Palliative care management committees: a model of collaborative governance for primary health care.

SETTING: The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. OBJECTIVE: To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. DESIGN: This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. RESULTS: Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes. CONCLUSION: Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.

CONTEXTE: Le programme communautaire de soins palliatifs primaires du Kérala, Inde, a été applaudi sur la scène internationale. Le fonctionnement du programme est soutenu par des Comités de gestion des soins palliatifs (PMC) au niveau des gouvernements locaux (LG). OBJECTIF: Évaluer le fonctionnement des PMC au sein de l'espace de gouvernance décentralisée, afin d'identifier les réussites, les lacunes et les principales innovations. MÉTHODES: Dans le cadre de cette étude qualitative, sept entretiens avec des informateurs clés (KIIs), 28 entretiens approfondis et une analyse des politiques et documents accessibles au public ont été réalisés. Les transcriptions des KII ont permis de faire émerger les thèmes principaux. Les codes émergeant de l'analyse documentaire et des transcriptions des entretiens approfondis ont été associés aux domaines thématiques identifiés. RÉSULTATS: Les PMC les plus performants ont pu mobiliser des ressources, telles que de l'argent, des ressources humaines ou des équipements. Ils proposaient également des options de soins de qualité pour soulager les symptômes, facilitaient la réduction des frais à la charge du patient en fournissant des soins à domicile et des médicaments gratuits, et ont permis d'améliorer l'accès aux interventions qui s'attaquaient aux déterminants sociaux de la souffrance, tels que la pauvreté. Les capacités techniques et de gestion variaient d'un PMC à l'autre. Le programme de certains LG était faible, principalement limité à la fourniture de médicaments et d'aides et de matériels de base pour le domicile des patients. CONCLUSION: Malgré des schémas de mise en œuvre variés, les PMC du Kérala sont des exemples d'initiatives communautaires de santé soutenues par l'état qui peuvent potentiellement s'attaquer aux déterminants sociaux et médicaux de la souffrance.

Medicare advantage and dialysis facility choice.

OBJECTIVE: To compare the characteristics of dialysis facilities used by traditional Medicare (TM) and Medicare advantage (MA) enrollees with end-stage kidney disease (ESKD). DATA SOURCES: We used 20% TM claims and 100% MA encounter data from 2018 and publicly available data from the Centers for Medicare and Medicaid Services. STUDY DESIGN: We compared the characteristics of the dialysis facilities treating TM and MA patients in the same ZIP code, adjusting for patient characteristics. The outcome variables were facility ownership, distance to the facility, and several measures of facility quality. DATA COLLECTION/EXTRACTION: We identified point prevalent dialysis patients as of July 15, 2018. PRINCIPAL FINDINGS: Compared to TM patients in the same ZIP code, MA patients were 1.84 percentage points more likely to be treated at facilities owned by the largest two dialysis organizations and 1.85 percentage points less likely to be treated at an independently owned facility. MA patients went to further and lower quality facilities than TM patients in the same ZIP code. However, these differences in facility quality were modest. For example, while the mean dialysis facility mortality rate was 21.85, the difference in mortality rates at facilities treating MA and TM patients in the same ZIP code was 0.67 deaths per 100 patient-years. Similarly, MA patients went to facilities that were, on average, 0.15 miles further than TM patients in the same ZIP code. CONCLUSION: MA enrollees with ESKD were more likely than TM enrollees in the same ZIP code to use the dialysis facilities owned by the two largest chains, travel further for care, and receive care at lower quality facilities. While the magnitude of differences in facility distance and quality was modest, the direction of these results underscores the importance of monitoring dialysis network adequacy as ESKD MA enrollment continues to grow.

Effectiveness of Screening for Household Gun Ownership in an Urban Primary Care Clinic.

Gun-related suicide and homicide are leading causes of death among children. Little is known about the effectiveness of screening for gun ownership in primary care. We examined positive gun ownership screens over a 2.5-year period in a pediatric primary care clinic. The main outcome was a positive screen for gun ownership. The main predictors included insurance type, neighborhood median income, number of clinic visits, and other social needs. Of 19 163 patients, 474 (2.5%) screened positive for gun ownership. Patients with private insurance and from higher income neighborhoods had 2 to 3 times higher odds of a positive screen. Patients with more visits and with food insecurity had approximately 2 to 4 times the odds of a positive screen for household gun ownership. In conclusion, the rate of positive gun ownership screens was very low and far below known gun ownership rates. Improved screening methods could better identify opportunities for gun safety advocacy.

