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Article

Communication Privacy Management Theory  

Sandra Petronio and Rachael Hernandez

Have you ever wondered why a complete stranger sitting next to you on a plane would tell you about a recent cancer diagnosis? Why your parents never disclosed that you were adopted, feeling shocked when you accidently find out as an adult? These and many other actions reflect decisions individuals make about managing their private information. Being aware of how individuals navigate decisions to disclose or protect their private information provides useful insights that aid in the development and sustainability of relationships with others. Given privacy plays an integral role in everyone’s life, knowing more about privacy management is critical. communication privacy management (CPM) theory was first introduced by Sandra Petronio in 2002. CPM is evidence-based and accordingly provides a dependable understanding of how decisions are made to disclose and protect private information. This theory uses plain language to understand privacy management in everyday life. CPM focuses on the relationship people have with each other in communicative contexts, such as face-to-face interactions, on social media, and in dyads or groups. CPM theory is based on a communicative-social behavioral perspective and not necessarily a legal point of view. CPM theory illustrates that privacy is not paradoxical but is sustainable through the process of a privacy management system used in everyday life. The theory of CPM has been employed in a number of contexts shedding light on antecedents, mechanisms, and outcomes of private information management. In addition, a number of researchers across multiple countries, such as the Netherlands, United Kingdom, Japan, Kenya, South Korea, and the United States, have used CPM theory in their research investigations. Learning more about the system of private information management allows for a better understanding of how people navigate managing their private information when others are involved. Literature illustrates patterns of privacy management and demonstrates the challenges as well as the positive outcomes of the way individuals regulate their private information.

Article

Accounting Narratives  

Tracey J. Riley and Alex C. Yen

Although accounting is typically seen as a numbers-oriented discipline, with an emphasis on quantifying economic events and activity, the nexus of language and accounting, specifically the role of language in communicating corporate accounting results, has received an increasing amount of attention in recent years. This is because quantified accounting results (e.g., earnings per share, sales revenue) are rarely communicated in isolation. Rather, they are usually accompanied by a non-quantitative narrative, such as an earnings press release, a corporate annual report, or the president’s letter, which, along with conference calls and content at corporate websites, we collectively refer to as “accounting narratives.” These narratives allow management to elaborate on and contextualize the financial performance of the company. However, because they are not as extensively regulated as the financial statements and are not standardized, these narratives can also be used by companies for impression-management purposes, to obfuscate (poor) performance and to “spin” the financial results to the companies’ favor. Research into accounting narratives dates back to 1952 and has focused on a wide variety of features of narratives and on how those features affect financial statement readers’ (most notably, investors’) reactions. The earliest studies focused on accounting narratives’ readability by performing a syntactic analysis to assess the cognitive difficulty of written passages. This line of research has found that accounting narratives are syntactically complex and difficult to read and that management intentionally makes bad news less readable in order to strain the readers’ cognitive processes and lead to lower comprehension of the bad news. In addition to this evidence of obfuscation, researchers have found support for managers engaging in attributional framing, which is the tendency to attribute positive outcomes to actions within the company and negative outcomes to actions external to the company (e.g., the government or the weather) in an effort to influence readers’ perception of good versus bad news. More recently, researchers have found that managers use syntactic (sentence structure), semantic (word meaning), and metasemantic (abstract versus concrete construal) manipulation and make broad stylistic choices such as emphasis, length, and scenario form. In terms of how those features affect the readers of the narratives, readers (most notably, investors) have been shown to respond to length and readability; level of negativity; words pertaining to risk, uncertainty, credibility, commitment, and responsibility; justifications of excuses of poor performance; optimistic and pessimistic tone; vivid versus pallid language; internal versus external attributions; and use of self-references.

