{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:45:53Z","timestamp":1782477953520,"version":"3.54.5"},"reference-count":33,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T00:00:00Z","timestamp":1722902400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000057","name":"National Institute of General Medical Sciences","doi-asserted-by":"publisher","award":["U54GM104940"],"award-info":[{"award-number":["U54GM104940"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000048","name":"American Cancer Society","doi-asserted-by":"publisher","award":["134579-RSG-20-058-01-PCSM"],"award-info":[{"award-number":["134579-RSG-20-058-01-PCSM"]}],"id":[{"id":"10.13039\/100000048","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Omega (Westport)"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:p>\n                    Across the United States, some regions demonstrate greater readiness to adopt palliative care than others. This geographic variation in access and utilization may be due to cultural variation in \u201ctightness\u201d and \u201clooseness,\u201d which can be understood as the relative strength and enforcement of social norms and behavioral constraint within a culture. The present study examined the influence of cultural tightness-looseness on access to palliative care (i.e., statewide percentage of hospitals with palliative care programs) across the 50 U.S. states while controlling for demographic covariates. Results of regression analyses demonstrated that states with looser cultures (i.e., less adherence to norms) had better palliative care access (\u03b2 = .501,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .012). Additionally, access was better in states with greater proportions of female (\u03b2 = .455,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .004) and white, non-Hispanic or Latino\/a (\u03b2 = .359,\n                    <jats:italic toggle=\"yes\">p<\/jats:italic>\n                    = .002) residents. Strategies to improve utilization should consider the influence of culture and the relative strength of existing social norms within the region.\n                  <\/jats:p>","DOI":"10.1177\/00302228241272635","type":"journal-article","created":{"date-parts":[[2024,8,6]],"date-time":"2024-08-06T12:01:53Z","timestamp":1722945713000},"page":"1767-1779","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Cultural Differences Predict Palliative Care Development Across the United States: The Role of Cultural Tightness and Looseness"],"prefix":"10.1177","volume":"93","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3343-111X","authenticated-orcid":false,"given":"Brenna","family":"Mossman","sequence":"first","affiliation":[{"name":"Tulane University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damian R.","family":"Murray","sequence":"additional","affiliation":[{"name":"Tulane University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Gerhart","sequence":"additional","affiliation":[{"name":"Central Michigan University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Tulane School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taylor","family":"Alcorn","sequence":"additional","affiliation":[{"name":"Tulane University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Hoerger","sequence":"additional","affiliation":[{"name":"Tulane University"},{"name":"Tulane University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,6]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000154"},{"key":"e_1_3_5_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2022.115546"},{"key":"e_1_3_5_4_1","volume-title":"Urbanization index","author":"FiveThirtyEight","year":"2020","unstructured":"FiveThirtyEight. 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