Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

Premature menopause and self-concept disjunctions. A case for crisis management

1. Surgically or chemically induced premature menopause is a life transition characterized by a situational crisis superimposed on a developmental crisis. 2. After surgically or chemically induced premature menopause, women's self-concept shifts and evolves through an interactive or relational process. 3. Nurses can use crisis management to increase women's understanding of the physiological and psychological dimensions of premature menopause, facilitate their links with community support systems, and strengthen their existing social networks. 4. Effective crisis intervention approaches include structuring, verbalizing, clarifying, normalizing, and supporting.     

The effects of domestic violence during pregnancy on maternal and infant health

The present study examined the impact of domestic violence on maternal and infant health by assessing maternal health during pregnancy and infant health at two months postpartum. Two hundred and two women (68 battered and 134 non-battered) were recruited from the community and completed both pregnancy and 2-month postpartum interviews. Results revealed that domestic violence during pregnancy was associated with numerous health problems for mothers and infants including more health problems during pregnancy, more likelihood of premature labor, later entrance into prenatal care, lower infant birth weight, greater utilization of health care resources, and more prenatal substance use. After income was controlled, the relationship between violence and timing of prenatal care and infant birth weight became nonsignificant. Maternal social support was found to protect against the effects of violence for several health outcomes. The current findings suggest the need for domestic violence screening during pregnancy, as well as clinical interventions for battered, pregnant women in order to prevent serious physical and emotional problems for both mothers and their infants.     

Perspectives on workplace disability management: a review of the literature

Work-related musculoskeletal injuries represent a major source of work disability. While many employers recognize the importance of workplace disability management approaches and are assuming greater responsibility for preventing and minimizing work-related disability, questions about the effectiveness of these interventions exist. The purposes of this article are to: 1) describe the essential components of workplace disability management programs related to musculoskeletal injuries; 2) review the literature on disability management practices based on research evidence by focussing on workplace-based interventions and the role of the workplace; and 3) provide recommendations for disability management in the prevention and reduction of disability, and the rehabilitation of injured workers with musculoskeletal work injuries. The literature suggests that employer participation, a supportive work climate and cooperation between labour and management are crucial factors in facilitating return to work. Given the complexity of the disability management process and the numbers of individuals involved, it is essential that all workplace parties work together to achieve the goal of safe and early return to work.     

Perspectives on work (re)entry for persons with disabilities: implications for clinicians

Despite the prevalence of government funding to support employment opportunities for persons with disabilities, real jobs for this population still appear to be elusive. McMaster University researchers examined how six stakeholder groups defined workplace (re)entry success for persons with disabilities. Focus groups and individual interviews were conducted with representation from employers, unions, persons with disabilities, co-workers, supervisors and human resource departments. Participants numbered 86 and the average age was 42. Participant comments provided the researchers with rich data related to the study objectives. Success was perceived as not only a match between the employee and the job but also a win-win for employer and employer, a uniquely defined set of circumstances based on the specific individual and their environment as well as respect for the individual's dignity and quality of life. This article discusses the study and its outcomes and highlights implications for clinicians.     

Predictors of substance abuse treatment outcomes in Tennessee

In planning and implementing programs to treat substance abuse, it is important to understand which factors influence post-treatment abstinence.This article identifies and analyzes several variables important in predicting the likelihood of abstinence among substance abuse clients. The data used in this study was collected from 1,350 clients treated for alcohol or drug abuse in residential, halfway house, or outpatient facilities in Tennessee. We analyzed 22 variables as possible treatment outcome predictors by using two statistical procedures: stepwise logistic regression analysis and Quick, Unbiased, Efficient, Statistical Tree (QUEST) analysis, a tree-structured classification algorithm analysis. We found one pretreatment, five in-treatment, and three post-treatment variables to be significant predictors of treatment outcome: previous treatment history, perceived helpfulness of the treatment, simultaneous treatment for mental health, number of days in treatment,completion of treatment, special skills training during treatment, obtaining healthcare services for major physical health problem after treatment, living with someone using alcohol or drugs post treatment, and arrest record since treatment.     

Reliability of the Demand-Control Questionnaire for sewing machine operators

The Demand-Control Questionnaire (DCQ), a 20-item scale that measures psychological work demands, job control and workplace social support, has frequently been used to assess occupational stress. The purpose of this study was to determine the test-retest reliability and internal consistency of the DCQ with sewing machine operators. Forty-six sewing machine operators completed the DCQ on two occasions with an 11-week time interval. A repeated measures analysis of variance model and subsequent application of generalizability theory were used to calculate the test-retest reliability of the subjects' ratings on the DCQ. Cronbach's alpha was used to determine the internal consistency of the scale. The test-retest reliability was 0.33 (95% confidence interval = 0.05-0.61), indicating fair reliability. Good internal consistency (Cronbach's alpha = 0.70) was found. The DCQ appears to be a reliable measure for assessing occupational stress in sewing machine operators. Workplaces need to place greater emphasis on the role of occupational stress in the prevention and treatment of musculoskeletal injuries among sewing machine operators.     

Neighborhood disadvantage, stress, and drug use among adults

This paper explores the relationships among neighborhood disadvantage, stress, and the likelihood of drug use in a sample of adults (N = 1,101). Using the 1995 Detroit Area Study in conjunction with tract-level data from the 1990 census, we find a positive relationship between neighborhood disadvantage and drug use, and this relationship remains statistically significant net of controls for individual-level socioeconomic status. Neighborhood disadvantage is moderately associated with drug related behaviors, indirectly through increased social stressors and higher levels of psychological distress among residents of disadvantaged neighborhoods. A residual effect of neighborhood disadvantage remains, net of a large number of socially relevant controls. Finally, results from interactive models suggest that the relationship between neighborhood disadvantage and drug use is most pronounced among individuals with lower incomes.     

Parental altruism and nest leaving in Europe: evidence from a retrospective survey

We use retrospective life-history data from the Survey of Health, Ageing and Retirement in Europe to assess parental altruism through the effect of parental resources and home characteristics on the age at which individuals now aged 50 or more left the nest in 13 countries. We show that the nest leaving age has declined from one cohort to the next and that the tendency has been of a relative decline in leaving one’s parents to start a family and an increase in leaving home to pursue higher education, even if the first pattern was still the most common for the baby-boomers. We test an altruistic model where constrained parents push the child out, where less constrained “proximity altruistic” parents can help the child by providing a home or even, for the richest “active altruists”, help the child leave the nest. Taking into account the endogenous child’s choices of education, we find that most parents helped by being proximity altruists, while some helped their children move out and that the quality of the home had an important influence on the nest leaving age.     

Knowledge, Consequences, and Experience: The Social Construction of Environmental Problems

Perhaps one of the most obvious yet difficult questions confronting sociologists concerned with large-scale environmental problems is an epistemological one: How do we know what we know about the state of the environment? This paper explores the realist and constructionist approaches to environmental-social problems and finds both inadequate as currently formulated. A case is made for a phenomenological constructionism that moves beyond relativism and simple definitional constructionism by exploring how we actually experience the world. This approach recognizes the existence of a natural world independent of our constructions, yet suggests that our knowledge of it is always mediated, indirect, and pragmatically motivated.