Background: Teachers constitute an occupational group experiencing high levels of stress and with high sick-leave rates. Therefore, examining potentially protective factors is important. While prior research has mainly focused on the link between teachers’ own experiences of their work environment and stress-related outcomes, it is also possible that colleagues’ perception of the work environment and their possibilities for dealing with work-related stress contribute to influencing individual teachers’ stress. Aim: The aim of this study was to investigate how teachers’ reports of high job strain (i.e. high demands and low control) and sense of coherence (SOC), as well as the concentration of colleagues reporting high strain and high SOC, were associated with perceived stress and depressed mood. Methods: The data were derived from the Stockholm Teacher Survey, with information from two cross-sectional web surveys performed in 2014 and in 2016 (N=2732 teachers in 205 school units). Two-level random intercept linear regression models were performed. Results: High job strain at the individual level was associated with higher levels of perceived stress and depressed mood, but less so for individuals with high SOC. Furthermore, a greater proportion of colleagues reporting high SOC was associated with lower levels of perceived stress and depressed mood at the individual level. Conclusions: High SOC may be protective against work-related stress among teachers. Additionally, the proportion of colleagues reporting high SOC was related to less individual stress, suggesting a protective effect of school-level collective SOC. Teachers are an occupational group that experiences high levels of stress in their workplace compared to many other occupational groups ,2. This 3339Research on the psychosocial work environment is extensive, and different theoretical models have been used to explain associations between working conditions and stress and stress-related outcomes. One commonly studied theoretical model is the Demand-Control Model , suggestTraditionally, identifying risk factors has dominated the research field of work-related health, but more recently a salutogenic approach has become more prevalent . The sal23Previous research shows that work-related stress is not only caused by individual experiences, but that it can also spill over to others within a workplace, meaning that collective experiences within a workplace also may affect the individuals within that setting ,32. Prio33The aim of the study was to investigate how teachers’ reports of high job strain (i.e. high demands and low control) and SOC, as well as the proportions of colleagues who reported high strain and high SOC, were associated with perceived stress and depressed mood at the individual level.n=308), just as teachers with missing information on any of the variables used in the analysis (n=908), meaning that the final study sample comprised 2732 teachers distributed across 205 school units.The data were derived from the Stockholm Teacher Survey of 2014 and 2016. These cross-sectional surveys were carried out by our research group through a web-based questionnaire targeting teachers in the Stockholm municipality. The questionnaire included questions related to SOC and a wide range of questions on work-related issues such as psychological demands, job control, stress and stress-related complaints. The questions used to assess working conditions derive from the DCQ ,19 and hTeacher stress was measured by an index comprised of three items derived from asking teachers to what extent they: ‘have days when they constantly feel tense or wound up’, ‘have days when they feel pressured, nearly more than they can manage’ and ‘have days when they constantly feel stressed’. The response categories were ‘not at all’, ‘sometimes’, ‘fairly often’ and ‘nearly always’ which were given numeric values 1–4, resulting in a sum index ranging between 3 and 12, with higher values indicating more stress (Cronbach’s α=0.88).Teacher depressed mood was captured by the question ‘To what extent in the past week have you experienced. . .?’ followed by six items: ‘fatigue or lack of energy’, ‘depressed mood’, ‘blaming yourself for things’, ‘excessive worry’, ‘lack of interest’ and ‘that everything feels exhausting’. The response categories were ‘not at all’, ‘a little’, ‘moderately’, ‘fairly’ and ‘very much’. These were given numeric values 1–5, resulting in a sum index ranging between 6 and 30 (Cronbach’s α=0.91). The Symptom Checklist – Core Depression (SCL-CD6) has been widely used in previous research and has been found to be a valid scale for measuring depressed mood .M=0, SD=1), and the correlation between the two measures was r=0.62.Both indices were standardised , resulting in a sum index ranging between 5 and 20, with higher values indicating higher demands (Cronbach’s α=0.79).Job control was measured by six questions, also derived from the DCQ: ‘Do you get to learn new things in your job?’, ‘Does your work involve doing the same thing over and over again?’, ‘Do you have the freedom to decide how your work tasks will be performed?’, ‘Do you have the freedom to decide which work tasks you will do?’, ‘Does your work require skilfulness?’ and ‘Does your work demand ingenuity?’. The response categories were ‘often’, ‘sometimes’, ‘rarely’ and ‘never’ and were given numeric values ranging from 4 to 1 (the second item reversely coded), resulting in a sum index ranging between 6 and 24 (Cronbach’s α=0.52).Job strain is a combination variable of the individual’s reports of psychological demands and job control, as described above. To define the variable, the median values for the demand and the control scale, respectively, have been used. The median value for demands is 16 , and for control it is 20 . As pointed out in previous research , no numeSOC was captured by a validated three-item instrument . It was Proportion of teachers with high job strain was defined as the percentage of teachers in each school who reported high strain. Proportion of teachers with high SOC was defined as the percentage of teachers in each school who reported high SOC.A set of control variables were included: sex , years in profession, study year (2014 or 2016), school level (senior or upper secondary level) and school type (public or independent).The Stockholm Teacher Survey has been approved by the Regional Ethical Review Board of Stockholm .xtmixed command. In an initial step, we performed two-level (because of the data structure) linear regressions to assess the associations between teachers’ reports of psychological demands, job control and SOC, on the one hand, and their perceived stress and depressed mood, on the other. Subsequently, we performed two-level linear regression analyses examining low/high strain combined with low/high SOC, as well as the contextual school-level variables: proportion of teachers reporting high strain and the proportion of teachers reporting high SOC, and their associations with stress and depressed mood. These analyses were performed in a series of models. First, an empty model was estimated in order to investigate the variation between schools in each of the dependent variables. This allows the variation in the dependent variables to be separated into two components: teachers and schools. Model 1 shows the estimates for different combinations of low/high strain and low/high SOC, where low strain and high SOC serve as the reference category. In model 2, the contextual school-level variable proportion of teachers with high strain was added, while model 3 instead added the proportion of teachers with high SOC. Finally, in model 4, all variables were mutually adjusted for. All models were adjusted for sex, age, years in profession, study year, school level and school type. For each model, the intraclass correlation (ICC) is reported, which provides information about how much of the total variance in the dependent variable that is accounted for by the school level rather than the individual teacher level [R2 for the individual and school level was calculated by using the mltrsq command in Stata. Bryk/Raudenbush estimates presented in The method used was multilevel analysis which handles hierarchical data , for exaer level . In ordeEstimates from two-level linear regressions presenting the associations between psychological demands, job control and SOC with stress and depressed mood are presented in The results of the two-level linear regression analyses, including combinations of job strain and SOC as well as the school-level contextual variables, are presented in Next, to assess whether colleagues reporting high job strain and high SOC were associated with stress and depressed mood at the individual level, we included these contextual school-level measures, with results reported in models 2–4. The proportion of colleagues reporting high job strain was not significantly associated with higher perceived individual stress or depressed mood (model 2), and the model improvement was not significant when adding this school-level variable.b=−1.54, p<0.001) and depressed mood , and model fit was significantly improved for model 3 (p<0.001 for stress and p=0.004 for depressed mood) when this contextual variable was included. When mutually adjusting for both contextual school-level measures (model 4), the associations between high SOC among colleagues and stress and depressed mood remained robust and statistically significant. Furthermore, it can be noted that there are relatively small differences in the explained variance (R2) between the different models. In the case of perceived stress, the R2 at the school level increased from 0.46 to 0.57, and in the case of depressed mood, it increased from 0.69 to 0.77 when introducing school-level SOC. The relatively high R2 at the school level may seem considerable, but the overall variation derived from the school level in the empty model is only 4.8% for perceived stress and 2.1% for depressed mood, which is why it is important to emphasise that the greatest variation in perceived stress and depressed mood is nevertheless due to differences at the individual level.The proportion of teachers in the same school reporting high SOC was linked with lower levels of stress  were associated with individual teachers’ perceived stress and depressed mood.The results showed that