Article

Whistleblowing and Whistleblowers  

Niamh M. Brennan

Whistleblowing (also called good faith reporting, anonymous reporting, protected disclosure) is growing in importance as a corporate governance mechanism. It is increasingly recognized as a key internal control mechanism. Whistleblowing is a term used to describe an act whereby wrongdoing is exposed. It gained impetus following the collapse of Enron in 2001 arising from financial reporting fraud, which culminated in the U.S. Time magazine selecting three whistleblowers (all women) as its person of the year in 2002. The term was first used in 1966. Researchers have invoked a variety of theories and models attempting to explain whistleblowing. Elements that influence the process include the whistleblowers, the type of wrongdoing, the wrongdoers, the decision to blow the whistle, whistleblowing recipients, organizational factors, and finally the consequences of whistleblowing. Organizational processes, alternative to the more extreme step of whistleblowing, include silence (the other side of the coin to whistleblowing), speaking up, and open disclosure. An organizational response resisting an employee speaking up is the trigger that creates a whistleblower. The definition of whistleblowing only includes organizational members. Should it be extended to include external parties as well as organizational members? Social media has had an impact on whistleblowing. Questions remain as to the efficacy of whistleblowing: Is it a substantive or symbolic mechanism of governance?

Article

Queer Healthcare Communication  

Nicole Hudak

Queer healthcare communication spans different literature and topic areas. The medicalization of queer bodies has historically and continues to influence how queer individuals interact and communicate within healthcare settings. Further, heterosexism is rampant within medical institutions that perpetuate the idea that all patients are heterosexual. Because of the influence of heterosexism, medical schools are designed to ignore queer bodies. If queer bodies are acknowledged, they are positioned as something exotic and not presented as a typical patient. Heterosexism is further communicated in patient and provider interactions by providers assuming their patients’ heterosexual identity and assuming all queer patients are promiscuous. In turn, queer patients may make decisions about their healthcare based on providers’ heterosexist attitudes. Providers who practice medicine have also demonstrated their limited knowledge about queer patients and how to care for them. The literature on discrimination of queer patients focuses more on how providers have used both verbal and non-verbal forms of communication. In looking at queer discrimination, queer invisibility demonstrates more covert functions of healthcare communication. Due to the invisibility of queer patients, disclosure becomes a site of interest for researchers. While some queer patients try to seek out queer-friendly providers, researchers have given recommendations on how healthcare providers can improve their queer competency. Finally, some notable topics within queer healthcare communication include queer pregnancy, HIV, and why transgender identity should be a separate topic as transgender people have their own healthcare needs.

Article

Transparency in Journalism  

Michael Koliska

Transparency is the most recently established ethical principle for professional journalists, even though its roots stretch back almost a century. The emergence of transparency as a core journalistic ethic and value has been fueled mainly by three distinct yet interdependent developments. First, sociocultural advances in society have gradually increased the availability and demand for more information, including in areas such as politics and business. This development instilled an expectation of the “right to know,” also impacting the journalistic institution. Second, the introduction of digital media technologies has provided more means to disclose information, interact with journalists, and witness news production. Third, ethical and normative discussions by journalists and scholars have promoted more openness about journalism. Transparency has frequently been advocated as an effective way to combat the ongoing decline of trust and credibility in the news media. A central rationale supporting information disclosure and providing direct access to journalists and news organizations is that the audience will be able to ascertain which journalism it can trust to be true or which journalism may be superior. Specifically, in times when the news media is being labeled as fake or lying to the public, transparency may indeed be an important mechanism for the audience to hold journalism accountable. Yet, while the promise of transparency is an enticing prospect for the journalistic institution, empirical research has not quite been able to support all the claims that transparency will indeed improve credibility and trust in the news media. However, transparency is a nascent ethic and practice in journalism, and has only recently been officially recognized. Journalists and news organizations are still in the process of finding new ways to openly engage with the public, showing them the journalistic production process and building relationships with their communities. After all, building trust takes time and may only be achieved in a continuous effort to engage in an open, honest, and personal dialogue with the people.

