in these 4 societies from 2,017 to 2,019. 41 00:06:55.150 --> 00:07:00.999 Zhe CHEN: So, in terms of environment, the individual's house was murdered by a self- 42 00:07:01.160 --> 00:07:16.820 Zhe CHEN: mit Ctl. And a self-rated house scale from one to 5. For political analogy a. Still was used to matter the individual's political and allergy directly, but this fear was not included in the survey in China, so one 43 00:07:16.830 --> 00:07:44.269 Zhe CHEN: to make comparative analysis for all this, for this agent societies, and use some other questions to matter the individuals, political and allergy? Indirectly, these questions included confidence in government, the view of governments versus individuals, responsibility. View of government's wine to Se. On people and a society view of heaven and democratic system and satisfaction with current political system. 44 00:07:44.810 --> 00:07:55.030 Zhe CHEN: This study also included a set of control rivals at the individual level, including education, sex, age, employment, and economic standards. 45 00:08:00.210 --> 00:08:26.339 Zhe CHEN: Erez agmoni. So in the statistic analysis, I use 2 steps in step one, I use multiple right linear regression models to examine the the relationship between individual health status and the directly matter political and algae in step 2, I use multiple rights linear regression models to examine the relationship between individual health status and the indirectly measured 150 46 00:08:26.490 --> 00:08:28.160 Zhe CHEN: political and allergies. 47 00:08:31.360 --> 00:08:36.379 Zhe CHEN: So first, here are some of the descriptive statistics 48 00:08:38.600 --> 00:08:39.990 Zhe CHEN: and the 49 00:08:40.060 --> 00:08:52.369 Zhe CHEN: the results of the statistical model shows that, firstly, and the the political analogy was significantly associated with individual health status in South Korea, even after adjusting for 50 00:08:52.450 --> 00:08:54.460 Zhe CHEN: and the country of arrivals 51 00:08:54.620 --> 00:09:02.750 Zhe CHEN: and the individual's confidence in garments, was positively associated with health status in mainland China, Japan, and Taiwan. 52 00:09:03.150 --> 00:09:11.470 Zhe CHEN: and the individual's view on government responsibility was significantly associated with health status in China and Japan. 53 00:09:13.660 --> 00:09:17.709 Zhe CHEN: and the individual's view on the government's civilians. 54 00:09:18.230 --> 00:09:26.200 Zhe CHEN: Civilians. Civilians on society was significant, was significantly associated with health status. In Japan. 55 00:09:26.270 --> 00:09:36.679 Zhe CHEN: however, the individuals view on the democracy system was not significantly associated with health status. In all of the 4 societies. 56 00:09:37.110 --> 00:09:46.259 Zhe CHEN: and the individual satisfaction with government was significantly associated with health status in England, China, Japan, and Taiwan. 57 00:09:49.570 --> 00:10:00.770 Zhe CHEN: So finally, this in this results shows that political and and analogy was associated with the individuals. Health status in East Asia. 58 00:10:01.110 --> 00:10:17.840 Zhe CHEN: So specifically, respondents who position themselves on the left side of the and allergy spectrum have been health status compared to those on the west side in South Korea, and have levels of confidence in government, were positively associated with band health status in man, China and Japan and Taiwan. 59 00:10:17.980 --> 00:10:42.759 Zhe CHEN: and the view that in videos held more responsibility than garments was significantly associated with band health status in men in China, and we believe that the Government should have right to contest civilians outside were significantly associated with band health status in Japan and and and higher levels of satisfaction with garment was significantly associated with band health status in China, Japan, Taiwan. 60 00:10:43.180 --> 00:10:45.950 Zhe CHEN: And here are some implications from this study. 61 00:10:46.080 --> 00:11:11.520 Zhe CHEN: So, firstly, the study shows the importance of contests. In discussing the political differences of house, for example, the d, the dials from this study about the relationship between political and allergy and individual health in South Korea is very different. It's very different from the results conducted in the Western societies, and second, this study fund. The heterogeneity with, we think, is Asian contest, one. 62 00:11:11.720 --> 00:11:21.220 Zhe CHEN: As there are many differences in the association between political and allergy and health status across these Asian societies. 63 00:11:21.500 --> 00:11:37.139 Zhe CHEN: Third, this study suggests that tolerate interventions of all health communications and risky publications could be useful to promote health of the whole population, especially facing the challenges of misinformation and conspiracies. 64 00:11:38.400 --> 00:11:45.690 Zhe CHEN: So thanks for listening, please feel free to content me if you have any kind of questions, and thank you. 65 00:11:53.840 --> 00:12:00.739 Kate Jaffe: Thank you. And thanks for the applause. That's the first indication that there are folks in the room. So I appreciate that. 66 00:12:00.790 --> 00:12:09.690 Kate Jaffe: I think we'll do Q. A. At the end. so we'll keep right on going. I think I'm next on the program. So I'm going to share my screen. 67 00:12:12.680 --> 00:12:13.810 Kate Jaffe: All right. 68 00:12:17.170 --> 00:12:23.299 Kate Jaffe: Great! So Hi! My name is Kate Jaffe. I'm a medical sociologist. 69 00:12:23.350 --> 00:12:31.779 Kate Jaffe: I'm currently a post-doctoral fellow at the University of Michigan, and I'll be an incoming assistant professor at the University of Massachusetts. 70 00:12:33.680 --> 00:12:42.770 Kate Jaffe: so in medical research, randomized control trials or Rcts are considered their gold standard in testing and developing novel treatments. 