psychological demands at work were positively associated with stress and depressed mood, and that job control and SOC demonstrated negative associations with both studied outcomes. These results are in line with international research based on the job strain model ,8,13,14,23With regard to the contextual level, it was demonstrated that the proportion of colleagues reporting high SOC was associated with lower levels of perceived stress and depressed mood, suggesting that this contextual factor may impact on the individual’s perceived stress and function as a contextual protective factor for stress. There are several possible reasons for this. As argued in previous research , even thConcerning the investigated contextual effects, we can, based on the results from this study, partly confirm previous findings that have shown that collective experiences within a workplace may affect the individuals within that workplace –33,43. TIn line with the job strain model  and the One major strength of the study is that we analysed both individual and contextual aspects of teachers’ work environment using well-conceptualised measures of both independent and dependent variables. Another strength is that we used two separate measures for teachers’ stress and depressed mood. Even though they were strongly correlated, together they provide a clearer picture than what just one of them would do. However, it should be acknowledged that the internal consistency for the independent variables control and SOC was relatively low.The response rate of 55% can be regarded as a limitation. It is possible that non-participating teachers experienced higher levels of stress than those within the study sample, but it is also possible that there is a selection bias among the non-participants towards the less stressed. However, we do not know if any such bias exists or in what possible way this would have affected our findings. Furthermore, among those who participated, there was also item non-response. To investigate possible bias between the teachers in the study sample and the total number of responding teachers, mean values of all variables of interest were compared between these groups, and no noteworthy differences were found.Another limitation is the fact that the data are cross-sectional in nature, meaning that we cannot make any claims about causality with support in our data. Longitudinal data are desirable for future research. Furthermore, data derive from two waves of cross-sectional data collection, and because the data are anonymised, we have no opportunity to check whether the same teacher participated in both collections, which is considered a limitation. However, stratified analyses were performed separately for senior-level teachers from 2014 and 2016, as well as upper secondary level teachers separately. The associations examined pointed at the same direction for all these groups but did not always reach statistical significance, which may be due to lower statistical power. Finally, while the study was performed among teachers in Stockholm, generalisability to other geographical areas and educational systems should be made with caution. To corroborate the findings, studies of individual and contextual expressions of teacher job strain and SOC in relation to teachers’ stress-related health outcomes in other geographical and educational contexts are recommended. Future studies could use other theoretical models, such as the Effort-Reward Imbalance model or the JDR model, to explore the relationships between the work environment, SOC and stress. Likewise, other questionnaires, such as the COPSOQ or the Job Content Questionnaire, could be used to assess working conditions in order to study individual and contextual associations between working conditions and stress-related health among teachers.This study contributes to increased knowledge about the links between psychosocial work-related factors, SOC and stress-related outcomes among teachers. The results showed that high job strain was related to higher levels of stress and depressed mood among teachers in Stockholm municipality, but that high SOC seems to be a protective factor. Furthermore, the proportion of colleagues reporting high SOC was related to less individual stress and depressed mood, suggesting a protective effect of school-level collective SOC.


In the published article, there were three instances where there was a mistake in the cited references. This is because the references were renumbered sequentially after revision of manuscript.In the Results section, the sentence “By comparison, a non-linear dose–response meta-analysis with 13 eligible studies ” has been changed to “By comparison, a non-linear dose–response meta-analysis with 13 eligible studies ”.In the Results section, the sentence “Another negative linearity association also existed between the CDDD and the incidence risk of endometrial, corpus uteri, and cervical cancer, from four eligible studies ” has been changed to “Another negative linearity association also existed between the CDDD and the incidence risk of endometrial, corpus uteri, and cervical cancer, from four eligible studies ”.In the Discussion section, the sentence “Moreover, different from several studies that have found that prolactin may encourage the development of estrogen receptor (ER)-positive tumors (89) and higher risk in in situ ” has been changed to “Moreover, different from several studies that have found that prolactin may encourage the development of estrogen receptor (ER)-positive tumors (89) and higher risk in in situ ”.The authors apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Such a shift presents a unique opportunity to assess the impact of online and hybrid education for international students. This qualitative study interviewed 30 international students who had arrived on campus and shared their first-year university transition experiences during the pandemic. The analysis shows that spatial and temporal circumstances created two scenarios and thus resulted in different first-year university experiences. Although all students were dissatisfied with online learning, studying at a distance in different time zones was particularly detrimental to international students’ mental and physical health. The (im)mobile environments led to mismatches in expectations, roles, activities, and realities, negatively affecting student learning and adjustment. This study highlights the complex international transition issues and offers implications for sustainable online and hybrid-learning practices in the educational system.International education activities suddenly halted due to the COVID-19 pandemic, severely disrupting student mobility and academic learning. Many educational institutions have delivered programs to students through digital devices globally rather than  Safety,Examining international students currently residing in the host countries, many researchers proposed ways for institutions to provide adequate psycho-social support. Large-scale quantitative assessments have identified that international students were under social, emotional, academic, and discrimination stresses . Many quWhile the above studies focused on the students already on campus, less research has explored the experiences and infrastructure support of non-traveling international students. The student population who transitioned from Asian international schools to Anglophone higher education has been growing yet received little attention. One related research study examines International Baccalaureate Diploma Program graduates in higher education. In these studies, students’ high schools are in anglophone countries , and students tend to continue to attend higher education institutions within these contexts. As such, the students encountered fewer transitional difficulties because they were in the same countries. Research demonstrates that there is high pressure and stress associated with the International Baccalaureate high school curriculum, and students report being well-prepared for college in terms of entrance, retention, and competition . Recent Global Nomads or Third Culture Kids (TCKs) to describe students who have spent significant parts of their developmental years outside their parents’ culture(s)  . With inlture(s) . TCKs arlture(s) . As suchCollectively, the literature supports the need to understand how international high school graduates transitioned into university during the pandemic. Empirical research on the transition to online teaching and learning in higher education has been limited, and several gaps exist. One example is the predicament facing first-year students: they were new to a university, had limited exposure to the surroundings, and lacked facilities comparable to those provided by Franklin and Marshall College. It begs the theoretical assessment of the transitions among students. Moreover, more research is needed to discover whether students whose language of instruction in high school is English will also have adjustment difficulties while entering western anglophone higher education institutions. The pandemic put students in a dire situation, which motivated an empirical examination of such impacts.4.Theories from the person-environment framework guided the research design, data collection, and analysis. To best understand how students experienced transitions during the pandemic, two theories within the person-environment framework: ecological systems theory and transition theory, are utilized . The perA college student’s development is nested within and affected by relationships in the environmental systems: from the immediate face-to-face settings to the most distal broader social contexts . In BronThe transition model consists of three process stages: “moving in,” where the individual student tries to figure out the new environment, “moving through,” as the individual adjusts to the new environment, and “moving out,” as the individual leaves the environment . This stSituation, Self, Support, and Strategy; these are the resources that an individual student possesses during the transition. This framework suggests that going to university was a voluntary anticipated event that these students planned for over the past years. The context of the global pandemic would affect their reactions, which has an impact on their daily lives. Using this frame allows questions to be designed and asked on students’ perceptions on the situation, self, support, and strategy.Transitions produce stress and require coping, with “four main factors [impacting] an individual’s abilities to deal with a transition” , p. 48. 