A multimodal intervention for grandparents raising grandchildren: results of an exploratory study

This article describes the results of an exploratory study of a multimodal, home-based intervention designed to reduce psychological stress, improve physical and mental health, and strengthen the social support and resources of grandparents raising grandchildren. The six-month intervention included home visits by registered nurses, social workers, and legal assistants; the services of an attorney; and monthly support group meetings. The intervention resulted in improved mental health scores, decreased psychological distress scores, and increased social support scores. Participants also experienced improvement in the level of public benefits received and in their legal relationships with their grandchildren. Implications of these findings for practice are highlighted.     

The midwife in Taiwan: an alternative model for maternity care

While more than 99% of all American babies are delivered by obstetricians, the majority of Taiwanese babies are delivered by midwives. The history of traditional and professional midwives in Taiwan is reviewed. Taiwanese midwives operate their businesses according to the principles of client-centered health service. They also serve many social and religious, as well as health, needs of their clients. This system contrasts with that in operation in the U.S. where pregnant women utilize physician-centered, not client-centered, maternity care. The role of the Taiwanese midwife in the management of childbirth is described. Postpartum care provided by the midwife includes nutrition information and initial care of the infant once the mother returns home. The role of the midwife in relation to abortion, adoption and other obstetric and gynecologic services is explained. The American system of childbirth might be made more flexible and acceptable if the client-centered features of the Taiwanese system could be incorporated into the modern American health care system.     

Informal caregiving for elders in Sweden: an analysis of current policy developments

In Sweden, care of elderly people is a public responsibility. There are comprehensive public policies and programs providing health care, social services, pensions, and other forms of social insurance. Even so, families are still the major providers of care for older people. In the 1990s, the family was "rediscovered" regarding eldercare in Sweden. New policies and legislative changes were promoted to support family caregivers. The development of services and support for caregivers at the municipal level has been stimulated through the use of national grants. As a result, family caregivers have received more recognition and are now more visible. However, the "Swedish model" of publicly financed services and universal care has difficulty addressing caregivers. Reductions in institutional care and cutbacks in public services have had negative repercussions for caregivers and may explain why research shows that family caregiving is expanding. At the same time, a growing "caregivers movement" is lobbying local and national governments to provide more easily accessible, flexible, and tailored support. In 2009, the Swedish Parliament passed a new law that states: "Municipalities are obliged to offer support to persons caring for people with chronic illnesses, elderly people, or people with functional disabilities." The question is whether the new legislation represents a paradigm shift from a welfare system focused on the individual to a more family-oriented system. If so, what are the driving forces, motives, and consequences of this development for the different stakeholders? This will be the starting point for a policy analysis of current developments in family caregiving of elderly people in Sweden.     

Women's work: the role of grandparents in inter-generational transfers1

This article surveys the role of grandparents in providing a continuing level of material support in 61 households with dependent children in an inner city area. It concludes that assistance is structured by gender, income level, household financial organisation, residential proximity, need and ideology. In terms of the provision of continuing support to households with young children, grandparents are important but grandmothers give more assistance than grandfathers and they direct it where it is most needed. It is important for grandmothers to have access to paid work. The ideology of assistance is differentiated by class. In professional families the married couple is the unit of transfer but for working class families the solidarity of female relatives, in particular, of daughters and mothers and mothers-in-law, is more important.     

Parents and grandparents of deaf children in Ecuador: concerns and expectations

Despite a growing number of anthropological studies of deaf communities, little attention has been paid to how socioeconomic and cultural factors influence the experiences and the concerns of hearing parents of deaf and hearing-impaired (DHI) children. This study draws on interviews with parents (and some grandparents) of DHI children in Ecuador, a country marked by profound inequality but also by considerable recent progress in poverty reduction and enhanced provisions for people with disabilities. Despite progress, many carers are nevertheless critical of the way in which new measures have been implemented, and of the schooling available to their child. They are also worried by their child’s vulnerability, the likelihood of discrimination, and the possibility of abuse.     

Child health: An underplayed variable in parental leave policy debates?

