Family health care decision making

How do families choose a health plan when offered the option of insurance or a Health Maintenance Organization (HMO)? Choices are influenced by health consumerism, decision variables, family health needs, family composition, family socioeconomic status, and knowledge about HMOs. Subjects in the research reported here chose insurance or one of four HMOs; control subjects had no HMOs available. The model is estimated with LOGIT regression, yielding a pseudoR ² of.22 for the adjusted model. Participation in the decision process, number of chronic illnesses, and knowledge about HMOs all are significantly and positively associated with choosing an HMO; also, young adults are more likely than older adults to choose HMOs. The consumerism variable fails to attain significance. LOGIT analysis of the adjusted model indicates that the model predicted 72% of plan choices correctly. Suggested research for other family forms, for the poor, and for the elderly's health plan choices are discussed.     

"We just happen to live here": two social workers share their stories about Oregon's Death with Dignity Law

This article is written more like a conversation with the reader rather than a strictly academic piece. The purpose is to share from a more personal perspective the unique circumstances and challenges faced by two social workers in Oregon as they grappled with the Death with Dignity Law. The law has been in effect for six years and a May 2004 decision from the Ninth U.S. Circuit Court allowed the law to remain a legal end-of-life option. Each writer has a unique voice on the process of social work involvement in practice, research, and policy since the law was originally passed in 1994.     

The healing power of dogs: Cocoa's story

Animals bring a sense of "at homeness" and even normalcy to people who are hospitalized or live in health care facilities. Illnesses, separation from family, fear, loneliness, and even depression may be lessened for those who receive a therapy dog visit by providing a welcome change in routine and something to look forward to. Individuals are often more active and responsive during and after a visit. Just stroking and petting a dog requires the use of hands and arms, as well as the motions of stretching and turning. Dogs are also unconcerned with age or physical ability; they accept people as they are. This alone causes many to reach out and interact with dogs. Animals provide a focus for conversation and a common interest. As Cocoa's human partner can attest, a pet also makes it easier for strangers to talk. Cocoa is known by so many people at the facilities she visits that residents' family members often stop to talk with "Cocoa's mom" when they meet her in the community, asking questions about how Cocoa is doing. When Cocoa is no longer able to perform her services, many in her community will mourn. Cocoa's story, as well as the limited research literature, supports the positive physical and psychological effects of animals, but continued research on the effect of therapy animals on health outcomes is needed. As advocates for clients, nurses are in key positions to facilitate the inclusion of animals in clients' care. Although not for everyone, including those who react negatively to animals or who are allergic, pet therapy offers important possibilities for providing holistic care that extends not only to clients, but also to family members and staff, and to the pets themselves.     

Work Opportunities in a Non-Traditional Setting for Women Exiting Welfare: A Case Study

The purpose of this research is to explore key issues regarding the need to provide jobs for women who are making the transition from welfare to wage work. A traditionally male-dominated industry, the secondary wood products industry, in a ten-parish rural region in northern Louisiana is used as a case study. One goal of the project is to explore barriers to expanding job opportunities for women in this industry, which is located in an economically disadvantaged region of the state. In-depth personal interviews were conducted with employers and business owners in this industry, and focus group discussions were conducted among employees at selected sites. Potential barriers to employing women in this industry are discussed, and recommendations for reducing barriers are made.     

Diversity in Pathways to Parenthood: Patterns,Implications, and Emerging Research Directions

This review examines and synthesizes recent research on pathways to parenthood. We begin by providing basic information about patterns, differentials, and trends and discussing adoption and new reproductive technologies. We next turn to several areas of inquiry that became particularly prominent in the last decade: the continued “decoupling” of marriage and childbearing, the parental relationship context of nonmarital childbearing, family structure stability, multiplepartner fertility, and racial and ethnic variation in childbearing patterns. We then consider the implications of this body of scholarship and identify avenues for future research. Throughout, we highlight racial/ethnic and social class variation in childbearing patterns.     

Physiological Regulation at 9 Months of Age in Infants Prenatally Exposed to Cigarettes

The primary purpose of this study was to examine the association between prenatal cigarette exposure and physiological regulation at 9 months of age. Specifically, we explored the possibility that any association between prenatal cigarette exposure and infant physiological regulation was moderated by postnatal environmental tobacco smoke (ETS) exposure or infant gender. We evaluated whether male infants with prenatal cigarette exposure or infants who were also exposed to ETS after birth had the highest levels of physiological dysregulation. Respiratory sinus arrhythmia (RSA) was obtained from 206 (142 exposed and 64 nonexposed) infants during a baseline period and during procedures designed to elicit both positive and negative affect. There was a significant suppression of RSA during the negative affect task for nonexposed infants, but not for exposed infants. Postnatal ETS exposure did not moderate this association; however, gender did moderate this association such that boys with prenatal cigarette exposure had a significant increase in RSA rather than the suppression seen among both nonexposed boys and girls. These results provide additional support for the idea that boys are particularly vulnerable to the effects of prenatal cigarette exposure.     

The Experience of Nonresidential Stepmothers

Despite the growing body of research examining the experience of stepparents, very little is known about the unique experience of nonresidential stepparents. This research examined the experience of nonresidential stepmothers (N = 10) using semistructured interviews. Thematic content analysis identified 2 principal themes. Those themes were perceived control (with the subtheme of visitation and parenting and financial matters) and psychological and physical well-being. The perceived inability to control parenting practices during periods of visitation and financial matters associated with the payment of child support generated a sense of powerlessness, anger, and resentment that manifested in depression. Implications for family service providers and clinicians working with stepfamilies are discussed.