Flying cars economically favor battery electric over fuel cell and internal combustion engine.

Flying cars, essentially vertical takeoff and landing aircraft (VTOL), are an emerging, disruptive technology that is expected to reshape future transportation. VTOLs can be powered by battery electric, fuel cell, or internal combustion engine, which point to entirely different needs for industry expertise, research & development, supply chain, and infrastructure supports. A pre-analysis of the propulsion technology competition is crucial to avoid potential wrong directions of research, investment, and policy making efforts. In this study, we comprehensively examined the cost competitiveness of the three propulsion technologies. Here we show that battery electric has already become the lowest-cost option for below-200-km VTOL applications, covering intra-city and short-range inter-city travels. This cost advantage can be robustly strengthened in the long term under various technology development scenarios. Battery energy density improvement is the key to reducing cost. In particular, a 600 Wh/kg battery energy density provides battery electric with all-range cost advantage, and promises high return in business. Fuel cell and internal combustion engine, under certain technology development scenarios, can obtain cost advantage in long-range applications, but face intense competition from ground transportation such as high-speed rail. The findings suggest a battery-electric-prioritized VTOL development strategy, and the necessity of developing VTOL-customized high-energy-density batteries.

Attitudes and Behaviours Towards Cats and Barriers to Stray Cat Management in Bulgaria.

This research uses an online questionnaire (n = 1148) to survey the Bulgarian public's attitudes and behaviors toward owned and stray cats and explore potential barriers to stray cat population management. Generally, the survey participants indicated positive attitudes toward stray cats, with 82.0% of the respondents reporting feeling sorry for stray cats. Semi-ownership behaviors were prevalent, with 82.5% feeding stray cats but only 18.1% neutering the cats they fed, posing a barrier to stray cat management. Overall, the respondents held mixed attitudes toward neutering. Of all cat owners sampled (n = 859) only 47.2% had neutered all their cats and 44.4% of owners allowed cats outdoor access or their cats lived exclusively outdoors. Multinomial logistic regression predicted that intact cats were more likely to be allowed to roam free and reproduce, which may present a significant barrier to stray cat population management. This is the first academic survey on attitudes toward cats in Bulgaria and the findings should contribute to stray cat management and ultimately improve feline welfare.

Synchronous motor imagery and visual feedback of finger movement elicit the moving rubber hand illusion, at least in illusion-susceptible individuals.

Recent evidence suggests that imagined auditory and visual sensory stimuli can be integrated with real sensory information from a different sensory modality to change the perception of external events via cross-modal multisensory integration mechanisms. Here, we explored whether imagined voluntary movements can integrate visual and proprioceptive cues to change how we perceive our own limbs in space. Participants viewed a robotic hand wearing a glove repetitively moving its right index finger up and down at a frequency of 1 Hz, while they imagined executing the corresponding movements synchronously or asynchronously (kinesthetic-motor imagery); electromyography (EMG) from the participants' right index flexor muscle confirmed that the participants kept their hand relaxed while imagining the movements. The questionnaire results revealed that the synchronously imagined movements elicited illusory ownership and a sense of agency over the moving robotic hand-the moving rubber hand illusion-compared with asynchronously imagined movements; individuals who affirmed experiencing the illusion with real synchronous movement also did so with synchronous imagined movements. The results from a proprioceptive drift task further demonstrated a shift in the perceived location of the participants' real hand toward the robotic hand in the synchronous versus the asynchronous motor imagery condition. These results suggest that kinesthetic motor imagery can be used to replace veridical congruent somatosensory feedback from a moving finger in the moving rubber hand illusion to trigger illusory body ownership and agency, but only if the temporal congruence rule of the illusion is obeyed. This observation extends previous studies on the integration of mental imagery and sensory perception to the case of multisensory bodily awareness, which has potentially important implications for research into embodiment of brain-computer interface controlled robotic prostheses and computer-generated limbs in virtual reality.

Impact of government subsidies on innovation of Chinese biopharmaceutical firms: Based on kink threshold model.

