Patterns of Mental Health Care Utilization Among Sexual Orientation Minority Groups

Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013–2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.     

An instrumental case study examining the introduction and dissemination of the Baby Friendly Health Initiative in Australia: Participants’ perspectives

Background

Australia experiences high breastfeeding initiation but low duration rates. UNICEF introduced the global breastfeeding strategy, the Baby-Friendly Hospital Initiative, to Australia in 1992, transferring governance to the Australian College of Midwives (ACM) in 1995. In 2017 23% of facilities were registered as ‘baby-friendly’ accredited.

From the West Indies to Africa: A universal generational decline in health among blacks in the United States

Research shows that foreign-born blacks have better health profiles than their U.S.-born counterparts. Less is known, however, regarding whether black immigrants’ favorable health outcomes persist across generations or whether these patterns differ across the diverse sending regions for black immigrants. In this study, we use data from the 1996–2014 waves of the March Current Population Survey (CPS) to investigate generational differences in self-rated health among blacks with West Indian, Haitian, Latin American, and African ancestry. We show that first-generation black immigrants have a lower probability of reporting fair/poor health than third/higher generation blacks. The health advantage of the first generation over the third/higher generation is slightly more prounced among the foreign-born who migrated to the United States after age 13. Second-generation immigrants with two foreign-born parents are generally less likely to report their health as fair/poor than the third/higher generation. However, we find no evidence that self-reported fair/poor health varies between second-generation immigrants with mixed nativity parents (only one foreign-born parent) and the third/higher generation. These general patterns hold across each of the ancestral subgroups in the study sample. In summary, our findings highlight a remarkable convergence in health across immigrant generations among blacks in the United States.     

城镇化进程中农业转移人口 市民化的健康效应分析

农业转移人口健康状况关系着中国劳动力质量和生产效率及健康中国战略的实施。本文采用CLDS(2014)调查数据探讨城镇化进程中农业转移人口市民化的健康效应,考虑市民化与健康水平之间可能存在的内生性关系,使用IV Ordered Probit模型进行分析。研究发现农业转移人口市民化显著提升了农业转移人口的健康水平。市民化水平的提高代表农业转移人口可享受城市基本公共服务及社会福利的增加,对健康有促进作用。从健康方面看,农业转移人口市民化促进了总体健康、精神健康、活力、生理功能、情感功能和躯体活动功能。从产业角度看,对比第二产业从业的农业转移人口,第三产业从业的农业转移人口市民化的健康效应更显著,说明对产业工人的职业健康保护力度不够,应加快产业升级,减少或避免劳动者的危险或重复劳动。个体差异是影响农业转移人口市民化健康效应的一个重要因素,从个体差异的起点(教育程度)和个体差异的终点(收入水平)看,教育程度高、收入水平高的农业转移人口市民化的健康效应更显著。户籍制度(尤其是隐藏其背后的社会福利差异)极大地削弱了农业转移人口市民化的健康效应。基于农业转移人口的市民化程度和自身的健康状况的正相关关系,要想改善转移人口的健康状况,实现"健康中国"的目标,应该进一步推进城镇化进程,提高农业转移人口市民化水平;切实落实国务院关于进一步推进户籍制度改革的意见;持续对农村地区及偏远地区加大教育投资,改善教育质量,提高农村地区人口的教育水平。     

中国老年人隔代照料与 健康后果的实证研究及政策思考

在中国家庭代际关系的研究中,隔代照料这一选题极为重要,隔代照料也是老年和家庭福利政策制定的重要影响因素。老年人隔代照料与健康问题日益受到国内学者的关注,但对两者相关性的深入实证考察较少,仅有的研究也未就隔代照料产生的健康后果达成共识,政策应对亦存局限。为此,本文基于2014年中国老年社会追踪调查(CLASS)截面数据,探讨中国老年人照料孙子女对自身健康产生的后果及几个主要变量之间的交互作用,对其进行量化研究并通过稳健性检验。研究得出三项基本结论:隔代照料的健康后果受到照料强度、子女特征、居住模式及老年人自身罹患慢性疾病状况的影响,在不同的特征状况下呈现不同的健康结果;照料者受教育程度、照料者性别、健在子女数等变量间的交互作用对被解释变量(照料者健康)产生了不同程度的调节作用,成年子女向上的代际支持也对老年照料者的健康发挥了调节作用;使用工具变量(照料者是否享受老年优待政策)进行因果识别在一定程度上克服了解释变量与被解释变量间的内生性问题。最后,本文基于上述实证研究的结果从代际关系视角、社会性别视角和老年婚姻社会功能等方面提出公共政策的应对思考,以期为制定相应的老年和家庭福利政策提供策略和依据。     