Article

Coming Out in Interpersonal and Relational Perspectives  

Yachao Li

In a heteronormative society, coming out to others, or sexual orientation disclosure, is a unique and crucial experience for many sexual minority individuals. Past theoretical models of sexual identity development often view coming out as a milestone that profoundly influences sexual minority people. Existing studies related to sexual orientation disclosure have mainly explored the processes and outcomes of people’s coming-out decisions or outness levels. However, coming out is inherently a communication behavior. The message content and processes of coming out remain understudied. Emerging studies have attempted to address the research void. Scholars have examined different types of coming-out conversations and patterns of those interactions. They also explored the contents and disclosure strategies of coming out, as well as motivations and antecedents to varying levels of sexual orientation disclosure. Results indicate that while coming-out conversations may unfold differently, explicit disclosure is the mostly used coming-out strategy. In addition, disclosure goals, coupled with personal factors such as internalized homophobia and relational factors like relational power, predict disclosure message contents (what people say) and features (how people say it), which in turn predict disclosure receivers’ reactions and disclosers’ personal and relational outcomes. Future studies should continue investigating the message contents, features, and outcomes of coming out. Researchers should also focus more on marginalized members’ coming-out experiences, and conduct longitudinal and experimental studies to understand the long-term effects of different coming-out messages and experiences.

Article

Queer People’s Communication With Families of Origin  

Cimmiaron Alvarez and Kristina M. Scharp

Communicating with one’s family of origin requires considerable effort for queer people (e.g., LGBTQ+; queer is used as an encompassing term to include all gender and sexual identities that are not both cis and heterosexual). Queer people must decide if they want to disclose their gender and/or sexual identities, to whom they want to disclose, how they want to communicate, and anticipate the ways their family members may react. Immediate family members, such as parents and siblings, typically play an important role in queer people’s lives and are consequently some of the first people to whom queer people talk about their gender and/or sexual identities. Yet not all these disclosures are met with positive reactions from family members. Research suggests that queer people perceive their families’ reactions range from complete acceptance to total rejection. Thus, it is often the case that queer people must cope with multiple sources of stigma. From the family members’ perspective, parents and siblings also report having varied reactions to the queer person’s initial disclosure that require them to engage in sense-making. Thus, in addition to the communicative burden of queer people, their families may also have to share in the communicative work to communicate with people outside the family or (re)construct their family identity. All this communicative labor simultaneously reflects and constructs larger overarching ideologies surrounding gender and sexuality.

Article

Sexual Orientation and Gender Identity Disclosure in the Medical Context  

L. Brooke Friley and Maria K. Venetis

For individuals who identify as LGBTQ+, disclosing sexual orientation and/or gender identity can be a complex and risky conversation. However, in the medical context this conversation frequently becomes a central part of communication between patient and provider. Unfortunately, this conversation can also become a barrier that prevents patients from receiving or even accessing necessary medical care. LGBTQ+ individuals have reported experiencing significant discrimination in day-to-day life, and more specifically in patient–provider interactions. This discrimination leads LGBTQ+ individuals to avoid seeking necessary medical care and also frequently results in unsatisfactory care and poor health outcomes. This is of concern as LGBTQ+ individuals present with significantly higher rates of health issues and overall higher risks of cancer, chronic illnesses, and mental health concerns. Unfortunately, many medical providers are unequipped to properly care for LGBTQ+ patients and lack opportunities for education and training. This lack of experience leads many providers to operate medical offices that are unwelcoming or even inhospitable to LGBTQ+ patients, making it difficult for those patients to access inclusive care. This can be of particular concern when the patient’s sexual orientation or gender identity becomes relevant to their medical care, as they may feel uncomfortable sharing that information with a provider. Patient self-disclosure of sexual orientation or gender identity to a medical provider not only can contribute to a more positive relationship and improved quality of care but also can improve the psychological outlook of an LGBTQ+ individual. However, potential stigmatization can lead to the concealment of sexual orientation or gender identity information. These acts of concealment serve as intentional mechanisms of impression management within the patient–provider interaction. When LGBTQ+ patients do discuss their sexual orientation or gender identity with a provider, it is most often because the information is directly relevant to their health and disclosure, and therefore becomes essential and often forced. There are instances where LGBTQ+ patients are motivated to disclose to a provider who they believe will respond positively to information about their sexual orientation or gender identity. Disclosure of sexual orientation or gender identity may be direct in that it is clear and concrete. It may also be indirect in that individuals may use particular topics, such as talking about their partner, to broach the subject. Participants may also use specific entry points in the conversation, such as during taking a medical history about medications, to disclose. Some individuals plan and rehearse their disclosure conversations, whereas others disclose when they feel they have no other choice in the interaction. Increasing inclusivity on the part of providers and medical facilities is one way to promote comfortable disclosure of sexual orientation or gender identity. Additionally, updating the office environment and policies, as well as paperwork and confidentiality procedures, can also promote safe disclosure. Finally, improvements to training and education for healthcare professionals and office staff can dramatically improve interactions with LGBTQ+ patients. All of these efforts need to make integration of knowledge about how LGTBQ+ individuals can disclose comfortably and safely a central part of program design.

