Competing Priorities: Partner-Specific Relationship Characteristics and Motives for Condom Use Among At-Risk Young Adults

Condoms protect against human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) and unintended pregnancy and are essential to sexual health efforts targeting young adults, who are disproportionately affected by both outcomes. Understanding condom use motives is critical to increasing condom use. Research in this area is limited, particularly regarding the roles of partners and relationship factors. Using a longitudinal sample of 441 young adults and 684 reported partnerships we examined associations between relationship factors and condom use motives (pregnancy prevention, disease prevention, or dual protection). Simultaneous multilevel models identified variables associated with motives; level-specific models identified the levels (individual, partnership, time) variables impacted motives. Participants reported choosing condoms for pregnancy prevention, disease prevention, and dual protection in 51%, 17%, and 33% of partnerships, respectively. Partner-specific factors varied, to a differing degree, across the three levels. Seven variables (duration, condom self-efficacy, commitment, sexual decision-making, power, and vulnerability to harm [HIV/STIs] and pregnancy) distinguished condom use motives. The level of this association varied but was most pronounced at the partner and individual levels. Researchers and practitioners should consider the impact of both individual- and partner-level factors on condom use motives, in both research and sexual health programs.     

Are you ready for generation X?

Generational analysis considers the differences in world view and attitude between various generations of Americans and uses this information to develop insight and business strategies. The much discussed generation gap between the Baby Boomers and their elders during the 1960s and 1970s is equaled or exceeded by the differences between Generations X and Y and the Boomers. Generation X physicians will be coming into practice over the next two decades. Successful medical leaders must understand Gen-Xers to create clinical environments that meet their unique needs and concerns. This article describes some of the philosophical and attitudinal differences between the generations and what these differences may mean to the future of medicine and health care organizations.     

The coming medical apocalypse.

Is there a medical apocalypse in our future? Will it happen soon? No one can say for sure, but five ominous trends suggest that a medical meltdown could occur at any time. These trends are: (1) The practice of providing medical care becoming too complex from both a business and a legal perspective; (2) Less money being spent on medical care without any corresponding reduction in services provided, creating long-term operating deficits; (3) Investor-owned, for-profit corporations changing the focus of medicine by putting shareholder concerns ahead of patient care; (4) Employment-linked health care insurance creating a growing uninsured population, adding extra financial stress to our hospitals; and, (5) Providers losing faith in their future and becoming increasingly demoralized about practicing the healing arts. These dangerous trends are considered, along with some suggestions that physician executives and organizations might take to protect themselves.     

From Makeover Media to Remaking Culture: Four Directions for the Critical Study of Self‐Help Culture

The popularity of self‐improvement literature has lead to an abundance of scholarly considerations of the self‐help literature and lifestyle media. This interdisciplinary review article considers the dominant trends in these discussions and suggests four new directions for fruitful inquiry: (1) investigating self‐help literature from the global South and the evolving Asian economies in cross‐cultural comparative analyses; (2) more thoroughly assessing the role of religious movements and discourses in these self‐help discourses and practices; (3) exploring more fully the impact of interactive media on self‐help practices; and (4) continued creative explorations of strategies to transform makeover culture into a broader movement to make over our culture.     

The physician leader as logotherapist

Today's physicians feel helpless and angry about changing conditions in the medical landscape. This is due, in large part, to our postmodernist world view and the influence of corporations on medical practice. The life and work of existentialist psychiatrist Viktor Frankl is proposed as a role model for physicians to take back control of their profession. Physician leaders are in the best position to bring the teachings and insight of Frankl's logotherapy to rank-and-file physicians in all practice settings, as well as into the board rooms of large medical corporations. This article considers the spiritual and moral troubles of American medicine, Frankl's answer to that affliction, and the implications of logotherapy for physician organizations and leadership. Physician executives are challenged to take up this task.     