This paper examines parental leave policy from the perspective of infant and young child health. Factors assisting the successful integration of breastfeeding and maternal employment are outlined. Health effects of day care attendance are also explored as an integral component of this assessment. It is suggested that the potential health disadvantages associated with lack of, or inability to access, parental leave to care for infants may be compounded by the possible adverse health effects of involvement in group day care. Possible reasons for the relative lack of attention to infant health concerns, including those related to both breastfeeding and day care attendance, in the English-language parental leave literature are examined. This includes an analysis of the tensions posed for gender equity objectives by a child health emphasis in parental leave discussions. Two contrasting country-level case studies--the USA and Sweden--are presented in order to highlight the implications of specific configurations of parental leave and early childhood education and care policies for both infant health and gender equity objectives. The paper concludes by looking at how parental leave development and design can best take account of child health considerations. Éste articulo evalúa la política del permiso laboral (la baja por maternidad/paternidad) desde la perspectiva de la salud de los niños. Se resumen los factores que ayuden la integración exitosa entre el amamantar y el empleo materno. Además, como elemento esencial se esta investigación, se indaga los efectos de guardería para la salud infantil. Sugerimos que las posibles desventajas para la salud infantil asociadas con la carencia de, o la incapacidad de obtener, la baja para cuidar a los niños pueden agravar las semejantes desventajas asociadas con la asistencia del niño a la guardería. Se buscan explicaciones posibles para la falta relativa en la literatura inglés de la atención al asunto de la salud infantil. Se incluye un análisis de las tensiones en los objetivos de la igualdad de los sexos que salen de un énfasis en la salud infantil en debates sobre el permiso laboral de los padres. Se presento estudios de los casos de los EEUU y Suecia para destacar las implicaciones de configuraciones especificas del permiso de los padres y la política de la educación y guardaría infantil tanto para los objetivos sociales de la salud infantil como la igualdad entre los sexos. En conclusión se considera cómo el desarrollo y diseño del permiso de los padres pueda mejor tomar en cuenta el asunto de la salud de los niños.     

The unique effects of environmental strategies in health promotion campaigns: a review

Various strategies are used as tools in health promotion campaigns to increase health-related outcomes among target populations. Evaluations of these campaigns examine effects on changing people's knowledge, attitudes, and/or behaviors. Most evaluations examine the combined impact of multiple strategies. Less is known about the unique effects of particular strategies. To address this gap, we used highly systematic methods to identify and review scientifically rigorous evaluations of 18 campaigns that examined the unique effects of three sets of intervention strategies (entertainment education, law enforcement, and mass media) on changes in knowledge, attitudes, and practice with regard to various health behaviors. Results showed differences in evaluation processes based on the type of strategy used to promote campaign messages. For instance, evaluations of mass-media based campaigns were more likely to examine changes in knowledge, relative to evaluations of campaigns that used law enforcement strategies. In addition, campaign effects varied by particular strategies. Mass media-based campaigns were more likely to affect knowledge, relative to behaviors. Law enforcement and entertainment education-based campaigns showed positive effects on behaviors. The implications for planning and evaluating health promotion campaigns are described.     

The effect of immigration on aggregate native unemployment: an across-city estimation

This study investigates the relationship between the rate of immigration into various cities in various years and the level and change in unemployment. In pooled regressions, immigration lagged one year does not show a statistically significant effect either by itself or when other lags are added. Individual regressions using the difference in unemployment rates over time show a slight, but statistically insignificant, positive displacement effect over two-year periods. The evidence indicates that there is little or no observed increase in aggregate native unemployment due to immigration, even in the relatively short run during which adjustment frictions should be most severe. We are grateful to Bryan Boulier, Charles Brown, Glen Cain, Robert Goldfarb, Allen Kelley, Mitchell Kellman, Wallace Oates, Albert Rees, and Edward Reubens for reading earlier drafts and generously giving us their criticism and ideas.     

Public broadcast of health communication: Extending public relations through social capital in Taiwan

This paper shows how a public media can effectively utilize its social capital, and integrate with different resources from the related non-profit organizations and corporations in public relations perspective. A case study of a high-popularity Taiwanese public traffic radio: Police Broadcasting Service (PBS) is conducted. The finding shows that the public radio can cost-effectively deliver health communication with the principle of social marketing.     

Efforts to create meaning in the relationship between aging mothers and their caregiving daughters: A qualitative study of caregiving

Using grounded theory methodology, this research identifies the major themes or meaning systems that caregiving daughters and their aging mothers apply to their caregiving. In depth interviews with 11 mother-daughter pairs explore attitudes toward filial responsibility and actual caregiving experiences. Five themes emerge describing the cognitive, affective, motivational, and interpersonal components of the meaning systems of filial caregiving: increased relational tolerance or acceptance, redefinition of the mother-daughter relationship, aging awareness, relationship priority, and sacrifice. Four themes are evident in both mothers' and daughters' narratives, whereas the final theme, sacrifice, is linked to daughters' accounts. These themes reflect efforts to create meaning at the interpersonal, familial, symbolic, and psychological levels. The significance of the findings for understanding the dynamic nature of the mother-daughter relationship is discussed.     

