Midwifery management of second-degree perineal tears in New Zealand: A cross-sectional survey of practice

Background

Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives’ perineal practice.

Underestimating Protection and Overestimating Risk: Examining Descriptive Normative Perceptions and Their Association with Drinking and Sexual Behaviors

Individuals who engage in risky sexual behavior face the possibility of experiencing negative consequences. One tenet of social learning theory is that individuals engage in behaviors partly based on observations or perceptions of others’ engagement in those behaviors. The present study aimed to document these norms–behavior relationships for both risky and protective sexual behaviors, including alcohol-related sexual behavior. Gender was also examined as a possible moderator of the norms–behavior relationship. Undergraduate students (n = 759; 58.0% female) completed a Web-based survey, including various measures of drinking and sexual behavior. Results indicated that students underestimate sexual health-protective behaviors (e.g., condom use and birth control use) and overestimate the risky behaviors (e.g., frequency of drinking prior to sex, typical number of drinks prior to sex, and frequency of casual sex) of their same-sex peers. All norms were positively associated with behavior, with the exception of condom use. Furthermore, no gender differences were found when examining the relationship between normative perceptions and behavior. The present study adds to the existing literature on normative misperceptions as it indicates that college students overestimate risky sexual behavior while underestimating sexual health-protective behaviors. Implications for interventions using the social norm approach and future directions are discussed.     

Sexual Hookups and Adverse Health Outcomes: A Longitudinal Study of First-Year College Women

“Hookups” are sexual encounters between partners who are not in a romantic relationship and do not expect commitment. We examined the associations between sexual hookup behavior and depression, sexual victimization (SV), and sexually transmitted infections (STIs) among first-year college women. In this longitudinal study, 483 women completed 13 monthly surveys assessing oral and vaginal sex with hookup and romantic partners, depression, SV, and self-reported STIs. Participants also provided biological specimens that were tested for STIs. During the study, 50% of participants reported hookup sex and 62% reported romantic sex. Covariates included previous levels of the outcome, alcohol use, impulsivity, sensation seeking, and romantic sex. Autoregressive cross-lagged models showed that, controlling for covariates, hookup behavior during college was correlated with depression, Bs = .21, ps < .05, and SV, Bs = .19, ps < .05. In addition, precollege hookup behavior predicted SV early in college, B = .62, p < .05. Hookup sex, OR 1.32, p < .05, and romantic sex, OR 1.19, p < .05, were associated with STIs. Overall, sexual hookup behavior among college women was positively correlated with experiencing depression, SV, and STIs, but the nature of these associations remains unclear, and hooking up did not predict future depression.     

Do Alcohol and Marijuana Use Decrease the Probability of Condom Use for College Women?

Alcohol and marijuana use are thought to increase sexual risk taking, but event-level studies conflict in their findings and often depend on reports from a limited number of people or on a limited number of sexual events per person. With event-level data from 1,856 sexual intercourse events provided by 297 college women (M _age = 18 years; 71% White), we used multilevel modeling to examine associations between alcohol and marijuana use and condom use as well as interactions involving sexual partner type and alcohol-sexual risk expectancies. Controlling for alternative contraception use, partner type, regular levels of substance use, impulsivity and sensation seeking, and demographics, women were no more or less likely to use condoms during events involving drinking or heavy episodic drinking than during those without drinking. However, for drinking events, there was a negative association between number of drinks consumed and condom use; in addition, women with stronger alcohol-sexual risk expectancies were marginally less likely to use condoms when drinking. Although there was no main effect of marijuana use on condom use, these data suggest marijuana use with established romantic partners may increase risk of unprotected sex. Intervention efforts should target expectancies and emphasize the dose-response relationship of drinks to condom use.     

