Managing in the Trenches of Consumer Care: The Challenges of Understanding and Initiating the Advance Care Planning Process

To better understand how community-based long-term care providers define advance care planning and their role in the process, we conducted 8 focus groups with 62 care managers (social workers and registered nurses) providing care for Ohio's Medicaid waiver program. Care managers shared that most consumers had little understanding of advance care planning. The care managers defined it broadly, including legal documentation, social aspects, medical considerations, ongoing communication, and consumer education. Care managers saw their roles as information providers, healthcare team members, and educators/coaches. Better education, resources, and coordination are needed to ensure that consumer preferences are realized.     

Condom use negotiation in heterosexual African American adults: responses to types of social power-based strategies

This study examined gender differences and preferences in the use of and response to six different styles of condom use negotiation with a hypothetical sexual partner of the opposite gender. Participants were 51 heterosexually active African American adults attending an inner-city community center. Participants completed a semistructured qualitative interview in which they were presented with six negotiation strategies based on Raven's 1992 Power/Interaction Model of Interpersonal Influence. Results showed that female participants responded best to referent, reward, and legitimate strategies, and worst to informational tactics. Male participants responded best to reward strategies, and worst to coercion to use condoms. Further, responses given by a subset of participants indicated that use of negotiation tactics involving coercion to use condoms may result in negative or angry reactions. Response to strategies may vary with the value of the relationship as viewed by the target of negotiation. Implications for HIV prevention efforts are discussed.     

The truncation-by-death problem: what to do in an experimental evaluation when the outcome is not always defined

Although experiments are viewed as the gold standard for evaluation, some of their benefits may be lost when, as is common, outcomes are not defined for some sample members. In evaluations of marriage interventions, for example, a key outcome--relationship quality--is undefined when a couple splits up. This article shows how treatment-control differences in mean outcomes can be misleading when outcomes are not defined for everyone and discusses ways to identify the seriousness of the problem. Potential solutions to the problem are described, including approaches that rely on simple treatment-control differences-in-means as well as more complex modeling approaches.     

Correlates of gay and lesbian couples' relationship satisfaction and relationship dissolution

A sample of committed gay and lesbian cohabiting couples engaged in two conversations after being apart for at least 8 hours: (a) an events of the day conversation and (b) a conflict resolution conversation. Physiological data were collected during the conversations and a videotape record was made. Couples viewed the videotapes and rated their affect during the interaction. The video records were coded with a system that categorized specific affects displayed. Models derived from physiology, from the perception of interaction, and from specific affective behavior were related to relationship satisfaction, and to the prediction of relationship dissolution over a 12-year period. Results supported previous findings that satisfaction and stability in gay and lesbian relationships are related to similar emotional qualities as in heterosexual relationships.     

Unintended Population Consequences of Policies

Unintended population consequences of policies stem from three sources: (1) A policy overshoots its original goal; (2) different policies conflict, so that the implementation of one policy inhibits implementation of another policy; (3) negative consequences of a policy are unforeseen, or are anticipated but judged unlikely to be severe or considered less important than the positive aims of the policy. Examples from Singapore, South Africa, Italy, the U.S., and the former Soviet Union are discussed.     

Considerations of family structure and gender composition: the lesbian and gay stepfamily

Lesbian and gay stepfamilies are unique family forms which must be investigated as such. This paper explores the similarities and dissimilarities between heterosexual stepfamilies and lesbian/gay stepfamilies, arguing that similarity of structure is impacted by gender composition. Utilizing face-to-face and telephone interviews with biological and stepparents in 23 lesbian and gay stepfamilies, the results show that while lesbian and gay stepfamilies share some challenges and strengths with heterosexual stepfamilies, they also evidence a unique and flexible adaptation to becoming a family. The paper is aimed at delineating future areas for lesbian and gay stepfamily research.     

Expression and ambivalence over expression of negative emotion:psychometric analysis in the Women's Health Initiative

Inhibition of emotional expression has been associated with the incidence and progression of breast cancer and other chronic illnesses. Others have theorized that it may not be repression itself, but rather ambivalence over the expression of emotions that is the important health-related factor. The Women's Health Initiative (WHI), a long-term, national study focusing on disease prevention among postmenopausal women, is unique in its assessment of expression and ambivalence of negative emotion in a large study sample of multiethnic, older women. Psychological factors such as expression of negative emotion and ambivalence about expression of emotion are also determined by social patterning. The current study examined the psychometric properties of the instruments used to measure each construct and variation across race/ethnicity and age. The analysis suggests that the scales can be used with confidence in diverse ethnic and age groups. Examining ambivalence about expression of negative emotion in future longitudinal research will further elucidate its role in predicting disease incidence and recovery, both important in reducing the public health burden of chronic disease.