71 00:12:42.870 --> 00:13:01.909 Kate Jaffe: and pragmatic trials are increasing in popularity as opposed to explanatory trials and their way to measure effectiveness or feasibility of interventions and real world practice settings. using the apparatus of an existing healthcare system, and often these trials are conducted across sites to enhance generalizability. 72 00:13:03.340 --> 00:13:26.419 Kate Jaffe: Another area in which we are seeing rapid is expansion is in substance use research, in part because of the ongoing overdose crisis in which over a hundred 1,000 Americans died last year of drug poisoning and in response to unmet treatment need. It's been estimated that 86% of people with opioid use disorder don't receive treatment. And there are a lot of barriers to staying in treatment 73 00:13:26.590 --> 00:13:38.389 Kate Jaffe: and so giving these trends. We've seen an increase in the number of clinical trials for substance use disorders. So this is evident in the National Institutes of Health recent Heel initiative in which they've already invested 74 00:13:38.510 --> 00:13:42.580 Kate Jaffe: 2 billion dollars in opioid research initiatives. 75 00:13:43.100 --> 00:14:01.810 Kate Jaffe: But in order to conduct these studies, we need representation from people who use drugs in these studies. And I want to know here I use the term people who use drugs as a person. First language that's less stigmatizing. But it can be in precise, a lot of people use drugs. So here I'm talking about a problematic drug use. 76 00:14:02.830 --> 00:14:28.210 Kate Jaffe: And so, while the field of substance use research is expanding, there remain challenges for people who use drugs versus other study populations. So of course, there are specific characteristics of substance use disorders. it can be characterized by chronic relapsing nature. There can be craving withdrawal linkages to trauma, mental health and our diversity and clinical presentation. So substance use looks different for everybody. 77 00:14:28.470 --> 00:14:50.769 Kate Jaffe: Well, we can also think about the social and contextual factors, the sociologists. in these real world trials. So we could think about stigma and discrimination. You can think about substance use as a mark through which people who use drugs, experience, status loss, and are a penalty through laws, policies, and biases compounded by a intersectional disadvantage. 78 00:14:50.900 --> 00:15:06.069 Kate Jaffe: And so you can imagine the stigma in a health care setting might deter people from participating in a in a health study. We can also see it in criminalization and drug policy. So this can shape research experiences in different ways. 79 00:15:06.280 --> 00:15:22.670 Kate Jaffe: So the, for instance, the degree to which a drug is criminalized can impact how willing someone might be wanting to tell a researcher about their drug use, and of course, arrest and imprisonment can make it near possible to participate in a study, much less adhere to a medication. 80 00:15:23.450 --> 00:15:38.520 Kate Jaffe: And, of course, issues of treatment, coverage, and access. So if these pragmatic trials are mirroring what's like what it's like in the real world, you can imagine that treatment coverage can vary by jurisdiction and which can impact medication adherence during this study. 81 00:15:38.920 --> 00:16:05.870 Kate Jaffe: So all of this is situated in a broader drug policy, political climate and which folks have described as normality, policy or policy making that involves clashes of core values about the legitimacy of providing certain kinds of services to a target population, and we see this reflected, and how resources are allocated. A harm, reduction, prevention, treatment, criminalization, kind of signaling who's deserving? 82 00:16:07.120 --> 00:16:10.490 Kate Jaffe: So my collaborator, Lindsay Richardson and I. 83 00:16:10.950 --> 00:16:30.470 Kate Jaffe: We conducted a qualitative study within a pragmatic open label, Non Inferiority trial conducted across Canada. And so this trial, this parent trial was testing models of care for opioid use disorder. So they were looking at Methadone, which is a opioid agonist that acts as a replacement therapy for opioids. 84 00:16:30.480 --> 00:16:38.899 Kate Jaffe: It can kind of ease, cravings and withdrawals. it suspense in a liquid form, but it has to be witnessed every day by a health professional. 85 00:16:38.970 --> 00:16:41.959 Kate Jaffe: And then they were also looking at the boxone, which is 86 00:16:42.000 --> 00:17:01.519 Kate Jaffe: buprenorphine, or a partial agonist combined with Naloxone to also may know it's narcan, and so the boxone can block the effects of opioids. but it can be difficult to start, because you have to be in withdrawal. but it has this flexible dosing, because it's considered safer. 87 00:17:01.520 --> 00:17:13.579 Kate Jaffe: So both of these medications have been shown to be safe and effective in the Us. And Canada. But the investigators we're looking to investigate the feasibility of these medications. in clinical practice with flexible models. 88 00:17:14.120 --> 00:17:31.520 Kate Jaffe: So our study within this trial we conducted 115 qualitative interviews with 75 participants, and we talked to them at the start of their study participation. So we asked them, about their background housing income, generation substance use patterns, experiences with 89 00:17:31.590 --> 00:17:39.670 Kate Jaffe: criminal justice, health care, research, perspectives on the study. And then these things at the end of their study participation. 