Do government subsidies achieve the goals of stimulating firm innovation and macro-regulation? Existing studies have not reached a consistent conclusion. We will study the incentive effect of government subsidies on innovation of biopharmaceutical firms, analyze the optimal interval of government subsidies, and improve the efficiency of government subsidies. Thus, based on kink threshold model using data from Chinese biopharmaceutical listed companies from 2013-2019, this study analyzes the impact of government subsidies on innovation inputs and outputs. Government subsidies can stimulate innovation inputs and outputs of biopharmaceutical firms. Meanwhile, such subsidies have a significant threshold effect on innovation inputs and outputs, and there is an optimal interval effect. Additionally, concerning enterprise ownership, government subsidies have a more significant role in promoting innovation of non-state biopharmaceutical firms. Regarding regional differences, such subsidies have a more significant role in promoting innovation of firms in the less economically developed central and western regions. This study reveals the influence pattern of government subsidies, and provides insights and suggestions to formulate subsidy policies and enhance innovation.

Skin temperature changes in response to body ownership modulation vary according to the side of stimulation.

A growing body of research has shown that a unilateral alteration in the sense of limb ownership is associated with the cooling of a limb's temperature. However, the recent emergence of contradictory results calls into question the existence of a relationship between this physiological reaction and the sense of body ownership. In the light of evidence that the malleability of the sense of hand ownership differs based on the preferential motor use of the hand to which the illusion is applied, one might observe the same lateralised pattern in the skin temperature cooling. In particular, if skin temperature change is a signature of body ownership, we expected a stronger illusion and reduction in skin temperature when altering ownership alteration of the left hand compared to the right hand in dextral individuals. To test this hypothesis, we selectively perturbated body ownership of the left or right hand in 24 healthy participants in different experimental sessions using the Mirror-Box Illusion (MBI) paradigm. Participants were asked to tap synchronously or asynchronously at a constant rhythm with their left and right index fingers against two parallel mirrors while looking at their reflected right/left hand. Skin temperature was measured before and after each MBI application, and explicit judgments of ownership and proprioceptive drift were collected. The results showed a consistent cooling of the hand's temperature only when the illusion was performed on the left hand. Proprioceptive drift exhibited the same pattern. In contrast, the explicit judgment of ownership of the reflected hand was similar across the two hands. These data provide evidence in favor of a specific laterality effect of the physiological response to an induced alteration of body part ownership. Moreover, they highlight the possibility of a direct link between proprioception and skin temperature.

Cooperative Ownership as a Health Justice Intervention: A Promising Strategy to Advance Health Equity Through the U.S. Childcare System.

In their article "The Civil Rights of Health," Harris and Pamukcu offer a framework connecting civil rights law to unjust health disparities with the aims of creating broader awareness of subordination as a root cause of health inequities and inviting policymakers to create new legal tools for dismantling it. They close with a call to action. Here, we take up their call and propose cooperative enterprises as a health justice intervention. To illustrate this conceptualization, we focus on childcare as a system with robust connections to social, economic, and health equity for children, workers, and families.

Aboriginal and Torres Strait Islander Women's Access to and Interest in mHealth: National Web-based Cross-sectional Survey.

BACKGROUND: Health programs delivered through digital devices such as mobile phones (mobile health [mHealth]) have become an increasingly important component of the health care tool kit. Aboriginal and Torres Strait Islander women of reproductive age are likely to be caring for children and family members and needing health care, but little is known about their access to and interest in mHealth. OBJECTIVE: The objectives of this study were to investigate Aboriginal and Torres Strait Islander women's ownership of digital devices, access to the internet, current mHealth use, and interest and preferences for future mHealth. We examined the factors (age, remoteness, caring for a child younger than 5 years, and level of education) associated with the ownership of digital devices, use of internet, and interest in using a mobile phone to improve health. This study also examines if women are more likely to use mHealth for topics that they are less confident to talk about face-to-face with a health professional. METHODS: A national web-based cross-sectional survey targeting Aboriginal and Torres Strait Islander women of reproductive age (16-49 years) was performed. Descriptive statistics were reported, and logistic regressions were used to examine the associations. RESULTS: In total, 379 women completed the survey; 89.2% (338/379) owned a smartphone, 53.5% (203/379) a laptop or home computer, 35.6% (135/379) a tablet, and 93.1% (353/379) had access to the internet at home. Most women used social media (337/379, 88.9%) or the internet (285/379, 75.2%) everyday. The most common modality used on the mobile phone for health was Google (232/379, 61.2%), followed by social media (195/379, 51.5%). The most preferred modality for future programs was SMS text messaging (211/379, 55.7%) and social media (195/379, 51.4%). The most preferred topics for future mHealth programs were healthy eating (210/379, 55.4%) and cultural engagement (205/379, 54.1%). Women who were younger had greater odds of owning a smartphone, and women with tertiary education were more likely to own a tablet or laptop. Older age was associated with interest to use telehealth, and higher educational attainment was associated with interest for videoconferencing. Most women (269/379, 70.9%) used an Aboriginal medical service and overall reported high rates of confidence to discuss health topics with a health professional. Overall, women showed a similar likelihood of selecting a topic in mHealth whether they were or were not confident to talk to a health professional about that. CONCLUSIONS: Our study found that Aboriginal and Torres Strait Islander women were avid users of the internet and had strong interest in mHealth. Future mHealth programs for these women should consider utilizing SMS text messaging and social media modalities and including content on nutrition and culture. A noteworthy limitation of this study was that participant recruitment was web-based (due to COVID-19 restrictions).