Article

Communication Privacy Management Theory and Health and Risk Messaging  

Sandra Petronio and Maria K. Venetis

Communication privacy management theory (CPM) argues that disclosure is the process by which we give or receive private information. Private information is what people reveal. Generally, CPM theory argues that individuals believe they own their private information and have the right to control said information. Management of private information is not necessary until others are involved. CPM does not limit an understanding of disclosure by framing it as only about the self. Instead, CPM theory points out that when management is needed, others are given co-ownership status, thereby expanding the notion of disclosing information; the theory uses the metaphor of privacy boundary to illustrate where private information is located and how the boundary expands to accommodate multiple owners of private information. Thus, individuals can disclose not only their own information but also information that belongs to others or is owned by collectives such as families. Making decisions to disclose or protect private information often creates a tension in which individuals vacillate between sharing and concealing their private information. Within the purview of health issues, these decisions have a potential to increase or decrease risk. The choice of disclosing health matters to a friend, for example, can garner social support to cope with health problems. At the same time, the individual may have concerns that his or her friend might tell someone else about the health problem, thus causing more difficulties. Understanding the tension between disclosing and protecting private health information by the owner is only one side of the coin. Because disclosure creates authorized co-owners, these co-owners (e.g., families, friends, and partners) often feel they have right to know about the owner’s health conditions. The privacy boundaries are used metaphorically to indicate where private information is located. Individuals have both personal privacy boundaries around health information that expands to include others referred to as “authorized co-owners.” Once given this status, withholding to protect some part of the private information can risk relationships and interfere with health needs. Within the scheme of health, disclosure risks and privacy predicaments are not experienced exclusively by the individual with an illness. Rather, these risks prevail for a number of individuals connected to a patient such as providers, the patient’s family, and supportive friends. Everyone involved has a dual role. For example, the clinician is both the co-owner of a patient’s private health information and holds information within his or her own privacy boundary, such as worrying whether he or she diagnosed the symptoms correctly. Thus, there are a number of circumstances that can lead to health risks where privacy management and decisions to reveal or conceal health information are concerned. CPM theory has been applied in eleven countries and in numerous contexts where privacy management occurs, such as health, families, organizations, interpersonal relationships, and social media. This theory is unique in offering a comprehensive way to understand the relationship between the notion of disclosure and that of privacy. The landscape of health-related risks where privacy management plays a significant role is both large and complex. The situations of HIV/AIDS, cancer care, and managing patient and provider disclosure of private information help to elucidate the ways decisions of privacy potentially lead to health risks.

Article

Blogging, Microblogging, and Exposure to Health and Risk Messages  

Stephen A. Rains

The widespread diffusion of social media in recent years has created a number of opportunities and challenges for health and risk communication. Blogs and microblogs are specific forms of social media that appear to be particularly important. Blogs are webpages authored by an individual or group in which entries are published in reverse chronological order; microblogs are largely similar, but limited in the total number of characters that may be published per entry. Researchers have begun exploring the use and consequences of blogs and microblogs among individuals coping with illness as well as for health promotion. Much of this work has focused on better understanding people’s motivations for blogging about illness and the content of illness blogs. Coping with the challenges of illness and connecting with others are two primary motivations for authoring an illness blog, and blogs typically address medical issues (e.g., treatment options) and the author’s thoughts and feelings about experiencing illness. Although less prevalent, there is also evidence that illness blogging can be a resource for social support and facilitate coping efforts. Researchers studying the implications of blogs and microblogs for health promotion and risk communication have tended to focus on the use of these technologies by health professionals and for medical surveillance. Medical professionals appear to compose a noteworthy proportion of all health bloggers. Moreover, blogs and microblogs have been shown to serve a range of surveillance functions. In addition to being used to follow illness outbreaks in real-time, blogs and microblogs have offered a means for understanding public perceptions of health and risk-related issues including medical controversies. Taken as whole, contemporary research on health blogs and microblogs underscores the varied and important functions of these forms of social media for health and risk communication.

