Uncounted care

Family care (care for dependent persons at home by family members and friends) is widely endorsed, politically and personally, as the chronic care option that is superior to institutionally-based, formal care services. Politicians, health planners, and analysts may be especially supportive of a preferred form of care which is also believed to be economical. But the full costs of family care, including the value of the unpaid work of caregivers, are rarely acknowledged. This article reviews studies of caregiving and its costs and acknowledges the gender bias inherent in caregiving which has been regarded as free before its costs were calculated. Policy and health care practice will benefit from examination of both the costs and benefits of family care.Debbie Ward is Assistant Professor in the Community Health Care Systems Department of the School of Nursing (mail stop SM-24) at the University of Washington, Seattle, WA 98195. She trained as a family nurse practitioner at Yale University in New Haven, Connecticut, and earned her Ph.D. in health policy from Boston University. Her research interests include women's paid and unpaid labor, and public health policy.     

The Impacts of Acculturative Stress and Social Competence on the Mental Health of Mainland Chinese Immigrant Youth in Hong Kong

Correspondence to Dr Daniel Fu Keung Wong, Associate Professor in the Department of Social Work and Social Adminstration, 1317 K K Leung Building, The University of Hong Kong, Pokfulam Road, Hong Kong.E-mail: dfkwong{at}hkucc.hku.hk Summary Attempts were made to examine migration stressors, social competence,and mental health status of immigrant youth in Hong Kong andto examine the effects of social competence on stress and themental health of immigrant youth. Data on 106 immigrant youth,which were collected through a structured questionnaire, wereanalysed. It was discovered that immigrant youth found survivalissues and losses, rather than cultural differences and unfulfilledexpectations, to be stressful. Male immigrant youth exhibitedmore psychological distress symptoms than female immigrant youth.Hierarchical regression analyses revealed that social competenceexerted moderating effects on stress and the mental health ofimmigrant youth. Immigrant youth who had a higher level of socialcompetence, in terms of self-control, empathy, assertivenessand the ability to read social cues, had less stress and enjoyedbetter mental health. In conclusion, personal and socio-culturalreasons are put forward to explain the findings. Practice andpolicy implications are also discussed.     

The empirical basis of risk assessment in child welfare: the accuracy of risk assessment and clinical judgment

The importance of risk assessment is juxtaposed with the lack of empirical support regarding the validity of risk inventories. This study compared risk ratings of one risk assessment tool to decisions made by case managers. The researchers sampled 450 children and compared predictive utility of risk assessment to child protection decisions. Risk assessment was consistent with clinical judgment in 74% to 81% of cases, more than previously reported in studies of risk assessment validity. Further analyses identified discriminate functions at the instrument's category and individual-item levels. The results have implications for the validity of the instrument and its utility in child welfare.     

The 'biliterate' ballot controversy: language acquisition and cultural shift among immigrants

This US study tested the validity of assumptions made regarding multilingual electoral ballot provisions. Rationale for language assistance was found to exist on the basis of number and proportion of recent immigrants, proportion of foreign born, lag of biliterate skill behind bilingual ability, linguistic differences between the Chinese language and English, and the discriminatory structure of the labor market. In California, where close to 1/2 the population is an ethnic minority, the issue is particularly relevant. Bilingual advocates view English-only advocates as "un-American" on legal and ideological grounds, while English-only advocates consider it "un-American" to be non-English speaking. In addition to census data and the existing literature, this study relies on the structured interview survey data of a representative sample of the Chinese adult population of San Francisco's Chinatown. 2/3 of the immigrants believed an immigrant should make some cultural changes, and 1/2 of the immigrants had done so. Data failed to support the claim that immigrants are uninformed that English is necessary for sociopolitical participation. Their more recent pattern of immigration, the linguistic differences between Asian languages and the English language, and structural constraints of US society make successive language acquisition difficult for Chinese migrant adults. Policy recommendations include: 1) changing language assistance criteria in the electoral process, 2) adding Vietnamese as a single language minority, 3) not considering Asian language minorities as 1 generic category, 4) justifying electoral assistance on several grounds, 5) disseminating data bearing directly on misguided assumptions related to language and cultural shift factors, and 6) renaming the "bilingual ballots" to "biliterate ballots."     

Substance use during sexual and physical assault in HIV-infected persons

Data from the HIV-Alcohol Longitudinal Cohort was used to determine the prevalence of substance use by victims and assailants during physical and sexual assault against HIV-infected persons and whether these findings differed by gender. Of the sexually assaulted participants, 31% of victims and 70% of assailant(s) had used drugs/alcohol during sexual assault. Compared with men, women had higher odds of substance use during sexual assault (adjusted odds ratio [OR] 3.8, 95% confidence interval [CI] 1.6 to 8.7) and of substance use by their assailant(s) during sexual assault (adjusted OR 5.9, 95% CI 1.7 to 20.6) in adjusted analysis. Of the physically assaulted participants, 66% of victims and 85% of assailants used drugs/alcohol during physical assault; these results did not differ by gender.     

Maternal mortality in South Africa: lessons from a case study in the use of deaths reported by households in censuses and surveys

South Africa is unique in being a developing country which has asked questions on pregnancy-related deaths in both its 2001 census and 2007 household survey, and monitors maternal and pregnancy-related mortality through vital registration and a confidential enquiry into maternal deaths. These sources of data provide a wide range of estimates of maternal mortality for the country. This paper examines these estimates to assess to what extent the differences between them are due to data deficiencies, methodological deficiencies or definitional differences. The results show that since maternal deaths are relatively rare it is fairly difficult to establish the maternal mortality rate with a great degree of accuracy in a setting where data are less than perfect. They also show that to some extent the differences are due to differences and errors in processing of data but that pregnancy-related mortality should not be treated as synonymous with maternal mortality. However, after adjustment, pregnancy-related mortality from vital registration was comparable with the level that may be expected using several alternative approaches, while the rate reported by households in census and surveys was about double that from vital registration. Nonetheless, all the data indicate an upward trend in maternal mortality that is in keeping with the impact of the HIV/AIDS epidemic, which is likely to have contributed to the discrepancies.