Culture and sex education: the acquisition of sexual knowledge for a group of Vietnamese Australian young women

Background. This paper explores how a group of Vietnamese Australian young women acquire knowledge of sexual issues, and the impact the traditional Vietnamese culture has on the acquisition of this knowledge. It is based on a qualitative study that examined the factors which shape the sexual behaviour of Vietnamese Australian young women living in Australia.

Methods. A Grounded Theory methodology was employed in this investigation, and involved in-depth interviews with 15 Vietnamese Australian young women aged 18–25 years, who reside in Victoria, Australia.

Results. The findings illustrated three key elements involved in the acquisition of knowledge of sexual issues: ‘Accepting parental silence’, ‘Exploring sources of knowledge’ and ‘Needing culturally targeted information’. The young women desired discussion about sexual issues but accepted that cultural ‘barriers’ were formidable. Their desire conflicted with the traditional familial norm of ‘silence’ regarding sexual matters. Consequently, knowledge was sought outside the home, specifically from peers and the media. The importance of culturally appropriate and adequate sexual discussions for Vietnamese Australian young people was stressed, so that informed decisions could be made about their sexual lives.

Conclusion. It is imperative for young people to have adequate and appropriate sexual education so that informed and safe sexual choices can be made. For young people from diverse cultural backgrounds, this education must be culturally appropriate and accessible, taking into consideration cultural mores regarding gender and sexual matters, as well as current beliefs in the ‘mainstream’ youth culture.     

Rodent control in urban communities in Johannesburg,South Africa: from research to action

Introduction:

Rodents are troublesome urban pests, with potentially serious health implications. Preventive efforts require greater understanding of social contexts in which they are prevalent. This study aimed to determine rodent prevalence and identify factors associated with rodent infestations in urban residential settings.

Methods:

The Health, Environment and Development study is a longitudinal panel study conducted in five settlements across Johannesburg. Data on socio-economic status, domestic behaviour and housing quality are collected annually. Logistic regression revealed risk factors for rodent prevalence at household level.

Results:

Rodents are a major household problem in all study areas (prevalence 54%). Factors associated with increased prevalence of rats included lower income, living in informal areas, overcrowding, cracks in dwelling walls and internal damp.

Conclusion:

Socio-economic status, housing quality, domestic behaviour and environmental health services are associated with exposure to rodents in urban Johannesburg communities. This information served as a platform to launch rodent awareness campaigns at study sites.     

Book Reviews

The Mad Cow Crisis: Health and the Public Good SCORN C. RATZAN (Ed.) UCL Press, London, 1997 247 pp., £14.95 ISBN 1-85728-812-2

Risk vs Risk: Tradeoffs in Protecting Health and the Environment J. GRAHAM & J. B. WIENER (Eds) Harvard University Press, London, 1997 337 pp., £12.50 ISBN 0-674-77307-1

Good Practice in Risk Assessment and Risk Management 1 HAZEL KEMSHALL & JACKI PRITCHARD Jessica Kingsley Publishers, London, 1996 224 pp., £16.95 ISBN 1-853-02338-8, pbk

Good Practice in Risk Assessment and Risk Management 2: Protection, Rights and Responsibilities HAZEL KEMSHALL & JACKI PRITCHARD Jessica Kingsley Publishers, London, 1997 446 pp., £19.95 ISBN 1-853-02441-4, pbk.

Suicide and the Inner Voice: Risk Assessment, Treatment and Case Management R. W. FIRESTONE Sage, London, 1997 333 pp., £16.50 ISBN 0-7619-0555-3

Managing High Security Psychiatric Care C. KAYE & A. FRANEY (Eds) Jessica Kingsley Publishers, London, 1998 302 pp. ISBN 1 85302581 (pbk) £19.95, ISBN 1 85302 582 8 (hbk) £45.00

Risk, Health and Health Care: A Qualitative Approach BOB HEYMAN (Ed.) Arnold Publishing, London, 1997 384 pp., £18.99 ISBN 0 340 66201 8

Foucault, Health and Medicine A. PETERSEN & R. BUNTON (Eds) Routledge, London, 1997 £15.95 pbk ISBN 0415151783

Smoking in Adolescence. Images and Identities B. LLOYD & K. LUCAS Routledge, London, 1998 215 pp., £14.99 ISBN, 0-415-17860-6     

Ethnicity, genetics, and breast cancer: media portrayal of disease identities

Design

Results

Conclusions

To describe, compare, and analyze how the risk of breast cancer is framed in newspapers directed towards an ethnic minority population (Jewish) with higher risk of inherited breast cancer compared with newspaper coverage for the general population (Anglo-Canadian) without this risk.

This investigation utilized a mixed methods (quantitative and qualitative) approach. The design emphasized a content analysis conducted on ethnically specific and non-ethnic newspaper articles.

It is noteworthy that the ‘Jewish’ newspapers devote a substantially larger proportion of articles on breast cancer to genetic risk as the key risk factor for this disease. Articles in the Jewish newspapers tend to link being a Jewish woman with being at risk for a diagnosis of breast cancer. This ethnic ‘identity’ is reinforced through the repeated association of Jewish heritage and genetic breast cancer risk at the exclusion of other known risk factors. This isolated genetic link to breast cancer is not a message that is replicated within the provincial newsprint articles.

These findings assist in the facilitation of prevention and treatment of those with or at risk of breast cancer. The health policy implications of this portrayal as well as suggestions for change are considered.     

Alexithymia is associated with low level of vitamin D in young healthy adults

Objective

Vitamin D plays an important role in brain development and functioning. Low levels of vitamin D have been described in several psychiatric and neurologic conditions including autism spectrum disorder. Alexithymia that shows high comorbidity with autism is also present in the general population as well as hypovitaminosis D.