Preventive healthcare among dogs and cats in Chile is positively associated with emotional owner-companion animal bond and socioeconomic factors.

Global companion animal population has been increasing as well as the number of dogs and cats being considered as a family member. However, it is unclear whether this close relationship could be associated with higher preventive healthcare in companion animals. Using data from 7,048 questionnaires of dogs and 3,271 of cats from the First National Study on Responsible Companion Animal Ownership, we estimated the proportion of preventive healthcare in companion animals of Chile. We also conducted a general linear mixed-effect regression model to identify socioeconomic factors and indicators of the emotional owners-companion animal bond that could influence owners' practices related to vaccination, parasite control, and veterinary visits. Based on the owner's answers, Chile has a satisfactory overall rates of parasite control (71%) and annual veterinary visits (65%) but a low vaccination coverage of both dogs (39%) and cats (25%). 'Purebred', 'live in urban areas', 'acquired by monetary compensation', and 'dog species' were associated with a higher probability of preventive healthcare in companion animals. Conversely, this probability was lower among senior animals compared to adults, males, and those owned by the Silent Generation or Baby Boomers (i.e., owners born before 1964). 'Sleeping inside', 'acquired for an emotional reason' (e.g., companionship), and 'considered a family member' were positively associated with at least one of assessed preventive measures. Our findings suggest that emotional owner-companion animal bonds could positively impact the frequency and quality of preventive healthcare in dogs and cats. However, owners who totally disagreed that a companion animal is a "family member" were also associated with a higher likelihood of vaccination uptake and veterinary visits for their animals. This highlights that owner's compliance with veterinary preventive healthcare is multifactorial. Chile has a high prevalence of infectious diseases circulating among dogs and cats and increasingly close contacts between owners and companion animals due to emotional bonds. Thus, our study calls for One Health approaches to reduce the risks of cross-species disease transmission. Specifically, increasing vaccination coverage of companion animals in Chile is the most urgent preventive measure needed, especially among cats, males, and older animals. Expand preventive healthcare among dogs and cats will promote public and animal health, including local wildlife that is susceptible to infectious diseases circulating in companion animals.

CEO financial background, managerial ownership, and corporate innovation: Insights from imprinting theory.

The global ecological environment is facing increasingly severe challenges; therefore, it is crucial to implement sustainable development policies and promote corporate innovation. Based on imprinting theory, we examine the relationship between CEO financial background and corporate innovation within the Chinese context. The results confirm that CEOs with a financial background negatively impact corporate innovation, while managerial ownership mitigates this effect. Existing literature has considered the impact of CEO background on corporate innovation; however, it mainly takes up corporate innovation from the perspective of upper-echelon theory. In addition, the mechanism of CEO financial background on corporate innovation is ambiguous in the Chinese cultural context. This study enriches the literature on the relationship between the characteristics of CEO background and corporate behavior, thereby offering guidance for corporate innovation practices.

Comparing Severely Injured Trauma Patients Admitted to Investor-Owned versus Public and Not-For-Profit Hospitals Reveals Opportunities for Improvement in the US.