5.5.1.The entire research project began in the summer of 2021 and concluded in the summer of 2022. It was designed to be a mixed-method project to explore students’ transitions from international high schools to higher education during the global pandemic, combining cross-sectional surveys and phenomenological interviews. The survey assessed how students’ overall remote college experiences were affected by factors at various life stages using UCLA’s Freshmen Survey 2021 edition . Using a5.2.The research population comprises students who fulfill the following criteria: graduated from international high schools in Asia; completed their first year of university in a country different from their passport country or high school country. As such, the participants could effectively reflect upon their transnational transition experiences as first-year university students from 2020 to 2021. Research participants were recruited through purposive and snowball sampling . This reBy design, the participants in this study cohort share many features with other Asian international high school students . All of 5.3.via Zoom. Interviews were conducted in English, recorded with consent, and transcribed verbatim. Each interview ranged from 60 min to 90 min.Data collection began after obtaining Institutional Review Board approval from the researcher’s institution’s Office for Research Protections. After signing the consent forms, 10 students joined the individual interviews in the summer of 2021. A year later, in the summer of 2022, 30 students participated in the interviews. Among them, eight were participants from 2021 who decided to join for the second round of the interview. The data became robust with the longitudinal component, as these interviews substantiated and verified the findings. Because of the travel restrictions still imposed by different governments, all interviews were conducted online 5.4.The interview analysis used a deductive method to answer the research questions within the theoretical model. Interview data were coded and analyzed with two rounds of memo writing and coding in NVivo 12 and then MAXQDA, allowing chances for re-examination, synthesizing, and merging of the codes in additional cycles . The firBecause the transition model stresses students’ evaluation and appraisal of the events, affective coding methods were applied to investigate the subjective qualities of participants’ experiences, which are “core motives for human action, reaction, and interaction” , p. 124.6.6.1.orientation, first-year integration, and counseling and well-being support as “not very satisfied.” In the interviews, students viewed their first year as crucial for establishing a new identity, forming new social ties, exploring via trial and error, and preparing for more advanced study. The contrast indicates the inadequate formation of institutional support in the students’ exosystems, which, in turn, affected the structure of their mesosystem and microsystem.The 30 in-depth interviews provided explanations for the survey findings, which identified an overall unfavorable to a neutral appraisal of students’ college experiences in hybrid and online contexts. In the survey, students evaluated programs relating to effectiveness of remote instruction received the lowest rating in the survey. However, interviewees clarified that it was not about professors’ or lecturers’ teaching and pedagogical styles. Instead, they interpreted the ineffectiveness as a result of three interrelated factors: lack of engagement and contact, fatigue, and distraction. All student interviewees stressed the issues of Zoom and online fatigue and boredom. Such issues caused behaviors relating to procrastination and distraction after a lengthy period spent online. Students frequently browsed web pages while attempting to do homework assignments, which was a major source of distraction. ST5  openly admitted,Regarding academic learning, the When you do not have any connection with your professors, you get tired of reading lecture materials. Then there’s no one around you to cheer you up or bring you back to the studying mood. I have more tendency to crush the deadline now than I was in high school.The lack of connection with professors and classmates was the most mentioned problem because students could not see or interact with each other effectively in real time. ST19, a very outgoing and active student leader in high school, also actively sought help in university. Nevertheless, she found the circumstance challenging because “I could not look to peers or walk up to the front desk for support or any interactive measures to help us learn.” ST3  illustrated her feeling of helplessness,Being a high school student, you don’t know what university is going to be like. If you are in person, you could talk to a teacher, a tutor, or a supervisor. When you were online, you would have no idea whom to contact. Although there were many emails from the undergraduates’ office, you don’t know how to address them or who they are. I feel like entering a new world without any information and not really prepared.Other cognitive problems, such as depression and anxiety, were intensified for students in online learning, as compared to hybrid learning. Students discussed how learning on Zoom did not feel natural and made it difficult to be engaged and present. Even when online support sessions were offered, “the reality is that people are not looking for online interaction anymore” . More introverted students like ST2  sadly confessed that learning and interacting on Zoom amplified their conditions of anxieties when speaking in public,When I’m speaking to a screen, I get distracted. When I’m distracted, everything just goes to hell. I don’t remember anything. I underperform. And I just ramble about random stuff. And I don’t even know what I’m saying.6.2.improving work ethics, establishing new connections in new environments, and gaining independence, together with 37 sub-code coverages. The negative evaluations were regarding learning online, missed opportunities, time zone differences, and building relationships, with 67 sub-code coverages. All positive evaluations on independence and handling the basic life tasks were reported by students who moved to campus and had on-campus interactions.Hybrid-learning students faced issues and challenges common to their developmental stages, such as seeking independence, connections and belongingness, while contemplating the best options for their future career choices. It is critical to use students’ appraisal of the situation to understand their perspectives . During Moving into a new environment contributed to young adults’ maturity and growth. Participants shared how they learned the basic tactics in a new country to “deal with the bank, health, healthcare, the paperwork” . This process added to their sense of achievement as independent adults. ST22  described his growth after arriving on campus,I had to grow up very quickly in the past year living in college. A variety of things used to be things that my parents would take care of. Now I go to the doctor and get a bill with insurance on my own. But I’ve figured out that since I’m doing it now. It’s a big challenge. There’s a process to it. I think I have grown up much faster due to my situation at university.Students viewed their first year of college as essential to building the foundation for academics and social development. Due to the pandemic restrictions, they constructed a limited on-campus support system, primarily with by roommates, classmates, and friendship groups as their microsystems. Peers were their important microsystem and source of support during difficult times. These students were overall pleased and satisfied with their first-year experiences: “I was still able to make friends and be social. I felt like it was a successful year because I was learning in my classes, and socially I formed good relationships” . ST21  appreciated how peers played a role in supporting her in forming a new identity,I was able to be around people that were kind of more like me and were interested in the same things as me… that helped sort of embrace my identity in a way. And yeah, I found it to be a really good year for growing.Similarly, ST19  stated, “I think it was good for me to move to this new country, even though my learning was online. I could access the facilities and know what my university looks like, rather than just seeing it on the screen.”6.3.The transition experiences were more negative for students studying abroad at home in Asia, in particular for those learning in a different time zone. Although appreciated the fact that they were being taken care of at home in a supportive and familiar environment, fully online students all faced physical and mental struggles. Issues and symptoms of worry, anxiety, and depression were associated with lack of sleep, lack of immediate institutional communication, and lack of regular social engagement.ST7  performed exceptionally well in an elite high school, but acknowledged frankly that she faced “a hardcore, difficult transitioning to university.” ST14 , who received an Australian world-class university’s merit scholarship, explained how the COVID-19 lockdown created a challenging environment to live and study,Transitioning to an online university was extremely difficult because it was the time my country had a ban, so we could not go outside at all. The total isolation phase was four months, which was the entire duration of my university education online. The workload was extremely intense. I couldn’t relax. I couldn’t go outside. I was constantly worried about my country’s situation, my parents’ health, and my own health. I didn’t have social support from my friends or any relationships with teachers, that’s why I think it was even more difficult than normal [times].ST5  stated, “the situation is so bad because you are always on a computer and your head just hurts all the time.” ST1 , a student who exuded confidence and optimism, quietly admitted: “I need a lot more assistance from friends and family to push