Article

Self-Disclosure  

Jenny Crowley

Self-disclosure, or revealing information about the self to others, plays an integral role in interpersonal experiences and relationships. It has captivated the interest of scholars of interpersonal communication for decades, to the extent that some have positioned self-disclosure as the elixir of social life. Sharing personal information is the means by which relationships are built and maintained, because effective disclosures contribute to greater intimacy, trust, and closeness in a relationship. Self-disclosure also confers personal benefits, including reduced stress and improved physical and psychological health. Furthermore, disclosing private thoughts and feelings is often a necessary precondition for reaping the benefits of other types of communication, such as supportive communication. Despite the apparent advantages for personal and relational well-being, self-disclosure is not a panacea. Revealing intimate information can be risky, awkward, and incite judgment from close others. People make concerted efforts to avoid self-disclosure when information has the potential to cause harm to themselves, others, and relationships. Research on self-disclosure has primarily focused on dyadic interactions; however, online technologies enable people to share personal information with a large audience and are challenging taken-for-granted understandings about the role of self-disclosure in relating. As social networking sites become indispensable tools for maintaining a large and robust personal network, people are adapting their self-disclosure practices to the features and affordances of these technologies. Taken together, this body of research helps illuminate what is at stake when communicating interpersonally.

Article

Interpersonal Communication Processes Within the Provider-Patient Interaction  

Maria K. Venetis

The degree to which patients are active and communicative in interactions with medical providers has changed in recent decades. The biomedical model, a model that minimizes patient agency in the medical interaction, is being replaced with a model of patient-centered care, an approach that prioritizes the individual patient in their healthcare and treatment decisions. Tenets of patient-centered care support that patients must be understood within their psychosocial and cultural preferences, should have the freedom to ask questions, and are encouraged to disclose health-relevant information. In short, this model promotes patient involvement in medical conversations and treatment decision-making. Research continues to examine approaches to effective patient-centered communication. Two interpersonal processes that promote patient-centered communication are patient question-asking and patient disclosure. Patient question-asking and disclosure serve to inform medical providers of patient preferences, hesitations, and information needs. Individuals, including patients, make decisions to pursue or disclose information. Patients are mindful that the act of asking questions or disclosing information, particularly stigmatized information such as sexual behavior or drug use, could make them vulnerable to perceived negative provider evaluations or responses. Thus, decisions to ask questions or share information, processes essential to the understanding of patient perspectives and concerns, may be challenging for patients. Various theoretical models explain how individuals consider if they will perform actions such as seeking or disclosing information. Research also explains the barriers that patients experience in asking questions or disclosing relevant health information to providers. A review of pertinent research offers suggestions to aid in facilitating improved patient-centered communication and care.

Article

Native Advertising  

Bartosz Wojdynski

Native advertising has become an increasingly important revenue component for many online journalism publications. Because Web consumers engage in advertising avoidance strategies when using the Web, advertisers have gradually come to rely increasingly on paid advertising that resembles in format, appearance, and content non-advertising content on websites. On news websites, native advertising forms include sponsored content, sponsored homepage links, and sponsored article-referral links. The spread of native advertising news content has led to concern that news consumers fail to recognize it as advertising, and questions about whether it is unethical or deceptive. Contemporary native advertising is not the first content delivered alongside news that blurs the boundaries between editorial and paid promotional content. Print advertorials, which took root in newspapers and magazines in the mid-20th century, are a direct analogue, but host-read ads on radio and television programs, text-based search engine result advertising, and newspaper special advertising sections can all be seen as advertising content designed to feel like non-paid content. However, because contemporary native advertising takes so many different forms, and because practices of disclosure to the user are so varied, there has been a rise in public concern and academic inquiry into the prevalence and effects of native advertising. Native advertising on online news sites has generated a number of ethical concerns from practitioners, media critics, and consumers. On the production side, scholars and practitioners worry that the creation of content on behalf of, or in partnership with, advertisers may erode norms of editorial independence that have governed media organizations’ practices for over half a century. Others are concerned that as consumers become accustomed to seeing articles produced with advertiser input, the credibility of news organizations and trust in their non-advertising content will decrease. Perhaps most prominent have been concerns that native advertising deliberately disables consumers’ ability to recognize advertising elements on a website, rendering advertiser and publisher liable for deceiving consumers. Research on native advertising has focused primarily on understanding how consumers detect and perceive native advertising, with additional streams focused on descriptive analyses of native advertising content and practitioner perspectives. Empirical studies show that many consumers do not recognize native advertising, and that there are substantial differences in how the content is received and trusted between those who recognize it and those who do not. Scholars have also identified characteristics of content, disclosure practices, and individual characteristics that influence the likelihood of advertising recognition.