90 00:17:39.760 --> 00:17:52.739 Kate Jaffe: and we paid them $30 per interview for their time. I also conducted interviews with 26 clinicians and staff who were working in the study. I haven't included this data, but it informs this analysis in a lot of ways. 91 00:17:54.150 --> 00:18:00.850 Kate Jaffe: when we used the the trial infrastructure. But we kept a lot of things separate to keep that 92 00:18:00.950 --> 00:18:03.849 Kate Jaffe: that that 93 00:18:03.950 --> 00:18:07.100 Kate Jaffe: objectivity from the from the trial 94 00:18:07.300 --> 00:18:20.670 Kate Jaffe: Interviews were transcribed in the French interviews were translated into English, and I conducted a qualitative analysis, using a flexible coding approach. and in vivo software. And so, Dale. 95 00:18:21.000 --> 00:18:33.629 Kate Jaffe: prepare, I'll share some of the results from one of these analyses. And I asked, how do the broader structural and political factor shape participant experiences in multi site substance use research. 96 00:18:34.010 --> 00:18:41.120 Kate Jaffe: And so briefly, just to give you an overview of the study sites. Well, Canada has a federal policy of universal health coverage. 97 00:18:41.140 --> 00:18:48.620 Kate Jaffe: the substance use and treatment contacts can vary significantly across provinces. and so by extension research settings. 98 00:18:48.670 --> 00:18:56.779 Kate Jaffe: So Vancouver is considered one of the most progressive drug policy settings, and they're generally the first to pilot different harm. Reduction and treatment approaches 99 00:18:57.080 --> 00:19:10.349 Kate Jaffe: Calgary tends to be a more conservative government. politically, they are generally pretty critical of harm reduction the staff and physicians tell me that the government allocates significant funding towards absence these treatment. 100 00:19:11.310 --> 00:19:19.000 Kate Jaffe: Toronto. it's the largest city in Canada, also fairly progressive. They had a large research facility that specialized 101 00:19:19.070 --> 00:19:30.780 Kate Jaffe: and addiction event to health, but tended to be a bit higher threshold. There was also a a site in Sudbury, Ontario that closed. That was a more rural, and had a large indigenous population. 102 00:19:31.230 --> 00:19:42.959 Kate Jaffe: and then Montreal, which is second largest city in Canada, and they have this beautiful research site in this new skyscraper, but it was in close proximity to a lot of drug scenes in a and a homeless shelter. 103 00:19:43.570 --> 00:19:50.269 Kate Jaffe: some interest of time, because I'm supposed to at hearing to time. I'm going to skip over the demographics. 104 00:19:50.320 --> 00:19:54.280 Kate Jaffe: and it's good to the results. So 105 00:19:54.820 --> 00:20:01.620 Kate Jaffe: one of the first big things that I noticed was the difference Despite the universal health care coverage context. 106 00:20:01.670 --> 00:20:22.290 Kate Jaffe: it became clear that there were significant gaps in medication coverage specifically in Alberta. So in Alberta, socioeconomically marginalized participants would often lose access to their income assistance. So they were in a program called Alberta Works, which had to demonstrate that you were actively looking for work, or you'd lose coverage. 107 00:20:22.300 --> 00:20:40.239 Kate Jaffe: And so Some side participants were able to get emergency covers for 6 months. But then the study would last for for 3 months of the study that last for 6 months and so study staff would end up helping participants file their taxes during the study so they could try to re-qualify for assistance. 108 00:20:40.320 --> 00:20:45.120 Kate Jaffe: And so Joseph recounted his experience. He says, Okay, so I'm Canadian. 109 00:20:45.150 --> 00:20:48.799 Kate Jaffe: I'm on social assistance. I have a grade 8 education. 110 00:20:49.110 --> 00:21:00.899 Kate Jaffe: but I need to get off of this, and I'm going on Methadone. Now you want me to find funding for that, Methodone. How am I going to do that? I don't know how to do that, but that was left in my back, and if the study staff wasn't there, I never would have done it. 111 00:21:00.980 --> 00:21:12.610 Kate Jaffe: So getting cut off. Treatment certainly isn't in line with clinical guidelines. And at best this could be discouraging for participants, because they felt, you know, they had achieved a stable dose after working so hard. 112 00:21:12.640 --> 00:21:19.820 Kate Jaffe: But at worse. This is life threatening because they're forced to return to the unregulated toxic drug supply and risk overdose 113 00:21:21.180 --> 00:21:36.399 Kate Jaffe: the second key. Differences that we saw were in treatment access across the sites. And so in Quebec and Ontario, potential participants or potential patients had saw wait times outside of the study. They were quoted weeks or even months, before they could get access. 114 00:21:36.510 --> 00:21:43.159 Kate Jaffe: but they could find really efficient access through the study. So Andrew describes his experience. He says 115 00:21:43.870 --> 00:21:46.000 Kate Jaffe: he called the clinic, and he says. 116 00:21:46.030 --> 00:21:56.950 Kate Jaffe: You you know you can't come for another 3 weeks, and Andrew says, well, in 3 weeks I could be dead. I want some help. Every treatment center. I've called the same thing unless you got 30 grand for treatment. You're not getting help. 117 00:21:56.980 --> 00:22:02.710 Kate Jaffe: Then the lady goes. Oh, wait a minute. Are you interested in the study? I said a study. I'm not calling for study. 118 00:22:02.850 --> 00:22:16.110 Kate Jaffe: She says it has to do with opioids. I can get you an appointment tomorrow. Someone just canceled. And I'm like, Yeah, sign me in. And then she goes. Do you want to hear about it? I said, No, if it means I'll get some type of treatment. Yeah, I'm in this study. 119 00:22:16.740 --> 00:22:32.769 Kate Jaffe: And so you can see Andrew's disregard for the study details speaks to how treatment wait. Times can shape the incentive structure that motivates study enrollment, and so participants sought, you know, the most efficient pathway to treatment. particularly in jurisdictions with more restricted availability. 