Older adults' narratives about a flood disaster: Resilience, coherence, and personal identity

Older adults are a vulnerable group in a disaster and are more at risk of adverse effects as a result. This paper draws on the use of narrative theory in health and gerontology studies to examine how a disruptive disaster was storied. Narrative interviews were conducted with nine older adults aged over 65 years who had recently experienced a flood disaster. The participants' narratives about the disruptive event were integrated with past personal events that spanned more than seven decades. The disaster became a reference point for previous challenging experiences, which created biographical continuity, coherence and order over time. Furthermore, the disaster stories were about biography and identity, and showed how older adults made sense of the flood from a life-course perspective. The use of narrative approaches provides an insight into how the flood disaster was experienced, and reveals how four older adults storied their experiences of a significant life challenge.     

Evaluation of a Training to Reduce Provider Bias Toward Pregnant Patients With Substance Abuse

The objective of this article is not to present a scientific or systematic study, but to provide an initial framework for designing a training workshop to enhance health practitioners’ (nurses, social workers, physicians, etc.) knowledge regarding substance abuse treatment and to decrease their bias toward substance-abusing women, particularly pregnant women in rural communities. We incorporated the 4 Transdisciplinary Foundations from the Substance Abuse and Mental Health Services Administration Competencies Model, with specific competencies targeted that related to provider bias. After the conference, 52 of the 70 participants completed a questionnaire to self-assess knowledge level and confidence in skill related to substance abuse management. Participant mean scores were statistically significantly higher following the conference than 1 week prior (p < .001) in the area of “gender difference with substance abuse,” moving from an average of 2.6 to 4.5 on a 5-point Likert scale. Our conference was successful in increasing attendees’ knowledge about gender difference and substance abuse among pregnant patients.     

Immigrant Latino Families Saving Against Great Odds: The Case of CSAs and the Prosperity Kids Program

Children’s savings account programs are interventions that seek to engage disadvantaged children and their families in early college saving, cultivate college-saver identities, and reduce disparities in educational and economic outcomes. Existing research has revealed positive effects of CSAs on children’s outcomes, but questions remain about how and for whom CSAs facilitate these outcomes. This study uses account data from 493 accountholders and findings from interviews with 50 participants to examine asset accumulation and savings experiences among mostly low income, Latino families in New Mexico’s Prosperity Kids CSA program. One-third of the families made a deposit into their child’s account designated as “savers” with a median total contribution of $123 and a median account balance, including initial seed deposit, of $345. Longer duration of program enrollment and fewer number of unexcused absences predicted savers status. Qualitative findings highlight emerging college-saver identities, viewed through the framework of identity-based motivation, understood to include salience, normalization of difficulty, and group congruence. Qualitative interview data further suggest that initial seed money, deposit incentives, and withdrawal restrictions were important influences on participants’ saving. These findings suggest CSA features that may encourage positive savings outcomes for economically disadvantaged households and, then, that may have implications for future CSA policy development.     

Peer paradox: the tensions that peer relationships raise for vulnerable youth

The contribution peer relationships make to positive adolescent development is well recognized. Accordingly, peer problem measures typically assess youth with few age‐appropriate peers as having peer problems. Yet, youth facing high levels of personal and/or social adversity may reduce their association with antisocial peers as part of coping or risk mitigation strategies. While such strategies will result in higher scores on peer problem measures, they may also facilitate resilience and constitute a resource social workers can draw on in their work with youth. To test this proposition of peer adaptation as a risk mitigation strategy, mixed‐methods data relating to two groups of youth who were exposed to different levels of adversity were compared on a standardized peer problem measure and a range of risk measures. Qualitative interviews extended this data and explored vulnerable youth perceptions of social withdrawal as a coping strategy. Results from the survey and qualitative data indicated that a subgroup of youth facing high levels of adversity restricted association with antisocial peers to reduce their behavioural risks. However, without adequate support from adults in both formal support systems and youths' social ecologies to compensate for the loss of peer friendships, this strategy did not reduce behavioural risk in the medium term. The social withdrawal strategy also appeared to heighten mental health concerns for these youth. The implications of this finding for the development of policy and practice with vulnerable youth are discussed.