me, [otherwise] I would be too tired and be in bed all day.” The participants in Thailand and China illuminated their struggles and confusion in more details.I was struggling to keep up in class, and I probably did not sleep through one night for the past year. I took my classes throughout the night because all my classes were discussion-based, and I had to participate in them actively, so I stayed up. Sometimes I don’t sleep for two days in a row… I would give anything to someone who could just let me sleep, you know, for one night, like seven hours straight. All I wanted was to survive this semester. Well, it was very hard for me. A lot of people adjusted their times. I tried to sleep and wake up at 12 at midnight to take classed. Sometimes I woke up, but sometimes I didn’t. Some classes and quizzes would start at midnight, but some were in the mornings. I had to sleep, wake up, and then go back to sleep after taking a quiz. I slept at around 4 am and woke up at around 1 pm. Daylight savings got really confusing for me. I never slept like this late in high school. It’s been quite tiring. Yeah, I have been tired. narrowed during their first year in university. While they could communicate with more people on the phone or computer, they became less motivated. Many mentioned that they did not make any new friend online , and “I guess we were all burned out and did not care about socializing anymore” (ST17). Students needed to make trade-offs and decisions about whether and how to form relationships in a new environment: “building friendships with other kids – I had to actively give that up because I needed to get that sleep in that time” (ST2). “For me and a lot of people, the close friend circles became smaller, rather than broadened, which is a sad thing” (ST1). In Bronfenbrenner’s terminology, such experiences indicated that students’ microsystems, composed of the most immediate supporting relationships to their development, were not properly formed.In contrast with the hybrid-learning students, fully online students remarked that their friend circle had 6.4.Students’ strategies fall into two categories: sticking to a strict schedule and reaching out to friends or mentors. All interviewees stressed the importance of finding a routine and maintaining a schedule to keep life on track during the chaotic time; “otherwise, many of my friends just break down” (ST1).For interviewees studying at home in different time zones, it also meant trying to schedule designated times to be part of the local society for in-person interaction. Possible ways include connecting with friends in the same geographic area for day trips, shopping, partying, and meeting over coffee. This was an important strategy to “force yourself back into normal society and making you talk to more people” (ST3) so that students could feel connected with other human beings.In the survey, 27% of the student participants experienced monthly “lonely and isolated” feelings, 27% reported such feelings weekly, and 20% daily. The questions on constructing relationships were explored in-depth during the interviews. On the interview transcripts, the most frequently mentioned microsystem relationship codes were peers/friends (44 references), faculty (30 references), and social media (24 references). Less frequently mentioned codes were institutions (department) (16 references), family (12 references), and college staff  transition to university, (2) transition to a foreign education environment, and (3) transition to online learning amid a global pandemic. All were complex processes that entailed challenges and adjustments. As the theoretical transition model predicted, students’ relationships, routines, assumptions, and roles during the transnational university transition all altered to adapt to the new circumstances.The first two transitions were anticipated changes, so some students might be able to utilize their psychological resources to prepare in advance . Howeverin situ were limited in forming a new identity and developing social skills in a new cross-cultural environment.The place and time dislocation or displacement emerged as a critical factor influencing the participants, ultimately revealing the differentiated experiences between the 12 hybrid-learning and 18 fully online students. The place-related concept has captured the interests of environmental psychology and mobility researchers e.g., . Student7.3.The global higher education sector has tried to focus institutional efforts to incorporate the United Nations’ Sustainable Development Goals (SDGs), but the pandemic may lead to a shift in priorities during rapid digitalization and emergency remote teaching and learning practices . The Gloin situ was not optimal and 79% of students, according to a global survey, desired to study abroad on campus , enrolled in a small selective liberal arts college in the United States, explained the situations at her institution,Most of my classes were synchronous; they expected participation and you to be online on Zoom. My friend talked to the college about how hard it was for the Chinese students to be online around 3 am and 4 am. But they were like, “Oh, well, you guys are the minority of our school.” Because we were a small college, it was hard for them to take care of everyone.At the same time, there are higher educational institutions that offered sustainable and effective practices for their students. Providing dedicated time and places for these international students studying in different time zones have proved to be a supportive strategy. For instance, Franklin Marshall College and New York University were exceptional in catering to the needs of international students studying abroad at home . The lat7.3.2.via digital platforms lends credence to the notion that social media could positively contribute to undergraduate students’ international educational experiences (During the epidemic, microsystems, even virtual ones, are essential for supporting first-year students. It is even more crucial and apparent when social distance is required, and only virtual friendships are available. Students’ responses on friends being the most helpful source of support during the transition corroborated findings on the sense of belonging and formation of friendships in higher education . The coneriences . Aside f8.The pandemic presented a unique opportunity to understand how students transitioned from high school to university abroad and in what ways they were affected by the environment. This research finds that firstly, first-year international students did not evaluate online learning as very effective due to a lack of engagement and an increase in distraction. Secondly, there was a remarkable contrast in the experiences and well-being of fully online and hybrid-learning students. At a macro-environment level, the pandemics led to government lockdowns, border controls, and travel restrictions. Following these strict measures, the complex “multiple transitions” and “time and place displacement” disrupted international students’ establishment of and interaction with various components from microsystems to exosystems. As such, higher education institutions should target practices and services to support international students in complex transitions and difficult situations. This study contributes to empirical knowledge of transnational transitions and theoretical development on transitions during cross-cultural, temporal, and spatial environments.This group of international first-year students were relatively well-prepared for universities with prior cross-cultural experiences. They did not confront the same linguistic and financial obstacles that other international and disadvantaged students did. Nevertheless, the results show that time zone distortion, place dislocations, missed opportunities, and narrowed support networks were detrimental to student growth and well-being at a crucial developmental stage. In the post-pandemic world, hybrid and distance learning will continue to be an important feature in all forms of education, as will students’ transitions into international higher education. The experiences and resources acquired from online teaching and learning hold practical value for the future of sustainable higher education practices, including retaining traditional in-person instruction features and building online competencies . It woulwangliz@bc.edu.The interview audio and transcript data are not readily available as per ethics requirements. Requests to access the datasets should be directed to the author LW, The studies involving human participants were reviewed and approved by Boston College Institutional Review Board. The participants provided their written informed consent to participate in this study.The author confirms being the sole contributor of this work and has approved it for publication.This study is supported by the Council of International Schools and Boston College’s Center for International Higher Education.The author declares that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Relevant influenceable factors were grouped into three main categories: confidence, complacency, and convenience. Vaccines are effective public health interventions to promote health and prevent diseases in rural areas. Practical solutions to engage healthcare providers, researchers, vaccine advocates, vaccine manufacturers, and other partners in local communities are needed to increase public trust in immunization systems to achieve community immunity.Vaccination remains one of the most effective ways to limit the spread of infectious diseases, and reduce mortality and morbidity in rural areas. Waning public confidence in vaccines, especially the COVID-19 vaccine, remains a cause for concern. A number of individuals in the US and worldwide remain complacent, choosing not to be vaccinated and/or delay COVID-19 vaccination, resulting in suboptimal herd immunity. The primary goal of this study is to identify modifiable factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to vaccines in two under-resourced rural states, Alaska and Idaho. This qualitative study used semi-structured interviews with providers and focus groups with community participants in Alaska and Idaho. A moderator’s guide was used to facilitate interviews and focus groups conducted and recorded using Zoom and transcribed