120 00:22:33.620 --> 00:22:56.230 Kate Jaffe: In British Columbia. I would say that the medication is more readily available outside of the study, but not necessarily the one that they wanted. So in 2,014, the province had switched the formulation from Methadone to Methodos with outpatient knowledge of consent, and so many people at the time didn't like this formation formulation. Other people have written about this but they went off of it. 121 00:22:56.400 --> 00:23:02.620 Kate Jaffe: And so a few participants who had this experience join the study because they thought they might get access to the real methadone. 122 00:23:04.440 --> 00:23:11.609 Kate Jaffe: And finally. the differences in social context shaped. How participants felt about this study. So, of course. 123 00:23:11.630 --> 00:23:19.720 Kate Jaffe: participants across all sides had voice opinions about what they thought how research should be allocated in the overdose crisis. 124 00:23:19.900 --> 00:23:26.439 Kate Jaffe: But in British Columbia the study perceptions were shaped by the local social context. And so in BC, 125 00:23:26.790 --> 00:23:45.820 Kate Jaffe: there's a really long history of drug user activism and innovations and harm reduction services and a lot of political support for kind of these continually emerging experimental novel treatments. And so for these participants in this study, the medications were old news, you know. They were less inclined to join for reasons of access. They were not that interested. 126 00:23:46.030 --> 00:23:47.679 Kate Jaffe: So Jason says. 127 00:23:47.990 --> 00:24:10.240 Kate Jaffe: you know the Opioid replacement, the I one is incredibly hard to get on, which is kind of Bs, actually, because I know that the medical clinic wants to expand their program too. But the BC government is, you know what I mean until they do that man. Every death is blood on their hands, as far as I'm concerned, because they could put an end to it by letting a clean, healthy heroin in and putting people on a program, they could end the crisis like that. 128 00:24:10.660 --> 00:24:24.379 Kate Jaffe: And so here Jason is referencing a local clinic in Vancouver that provides injectable, opioid agonist treatment, either in the form of injectable hydro, more phone, or like pharmaceutical heroin and diacetal morphine. 129 00:24:24.460 --> 00:24:34.680 Kate Jaffe: And then he's also discussing the safe supply initiatives in which people who use drugs make them in a regulated supply of opioids as opposed to the unregulated supply on the street. 130 00:24:34.700 --> 00:24:43.709 Kate Jaffe: And so these perspectives didn't arise at any of the other sites. Only in BC. Where this was kind of in the news, and a regular topic of discussion among policymakers. 131 00:24:44.940 --> 00:24:52.289 Kate Jaffe: And so these findings highlight the fundamental challenges of pragmatic multi-site studies, especially in the world of substance, use 132 00:24:52.310 --> 00:25:09.590 Kate Jaffe: to me most striking were the gaps in treatment, coverage, and access that reflect this public perceptions and a morality policy and the ways that resources are allocated. So, for instance, income assistance programs where you have to be looking for work in order to be covered or lengthy treatment. Wait times 133 00:25:09.620 --> 00:25:17.490 Kate Jaffe: and in a setting with more treatment options. Protestants may be less willing to be randomized to a medication to which they already have efficient access. 134 00:25:18.000 --> 00:25:38.960 Kate Jaffe: And so I would argue that by assessing participant experiences. across trial sites. This study illustrates how research is embedded in these complex social and policy contexts with circumstances that cannot be operationalized or manipulated, or necessarily even measured by a randomized control trial. 135 00:25:40.290 --> 00:25:48.470 Kate Jaffe: So before I go, I just want to thank our study participants, collaborators and the folks who have supported us along the way. Thank you. 136 00:25:55.290 --> 00:25:58.749 Kate Jaffe: Great. Next up Fernanda. 137 00:25:59.370 --> 00:26:01.320 Fernanda Lobato: Yeah, thank you. 138 00:26:01.490 --> 00:26:08.139 Fernanda Lobato: Thank you very much for these 2 very interesting presentations. So good morning. 139 00:26:08.180 --> 00:26:16.110 Fernanda Lobato: and good night, for those who, like me are are far away. I'm in France right now, so it's 3 am. In the morning. 140 00:26:16.380 --> 00:26:32.800 Fernanda Lobato: So my name is Fernando Lobato. I have just graduated from the sociology master of science, Paul in France, and I will be soon engaging in a Phd. Program also. at next year 141 00:26:33.540 --> 00:26:36.749 Fernanda Lobato: I will be sharing my screen. 142 00:26:36.980 --> 00:26:38.690 Fernanda Lobato: Let me just 143 00:26:39.940 --> 00:26:42.060 Fernanda Lobato: and yes. 144 00:26:46.420 --> 00:26:50.270 Fernanda Lobato: I will. Just oh, wait! Sorry! 145 00:26:51.510 --> 00:26:53.899 Fernanda Lobato: What happened? Oh, sorry. 146 00:26:55.140 --> 00:26:59.430 Fernanda Lobato: Some technical problems here. I would just try to. 147 00:27:10.560 --> 00:27:15.780 Fernanda Lobato: because I've never. I'm don't. I'm not used to you. to Google 148 00:27:17.570 --> 00:27:22.119 Fernanda Lobato: Google Presentation. Do you know where I should click what I had wear it. 149 00:27:22.690 --> 00:27:23.590 Fernanda Lobato: I know if 150 00:27:30.150 --> 00:27:33.570 Fernanda Lobato: well I can. 151 00:27:33.770 --> 00:27:37.019 Fernanda Lobato: The is it possible for you to read like this? 152 00:27:37.370 --> 00:27:45.350 Fernanda Lobato: Because I know where I click to go to the whole? we can. 153 00:27:46.690 --> 00:27:48.079 Kate Jaffe: Yeah, we can see it. 154 00:27:48.280 --> 00:27:54.260 Fernanda Lobato: Yes. Okay, okay, okay, sorry. Okay, let's let's do it like this. Maybe 155 00:27:54.580 --> 00:27:56.190 Fernanda Lobato: so. 156 00:27:56.490 --> 00:28:12.660 Fernanda Lobato: so the paper I'll be presenting today is based upon my master thesis, and it reflects on a controversy on the link between engaging in sex work and the prevailing of post-traumatic stress disorders, symptoms. 