The Value of Children,Parenting Strains,and Depression Among Urban African American Mothers

This exploratory analysis examines the relationship between two dimensions of the parenting experience—values regarding children and parenting strains—and depression in a sample of 285 urban, economically disadvantaged African American women. An examination of this relationship among economically disadvantaged African American women is important in light of the high stress exposure of these mothers, their limited opportunity to engage in rewarding employment, and in view of the centrality of motherhood in this cultural context. Our central finding is that the impact of parenting strains on depression is substantially moderated by beliefs about the costs and emotional fulfillment associated with having children. African American mothers who regard the costs of children as low and the potential of children for providing emotional fulfillment as high are significantly more depressed by high parenting strains than African American mothers who hold the opposite beliefs about the costs and benefits of children. Variation in values regarding children and parenting strains accounts for more than 40% of variation in depression. These findings suggest the importance of understanding the social–psychological factors that contribute to the quality of parenting, not only because maternal mental health is important in and of itself, but because maternal well-being has a direct impact on child well-being.     

Everyday Health Communication Experiences of College Students

Objective: The authors examined college students' day-to-day health communication experiences. Participants: A convenience sample of 109 midwestern university students participated in the study. Methods: The participants completed health communication diaries for 2 weeks, generating 2,185 records. Frequent health topics included nutrition and diet, minor health concerns, risky health practices, and body fitness. Results: Approximately 27% of health communication experiences involved the proactive seeking of health-related information or advice. Interpersonal venues (face-to-face, telephone, and e-mail) were evident in about 75% of the records, which were dominated by exchanges with friends and family members. The authors found modest interactions of topic, channel, and purpose. Conclusions: Congruent with the uses and gratifications theory, the authors found that satisfaction with and perceived impact of health communication experiences varied by topic, channel, relationship, and purpose.     

Everyday health communication experiences of college students

OBJECTIVE: The authors examined college students' day-to-day health communication experiences. PARTICIPANTS: A convenience sample of 109 midwestern university students participated in the study. METHODS: The participants completed health communication diaries for 2 weeks, generating 2,185 records. Frequent health topics included nutrition and diet, minor health concerns, risky health practices, and body fitness. RESULTS: Approximately 27% of health communication experiences involved the proactive seeking of health-related information or advice. Interpersonal venues (face-to-face, telephone, and e-mail) were evident in about 75% of the records, which were dominated by exchanges with friends and family members. The authors found modest interactions of topic, channel, and purpose. CONCLUSIONS: Congruent with the uses and gratifications theory, the authors found that satisfaction with and perceived impact of health communication experiences varied by topic, channel, relationship, and purpose.     

Risky sexual behavior in low‐income African American women: The impact of sexual health variables

In a sample of 163 low‐income African American women, we used logistic regression analyses to test for associations between (a) 5 operationalized constructs theorized in the Sexual Health Model to impact one's overall sexual health (barriers to healthy sexuality, sexual anatomy and functioning, positive sexuality, sexual health care, and cultural identity) and (b) several measures of risky sexual behavior (consistent condom use, multiple concurrent partnerships, and overall sexual risk). No significant relationship was found between acculturation and risky sexual behaviors. Having sexual difficulties was positively associated with overall sexual risk and multiple concurrent partnerships. Favorable attitudes toward condoms were positively associated with consistent condom use. Desiring or intending pregnancy was positively associated with inconsistent condom use and overall sexual risk behavior. This is only the second study linking sexual difficulties and risky sexual behavior. The exact nature of this correlational relationship needs to be studied and replicated in different and more heterogeneous populations.     

Health behaviors of culturally diverse inner-city community college students

ABSTRACT

Objective: To determine the prevalence of risk behaviors related to cigarette use, alcohol use, nutrition, physical fitness, and sexual behavior. Participants: Participants were 1,075 students attending an urban community college during the Spring 2012 semester. Methods: Data were collected in randomly selected classes using the American College Health Association National College Health Assessment II (ACHA-NCHA II) paper survey and analyzed using Statistical Package for the Social Sciences (SPSS) version 22 for frequencies and chi-square test of independence. Results: The sample population reported poor diet, low rates of physical activity, high rates of overweight/obesity, low rates of condom use for vaginal sex, multiple sexual partners, and unintentional pregnancy. Protective health behaviors included low rates of cigarette smoking and alcohol use, high rates of condoms use for anal sex, and high rates of human immunodeficiency virus (HIV) testing. Conclusion: Students are at high risk for health problems related to poor diet, lack of exercise, and risky sexual behaviors. Additional research is recommended to determine the most effective intervention strategies.     