BACKGROUND: Non-elderly trauma patients represent the largest portion of preventable years of life loss in the US. The purpose of this study was to compare outcomes in patients admitted to investor-owned vs public and not-for-profit hospitals across the US. MATERIAL AND METHODS: The Nationwide Readmissions Database 2018 was queried for trauma patients with an Injury Severity Score greater than 15 and age 18-65 years. The primary outcome was mortality; secondary outcomes were prolonged length of stay (LOS) greater than 30 days, readmission within 30 days, and readmission to a different hospital. Patients admitted to investor-owned hospitals were compared to public and not-for-profit hospitals. Univariable analysis was performed using chi-squared tests. Multivariable logistic regression was performed for each outcome. RESULTS: 157 945 patients were included with 11.0% (n = 17 346) admitted to investor-owned hospitals. The overall mortality rate and prolonged LOS were similar for both groups. The overall readmission rate was 9.2% (n = 13 895), with the rate in investor-owned hospitals at 10.5% (n = 1,739, P < .001). Multivariable logistic regression revealed investor-owned hospitals had an increased risk of readmission (OR 1.2 [1.1-1.3] P < .001) and readmission to a different hospital (OR 1.3 [1.2-1.5] P < .001). DISCUSSION: Severely injured trauma patients have similar rates of mortality and prolonged length of stay in investor-owned vs public and not-for-profit hospitals. However, patients admitted to investor-owned hospitals have an increased risk of readmission and readmission to different hospitals. Efforts to improve outcomes after trauma must consider hospital ownership and readmission to different hospitals.

Sensory fields: the visual and the bodily.

Philosophers of perception have been readier to postulate the existence of a visual field than to acknowledge sensory fields in other modalities. In this paper, I argue that the set of phenomenal features that philosophers have relied on when positing a visual field aptly characterise, mutatis mutandis, bodily sensation. I argue, in particular, that in localised bodily sensations we experience the body as a sensory field. I first motivate this claim for the case of haptic touch, and then generalise it to other kinds of bodily sensation. I demonstrate the theoretical fruitfulness of this notion of a bodily field for the debate on the phenomenology of bodily ownership.

Patient care ownership in medical students: a validation study.

BACKGROUND: Psychological Ownership is the cognitive-affective state individuals experience when they come to feel they own something. The construct is context-dependent reliant on what is being owned and by whom. In medical education, this feeling translates to what has been described as "Patient Care Ownership," which includes the feelings of responsibility that physicians have for patient care. In this study, we adapted an instrument on Psychological Ownership that was originally developed for business employees for a medical student population. The aim of this study was to collect validity evidence for its fit with this population. METHODS: A revised version of the Psychological Ownership survey was created and administered to 182 medical students rotating on their clerkships in 2018-2019, along with two other measures, the Teamwork Assessment Scale (TSA) and Maslach Burnout Inventory (MBI) Survey. A confirmatory factor analysis (CFA) was conducted, which indicated a poor fit between the original and revised version. As a result, an exploratory factor analysis (EFA) was conducted and validity evidence was gathered to assess the new instruments' fit with medical students. RESULTS: The results show that the initial subscales proposed by Avey et al. (i.e. Territoriality, Accountability, Belongingness, Self-efficacy, and Self-identification) did not account for item responses in the revised instrument when administered to medical students. Instead, four subscales (Team Inclusion, Accountability, Territoriality, and Self-Confidence) better described patient care ownership for medical students, and the internal reliability of these subscales was found to be good. Using Cronbach's alpha, the internal consistency among items for each subscale, includes: Team Inclusion (0.91), Accountability (0.78), Territoriality (0.78), and Self-Confidence (0.82). The subscales of Territoriality, Team Inclusion, and Self-Confidence were negatively correlated with the 1-item Burnout measure (P = 0.01). The Team Inclusion subscale strongly correlated with the Teamwork Assessment Scale (TSA), while the subscales of Accountability correlated weakly, and Self-Confidence and Territoriality correlated moderately. CONCLUSION: Our study provides preliminary validity evidence for an adapted version of Avey et al.'s Psychological Ownership survey, specifically designed to measure patient care ownership in a medical student population. We expect this revised instrument to be a valuable tool to medical educators evaluating and monitoring students as they learn how to engage in patient care ownership.

Official Turnover and Corporate ESG Practices: Evidence from China.