verbatim. Thematic, qualitative analysis was conducted using QDA Miner. Themes and subthemes that emerged were labeled, categorized, and compared to previously described determinants of general vaccine hesitancy: established contextual, individual and/or social influences, vaccine and vaccination-specific concerns. Themes ( Pandemics such as the 1918–1919 influenza, severe acute respiratory syndrome (SARS), H5N1 influenza (bird flu), and most recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease 2019 (COVID-19), have been responsible for over 20-million deaths worldwide Trimble, . VaccinaDespite current vaccine availability, waning public confidence in vaccines, especially the COVID-19 vaccine, remains a cause for concern for rural communities. Individuals in the US and worldwide may choose not to be vaccinated, especially given the expedited vaccine development timeline and technologies employed  and that additional factors may be contributing to the increased patient hesitancy noted by healthcare providers CDC, . The goaThis study was undertaken both in person and via Zoom (an electronic meeting room) with individuals from southcentral Alaska and southern Idaho. Health equity concerns of individuals in both Alaska and Idaho are similar to those found nationally in other primarily rural, under-resourced communities  and Mary Nies (nurse), faculty at Idaho State University who has worked with and for this and similar under-resourced communities . Both individuals are sensitive to and understand research participant challenges (reflexivity), trained to appropriately frame the research problem, and collect data in a culturally sensitive, respectful manner.To ensure consistency in the data collection process, a moderator’s guide was used to facilitate interviews and focus groups conducted via Zoom in 2021. Interviews were recorded and transcribed verbatim. Thematic, qualitative analysis was conducted using QDA Miner. The themes that emerged were labeled and categorized into areas reviewed and confirmed by members of the research team. IRB was obtained and consent was obtained from all interview participants.This study was granted expedited approval with a waiver of written consent by the Idaho State University Investigational Review Board (IRB) and is subject to established University research governance procedures. Participants and/or their legal guardians consented to participation at the time of interview and/or focus group scheduling  and verbal consent was confirmed and documented again prior to the interview and/or focus group initiation. All research was performed in accordance with relevant guidelines/regulations applicable to human subject participation .Community-based participatory research (CBPR), a well-developed model of relational research, offers a valuable framework for conducting research with community members to elicit understanding and identify stakeholder preferences and concerns. Utilization of the proposed qualitative methods within a CBPR framework will help identify the unmet needs of rural community members in the context of lived experience  with access to available COVID-19 vaccine  at the time of the study (government subsidized and/or insurance covered vaccine) from both urban and rural communities in Idaho and/or Alaska to assess access barriers COVID-19 potential differences in perceived susceptibility, severity, benefits, and risk. Informational flyers about the study were posted and shared by providers in the four-partner healthcare facilities and were shared on social media (Facebook and Google) by the University Marketing Department. Interested individuals then contacted the investigators, were screened for eligibility, and scheduled for one of the six focus groups for community members or seven interviews for healthcare providers.Seven healthcare providers, two physicians, one mid-level provider, two pharmacists, two nurses, and one community health worker from five different healthcare facilities  across Alaska and Idaho currently providing COVID-19 vaccinations were invited to participate in clinical service-focused interviews regarding COVID-19 vaccine hesitancy and delivery.most for COVID-risk & COVID-vaccine information? Who do you trust the least for COVID-risk & COVID-vaccine Information? Who are the key people/sources that influence your decision to recommend a COVID-19 vaccine? Note that no repeat interviews were completed and that transcripts were not returned to the participants for comment; however, audio recordings and field notes were assessed to ensure accurate information capture.Co-developed moderator guides, piloted in one focus group and one interview, were used by the two primary VACCINE Qualitative Research team members (Drs. Robinson and Nies) to conduct the seven 45-min semi-structured provider interviews and six 90-min virtual patient focus groups using Zoom, a collaborative cloud-based, videoconferencing service offering a secure, recordable, online meeting platform, over a 7-week period in Spring 2021. Prior to the interview, verbal consent was obtained from participants and the study focus was discussed. During the interview, providers were asked: How have you been personally impacted by COVID-19 ? Who do you trust the most for COVID-risk & COVID-vaccine information? Who do you trust the least for COVID-risk & COVID-vaccine Information? Who are the key people/sources that influence your decision to get a COVID-19 vaccine ? How does the government influence your decision to obtain a COVID vaccine? Have reports you heard or read in the newspaper or media prevented you from getting a vaccine (cues to action)?During the focus group, community members were asked: How have you been personally impacted by COVID-19 ? Do you plan to get/receive the COVID-19 vaccination (perceived susceptibility)? What is the number one reason behind your decision to get the vaccination ? Or not to get the vaccination? Who do you trust the The number of participants is based on prior work with the goal of achieving data and theory saturation as no new codes or themes were identified in the data, data repetition was noted, and identified codes and themes were exemplified in the data. Zoom recordings were subsequently uploaded to Rev, a cloud-based transcription service, and data was transcribed verbatim with over 99% accuracy. Patient identifiers were removed from interview transcripts, files were uploaded and stored in a secure, password-protected cloud-based site and subsequently uploaded directly into QDA Miner.A thematic analysis protocol was used to analyze data. Two coders systematically generated descriptive and analytic themes using a three-stage process: (1) line-by-line coding of the text for meaning and context, (2) development of descriptive themes and creation of code grouping based on differences, similarities, established literature , and (3) finally analytic themes are generated, identifying abstract messages and themes. Patterns and dominant concepts that emerged during analysis, and resultant themes and sub-themes were then compared to the established HBM, TPB, and SAGE theoretical frameworks focused on vaccine hesitancy: contextual influences , individual and/or social group influences , and vaccine and vaccination-specific issues.“I don’t know what the answer is as far as regaining trust with the CDC or the WHO, or Fauci, or just any level of government at this point, because it was so politicized from the beginning”.“I think the main concern for me is not knowing what information to trust…”—33-year-old childbearing female“My husband and I have had to regroup and then just make the decisions that are best for us and our immediate home and nuclear family. I don’t rely on social media for my information. I don’t trust the algorithms.”—50-year-old femaleVaccine confidence commonly refers to the trust patients, families, and providers have in recommended vaccines, and the processes and policies that led to vaccine development, manufacturing, approval, and administration. Under vaccine confidence, three main themes emerged: trust, information and resource needs , and fear of vaccine safety and side effects . A number of contextually based trust concerns were identified by participants relating to group influences, information sharing, vaccine, and vaccination-specific issues, for example:“[People come to pharmacists for] free advice. I mean, you don’t have to make an appointment. You can call it, you can walk up, you can do whatever you want. And so, especially at the retail level, [patients] really will trust whatever you say.’—Pharmacist“I’ve been getting information through my parents and then also through my in-laws, that’s where, I know my mother-in-law, she has daughters with disabilities so she does a lot of research about vaccines. I don’t know where my dad gets his information…. But I do trust my mother-in-law in terms of how she looks into each ingredient she kind of reads about… it does seem like she does put a lot of work into studying it.”—22-year-old female“I think self-report data is fine and it’s helpful, but I think I would prefer to see a longitudinal study where a follow-up is a full physical to check all vitals and to see if there are any issues or concerns and could those be related to the reception of the vaccine? I mean, because that’s what they do in some longitudinal studies is follow-up like that when it comes to health.”—48-year- old female“Not enough time has elapsed to know what the long-term effects of having had COVID are, to know how long your natural immunity lasts, to know how all the COVID vaccines work, or to know if there’s side effects. I mean, so I think it’s time. It’s not necessarily more information or access to information or whatever, it’s just we can’t speed that up.”—33-year-old female“The biggest scare for all of them is, uh, they’ve just heard bad things about people having bad signs and the thrombocytopenia and, and, and, you know, the reaction is the biggest scare and trying to reassure them that it has been hard because you can show them the data, you can explain to them, but then reach that we’re here to watch you”—Medical ProviderWe have a lot of people say, well, they skipped a phase. And what I’ve tried to explain to him is that the phase they skipped is the one that usually they do to make sure is this worth it for us or not.”