THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Couple Attitudes and Agreement Regarding Pregnancy Wantedness in the Philippines

We compare husbands' and wives' views of the wantedness of their most recent pregnancy in the Philippines, a country where relatively high levels of unintended fertility persist. This research is an extension of earlier work that looked separately at individual men's and women's responses. We analyze survey data for 369 couples and find that those most at risk of experiencing a pregnancy that neither spouse wanted tended to be higher parity couples, those who were more fatalistic, those who were practicing Catholics who attended religious services frequently, and those among whom the husband was the sole breadwinner. Higher parity women and older women were also more apt to experience a pregnancy that was wanted by only 1 spouse. Women who had difficulty discussing sexual matters with their husbands were more likely than other women to have a pregnancy that their husbands wanted but they did not.     

The vegetarian option: varieties, conversions, motives and careers

This paper reports the findings of a qualitative study of the dietary beliefs and practices of a ‘snowball sample’ of seventy-six vegetarians and vegans. The dynamics of the process of conversion are examined, along with respondents'accounts of their motives and of the impact of their dietary stance upon their relationships with kin, friends and colleagues. The study's findings, which appear to indicate the central importance of ethical considerations for this particular response group, are set in the context of broader debates concerning the sociological dimensions of the selection or avoidance of specific food items.     

Child health,breast-feeding,and survival in Malaysia: a random-effects logit approach

This study examines the possibility that estimation of the effect of breast-feeding on infant survival is affected by selection bias, in that children who are healthier at birth may be more likely to be breast-fed. Data are from the 1976 Malaysian Family Life Survey. "Ordinary logit models for breast-feeding and survival are estimated, and the results suggest that selection is indeed present. For example, children of higher birth weight appear to be more likely to be breast-fed and likely to survive. In addition, weight at birth and the duration of breast-feeding appear to be linked." Using birth weight as an indicator for the child's health, the authors conclude that "the direct influence of breast-feeding on survival remains of overwhelming importance even after corrections for selection bias are made."     

Infusing Career Development to Strengthen Middle School English Language Arts Curricula

An approach is presented for strengthening middle school standards‐based English language arts (ELA) classroom instruction by infusing theory‐ and research‐supported career development constructs and practices. Over an 8‐week period, 90 urban 7th graders participated in an integrated ELA–career development curriculum. Career agency emerged as an important construct for students. It was related to key markers of ELA achievement (i.e., standardized test scores, grades, and positive change in 6th‐ to 7th‐grade test scores) and elaborated on in nuanced ways by students in their written narratives. Four themes related to career agency were identified in student writings: time perspective, challenges of self‐direction, career development, and social and emotional development. Advantages for students and schools related to synergy, scale, and sustainability are discussed.     

Long-term care in Spain: Difficulties in professionalizing services

The aim of this article is to analyze the difficulties in professionalizing the long-term care system in Spain. Since 2006, the new Spanish law has recognized care as a subjective right, and regulations are being designed to create a framework for its professionalization. Nowadays, family remains the most important group of providers who care for their elders, and women remain the main informal caregivers. Why do families resist using public long-term care services and professional carers included in the new law? The hypothesis highlights sociocultural factors as an obstacle to professionalization of long-term care services in addition to political and economic factors. The results show qualitative data about expectations, preferences, and discourses that women caregivers have in relation to their responsibility. The empirical material includes 25 interviews with different profiles of caregivers and six focus groups with family caregivers. The article suggests that the Spanish ideal of care is a problem for the professionalization of services because the family remains as the main provider of care—without specific skills, knowledge, and abilities.     

Building Health Insurance Literacy: Evidence from the Smart Choice Health Insurance™ Program

With the passage of the Patient Protection and Affordable Care Act (ACA) of 2010, the health insurance literacy of Americans became a critical issue. In response, a consumer education program was created and tested by university researchers and educators associated with Cooperative Extension. This article draws extensively on the emerging literature on health insurance literacy and on data from participants in the Smart Choice Health Insurance? program. The intent of the study was to understand socio-demographic and environmental variables that predict initial health insurance literacy and gains in health insurance literacy. A standardized instrument measuring health insurance literacy was used to collect the data. Multivariate analysis showed higher income consumers demonstrated greater initial health insurance literacy scores compared to middle income consumers, whereas younger, male and lower educated consumers reported lower initial health insurance literacy. After participating in the Smart Choice Health Insurance? program, consumers who made greater gains in their health insurance literacy tended to be female, higher income, and consumers residing in states that showed supportiveness of the ACA. The findings highlight the importance of considering sociodemographic characteristics in program design and delivery, as well as how contextual issues, such as the political environment, might impact the delivery of educational efforts. Findings from the analyses help inform ways to adapt and tailor educational opportunities that focus on health insurance literacy for a range of consumers.