Examining the role of racism in the risky alcohol use behaviors of black female college students

Objective: This study explores the impact racism has on the drinking behaviors of Black college women. Little is known about Black college women's experience of racism and the impact racism has on their psychological wellbeing and drinking behaviors. The current study fills a gap in our understanding of the role racism plays in the risky drinking behavior of Black college women. Participants: 469 Black college women ages 18–29 were sampled from 8 colleges and universities across the US, in 3 waves from December 2014-August 2017. Results: Findings suggest that general life stress and perceived racism are significantly associated with alcohol use among Black college women. However, only increased experiences of racism increase Black college women's engagement in risky drinking. Conclusions: The findings of this study serve as an entry point for a more nuanced assessment of stressors among Black college women that may inform drinking behaviors in this population.     

Negotiating Quality: Total Quality Management and the Complexities of Transforming Professional Organizations

During the past two decades organizations in many industries have introduced management-style changes, such as employee involvement (EI) and total quality management (TQM). In the health care sector, one change has been the inclusion of TQM into the accreditation process. Using ethnographic and interview data, this case study examines the process of introducing TQM into a professional organization—a hospital—and shows how successful implementation of such new management styles in professional organizations requires complex negotiations of existing formal and informal power relationships. Some employees and middle managers embraced the TQM philosophy and techniques and successfully influenced the implementation and project-team design. In this case, administrators used TQM as rhetoric and justification for increased bureaucratic control, goals that are distinctly at odds with the ideological objectives of TQM.     

The relationship between Black and gay community involvement and HIV-related risk behaviors among Black men who have sex with men

Black gay men must navigate identities and stigmas related to being gay and Black, and report higher HIV incidence relative to their White male counterparts although they report lower rates of drug use and risky sexual behaviors. This study examined whether closeness to the gay or Black community correlated with HIV-related risk and protective behaviors. Data were drawn from uConnect, a population-based cohort study of young Black men who have sex with men (YBMSM) on Chicago's South Side. The sample consists of 618 Black MSM ranging in age from 16 to 29. Cross-sectional measures for this study include Black and gay community closeness, drug use, sexual risk behaviors, HIV testing, and health promotion behaviors. Closeness with the gay community was associated with greater pre-exposure prophylaxis (PrEP) knowledge as well as participating in health promotion programs along with higher rates of transactional sex and having sex under the influence of substances, and increased odds of self-reported HIV seropositivity. Involvement in the Black community was associated with lower odds of reporting being HIV positive. Findings suggest that programs and initiatives are needed to help promote the positive aspects of the Black and gay communities, while minimizing the negative correlates of such involvements.     

Risky Sexual Behaviors and Pregnancy Outcomes in Young Adulthood Following Substantiated Childhood Maltreatment: Findings From a Prospective Birth Cohort Study

Childhood maltreatment is associated with a range of adverse mental and physical health outcomes, including increased rates of sexually transmitted infections (STIs) later in life. However, the impact on risky sexual behaviors and pregnancy outcomes has not been adequately studied. This is particularly true for physical abuse, emotional abuse, and neglect. We examined associations between prospectively substantiated childhood maltreatment and reports of risky sexual behaviors by men and women, as well as selected pregnancy outcomes in women. We followed up 3,081 (45.7% female) participants from the Mater-University of Queensland Study of Pregnancy, a prospective Australian birth cohort study. Using logistic regression, we examined the association between substantiated childhood maltreatment from birth to 14 years, and self-reported risky sexual behaviors and youth pregnancy outcomes at the 21-year follow-up. In adjusted analyses, children who had experienced multiple childhood maltreatment exhibited more risky sexual behaviors than their nonmaltreated counterparts. In specific models, those exposed to each form of childhood maltreatment, independent of co-occurring forms of childhood maltreatment, had an increased likelihood of risky sexual behaviors, particularly an early sexual debut and, for women, youth pregnancy. Neglect was also associated with multiple sexual partners, and emotional abuse with higher rates of miscarriage. There was no difference between men and women in how different forms of childhood maltreatment predicted risky sexual behaviors in young adulthood. All forms of substantiated childhood maltreatment, including multiple substantiations, were associated with risky sexual behavior in both sexes as well as higher rates of youth pregnancy in women. Moreover, emotional abuse persistently predicted miscarriages in young adult women. Understanding the association between childhood maltreatment and risky sexual behaviors and youth pregnancy outcomes may help suggest preventive strategies.     