Assessing MSW Students’ Integrated Behavioral Health Skills Using an Objective Structured Clinical Examination

Within the last decade, there has been a significant shift in the field of social work toward competency-based education. This article details the use of the Objective Structured Clinical Examination (OSCE) Adapted for Social Work Performance Rating Scale. We used the measure to evaluate specific practice competencies among students (n=33) participating in a professional workforce development program, funded by the Health Resources Services Administration Behavioral Health Workforce Education and Training for Professionals. We report on students’ performance and their views of the OSCE as an assessment measure and learning experience, and on the interrater reliability and consistency of the OSCE. Results can be used by other social work programs to inform the use of OSCEs to facilitate competency-based assessment.     

The inflation-unemployment trade-offs of union members

Social preference functions between inflation and unemployment are estimated for individuals classified by union status using Gallup Poll presidential popularity data. We expected union members to assign higher weights to unemployment and lower weights to inflation than those who are not union members, but we found the reverse. Union members weight unemployment relative to inflation less than nonunion members because they weight unemployment less. Given the emphasis that trade union leaders place on reducing unemployment rather than inflation, this suggests a divergence in views between union leaders and the rank and file. The authors are indebted to Jeff Moore and an anonymous referee for helpful comments on earlier versions of this paper. Any remaining errors are our own. Smyth’s research was aided by the LSU Foundation.     

Teaching Note—Technology-Enhanced Clinical Simulations: Tools for Practicing Clinical Skills in Online Social Work Programs

ABSTRACT

Technology-based simulations provide vehicles for social work students to practice clinical skills in online environments. This teaching note reviews 2 simulation tools educators may consider implementing in their training programs: virtual patients and Second Life. The current literature is presented discussing the use of these simulations in online learning programs. Suggestions for incorporating simulations into distance education programs are provided along with suggestions for future directions for research in this area. Educators are encouraged to examine these tools and further evaluate their feasibility, acceptability, and efficacy in building direct practice skills in online environments.     

Contraceptive Method Choice Among Young Adults: Influence of Individual and Relationship Factors

Because decisions related to contraceptive behavior are often made by young adults in the context of specific relationships, the relational context likely influences use of contraceptives. Data presented here are from in-person structured interviews with 536 Black, Hispanic, and White young adults from East Los Angeles, California. We collected partner-specific relational and contraceptive data on all sexual partnerships for each individual, on four occasions, over one year. Using three-level multinomial logistic regression models, we examined individual and relationship factors predictive of contraceptive use. Results indicated that both individual and relationship factors predicted contraceptive use, but factors varied by method. Participants reporting greater perceived partner exclusivity and relationship commitment were more likely to use hormonal/long-acting methods only or a less effective method/no method versus condoms only. Those with greater participation in sexual decision making were more likely to use any method over a less effective method/no method and were more likely to use condoms only or dual methods versus a hormonal/long-acting method only. In addition, for women only, those who reported greater relationship commitment were more likely to use hormonal/long-acting methods or a less effective method/no method versus a dual method. In summary, interactive relationship qualities and dynamics (commitment and sexual decision making) significantly predicted contraceptive use.     

Inventor knowledge recombination behaviors in a pharmaceutical merger: The role of intra-firm networks

We study firms' abilities to increase the generative appropriability of their knowledge by studying the knowledge recombination patterns of inventors in the context of a merger between two equally sized pharmaceutical firms. Specifically, we study inventors' choices to recombine knowledge originating in the firm with which they merge. We hypothesize that mergers focus inventors' attention to units of knowledge originating in the other firm and that therefore, inventors will choose to recombine more of this knowledge, which exists in their intra-firm network, following a merger. We also hypothesize that inventors vary in terms of their recombination choices following a merger. We explore these differences by linking inventors' network positions with their abilities and motivations to recombine knowledge originating in the other firm. Specifically, we hypothesize an inverted-U shaped relationship between centrality and knowledge recombination from the other firm and a linear relationship between brokerage and knowledge recombination from the other firm. We test our hypotheses using patent data from the merger between Bristol-Myers and Squibb and find support for our hypotheses. The paper contributes to knowledge recombination research by exploring changes in knowledge recombination dynamics following a merger and by understanding how mergers affect firms’ generative research trajectories. Practically, we suggest that managers should identify and nurture certain types of inventors following a merger to be able to better leverage the knowledge bases of merging firms.