157 00:28:13.590 --> 00:28:27.610 Fernanda Lobato: It is a mental health controversy that became actually progressively political and more broadly, a public health controversy. and before going into details I would like to present 158 00:28:27.640 --> 00:28:31.350 Fernanda Lobato: some quick extract from how my field work 159 00:28:31.650 --> 00:28:38.069 Fernanda Lobato: that might maybe present you a little bit of how it fuse to go in depth into this debate and to imagine 160 00:28:38.140 --> 00:28:47.650 Fernanda Lobato: how this discussion might affect sex workers, lives and sex workers, sex workers, actual access to health care. 161 00:28:47.870 --> 00:28:49.159 Fernanda Lobato: and more broadly. 162 00:28:49.180 --> 00:28:57.400 Fernanda Lobato: how mental health discourses might engage in the control and the construction of deviant sexualities. 163 00:28:59.820 --> 00:29:02.670 Fernanda Lobato: So this first extracts 164 00:29:02.930 --> 00:29:10.510 Fernanda Lobato: comes from a political actor engaged in the in this controversy a far more French feminist deputy. 165 00:29:10.630 --> 00:29:13.580 Fernanda Lobato: during a public parliamentary session 166 00:29:13.830 --> 00:29:15.460 Fernanda Lobato: around the 167 00:29:15.580 --> 00:29:25.470 Fernanda Lobato: a discussion about the 2,016 act on prostitution in France. It is an act that criminalized the fact of paying for sexual services. 168 00:29:26.030 --> 00:29:31.040 Fernanda Lobato: and this deputy asks a Ngo worker during the session I quote. 169 00:29:31.380 --> 00:29:42.169 Fernanda Lobato: Do you think it's possible to fall into prostitution when you haven't suffered violence in your childhood or youth? Is it possible to endure prostitution without addictions. 170 00:29:42.350 --> 00:29:45.249 Fernanda Lobato: So here she's hypothesizing 171 00:29:45.490 --> 00:29:47.609 Fernanda Lobato: a link between child abuse. 172 00:29:47.710 --> 00:29:52.530 Fernanda Lobato: The fact of engaging in sex work through 173 00:29:52.920 --> 00:29:55.410 Fernanda Lobato: trauma through the idea of trauma. 174 00:29:59.180 --> 00:30:11.319 Fernanda Lobato: The second extract comes from a different actor. It is a psychiatrist who talks during a conference organized by the Paris City Hall, a Parisian psychiatric hospital 175 00:30:11.690 --> 00:30:12.899 Fernanda Lobato: and an angel. 176 00:30:13.300 --> 00:30:26.410 Fernanda Lobato: The psychiatrist says, I quote these perverse children because of what they have suffered from ancestral, physical, psychic, and sexual abuse, become susceptible to all kinds of reactionary perversions. 177 00:30:26.660 --> 00:30:31.079 Fernanda Lobato: All forms of prostitution are on the arisen. 178 00:30:31.210 --> 00:30:39.790 Fernanda Lobato: One treatment is not effective on that point. So this type of argument is a bit different because there's a psychology, psychoanalytic framework 179 00:30:40.130 --> 00:30:45.770 Fernanda Lobato: that is introduced to the debate through this category of perversion. 180 00:30:46.260 --> 00:30:49.320 Fernanda Lobato: And finally, there is an third actor 181 00:30:49.640 --> 00:31:03.300 Fernanda Lobato: engaged in the controversy which is the scientific actor. In this specific example I call to researcher in psychiatry and legal medicine that asks in her medicine thesis. I quote again 182 00:31:03.640 --> 00:31:10.109 Fernanda Lobato: more briefly, the question is, why don't they cross it? The prostitutes seek treatment 183 00:31:10.310 --> 00:31:26.129 Fernanda Lobato: when they could? Our theory is that this phenomenon is caused by it's caused by the presence of disorders of self-consciousness, consciousness, and bodily experience that it will call the copper decoralization. This is my translation from French 184 00:31:26.220 --> 00:31:35.220 Fernanda Lobato: disorders. generated by the prostitution situation itself, and not by the conditions in which the situation takes place. So 185 00:31:35.330 --> 00:31:43.409 Fernanda Lobato: when I first I was first confronted to all of these kinds of affirmations, and and to despite this debate in general. 186 00:31:43.750 --> 00:31:45.189 Fernanda Lobato: I question myself. 187 00:31:45.240 --> 00:31:53.189 Fernanda Lobato: how has the practice of commercial sexuality become progressively associated with mental health disorder 188 00:31:53.330 --> 00:31:57.769 Fernanda Lobato: disorders specifically with post-traumatic stress disorder 189 00:31:58.180 --> 00:31:59.290 Fernanda Lobato: terminating 190 00:31:59.420 --> 00:32:04.540 Fernanda Lobato: in such a public health controversy, and more broadly, in what I will name 191 00:32:04.580 --> 00:32:08.179 Fernanda Lobato: in my study, a psychomaticalization of this activity. 192 00:32:08.530 --> 00:32:14.959 Fernanda Lobato: a specific specific kind of this broader process that is medicalization. 193 00:32:16.820 --> 00:32:27.239 Fernanda Lobato: So more generally, I would say that this study is an account of the credibility struggles surrounding this correlation between sex work and mental health 194 00:32:27.500 --> 00:32:38.160 Fernanda Lobato: based on specific case. That is the the French, the French case, because in France not only the act of buying sexual services is illegal. 195 00:32:38.650 --> 00:32:48.050 Fernanda Lobato: but also the French Government is openly engaged in fighting against commercial sex as a as a feminist struggle. 