In recent years, environmental, social, and governance (ESG) have been extensive concerned. However, few studies have focused on the impact of situational factors on corporate ESG practice decisions. Based on this, using 9428 observations of Chinese A-share listed companies from 2009 to 2019, this paper attempts to explore the impact of local official turnover on corporate ESG practices, and analyzes the boundary effects of this impact from three aspects: region, industry, and corporate. Our results suggest that (1) official turnover can lead to changes in economic policies and redistribution of political resources, which can stimulate companies' "risk aversion motivation" and "development motivation" and thus promote their ESG practices; (2) this effect is more significant in the high degree of government intervention, the high level of industry competition and private corporates. (3) Further test finds that only when the official turnover abnormally and the regional economic development well, official turnover can significantly contribute to corporate ESG. This paper enriches the relevant research on the decision-making scenarios of corporate ESG practices from the macro-institutional perspective.

Management equity incentives and corporate tax avoidance: Moderating role of the internal control.

Introduction: Under the modern enterprise system, the principal-agent relationship can cause a conflict of interest between the two power counterparts, thus affecting the degree of corporate tax avoidance. As a tool to align the interests of management and owners, management equity incentives can alleviate the conflict of interests brought about by the separation of powers and, therefore, may influence corporate tax avoidance. Objectives and methods: We examine the relationship between management equity incentives and corporate tax avoidance from both theoretical and empirical perspectives by using data from Chinese A-share listed companies from 2016 to 2020. Firstly, the effect of management equity incentives on tax avoidance is theoretically and normatively analyzed. Secondly, examine the effectiveness of moderating the effect of internal control and distinguishing the ownership of enterprises' nature through regression analysis. Results: (1) There is a positive relationship between management equity incentives and corporate tax avoidance which means, more the stock incentive offered to executives, the more likely corporations are to pursue tax avoidance strategies aggressively. (2) Internal control deficiencies enhance the positive relationship between equity incentives and enterprise tax avoidance behavior. Therefore, in Chinese enterprises, the lack of an internal control system and the failure of internal control measures are prevalent, and such loopholes can intensify the tax avoidance behavior that arises when executives are subject to equity incentives. (3) The influence of management equity incentives on enterprise tax avoidance behavior is greater in state-owned (SOE) than private enterprises. State-owned enterprises are more likely to increase enterprise tax avoidance behavior when management is subject to equity incentives for reasons such as strict performance requirements, lower regulatory oversight, and less interference from negative information. Finally, our findings have significant implications for policymakers/regulators, public companies, investors, standard setters, managerial labor markets, and the welfare of the overall economy.

The Zone of Conformity: A Comparison of Private and State-Controlled Enterprises in M&As.

Drawing from the literature on institutional pressure, we argue that firms with different ownership types have different strategic options in domestic and overseas markets, namely the zone of conformity. State-controlled enterprises (SCEs) have a broader range of acceptable actions than do private-controlled enterprises (PCEs) in a domestic market but face more sanctions and stricter conformity requests in an overseas market. The concept of the zone of conformity predicts SCEs have a higher probability of deal failure overseas than in domestic markets and strategically seek less equity ownership of target firms in cross-border deals. The autocracy level of target country moderates the M&A behaviors difference between SCEs and PCEs. Our analysis of 12,497 Chinese mergers and acquisitions supports the study hypotheses. Supplementary Information: The online version contains supplementary material available at 10.1007/s11575-023-00501-9.

Some fear, more loathing? Threats and anxieties shaping protective gun ownership and gun carry in the U.S.

Given notable recent spikes in gun purchases in the U.S., we revisit the 'fear and loathing' hypothesis of firearm demand by (1) establishing how crime/victimization fears are shaped by broader economic, cultural, and racial status anxieties (those emerging from group status threats [loathing]) and (2) illustrating how both fear and loathing matter for protective gun ownership and gun carry (among owners), and openness to future protective ownership among non-owners. Using data from a nationwide survey of adults in the U.S. (n = 2,262) collected in 2019, we find that fears of crime and victimization are often more strongly associated with status anxieties than with safety threats. Both status anxieties and victimization are associated with protective ownership and carry. Among non-owners, those higher in cultural anxiety are especially likely to be open toward future protective gun ownership. This study illustrates the multidimensional fear-guns link, wherein both status-related threats and victimization-related fears shape why individuals own guns, and how they use guns.