A reverse sunk cost effect in risky decision making: Sometimes we have too much invested to gamble

The sunk cost effect refers to the empirical finding that people tend to let their decisions be influenced by costs made at an earlier time in such a way that they are more risk seeking than they would be had they not made these costs. This finding seems to be in conflict with economic theory which implies that only incremental costs and benefits should affect decisions. The effect is often explained in terms of prospect theory of (Kahneman, D., Tversky, A., 1979. Prospect theory: An analysis of decision under risk. Econometrica 47, 263–291), suggesting that sunk costs may induce a ‘loss frame,’ consequently causing risk seeking behavior. We argue that sunk costs may also result in risk aversion. In the present study we investigated the effect of time and effort investments (Behavioral Sunk Costs) on risky decision making in gain and loss situations. The results show that, in agreement with prospect theory, participants were more risk averse in gain situations than in loss situations. Moreover, incurring Behavioral Sunk Costs appeared to increase risk aversive choices, i.e., a reverse sunk cost effect. Furthermore, the results suggest that, in loss situations, Behavioral Sunk Costs mainly lead to risk aversive behavior if opting for the ‘safe’ alternative is not accompanied by an increased possibility to regret the decision.     

Risk and protective factors for recent alcohol use among African-American youth

A total of 7488 7th-12th grade African-American students completed a survey assessing factors associated with recent alcohol use. Results indicated that 13.6% used alcohol in the past month. A series of odds ratios revealed that making good grades, participating in school activities, attending church, and having parents/teachers talk about the dangers of alcohol and set/enforce rules regarding alcohol were associated with decreased recent use. Participating in risky behaviors such as getting into trouble, skipping school, and having friends who use alcohol and other drugs was directly related to recent use. Prevention specialists should encourage parents/teachers to engage youth in family, school, and community activities to deter alcohol use. Results may assist youth health professionals in developing prevention programs aimed at African-American youth.     

Monitoring and evaluation design of Malawi’s Right Foods at the Right Time nutrition program

Child stunting is a public health problem in Malawi. In 2014, the Government of Malawi launched the Right Foods at the Right Time (RFRT) program in Ntchisi district delivering nutrition social and behavior change communication, a small-quantity lipid-based nutrient supplement to children 6–23 months, and nutrition sensitive activities. Monitoring and evaluation (M&E) systems are key aspects of successful program implementation. We describe these and the methodology for an impact evaluation that was conducted for this program. Two monitoring systems using traditional and electronic platforms were established to register and track program delivery and processes including number of eligible beneficiaries, worker performance, program participation, and to monitor input, output, and outcome indicators. The impact evaluation used comparative cross-sectional and longitudinal designs to assess impact on anthropometric and infant and young child feeding outcomes. Three cross-sectional surveys (base-, mid-, and end-line) and two longitudinal cohorts of children followed in 6-month intervals from 6 to 24 months of age, were conducted in sampled households in the program and a neighboring comparison district. Additional M&E included qualitative studies, a process evaluation, and a cost-effectiveness study. The current paper describes lessons from this program’s M&E, and demonstrates how multiple implementation research activities can inform course-correction and program scale-up.     

Effects of Global Democracy on Women's Reproductive Health: 1970–2005, Cross-World Analysis

ABSTRACT

Despite many trends that have been commonly assumed to enrich societal well-being, this article posits that in addition to benefits there are also costs associated with democratization. This article comparatively analyzes the effects of democratic transition on women's health in democratizing well-developed as compared with developing countries across the world. Considering the junction of positive and negative outcomes of democratization, the author argues that to women the costs of democratization are much more substantial than to men because their societal roles are less valued and life for most women is centered at home and, hence, is not considered to be of public concern. Thus far, democratization's costs to women have been largely overlooked, not only in terms of economic opportunities but also in terms of their impact on women's health. These costs cannot be ignored as they limit women's empowerment and endanger national health.     

Neglect and Abuse Associated with Undernutrition in Long-Term Care in North America: Causes and Solutions

ABSTRACT

Protein-calorie undernutrition in institutional long-term care is a significant cause of morbidity, mortality, increased health care costs, and poor quality of life. Failure to provide adequate nutrition constitutes neglect, and certain practices associated with feeding the dependent elder or adult with developmental disabilities can be abusive. The causes are multifactorial. They are related to conditions common to these persons; multiple medication use, difficulty in swallowing, gastrointestinal dysfunction, poor oral health and oral care, sensory changes with aging, and lack of education and training in the proper protocols required to provide adequate food and liquid to persons with cognitive and physical impairments. Solutions which are simple, cost-effective, easy to apply and cross national, ethnic, and cultural boundaries are described.     