196 00:32:52.660 --> 00:33:01.290 Fernanda Lobato: So in order to answer these questions, I developed a social historical perspective to a two-dimensional 197 00:33:01.440 --> 00:33:20.229 Fernanda Lobato: methodological approach. So, on the one hand, I have analyzed many archives existing in different formats, and which are situated in in a quite large timeline, going from 1,875 until 2,022. That are, of course, medical archives, but also 198 00:33:20.520 --> 00:33:23.639 Fernanda Lobato: political and and activist archives. 199 00:33:23.800 --> 00:33:28.480 Fernanda Lobato: and also semi-director. I'm sorry, semi-directed interviews 200 00:33:28.490 --> 00:33:33.630 Fernanda Lobato: with what I call actors directly involved in the controversy 201 00:33:33.790 --> 00:33:45.680 Fernanda Lobato: that might be visible publicly visible or not visible. And that's where the snow role process has helped me identify actors that are less visible in the controversy. 202 00:33:45.840 --> 00:33:52.369 Fernanda Lobato: but that are are not less important, like administrative actors in in health organizations. 203 00:33:52.680 --> 00:33:53.830 Fernanda Lobato: for instance. 204 00:33:57.010 --> 00:34:06.660 Fernanda Lobato: Of course I won't be able to present all of the results of the the master chases, but I would like to present at least my main ones. So the first one that surprised me. 205 00:34:06.730 --> 00:34:14.789 Fernanda Lobato: by the way, is the fact that this is actually, and a quite old historical phenomenon. as I showed with this this timeline. 206 00:34:15.070 --> 00:34:29.959 Fernanda Lobato: because at first I hypothesized that this phenomenon began with the emergency of the this mythological category of of post-traumatic stress disorder in the 1,900 eightys. But it actually emerged in the nineteenth century 207 00:34:30.780 --> 00:34:50.489 Fernanda Lobato: because I could already find actually, archives that try to establish some sort of link between what would be a prostitute site called from back, then not sees forward with them prostitutes, inherent personality, and the fact of engaging in prostitution. 208 00:34:51.440 --> 00:35:02.530 Fernanda Lobato: And these were mostly archives coming from medical hygiene. Hygienist approaches in the turn of the of the nineteenth to the twentieth century. 209 00:35:03.370 --> 00:35:07.189 Fernanda Lobato: and also some criminal anthropology ones. 210 00:35:08.120 --> 00:35:25.490 Fernanda Lobato: And actually, what happens is that there is a deepening of this phenomena in the turn of the 20 first century specific, specifically with the emergency of this, this category of post-traumatic stress disorder, but also with the appropriation 211 00:35:25.680 --> 00:35:36.239 Fernanda Lobato: mit ctl, and of this category by the feminist movement that uses trauma as a political tool for recognizing sexual violence. So there is a a deepening one 212 00:35:36.500 --> 00:35:39.410 Fernanda Lobato: of this medicalization. 213 00:35:39.900 --> 00:35:48.810 Fernanda Lobato: because now, it's not only in a conceptual level and not only engaged by medical actors, but it's now appropriated by activists and politicians. 214 00:35:48.840 --> 00:35:56.030 Fernanda Lobato: and it comes based on on currents, distinction to a a institutional level of medicalization. 215 00:35:59.180 --> 00:36:09.060 Fernanda Lobato: But what is interesting is that, besides all of these transformations in time, there is a persistent underlying discourse over time, a kind of feedback look 216 00:36:09.420 --> 00:36:32.759 Fernanda Lobato: erez agmoni, which is basically the idea that there is an experience, first, experience of sexual violence, mostly during childhood that would lead to symptoms of a post-traumatic stress disordered, and that these symptoms would lead to engaging in commercial sites. But commercial sex would also be a traumatizing event on itself, because it would be a 150 217 00:36:33.230 --> 00:36:39.130 Fernanda Lobato: sexual violence on itself. So it becomes this kind of vicious circle. 218 00:36:39.480 --> 00:36:42.320 Fernanda Lobato: and this discourse persists over time 219 00:36:45.530 --> 00:36:54.779 Fernanda Lobato: in the specific case of France, and I, as I already said, it is also related actually to the consolidation of what we would call a State feminism. 220 00:36:55.000 --> 00:37:11.790 Fernanda Lobato: which is basically the fact that the French government and many others appropriate the family struggles and tries to engage in feminist perspectives against sexual violence, for instance, and try to include in in State organizations. 221 00:37:12.190 --> 00:37:31.660 Fernanda Lobato: And that is interesting, because in in the French case there is a double reinforcement mechanism between what I would call not only a State feminism paradigm, but also maybe a State abolitionism. Abolitionism is the movement that in this case that fights against prostitution. 222 00:37:32.610 --> 00:37:42.180 Fernanda Lobato: because actually, these institutional French feminists defend that sex work is inherently violent, and that it would inherently cause 223 00:37:42.610 --> 00:37:48.440 Fernanda Lobato: cause a a traumatic experience. So it would be a duty of the French Government to 224 00:37:48.510 --> 00:37:50.340 Fernanda Lobato: to fight against it. 225 00:37:51.790 --> 00:37:53.720 Fernanda Lobato: but also. 226 00:37:53.900 --> 00:37:56.769 Fernanda Lobato: on the other hand, the psychomedical. The 227 00:37:57.140 --> 00:38:04.840 Fernanda Lobato: also reinforces this view, because it gives some kind of scientific legitimacy and credibility 228 00:38:05.270 --> 00:38:09.489 Fernanda Lobato: to the the this program of fighting against prostitution. 229 00:38:10.410 --> 00:38:13.119 Fernanda Lobato: And so in that sense, I argued that it 230 00:38:13.170 --> 00:38:19.940 Fernanda Lobato: might participate in the adoption of the 2,016 act on prostitution in France. 