Article

Incentives in Healthcare Payment Systems  

Ching-to Albert Ma and Henry Y. Mak

Health services providers receive payments mostly from private or public insurers rather than patients. Provider incentive problems arise because an insurer misses information about the provider and patients, and has imperfect control over the provider’s treatment, quality, and cost decisions. Different provider payment systems, such as prospective payment, capitation, cost reimbursement, fee-for-service, and value-based payment, generate different treatment quality and cost incentives. The important issue is that a payment system implements an efficient quality-cost outcome if and only if it makes the provider internalize the social benefits and costs of services. Thus, the internalization principle can be used to evaluate payment systems across different settings. The most common payment systems are prospective payment, which pays a fixed price for service rendered, and cost reimbursement, which pays according to costs of service rendered. In a setting where the provider chooses health service quality and cost reduction effort, prospective payment satisfies the internalization principle but cost reimbursement does not. The reason is that prospective payment forces the provider to be responsible for cost, but cost reimbursement relieves the provider of the cost responsibility. Beyond this simple setting, the provider may select patients based on patients’ cost heterogeneity. Then neither prospective payment nor cost reimbursement achieves efficient quality and cost incentives. A mixed system that combines prospective payment and cost reimbursement performs better than each of its components alone. In general, the provider’s preferences and available strategies determine if a payment system may achieve internalization. If the provider is altruistic toward patients, prospective payment can be adjusted to accommodate altruism when the provider’s degree of altruism is known to the insurer. However, when the degree of altruism is unknown, even a mixed system may fail the internalization principle. Also, the internalization principle fails under prospective payment when the provider can upcode patient diagnoses for more favorable prices. Cost reimbursement attenuates the upcoding incentive. Finally, when the provider can choose many qualities, either prospective payment and cost reimbursement should be combined with the insurer’s disclosure on quality and cost information to satisfy the internalization principle. When good healthcare quality is interpreted as a good match between patients and treatments, payment design is to promote good matches. The internalization principle now requires the provider to bear benefits and costs of diagnosis effort and treatment choice. A mixed system may deliver efficient matching incentives. Payment systems necessarily interact with other incentive mechanisms such as patients’ reactions against the provider’s quality choice and other providers’ competitive strategies. Payment systems then become part of organizational incentives.

Article

A Review of the Effects of Pay Transparency  

Emma Duchini, Stefania Simion, and Arthur Turrell

An increasing number of countries have introduced pay transparency policies with the aim of reducing gender inequality in the labor market. Firms subject to transparency requirements must disclose publicly or to employees’ representatives information on their employees’ pay broken down by gender, or indicators of gender gaps in pay and career outcomes. The argument at the base of these policies is that gender inequality may in part persist because it is hidden. On the one hand, employers rarely keep track of employees’ pay and career progression by gender, and, on the other hand, employees rarely engage in conversations with their colleagues about pay. The lack of information on within-firm disparities by gender may therefore hamper progress toward a more egalitarian labor market. Transparency policies have the potential to improve women’s relative pay and career outcomes for two reasons. First, by increasing the salience of gender gaps in the labor market, they can alter the relative bargaining power of male and female employees vis-à-vis the firm and lead lower-paid individuals to demand higher pay from their employer. Second, together with pressures from employees, the public availability of information on firms’ gender-equality performance may also increase public pressure for firms’ action in this domain. A clear message emerges from the literature analyzing the impact of pay transparency policies on gender inequality: these policies are effective at pushing firms to reduce their gender pay gaps, although this is achieved via a slowdown of men’s wage growth. Related results point to a reduction in labor productivity following the introduction of transparency mandates but no detrimental effect on firms’ profits because this effect is compensated by the reduction in labor costs. Overall, the findings in this literature suggest that transparency policies can reduce the gender pay gap with limited costs for firms but may not be suited to achieve the objective of improving outcomes for lower-paid employees.

