Lay Understanding of Synergistic Risk: The Case of Radon and Cigarette Smoking

The combination of radon and smoking produces a synergistic risk of lung cancer. Lay understanding of this risk was examined from the perspectives of mental models theory, the psychometric approach to risk perception, and optimistic bias. As assessed by interview, participants ( N = 50) had more extensive mental models for the risks of smoking than for the risks of radon or the combination of radon and smoking; 32% knew little or nothing about radon. Despite reading an informational brochure, their risk-perception ratings of the three hazards showed no perception of the synergy between smoking and radon risk, although the combined hazard was rated as less familiar but more controllable than the average of the single hazards ( p < .01). No evidence of optimistic bias for the health consequences of radon, or the combination of radon and smoking was observed. Participants appeared to be combining the single-hazard risks subadditively to arrive at their combined-hazard risk perceptions. Further research on the integration of perceived risks would be beneficial for designing optimal communications about synergistic risk.     

The Clinician's Cultural Countertransference: The Psychodynamics of Culturally Competent Practice

The purpose of this paper is to define the presence of the clinician's cultural countertransference in the cross-cultural therapeutic dyad, and describe its impact on the delivery of culturally competent services. The recognition of the contributing role of the therapist's own subjectivity in psychodynamically oriented practice cannot be more vital than in the treatment of patients whose culture, race, or class markedly differ from that of the therapist. The cultural countertransference is viewed as a matrix of intersecting cognitive and affect-laden beliefs/experiences that exist within the therapist at varying levels of consciousness. Within this matrix lie: the clinician's American life value system; theoretical beliefs and practice orientation; subjective biases about ethnic groups; and subjective biases about their own ethnicity. The author proposes that these countertransference attitudes are often: disavowed by the clinician; exert a powerful influence on the course of treatment; and though unspoken, are frequently perceived by the client.     

Preadolescent Parenting Strategies and Teens' Dating and Sexual Initiation: A Longitudinal Analysis

In this article we examine the effects of preadolescent parenting strategies on timing of adolescents' dating and sexual initiation. Using data from the 2 waves of the National Survey of Families and Households (1987–1988 and 1992–1994) involving interviews with parents as well as adolescents 4 years later, we estimate the effects of preadolescent parental support, coercive control, and monitoring on the timing of teens' dating and sexual initiation. We also examine how adolescents' gender, race, family structure, and socioeconomic background affect relationships between earlier parenting strategies and adolescent dating and sexual debut. We find evidence for the effect of preadolescent parental monitoring, though relatively little connection between parental support and coercive control, and variations in the timing of adolescent dating and sexual initiation. The findings suggest that parental monitoring prior to the onset of adolescence is important as a basic foundation for young people who later must make behavioral choices outside of parental purview.     

Population health performance as primary healthcare governance in Australia: professionals and the politics of performance

ABSTRACT

A range of institutional and financial instruments has been used to drive population health outcomes in primary health care in Australia. However, GP sovereignty and the corporatized nature of general practice have generated major challenges. The core of government reform strategy since 1992 has been the creation and financing of Primary HealthCare Organizations (PHCOs), in various forms, to provide an organizational basis to connect GPs to population health performance, and a closer link between the state and GPs. The shift from Divisions of General Practice, the first PHCO, to Medicare Locals (MLs) in 2011 was notable. The latter constructed the object of performance as a raft of broader population health goals, which were framed in terms of accountability to communities through public reporting. Drawing on interviews with Federal government, health professional associations, ML executives and GPs, this paper examines the ways in which such performance instruments were imagined and understood, and areas of contestation. The findings show the different rationalities at play and how different actors seek control of the policy space. They also demonstrate the political precariousness of PHCOs, and the wider difficulty of steering market-based professionals in the achievement of population health objectives.     

Practitioners' Documentation of Assessment and Care Planning in Social Care: The Opportunities for Organizational Learning

This paper analyses practitioners’ documentation of socialcare assessments and care plans for disabled adults of workingage. The data were collected in the course of an innovativeproject that introduced new outcome-focused documentation intoroutine social care assessment, care management and review processes.The project aimed to encourage practitioners to focus duringthese processes on the full range of outcomes that individualdisabled adults might seek to achieve; and identify the appropriateservices for realizing those outcomes. Analysis of the new documentationprovides insights into the diverse range of priorities and outcomesthat service users aspire to achieve as a result of receivingservices, and the service inputs that were agreed between practitionersand service users. However, despite the new documentation, themajority of both outcomes and services that were recorded tendedto cluster around a fairly narrow range of conventional socialcare service functions. Moreover, the emphasis of both outcomesand service inputs differed between different groups of socialcare professionals. In the context of current policies to makesocial care services more individualized and outcome-focused,each of these findings has major organizational implications.The opportunities for using routine practitioner documentationto identify areas of organizational and professional changeand learning are discussed.     

Toward a grounded theory of lesbians' recovery from addiction

This article presents the results of a qualitative study on lesbians' recovery from addiction. The study involved semi-structured interviews with 20 lesbians in recovery from addiction and was analyzed using grounded theory method. The central theme that emerged was self-acceptance, both as a lesbian and as a recovering alcoholic/addict, with considerable interaction between the two. Categories that contributed to this theme were learning to recover, relationships with other people, and relationship with something bigger than self. The discussion addresses how this information can be used to assist lesbians trying to recover from addiction.     

Health care for older persons in Singapore: integrating state and community provisions with individual support

Health care policy in Singapore is similar to that in the United States and the United Kingdom, where a residualist strategy is used to pass health care costs to individuals and their families, the rationale being that this enables the state to concentrate on devolution of care to the community and ensure efficient and affordable service to all Singaporeans. The services include public restructured hospitals and outpatient poly-clinics as well as community services such as community hospitals and hospitals for the chronically ill, nursing homes, day care centers, and home help services. Availability does not translate into optimum usage because current and potential users and their families are not able to match their financial and social resources with the services. Instead, the state acts as the case manager and places parameters on what individuals can access.     

Contraceptive self-efficacy: does it influence adolescents' contraceptive use?

This research investigates the relationship between contraceptive self-efficacy and contraceptive use, measured one year later, among adolescent boys and girls. Data are obtained from the two waves of the restricted use sample of the National Longitudinal Study of Adolescent Health (n = 3,577). Employing multiple regression and logistic regression strategies, we examine whether demographic and background characteristics influence contraceptive self-efficacy, and whether contraceptive self-efficacy increases the likelihood of contraceptive use. We find that adolescents who are female, older, live with step-parents, and whose mothers approve of contraceptive use report higher contraceptive self-efficacy, while adolescents whose mothers did not complete high school report lower contraceptive self-efficacy. Results partially support the expectation that adolescents with higher contraceptive self-efficacy act accordingly by using contraceptives.