—NurseA number of information needs were identified by participants including agenda-based, biased, and filtered information, highlighting the need for clear, unbiased, trustable sources of information that demonstrates long-term safety and efficacy, for example:Complacency is the low perceived risk and/or worry about getting COVID-19 virus disease and the perceived efficacy of treatment. Under the category of complacency two-main themes emerged: the importance of individual-level choice for health-related decisions , the role of big companies and government in individual-level health decisions, and the perceived need for the COVID-19 vaccine.“I’ve been coerced by a few different individuals in my life, my kids and my doctor, to the point where, “Oh yeah, it’s your choice, but you really should get this.” Now a little bit more by my kids who are both in the medical field who have both had their vaccinations. They won’t be around me because I haven’t been vaccinated. Well, that doesn’t make any sense to me because if they’re vaccinated, they should be fine. Why would they be concerned about me?”—64-year- old male“I try to find my own information independently. There’s some weight to Dr. Fauci and what he recommends. But I try to lean more on my own primary care doctor and my own health situation in evaluating the risks of getting COVID, or in my case getting COVID again, versus getting the vaccine and how necessary that is.”—32- year-old male“I don’t care if you’re 85 years old and you deserve to live the rest of your life until you naturally pass away or get hit by a car or however God has it planned out for you. So I just, I wonder if we’ve gone too far…”—85-year-old-female“My family members who are at high risk have already gotten vaccinated. So that puts me at ease of, okay, they got a little bit more protection from the coronavirus. So that influences me to be a little more relaxed or I don’t feel pressured to go get vaccinated.” —36-year-old female“Probably only adults who can legally make their own decisions who want it. I don’t think any minors who can’t make their own choices yet, can’t consent to things, I don’t think they should get it, but only adults and only people who want to.”—40-year-old femaleA number of contextually based concerns related to [individual] choice were identified by participants including concerns that the information being provided by industry, governmental agencies, and vaccine and vaccination-specific concerns was biased and that the messaging is coercive, for example:“So my issue personally is that I don’t want to set the precedent for the government, that they can require us to do something to our bodies.”—32-year-old female“I don’t think that in order to go on vacation, I don’t think that you should have to show a vaccine card. I can understand vaccines have been mandatory for certain things. You can’t enroll your kid in school without certain vaccines. And, they’ve been mandatory for a while for certain things, but something so new… you can’t just expect everyone to just jump on board and trust something that’s only been around for a couple of months.”—43-year-old female“I can understand if this was more urgent here, why [regulations] would be a necessity, but I don’t feel like, especially in Idaho where we are, it seems a little over the top to have a mandate about it, but I don’t know.”—36-year-old maleA number of contextually based concerns related to regulations were identified by participants suggesting group influences, information needs, and vaccine-specific issues, for example:“If I was over 65 or if I had diabetes, there’s plenty of people out there that are afraid of this, that have a reason to be afraid of this. And I think it’s great that we have a vaccine for those people, but I don’t think that it should be pushed on people that don’t feel they need it, just the flu. I don’t get the flu vaccine either”—33-year-old male“Do I trust big pharma? No…. I’m sure it’s [the vaccine] pretty darn safe and effective and all of that. So, yeah, I think in general there’s a lot of ethical issues with big pharma. But I don’t believe that they’re putting bad stuff in it [the vaccine]”—52-year-old male“If they were saying that this vaccine made you 100% not contagious and that it would stop this spread and it would save lives… but it’s saving lives of people that are highly susceptible to this and that are taking the vaccine to lower their risk of being hospitalized.”— 44-year-old femaleA number of contextually based concerns related to perceived vaccine efficacy and perceived vaccine need were identified by participants suggesting group influences, remaining information sharing, vaccine, and vaccination-specific issues, for example:Convenience: The quality of the service  and the degree to which vaccination services are delivered  the decision to vaccinate determines the priority that an individual person places on vaccination. Under the category of convenience, three main themes emerged: access, availability, and messaging. A number of contextually based concerns related to access were identified by participants suggesting group influences on vaccination and information, for example:“I seek out resources that I trust, and it might be WebMD or Mayo Clinic or other national organizations, and then just periodically try to understand how vaccines work, how does this vaccine work, what are the risk factors. I seek out information as well instead of just whatever the newspapers or media serves up to me.”—52-year-old female“Sometimes, you know, you end up with more people than you anticipate, and you need to pull that extra supply of band-aids, gauze, alcohol wipes, gloves, uh, wipes, uh, hand sanitizer, things that are just naturally in a clinic. It’s not uncommon to get somewhere and be like… the clinic froze up this weekend. So guess what? We’re moving over to the tribal hall…”—Nurse“I’ve even had some people that are just so frustrated with the whole trying to get an appointment has been really frustrating for people. And I’ve had some people say, well, by the time I get an appointment, I’ll be dead. So, I guess I shouldn’t worry about it. You know, like some elderly people have just made some really frustrating, you know, they’re frustrated. And so, you know, I always tell people and I have, this is a true story. I gave a shot to a 101-year old woman a few weeks ago.”—Healthcare ProviderTwenty-seven individuals, 52% women, ranging from 18 to 80 years of age, participated in one of the six-virtual focus groups conducted over a 2-week period. Seven healthcare providers involved in vaccine administration and currently working within a healthcare facility, 86% of women, ranging from 25 to 66 years of age, participated in a semi-structured virtual interview conducted over a 4-week period. All participants were actively involved in the administration of the vaccine, counseling of patients, and were aware of barriers to vaccine delivery within their clinical setting and community. Interviews lasted between 22 and 70 min (average 47 min) and focus groups lasted between 46 and 97 min (average 73 min). The result, nine-identified themes, and 51-sub-themes categorized are labeled and presented in Table “I don’t know the word incentive means something more to me than just not having a barrier to it. I think incentive means, I get something else rather than just the vaccine with no cost, but I think I wouldn’t risk my health for that initiative, unless it was really, really good, probably it’d have to be more than what’s reasonable.”—47-year-old female“At least in the beginning, they were only giving us the highest available options from testing centers… so that immediately skews the view that everybody has COVID…”—50-year-old femaleA number of contextually based concerns related to availability were identified by participants suggesting group influences, information needs, and vaccine-specific issues, for example:“I’ve got a 15-year-old son. He’s been absolutely indoctrinated by his school [to get the vaccine].”—50-year-old male“I feel strange about there being [media] ads about getting the vaccine”—50-year-old female“So I heard that somewhere that celebrities would come out and say, you need to take the vaccine, but they’re not telling you which one, nor have we seen the drug company itself come out and say, ours is the best or you need to take ours. Because my understanding is they can’t do that until it’s fully FDA approved, hopefully I’m wrong.”—46-year-old female“Advertisements I’ve seen, because they’re not by those companies, they don’t mention side effects or anything like that”—65-year-old male“They’re not getting a consistent message yet. And as such, if there’s any reluctance, they’re like, you know, you know, but I see, I have seen people who did not want it in December, come in January or February after they’ve seen people respond, you know, well, or, you know, that it didn’t kill us, that we’re all alive. I got, well, you know, that we’re all alive and that didn’t turn us into green monsters or anything. And we survived and we didn’t get COVID.”—Medical Provider“So maybe like the messaging around what people end up having to pay for versus what’s covered, and then telling people that they need the vaccine, there might be a disconnect. And like, you’re telling me I need to get vaccinated, but you’re not covering all of them [family members on the same visit]. So why are there any other opportunities that you see as far as kind of maybe messaging or education or things that we could kind of, maybe [provide] better support, like for vaccines in general for vaccine hesitancy in general?”—PharmacistLastly, a number of contextually based concerns related to messaging were identified by participants suggesting group influences, information needs, and vaccine-specific issues, for example:Factors such as individual vaccine confidence and complacency have been shown to impact the uptake of preventative care services such as immunizations and were of the greatest concern in our population. It is important to note that the fortuitous timing of the existing delivery system expedited delivery development and pressure to rapidly disseminate vaccines to local and state governments. However, a number of opportunities have been identified by patients and providers to increase confidence and reduce hesitancy.Patients have increasingly expressed the desire to be more involved in their treatment decisions, especially in critical situations such as with COVID-19 risk mitigation strategies and related decisions . Low perceived COVID-19 risk and low perceived treatment efficacy, contribute to the sub-optimal vaccination rates across the country; lower those seen earlier in the pandemic (66%), lower than those seen with other vaccinations which range from 15% to 90%, and lower than rates necessary to establish herd immunity (70%)  by patients needs to be matched with interventions and related educational resources.