Late-term pregnancy: Navigating in unknown waters — A hermeneutic study

BackgroundLate-term pregnancy is related to increased risk of serious complications for babies and women, as pregnancies proceed. Pregnancy is an individual, complex and existential situation for women, who may experience late-term pregnancy as a mentally strenuous period, characterised by worries and anxiety. However, there is a lack of studies in this area.AimTo describe women’s experiences of late-term pregnancy ≥41 gestational weeks.MethodsA lifeworld hermeneutic approach was used. Qualitative interviews were performed with ten women, two to seven months after the birth.FindingsSix themes emerged from the analysis Doubting the body’s ability to cope with the transition from pregnancy to giving birth, The importance of their partner’s support during the sea voyage, Lacking clear guidelines for the voyage, Worrying about the cargo at the end of the voyage, How the voyage turned out and Thoughts related to a future voyage.ConclusionThe women did not feel sufficiently empowered to trust their body’s ability to make the transition from late pregnancy to birth. It is vital that midwives provide clear guidance and empower women to trust the ability of their body to give birth. This transition is important in relation to positive thoughts about future pregnancies and births.     

Face-to-face health professional contact for postpartum women: A systematic review

The postpartum period is a time when physical, psychological and social changes occur. Health professional contact in the first month following birth may contribute to a smoother transition, help prevent and manage infant and maternal complications and reduce health systems’ expenditure.The aim of this systematic review was to assess the effect of face-to-face health professional contact with postpartum women within the first four weeks following hospital discharge on maternal and infant health outcomes.Fifteen controlled trial reports that included 8332 women were retrieved after searching databases and reference lists of relevant trials and reviews.Although the evidence was of moderate or low quality and the effect size was small, this review suggests that at least one health professional contact within the first 4 weeks postpartum has the potential to reduce the number of women who stop breastfeeding within the first 4–6 weeks postpartum (Risk Ratio 0.86 (95% Confidence Interval 0.75–0.99)) and the number of women who cease exclusive breastfeeding by 4–6 weeks (Risk Ratio 0.84 (95% Confidence Interval 0.71–0.99)) and 6 months (Risk Ratio 0.88 (95% Confidence Interval 0.81–0.96).There was no evidence that one form of health professional contact was superior to any other. There was insufficient evidence to show that health professional contact in the first month postpartum, at a routine or universal level, had an impact on other aspects of maternal and infant health, including non-urgent or urgent use of health services.     

Medicaid,motherhood, and the challenges of having a healthy pregnancy amidst changing social networks

BackgroundAfrican American women with low income face various challenges to having a healthy pregnancy. Unplanned pregnancies often amplify those challenges and negatively impact women’s ability to get the care that she needs. Research has shown that social networks can improve pregnancy outcomes by helping women cope with and address the problems that they face. However, there is little research on how unintended pregnancy impacts the medical and social support that African American women receive.AimThis research explored how unintended pregnancies impact women’s social networks and the type of support that they need throughout the pregnancy.Design and sampleThis ethnographic study included 20 African American women who used pregnancy services at a health department in the United States. Fourteen women were enrolled in the study during their first or second trimester and were interviewed upon enrollment, in their third trimester, and within one month of giving birth. An additional six women were enrolled and interviewed within one month of giving birth.ResultsAfrican American women’s needs and social support networks change throughout their pregnancy. When medical providers primarily offer pregnancy information and referrals to social service agencies during the first trimester, problems that women have later in the pregnancy are not properly addressed.ConclusionSocial support needs to be accessed at multiple times during the pregnancy. Pregnancy resources should be provided throughout the pregnancy, recognizing that social support and personal struggles evolve during the pregnancy.     

Change in VA Community Living Centers 2004–2011: Shifting Long-Term Care to the Community

The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004–2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.