Article

Environmental Regulations in China  

Haitao Yin, Xuemei Zhang, and Feng Wang

China’s environmental challenges are unprecedented in terms of their size and severity. The country’s constantly evolving regulatory systems are a blend of lessons learned from Western market- and information-based regulations, China’s own unique political and administrative context as an authoritarian country, the complex relationship between its central and local governments, and the balance between the needs for environmental protection and economic growth. A close look at China’s environmental regulatory system may offer useful insights to those working toward a more sustainable future. In the 21st century, the environmental regulatory system in China is entering a new era. Over the last three decades, efforts have focused on developing regulatory standards for air, water, and solid waste, among many other pollutants. This regulatory system primarily follows a command-and-control approach and is often criticized for its failure to curb China’s increasingly severe environmental degradation. In the future, the Chinese government may pursue two routes. The first is to increase the use of market mechanisms and information tools to enable and incentivize more stakeholders, such as consumers, nongovernmental organizations, and communities, to engage in the development and enforcement of environmental regulations, for instance, through cap-and-trade systems, information-disclosure programs, and environmental insurance. However, existing evidence shows that the usefulness of these new instruments is limited. Another route is to develop new mechanisms to strengthen the enforcement of traditional command-and-control regulations. Examples include making environmental performance a key performance indicator (KPI) in the performance appraisals of government officials or leveraging the power of financial sectors. These approaches are a footnote to the new argument in favor of environmental authoritarianism, which suggests that authoritarian regimes, setting authoritarian rules, may be more capable of handling complex environmental pressures. More studies need to be conducted on the effectiveness of these new approaches and the mechanisms by which they may achieve success.

Article

Quality in Nursing Homes  

Matteo Lippi Bruni, Irene Mammi, and Rossella Verzulli

In developed countries, the role of public authorities as financing bodies and regulators of the long-term care sector is pervasive and calls for well-planned and informed policy actions. Poor quality in nursing homes has been a recurrent concern at least since the 1980s and has triggered a heated policy and scholarly debate. The economic literature on nursing home quality has thoroughly investigated the impact of regulatory interventions and of market characteristics on an array of input-, process-, and outcome-based quality measures. Most existing studies refer to the U.S. context, even though important insights can be drawn also from the smaller set of works that covers European countries. The major contribution of health economics to the empirical analysis of the nursing home industry is represented by the introduction of important methodological advances applying rigorous policy evaluation techniques with the purpose of properly identifying the causal effects of interest. In addition, the increased availability of rich datasets covering either process or outcome measures has allowed to investigate changes in nursing home quality properly accounting for its multidimensional features. The use of up-to-date econometric methods that, in most cases, exploit policy shocks and longitudinal data has given researchers the possibility to achieve a causal identification and an accurate quantification of the impact of a wide range of policy initiatives, including the introduction of nurse staffing thresholds, price regulation, and public reporting of quality indicators. This has helped to counteract part of the contradictory evidence highlighted by the strand of works based on more descriptive evidence. Possible lines for future research can be identified in further exploration of the consequences of policy interventions in terms of equity and accessibility to nursing home care.