In this paper I attempt to contribute to the developing field of “political philosophy of mind.” To render concrete the notion of “affective frame,” a social situation which pre-selects for salience and valence of environmental factors relative to a subject’s life, I conduct a case study of a deleterious socially instituted affective frame, which, during the early days of the COVID-19 pandemic in the United States, produced individuated circumstances that came crashing down on “essential workers” who were forced into a double bind. We saw here an untenable and ultimately fatal situation that forced a choice between, on the one hand, increasing the risk of their failing to provide financial support for their family if they quit their job or reduced their hours, and on the other, increasing their risk of contracting the virus by continuing to work. The case study will thus be itself an affective frame that will bring to the fore for its readers a nexus of harmful social practices of contemporary American society. Form is reinforced by content here, as this particular affective frame brings forth a further emphasis on affect when we focus on workers simultaneously socialized into roles as breadwinners and as members of the caring professions. For those people, quitting work becomes even more difficult as they come to affirm their self-identity of being providers of affective labor for those in their care at work and of being the affective anchor of family life at home, the one who financially helps keep a roof over the heads of their loved ones as well as being the emotional backbone of the family. Hence the affective frame of “essential workers in Covid times” renders salient and affirmatively valenced their affectively laden self-image as caring helpers of those in need, at home and at work. In May 2020, as COVID-19 swept through southern Louisiana, I read an article in my local newspaper that was both heart-breakingly concrete and illustrative of wider trends . The artThe philosophical framework of this piece the enactive wing of the nascent movement to establish a “political philosophy of mind.” A political philosophy of mind integrates third-person political analysis of subjectification practices with the traditional philosophy of mind topics of third-person scientific investigation of sub-personal neural, endocrinological, and somatic mechanisms, first-person phenomenological explorations of experience, and studies of second-person interaction, as in “participatory sense-making” . A succeAction and Interaction, Gallagher cites Iris Marion Young on oppression and Charles Mills’ critique of ideal theory to support his call to “give cognitive science a critical twist.”The move toward a political philosophy of mind within the enactive framework can be said to have begun with Shaun Gallagher’s discussion of the “socially extended mind.” A second important figure is Jan Slaby, who moves from his work on critical neuroscience to the political philosophy of mind. Slaby and Gallagher take up the notion of institutional extension in a 2015 article, in which they state, “The rational human subject is not an exclusively biological entity-it is an entity coupled with other biological individuals and with various institutions, tools, procedures, and practices that enable cognition .” The poWe can… distinguish enabling from disabling social structures, we can assess the extent to which social domains work to establish mental patterns that, in the long run, are enabling, conducive to individual and collective flourishing, or whether they instead create unhealthy dependencies, bind us to oppressive routines, maintain inequality, destroy community ties, or lead to emotional and mental habits that are harmful to us or our loved ones.The Mind-Body Politic (2019), Michelle Maiese and Robert Hanna develop further the move that calls for a political philosophy of mind. Maiese and Hanna have a deep embodiment thesis  metabolic systems, endocrine system, the musculoskeletal system, and the cardiovascular system” , p. 56.in essential conflict with basic values associated with fundamental human needs and overall wellbeing”  the practices making up the sexuality framework (dispositif) very often “induced” a self-subjectification in which subjects are constituted in and by the search for personal truth in sexual desires. At this time, then, Foucault introduced “governmentality” as a frame for reading intransitive, non-adversarial, self-subjectifing power relations  disentangled several strands: religious self-subjectification as led by “pastoral power”; sexual self-subjectification as an agent searching for truth in sexual desires; liberal self-subjectification as an agent in pursuit of self-interest; and finally, neoliberal self-subjectification as a “self-entrepreneur”  is a noteworthy treatment of the destruction of the social safety net focused on the Fordist bargain and its “family wage.” Melinda Family Values refuses any left nostalgia for Fordism, and instead provides detailed case studies of the way in which, during the neoliberal restructuring of society, “instead of trying to revive the family form of the New Deal, they [neoliberal policy makers] tried to revive the much older poor law tradition of family responsibility, which identified marital and kinship relations as the proper source of economic security and a suitable alternative to the welfare state”  of younger generations.The Birth of Biopolitics (2008). Foucault writes that neoliberals reject the classical liberal notion that humans have a natural propensity to truck and barter, such that governments should step back to allow this natural process to take place. They rather assume, Foucault writes, that competition is fragile and needs state intervention to set up its conditions.“Neoliberalism” is sometimes said to have degenerated into an empty epithet, just a term for critics of contemporary capitalism to use to sound sophisticated -entrepreneur would start with contemporary American mandates for individual health insurance packages purchased on government subsidized insurance markets but extend to such matters as legalizing direct-to-consumer medical advertising (“ask your doctor if X is good for you!”), state support of medical research, laws and regulations for reproductive health, and on and on. Insofar as producing the conditions for self-entrepreneurship allows for management of an individualized population, American biopower practices depend on analyzing rates in a vast multiplicity of myriad dimensions. Just to begin, multiple agencies at local, state, and federal levels analyze the way in which citizens with such and such a demographic profile  consume such and such a level of health care  and have such and such health outcomes .“Society Must Be Defended” . Similar warnings hold against ascribing Covid racial discrepancies to behavior or to sheer residential patterns. The latter risks the psychological phenomenon of “place-based stigma,” when in fact we should be looking at “place-based risk,” that is, material factors responsible for poor health outcomes in the location .To fight this, Chowkwanyun and Reed insist, we need socioeconomic status data to contextualize disease rates. “Complementary SES information will clarify how racial and class forces are intertwined—and when they are not—in the case of COVID-19. In general, members of minority populations are disproportionately likely to have low SES and are likely to have the most undesirable health outcomes.”not explain COVID-19 racial disparities:Most interestingly for us, however, the authors now turn to the concept of “weathering” for cases when SES does One possible explanation is the role of stress and what public health researcher Arline Geronimus has termed “weathering,” or advanced aging caused by bodily wear and tear from fight-or-flight responses to external stressors, especially racial discrimination , we estimate that at ages 49–55, black women are 7.5 years biologically “older” than white women. Indicators of perceived stress and poverty account for 27% of this difference.Following up on her early research, With the notion of allostatic load, we come across an interesting connection with the currently prominent cognitive science school of “predictive processing.” Predictive processing says the brain seeks to minimize the gap between predictions of the environment and arriving sensory information that serves as error correction to those predictions. Current work looks at exteroceptive (from environment), proprioceptive , and interoceptive  prediction and sensation . Error cThe authors outline three aspects of stress: first, stress is evoked by situations with novelty, unpredictability, and uncontrollability; secondly, there must a sense of threat; and third, there must be multiple options for potentially uncertainty-resolving behavior. They then invoke three processes to resolve uncertainty: attention, learning, and habituation. In brief, information hungry Bayesian brains become hypervigilant to reduce uncertainty about strategy selection (information), and they selfishly need extra energy (thermodynamics) that is provided by the stress response.Long-term stress, however, wears you out; you accumulate allostatic load. To alleviate uncertainty, goal-directed decision making is seen as active inference, that is, changing the probability distribution of relations of three types of states: 1, the current states of body or world; 2, attainable states (repertoire of actions/what you can do); and 3, goal states (where you would like to be). If you’re confident that your actions will work, then you produce motor output. If you’re uncertain, then you initiate an “emergency program” to get information to update beliefs and get inferences back