The effects of women's employment: personal control and sex differences in mental health

Married women have been found consistently to have higher rates of anxious and depressive symptoms than married men. Power explanations for this difference predict that employment for women, which is associated with greater power in the family, would reduce women's symptoms to approximate men's more closely. Results on the effects of women's employment, however, are inconsistent. One explanation for this inconsistency concerns role overload, or the greater demands experienced by women with employment. This paper proposes that overload creates greater symptoms for the same reason as low power; that is, through lowering individuals' sense of personal control. Thus employment for women is not consistently positive because it often trades one source of low control for another. We test a personal control explanation for the effects of women's employment, using community surveys of mental health. Results indicate that issues of personal control underlie the effects of both high demands and low power on sex differences in anxious and depressive symptoms.     

Long-term care of the disabled elderly: do children increase caregiving by spouses?

Do adult children affect the care elderly parents provide each other? We develop two models in which the anticipated behavior of adult children provides incentives for nondisabled elderly parents to increase care for their disabled spouses. The “demonstration effect” postulates that adult children learn from a parent’s example that family caregiving is appropriate behavior. The “punishment effect” postulates that adult children may punish parents who fail to provide spousal care by not providing future care for the nondisabled spouse if and when necessary. Thus, joint children act as a commitment mechanism, increasing the probability that elderly parents will provide care for their disabled spouses. We argue that stepchildren provide weaker incentives for spousal care because the attachment of a stepchild to a stepparent is likely to be weaker than the attachment of children to parents in a traditional nuclear family. Using data from the HRS, we find evidence consistent with the hypothesis that joint children provide stronger incentives than stepchildren for nondisabled elderly parents to provide care for their disabled spouse.     

The last mile of the way: understanding caregiving in African American families at the end-of-life

This research is based on in-depth ethnographic interviews and focus groups with 88 African American family caregivers from various regions of the United States during a stressful time in their family development--caregiving at the end-of-life--and the grieving during the aftermath. The study employed a stratified purposeful sampling strategy. Subjects were African Americans from the Northern, Southern, and Midwestern United States. Formal care is complicated by the distrust that many African Americans hold toward the health care system, which has resulted from years of exclusion, racism and discrimination. The findings highlight the importance of hearing from African American families to gain an understanding of what services, including family therapy and other psychotherapy, they will need during this process.     

An instrumental perspective on apologizing in bargaining: The importance of forgiveness to apologize

Although very little research in bargaining has addressed how perpetrators should deal with the aftermath of unfair allocations, it has been proposed that an apology may help the reconciliation process. Prior research, however, only focused on whether apologies can reveal positive effects on the reconciliation process but did not focus yet on whether perpetrators are actually willing to apologize. In this paper we investigate perpetrator’s willingness to apologize for a trust violation in a bargaining setting. We hypothesized that perpetrators willingness to apologize would be a function of the extent to which the victim of the trust violation is willing to forgive. This effect, however, was expected to emerge only among those perpetrators who are low in dispositional trust. The results from a laboratory study with actual transgressions and actual apologetic behavior supported our predictions and thus emphasize an instrumental view on apologizing in bargaining situations.     

The effects of teenage childbearing on long-term health in the US: a twin-fixed-effects approach

This paper explores the effect of teenage childbearing on long-term health outcomes and behaviors of mothers using the Midlife Development in the US dataset. Within-family estimations, using samples of siblings, and twin pairs, are employed to overcome the bias generated by unobserved family background and genetic traits. The results suggest no significant effects on health outcomes, and modest effects on health behaviors, including exercise and preventive care. However, accounting for life-cycle effects demonstrates that teenage childbearing has significant effects on both health outcomes and behaviors early in life, but very few significant effects later in life. Moreover, teenage childbearing has a particularly acute effect among minorities. Finally, this paper provides evidence that the effects operate through reduced income and labor force participation, and matching with a lower “quality” spouse.     

Women and work in rural Taiwan: building a contextual model linking employment and health

This paper is based on ethnographic research in a rural Taiwanese village in which married women with children are a major source of labor for local industry. Responsibility for job and home exposes these women to repeated stressors that can increase their susceptibility to illness. Existing explanatory models linking employment and women's health, however, do not explain adequately the women's response to their wage labor and the consequences of the social aspects of their work on their health. This paper describes women's work and its meaning, and discusses the way in which micro phenomena such as meanings and health states are linked to macro phenomena such as national political-economic processes and the world capitalist system.