231 00:38:23.470 --> 00:38:34.770 Fernanda Lobato: mit Ctl. And finally, as I have quickly mentioned before, it is possible to analyze this process through the lens of the medicalization concept, which was something that was not obvious for me in the beginning, one 232 00:38:35.160 --> 00:38:38.369 Fernanda Lobato: because traditionally studies on medicalization. 233 00:38:38.470 --> 00:38:50.150 Fernanda Lobato: See? what we would called 7 7. Yeah. I think it's seventh in English. Sorry a medicalization as processes that goes against the 234 00:38:50.370 --> 00:38:51.440 thick. 235 00:38:52.350 --> 00:38:55.240 Fernanda Lobato: quote quotes 236 00:38:55.500 --> 00:39:07.930 Fernanda Lobato: erez agmoni in general, the sick as a social actor, and lay medical medicalizations as processes that would go for the sake as a possible pathway to political liberation through 150, 237 00:39:08.290 --> 00:39:25.549 Fernanda Lobato: an alternative medical knowledge and and healthcare. But what we see here is that there is a lay medicalization, because it is mostly engaged by actors outside of the medical field. But it is a lay medicalization that, of course, despite the quote, unquote, safe 238 00:39:25.890 --> 00:39:35.570 Fernanda Lobato: in this specific case, despite sex workers, because actually, many sex workers, activists and friends position themselves against these ideas. 239 00:39:38.340 --> 00:39:48.850 Fernanda Lobato: And what is even more interesting is that in the past 10 years, and especially past 5 years, there is this gradual takeover of the mental health topic by sex worker movements in France. 240 00:39:48.860 --> 00:39:54.930 Fernanda Lobato: and this it is this valeration of situated knowledge or knowledge that 241 00:39:54.980 --> 00:39:56.709 Fernanda Lobato: that sex workers have 242 00:39:56.720 --> 00:40:12.589 Fernanda Lobato: regarding their their own mental health and and the practice of demedicalizing mental health to what they would call self-care and and militant care, and for them these 2 visions would be intrinsically related. 243 00:40:14.330 --> 00:40:17.470 Fernanda Lobato: I don't have much time, 244 00:40:17.980 --> 00:40:20.390 Fernanda Lobato: but I will maybe just bring some quick 245 00:40:21.390 --> 00:40:27.180 Fernanda Lobato: elements about contributions and and limitations. So the study questions the linearity. 246 00:40:27.510 --> 00:40:54.460 Fernanda Lobato: And I would say, the analytical dichotomy in studies of medicalization processes, showing it that it can be actually quite paradoxical sometimes, but also it allow us to rethink the process of victimization of sex workers in the light of this mental health debate, and I would say even more broadly, it leads us to evaluate the role of science and medicine in debates on sex works. And and we could say on on the social 247 00:40:54.800 --> 00:41:02.100 Fernanda Lobato: control and construction of activian sexualities. of course there are many limitations. 248 00:41:02.970 --> 00:41:08.199 Fernanda Lobato: I won't have the time to talk about all of them here. But these are my 249 00:41:10.230 --> 00:41:13.070 Fernanda Lobato: main points. 250 00:41:13.580 --> 00:41:24.750 Fernanda Lobato: and yeah, if you, if you have any question, or if you want to discuss more about the limitations or or about other elements of the presentation, feel free to to contact me. And 251 00:41:25.200 --> 00:41:27.600 Fernanda Lobato: and yeah, thank you very much 252 00:41:36.860 --> 00:41:42.030 Kate Jaffe: great. Thank you. So I think now I'll open it up for questions. 253 00:41:55.020 --> 00:41:58.960 I have a question. Can you hear me here? Yep. 254 00:41:59.430 --> 00:42:01.669 I have a question for Fernanda. 255 00:42:02.680 --> 00:42:10.150 just about. Thank you for your presentations. By the way, all super interesting stuff. Is there a question about 256 00:42:10.730 --> 00:42:15.230 you know, in the Australian context, and it might very well be different in France. 257 00:42:15.260 --> 00:42:27.290 The sort of sex work lobby, the kinds of you know, women who get involved in this kind of political activity generally tend to come from some degree of 258 00:42:27.560 --> 00:42:34.840 privilege or a sort of situatedness. I'll say that affords them 259 00:42:35.250 --> 00:42:42.589 a bit of a different experience than sort of potentially migrant women potentially trafficked women who are in. 260 00:42:42.700 --> 00:42:47.360 you know, circulating in this sort of sex economy that 261 00:42:47.920 --> 00:43:05.120 potentially have radically different experiences. And so, you know, I can obviously see both both sides of the argument, and I just wonder how that side of things factors in for you. I know that you've sort of described the. And I'm assuming it's the Nordic model based on how you've described the 262 00:43:05.490 --> 00:43:20.859 the French act, the 2 2,016 act decriminalizing. Criminalizing the buyers as opposed to the sellers of sex is, I may have misinterpreted that. But yeah, just how sort of this factors into your your analysis and perspective. 263 00:43:24.800 --> 00:43:34.969 Fernanda Lobato: Mit Ctl, and thank you. Thank you very much for the question. Actually, it is not an easy subject and easy topic in France, because it is quite polarized, and one of my 2 264 00:43:35.090 --> 00:43:46.880 Fernanda Lobato: main. Many struggles were it was actually to to separate this political debate, but also in relation to this scientific debate and 265 00:43:47.270 --> 00:43:50.190 Fernanda Lobato: regarding the situation that the 266 00:43:50.350 --> 00:44:04.839 Fernanda Lobato: social status of sex workers and mainly the ones that I've interviewed because I interviewed mostly sex workers who are activists and come from a specific background, right? As as you said. And it is interesting that 267 00:44:05.010 --> 00:44:09.410 Fernanda Lobato: actually, in in my interview panel. 