in good shape. That is, stress reaction will sharpen senses/attention and increase learning via release of cortisol and catecholamines.The upshot is that living through a no-win situation requires a juggling of multiple future scenarios, a cognitive load that has both affective and physiological consequences see also . The affBut—and here is why the enactive interpretation of predictive processing the we will shortly turn to is important—the situation is ultimately political and material rather than epistemic; your problem is lack of power not lack of information, so continuing an information search to refine your risk probabilities doesn’t get you anywhere and in fact actually wears out your body, setting you up for an even worse case of Covid should you catch it.The enactive approach to cognition  sees cogAutonomous systems have self-production and self-distinction; enactive sense-making is historical (path-dependent) as experience locks in habits and extended to sometimes include active engagement with other agents that produce participatory sense-making in which coupled dynamics have a life of their own . So inteWhen it comes to consciously accessible pondering of options, it’s intuitively clear, I believe, that you can get worn out consciously “ruminating,” or endlessly going over options in a no-win situation. There is a physiological cost even to sub-personal, off-line simulations in conditional mode (“what would happen if I adopted this strategy?”). In high-stakes situations, with high-risk scenarios abounding on all sides, you get some allostatic load even before you act and get the real-world feedback that predictive processing is supposed to save you from .People in vulnerable social positions, that is, deleterious affective frames, then, are doubly punished, especially in double-bind or no-win situations: even thinking about your options can exert a physiologically inscribed emotional cost, and then you must absorb the cost of the real-world feedback on top of that. In other words, in traditionally conceived allostatic action, you’re trying to change the world to restore a stable environment fit to habitual predictions. But if the world is recalcitrant, if the deck is stacked against you, then you get a double dose of allostatic load: not just a high cost to those allostatic actions which are swimming upstream in a racialized world, but there’s even a high cost to simple internal scenario generation.Shenetta White-Ballard lost her life while serving as an “essential worker” in her job as a nurse in a senior care facility. Naming people as “essential worker,” and thus changing their attendant risk profiles, differs across political jurisdictions. In the case at hand, Louisiana had a fairly standard “Stay at Home” order , which iAs would be expected, White-Ballard’s employer reduces the situation to “choice” and willing assumption of risk on behalf of patients, thus naturalizing and individualizing the multiplicity or affective frame. DeRobertis reports, “Legacy representatives say White-Ballard made ‘a personal choice’ to continue working in an environment with COVID-19 positive patients.” Nothing is said about financial circumstances or forced choices. “Mrs. White, like many healthcare professionals across the country, chose to continue serving her resident population,” said Myles Holyfield, a Legacy spokesperson. “She did so with honor and professionalism. Shenetta is an example of risk that healthcare workers are willing to take while caring of the most vulnerable of our citizens.” A bit later in the article the mealy mouthed abnegation of corporate responsibility in the name of “choice” is made even more clear:A Legacy representative said White-Ballard was aware of her options. Some employees chose not to work in the facility because of COVID-19 positive residents. Others took a short leave of absence and have since returned to work, while others have chosen to not return at all. “These choices are very personal to health care workers across the industry,” Holyfield said. “We, at Legacy, support those choices, whichever direction they may lead.”The reporter follows up with a better, more concrete analysis than sheer “choice” of the affective frame that produced the entangled individuation of self-image as caring worker and financial and viral risk management facing White-Ballard: “Yet friends and family said she was terrified. As the member of her household with more secure financial footing, she felt a responsibility to keep working.” Here we see the affective term “terrified” linked to the status of the breadwinner responsible for the family; in the destruction of the social safety net, i.e., the Great Risk Shift, the family becomes the locus of private debt substituting for public policy, as we saw with Cooper. Another analysis from DeRobertis shows the double bind: “White-Ballard’s experience on the front lines of the coronavirus battle highlights the plight of many essential workers these past few months: continue to work at a job that places an employee at risk of infection, or walk away and face serious financial challenges.” Here we also see the predictive processing stress-load of constant risk calculation of viral and financial risk scenarios.The conclusion of the article is gut-wrenching. First, we read of those left behind: “Eddie Ballard, Shenetta White-Ballard’s husband of 11 years, knows all too well the struggles of being ‘essential’ right now. He works at Walmart and has been given a 2-week period to mourn his wife’s death. His grief has debilitated him, he said, leaving him feeling aimless and unable to think clearly.” DeRobertis quotes Ballard:“The only thing I’m doing right now is trying to hide it—I’m holding it down inside,” Ballard said. “I know I have to release it, but I can’t right now. I have too many things to do.” Now, he has to both raise and provide for their 14-year-old son alone. For this reason, Ballard said he “can’t completely break down” from his sadness. “I wish I could,” he said.Turning again for the last time to White-Ballard’s situation, we see that self-subjectification as caring worker cannot ultimately be divorced from financial and viral risks. DeRobertis reports,A coworker of White-Ballard, who did not wish to be named to protect her job, said she feels it is not a mystery why her colleague returned day after day to a place that put her in danger. “The same reason as to why she was willing to go to work is the reason a lot of people are still going to work,” she said. “They don’t have anyone else to do [the job]. It has to get done.”At the very end of the article, DeRobertis re-establishes the double bind of affective workers who identify strongly with their caring for others: “Her husband said she never told him she dealt with COVID-19 patients; had he known, he would have demanded she find a way to stay home. Friends said she didn’t feel financially stable enough to walk away, but also that she loved her patients and cared for them deeply. ‘She had a beautiful heart,’ her husband said. ‘I want her to be known for her sacrifice.”’it’s a truism of critical social theory that there’s no such thing as a natural disaster. In Latourian terms, the SARS-CoV-2 virus is an actant in an Actor Network including social practices and individual human bodies as they have been shaped by social systems . The verWe must remember that biopower did not begin in March 2020 with Covid “lockdowns.” Hence the desire to return to the “normal” rates for flu, asthma, COPD, and so on tempts us to overlook the multiple biopower dimensions that established the very same baseline rates to which we want to return. Furthermore, even keeping such a denaturalizing genealogy of the pre-Covid “normal” in mind as we scrutinize government Covid actions, we need to remember that not all “lockdowns” are the same, as different levels of government support are going to influence the fallout taking the form of increased rates of depression, anxiety, domestic violence, substance abuse, and so on.As we have seen with Chowkwanyun and Reed, Covid illness factors are all subject to gender, race, class, and other analyses. A more fine-grained analysis would add to those factors status as “essential workers,” transport modes, intergenerational living, pre-existing conditions, and, as we will see, personal and familial financial risk-management. Following All these levels intersect governmental risk management in the naming of “essential workers” as those whose increased exposure to the Covid virus was an acceptable cost in implementing lockdowns: masks for all; remote work for some; in-person work for “essential workers.” A final dimension to the multiplicity that individuated in White-Ballard’s last days: as we noted above, emotional labor has a way of becoming a self-subjectifing practice, as many come to identify themselves with the caring aspects of a job. This only deepens the double bind: not only must you work for your family’s financial security, but you must also live up to your self-image as a caring health professional on the job, as well as providing emotional in additional to financial support to those at home.In the reporting on White-Ballard’s death we see all the dimensions of this case study of Covid as an affective frame: distributed bio-social systems individuated as “bodies politic”; the neoliberal self-family-health-entrepreneur juggling risks in our epoch of biopower; the corporealization of racism in weathering as a subset of “political physiology”; and essential worker status forcing a complex juggling of financial and health risks in a no-win situation; and finally, an affective-cognitive “allostatic load” from that risk juggling that we can speculate exacerbated weathering-enabled pre-existing conditions and “co-morbidities” and contributed to the tragic death of Ms. White-Ballard.https://www.theadvocate.com/baton_rouge/news/coronavirus/article_c2b7dd12-96e0-11ea-9ff8-9ff8faef31c2.html.Publicly available datasets were analyzed in this study. This data can be found here: Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Written informed consent from people mentioned in the article was not required to participate in this study in accordance with the national legislation and the institutional requirements.The author confirms being the sole contributor of this work and has approved it for publication.