The ethics of parimutuel systems

One strand of the moral case for the superiority of parimutuel systems of betting over bookmaking emphasises that, as the name implies, the bettors are betting amongst themselves and that there is no discrimination against any individual bettor or groups of bettors. This claim is undermined by three deviations from the pure parimutuel principle found in many systems. Given that there is a close inverse relationship between the income/wealth of bettors and the average odds of the bets they place, the three deviations—higher deductions from long odds (exotic) pools, higher deductions from pools when longer odds horses win and the paying of minimum dividends—each move a parimutuel system in the unethical direction ofregressive taxation.     

Are cash transfers the answer for child nutrition in sub‐Saharan Africa? A literature review

Early evidence is ambiguous on the effects of cash transfer programmes on children, but until the last few years there has been little focus on Africa. We review the literature on 20 cash transfer schemes, including 12 from sub‐Saharan Africa. Such interventions have shown improvements in household diet and, in some cases, to agriculture, but have not always improved child health. However, a larger perspective focusing on two key time periods for nutrition—adolescence and the first 1,000 days of life reveals more opportunities for impact. In particular, the opportunity to empower young women to access secondary education and the reduction of adolescent pregnancy rates can improve the health of African children. Cash transfer programmes show promise, though there is room for improvement.     

The role of evidence in nutrition policy‐making in Ethiopia: Institutional structures and issue framing

Malnutrition is the single greatest contributor to the global burden of morbidity and mortality, with most cases arising in low‐ and middle‐income countries. However, the multi‐sectoral nature of nutrition policy‐making adds considerable complexity to the implementation of effective programmes. This raises questions about why or how relevant policy change can come about within different country settings. This article examines multi‐sectoral nutrition policy‐making from the health sector perspective, specifically focusing on different sectoral perspectives and the role and use of evidence within this. Ethiopia provides a unique example of the challenging nature of multi‐sectoral nutrition policy‐making, even with a strong co‐ordinating infrastructure. In December 2014 we undertook 23 in‐depth semi‐structured interviews with stakeholders from key health sector organizations, along with a related documentary analysis. Participants represented a diverse range of perspectives, including government representatives, policy stakeholders, aid providers from multi‐lateral organizations and academic researchers. Our respondents described how nutrition framing in Ethiopia is changing, with greater consideration of overweight, obesity and non‐communicable diseases, as well as undernutrition and micronutrient deficiencies. However, overweight‐ and obesity‐related concerns are still less evident in key documents. Some health actors described the challenge of enacting structural policy changes when doing so requires engagement from the agriculture sector. While multi‐sectoral plans and infrastructure to address malnutrition are in place, respondents suggested that the mandate for addressing nutrition resting with the health sector was reinforced by the nature of evidence collected. This study of nutrition policy‐making in Ethiopia highlights the complex interaction of evidence within different conceptualisations of policy problems and responses. Despite Ethiopia's strategic framework and its progress in achieving terms of nutrition targets, it shares the challenge of countries elsewhere in addressing nutrition as a multi‐sectoral issue.     

“We're Not Old!”: Older Women's Negotiation of Aging and Oldness

This article is based on participant observation research at a seniors' center in central Canada in which the writer sought to acquire an understanding of how older adults define, interpret, and negotiate their realities and identities. Through activity and group membership, the center members — the majority of whom are single, older women between the ages of 50 and 90 — seek to distance themselves from the category of “old” and the accompanying ageist stereotypes. Striving to establish and preserve their precarious membership in the “not old”, center members struggle to reconcile their belief and experience of older adulthood as a time of activity, health, and happiness with their ever-present fear of declining health and the realities of widowhood and the loss of youthful attractiveness.     

The effect of alternative staff time data collection methods on drug treatment service cost estimates

Although a limited number of service cost estimates exist, no study has evaluated how differences in the method used to collect the staff time allocation across treatment services contribute to differences in service cost estimates. Three alternative data collection methods for estimating service-level costs in methadone treatment programs were evaluated: key informants, staff surveys, and staff diaries. We analyzed data from 25 methadone clinics across the United States. Results indicate that for the three primary services offered at methadone clinics—individual counseling, group counseling, and methadone dosing—no statistically significant differences exist in the mean estimates of costs per session across programs. Of the other five services analyzed, we found no statistically significant differences in two of the mean costs per session and a small but statistically significant difference in another service. We found large and statistically significant differences in mean costs for two services, initial patient assessment and initial medical services. Although there is no gold standard available to judge which method is the best to use, we concluded that the key informant method yields more reliable cost estimates compared with the staff methods and is less burdensome to both the treatment programs and to researchers. Our findings suggest that the key informant method is the preferred method for costing substance abuse treatment services.