268 00:44:09.660 --> 00:44:13.500 Fernanda Lobato: most of my interviews, who 269 00:44:13.780 --> 00:44:17.369 Fernanda Lobato: were able to question the the scientific 270 00:44:17.420 --> 00:44:29.990 Fernanda Lobato: basis and to to to actually appropriate themselves of this. This debate on mental health were actually people who had a personal trajectory of of a high education. 271 00:44:30.150 --> 00:44:39.329 Fernanda Lobato: or of working, for example, as a nurse and also as a sex worker, and having so this is more privileged, as you said, a trajectory. 272 00:44:39.610 --> 00:44:55.669 Fernanda Lobato: not all of them. There was still some diversity, and there were also migrant sex workers and also sex workers that I had already engaged in were already victims of sexual trafficking. But mostly it is interesting that 273 00:44:56.300 --> 00:45:01.009 Fernanda Lobato: What is actually made possible for them to, to. 274 00:45:01.150 --> 00:45:19.660 Fernanda Lobato: to being, a contact, to be, to be, to oppose themselves to these ideas is the fact that within time there were more activist sex worker activists that had a lot at different social status, and that had a different voice in 275 00:45:19.770 --> 00:45:26.229 Fernanda Lobato: this debate. And and it's also related to to class and and 276 00:45:26.240 --> 00:45:28.309 Fernanda Lobato: and racial elements to. 277 00:45:28.770 --> 00:45:33.960 Fernanda Lobato: So thank you for reminding this this topic. This part. Thank you. Cheers. Thanks 278 00:45:38.330 --> 00:45:39.050 the 279 00:45:49.130 --> 00:45:50.090 Us. 280 00:45:51.050 --> 00:45:55.919 I don't think that we have any any more questions in the room, Kate? 281 00:45:56.380 --> 00:46:03.039 Kate Jaffe: Great! So we have a question on Zoom. I'll read it. Or Jess, maybe, Jessie, would you like to read it out loud. 282 00:46:06.860 --> 00:46:08.369 Jessie: Hello! Could you hear me? 283 00:46:09.150 --> 00:46:09.970 Kate Jaffe: Yes. 284 00:46:10.430 --> 00:46:35.419 Jessie: and because I so my microphone is broken. So so I thank you for sharing, and I have a question for the first presenter, and I think it's really an interesting topic and started But I noticed that the model you use is Lena the near model rather than like panel model or other model that can be 285 00:46:35.420 --> 00:46:50.570 Jessie: schedule if that's between the 2 centers. So it just reveal an associate association. So maybe it's not because political ideologies that affect the subjective. 286 00:46:50.890 --> 00:47:03.909 Jessie: Sorry. It's not health care. It's health station. Maybe there are some other factors of these 2 variable simultaneously, or the relationship is maybe 287 00:47:04.160 --> 00:47:05.880 Jessie: in your. 288 00:47:06.310 --> 00:47:22.270 Jessie: there are a lot of different situations. So I think it might be risky to compute that if it's because they have such a kind of a certain kind of in the allergies or executives, or satisfaction 289 00:47:22.390 --> 00:47:28.199 Jessie: towards the Government. That's a fast their house. and especially I. 290 00:47:28.360 --> 00:47:41.160 Jessie: when it comes to the policy implication that maybe we can make some intervention towards people's my or ideology to improve their 291 00:47:41.170 --> 00:47:42.859 Jessie: how is the situation? 292 00:47:43.460 --> 00:47:48.190 Jessie: Yes, kind of my question also a bit credit. Thank you. 293 00:47:49.550 --> 00:47:51.740 Zhe CHEN: Well, I'll send you Jesse for a question. 294 00:47:52.210 --> 00:48:04.559 Zhe CHEN: Yes, it's it's very important to to to to distinguish a causal relationship, to distinguish because of relationship from a from a linear institution. 295 00:48:04.720 --> 00:48:18.090 Zhe CHEN: Yes, my study only offers a statistical analysis about the association, about the about the association between political and allergy and health status, and in read label. 296 00:48:18.240 --> 00:48:25.120 Zhe CHEN: go into the restriction from the resigns, from the databases I use. 297 00:48:25.150 --> 00:48:35.700 Zhe CHEN: So I read, I couldn't get. I couldn't contribute to any causal relationship between individuals, political health and algae and their health status. 298 00:48:35.930 --> 00:48:54.169 Zhe CHEN: So even though I have controlled a sense of virus like the individuals so the economic standards and the demographic characteristics. But it would be still possible that there could be other 299 00:48:54.370 --> 00:48:55.850 Zhe CHEN: confounders that 300 00:48:55.880 --> 00:49:06.040 Zhe CHEN: that's those who we are, influencers, the as the association so and I so 301 00:49:06.550 --> 00:49:16.479 Zhe CHEN: we need to be very cautious to make any past implications, to make any intervention of the 302 00:49:16.790 --> 00:49:20.489 Zhe CHEN: to to improve by, to 303 00:49:20.850 --> 00:49:26.199 Zhe CHEN: to improve Publisher House by focusing on the political ideology. 304 00:49:26.560 --> 00:49:47.530 Zhe CHEN: So well, so that's maybe the question that I need to address in the next stage. Maybe I'm need a calls or design, or need some panel data to to conclude into any causal conclusion. So thank you for this question. Guessing 305 00:49:58.780 --> 00:50:00.519 Kate Jaffe: great. Thank you. 306 00:50:01.280 --> 00:50:08.879 Kate Jaffe: And it sounds like we don't have any more questions from the room, so I think that I might conclude our session. 307 00:50:09.370 --> 00:50:16.230 Kate Jaffe: so thank you for coming and thanks for folks who attended in person and online. 308 00:50:16.260 --> 00:50:29.840 Kate Jaffe: and I'll send. And Carrie sent his regards. I'll I'll let him know how the session went, and It was nice to meet you all and have a good day or a night. yeah, thank you.