Article

Gay Straight Communication  

Fabio Fasoli

Sexual orientation is a private matter that individuals can decide to disclose or conceal. Nevertheless, when interacting with others, people look for cues of sexual orientation. Hence, the person’s face, voice, or non-verbal behavior is taken as a cue revealing sexual orientation. As research on “gaydar” has shown, this detecting ability can sometimes be accurate or stereotype-based. Sometimes gay, lesbian, and bisexual people themselves intentionally communicate their sexual identity explicitly or through more subtle cues. Intentional or not, several cues are taken as communicating sexual orientation with the consequences of shaping interpersonal interactions. Identifying someone as gay or lesbian has several implications. On the one hand, it leads straight men and women to non-verbally behave differently than when interacting with other straight individuals (e.g., more physical distance, more self-touching). On the other hand, it also affects verbal communication (e.g., topics of conversation, questions, and statements). The harshest consequence is hate speech and homophobic language. Research has shown that being labeled as “faggot” or “dyke” not only negatively affects those who are the target of such verbal derogation but also negatively impacts on straight bystanders. Indeed, gay and lesbian targets of homophobic language report a lower level of well-being and self-acceptance, while being exposed to such language increases prejudice toward gay men and lesbians among straight people. In the case of straight men, the use of homophobic language is often associated with identity self-affirmation and self-presentation. Interestingly, a recent trend among gay people has been noticed: they use homophobic labels among them as a form of “reclaimed language,” meaning that these derogatory terms are used with a different intent and reframed in a more positive way. Moreover, communicating sexual orientation can increase self-acceptance, social support, and positive social comparison among gay men and lesbians and can also increase positive attitudes toward gay people, especially when it happens with friends and family members.

Article

Incest Survivors  

Valandra and Jeni McIntyre

Incest is recognized as a societal taboo in many cultures. Despite customs, laws, and moral edicts that forbid sex between familial adults and children or minors and adults, incest continues to occur. Although incidence rates have generally declined over the last three decades, incest is still a prevalent problem in society. The primary focus of this article is incest between adults and children, between siblings, and between children in the United States. The article provides content on the complex interplay of individual, family, and cultural structures that shape survivors’ lives using an ecological, person-in-environment perspective and an examination of the clinical and empirical forces that drive assessment, evaluation, and treatment approaches in support of culturally informed trauma recovery and healing.

Article

Communicative Decisions in Families  

Rudy C. Pett, Kristina M. Scharp, and Yueyi Fan

Families represent a central relational unit within society and a formative context of interdependence throughout one’s life. How family members individually and collectively navigate communicative decisions therefore illustrates a process offering implications for each member within a family. Although various forms and contexts of decision-making might emerge, decisions guiding how family members communicate remain inevitable. Thus, particular importance emerges in understanding the processes and considerations that guide communicative decisions in families. Some decision-making processes might remain implicit, but several communication theories and models illuminate explicit considerations guiding family members’ communicative decisions. The first set of theoretical perspectives provides insights regarding communicative decisions relevant in contexts of uncertainty. The theory of motivated information management, for example, suggests that family members must make decisions regarding how they wish to manage a lack of information and any resulting uncertainty. However, those decisions likely remain guided by how family members assess their individual (or collective) ability to obtain the desired information, as well as cope with the outcomes of obtaining new information. Relatedly, uncertainty management theory illustrates the ways that family members experiencing uncertainty likely face decisions regarding if, as well as to what extent, they wish to acquire more information related to the source of uncertainty. Communication often serves as an information-seeking behavior family members decide to either enact or avoid, depending on how interested they are in reducing their uncertainty. A second set of theoretical perspectives illustrates the decisions family members face regarding if (and how) they communicate “private” information, as well as secrets. When managing private information, communication privacy management theory outlines decisions family members likely confront related to privacy ownership, privacy control, and privacy turbulence. In terms of secrets, the revelation risk model explicates considerations guiding if (and how) individuals decide to reveal secrets to their family members. These considerations include assessments of potential risk, perceived communication efficacy, and the relational closeness between the family members. The cycle of concealment model also examines decisions to reveal secrets, but this model suggests that these decisions also consider elements such as family interaction histories and, similarly, the quality of the relationship shared between the family members. A final theoretical perspective illuminates how health contexts introduce unique considerations that might dictate if (and how) family members decide to communicate about health-related information. Specifically, the disclosure decision-making model proposes that these types of communicative decisions remain guided by more unique considerations, such as (a) the type of information to be disclosed, (b) the relationships among the family members, (c) how a family member is likely to respond to the disclosure, (d) perceived disclosure efficacy, and (e) available strategies to disclose the information. Collectively, these six theoretical perspectives provide a multifaceted understanding of the central processes and considerations that guide communicative decisions in families.