Methods

Here we assessed the relation between alexithymia as measured by the Toronto Alexithymia Scale-20 and vitamin D level in healthy young adults.

Results

We found an inverse correlation between the levels of alexithymia and vitamin D.

Discussion

These data suggest the association between disturbed emotional processing and low levels of vitamin D to be present in young healthy subjects.     

Book Review

Changing the public health

Rcswch Unit in Health .ad Behaviourd Chutge. University of Edinburgh, John Wdey and Son, London, 1989, ISBN 0 471 91976 4.

The new public health

John Ashtw and RowYd Seymour. Open University Press, 1988. ISBN 0 335 15550 2, £6.95.

Infertility services-a desperate case

N d Pfeilu cmd Allison Qukk. Greater London Association of Community Health Councils, 1988.

A new kind of Doctor

Julian Tudor Hart. Merlin Press, 1988. ISBN 085036 299 7, £11.95 (hardback).     

Changes in food habits among Pakistani immigrant women in Oslo, Norway

Design

Results

Conclusion

South Asians are generally known to have high prevalence of diabetes type 2 and coronary heart diseases. The Pakistani immigrant group in Norway constitute a high-risk subgroup of the population that needs a selective prevention approach. The main objective of this study was to provide information on dietary change and factors leading to these changes in Pakistani women after migration from Punjab, Pakistan to Oslo, Norway. Such information is important in designing appropriate strategies for dietary counselling.

Twenty-five Pakistani immigrant women, recruited through the Oslo Health Study 2000–2001, participated in focus group interviews. Each group met four times, aided by a moderator and professional interpreters. A model developed by Koctürk was tested for its usefulness in analysing the dietary changes. PRECEDE was used to organise and structure the factors that were found to cause the changes.

According to the women, life in Norway has led to several changes in meal pattern, meal composition and intake of different foods. In accordance with the Koctürk model, the cultural importance of breakfast and lunch has diminished, and dinner has become the most important meal. Meals on weekends tend to be more traditional than on working days. The study gives limited support to the hypothesis that changes occur predominantly among the accessory foods and least among staples. The focus group interviews revealed a rich variety of factors influencing dietary change: health aspects, children's preferences, work schedules, social relations, stress, traditional beliefs, climate, season and access of foods.

To develop effective intervention strategies, it is vital to understand both how changes do occur and how different factors influence dietary habits. The Koctürk model was useful to structure the various foods and changes that may occur. Strategies for dietary counselling should not only include dietary advice but also focus on the multitude of factors causing dietary changes.     

Reproductive and maternity health care services in Finland: perceptions and experiences of Somali-born immigrant women

Objective. To explore immigrant Somali women's experiences of reproductive and maternity health care services (RMHCS) and their perceptions about the service providers.

Design. Five focus group discussions were conducted from April 1999 to June 2000 using a purposeful sampling strategy in order to reach multiparous female Somali-born Immigrants with experiences from the maternity health care in Finland.

Participants. A total of 70 married Somali women aged 18–50 and mother of 2–10 children were studied. Among them, 18 came from Kenya, 32 from Mogadishu and 20 from Hargeysa.

Settings. Of the participants, 45 were living in the city of Vantaa, 22 in the city of Helsinki and 13 in the city of Turku.

Results. Participants were satisfied with the RMHCS they received in Finland. Despite their satisfaction, the health care providers' social attitudes towards them were perceived as unfriendly, and communication as poor.

Conclusions. The women's experiences revealed that they have access to good quality RMHCS in Finland. While their experiences are significant, their perceptions are important for physicians, nurses and midwives in order to achieve culturally competent care.     

Ingredients and change processes in occupational therapy for children: a grounded theory study

Background: There is limited evidence about the effectiveness of occupational therapy interventions for participation outcomes in children with coordination difficulties. Developing theory about the interventions, i.e. their ingredients and change processes, is the first step to advance the evidence base.

Aim: To develop theory about the key ingredients of occupational therapy interventions for children with coordination difficulties and the processes through which change in participation might happen.

Material and methods: Grounded theory methodology, as described by Kathy Charmaz, was used to develop the theory. Children and parents participated in semi-structured interviews to share their experiences of occupational therapy and processes of change. Data collection and analysis were completed concurrently using constant comparison methods.

Results: Five key ingredients of interventions were described: performing activities and tasks; achieving; carer support; helping and supporting the child; and labelling. Ingredients related to participation by changing children’s mastery experience, increasing capability beliefs and sense of control. Parents’ knowledge, skills, positive emotions, sense of empowerment and capability beliefs also related to children’s participation.

Conclusion and significance: The results identify intervention ingredients and change pathways within occupational therapy to increase participation. It is unclear how explicitly and often therapists consider and make use of these ingredients and pathway.     

Gender and ethnic differences in the co-occurrence of adolescent risk behaviors

Design

Results

Conclusion

We consider gender and ethnic differences in the co-occurrence of adolescent behaviors related to health and well-being.

Using a nationally representative sample of adolescents in the National Longitudinal Survey of Youth (1997–2000), we examine behavior among students as well as school drop-outs. We use latent class models (LCMs) to identify subpopulations of adolescents with similar patterns of co-occurring behaviors. The generalizability of the findings for African American adolescents in the 1970s is considered using a sample of inner-city youth from the Pathways to Adulthood Survey.

For all ethnic groups, we find a subpopulation with ‘problem behavior’ characteristics (in which early sexual initiation, alcohol use, smoking, marijuana use, and truancy are all highly prevalent). This cluster is most common among European American adolescents and among young men. A subpopulation characterized by behaviors often leading to poor social outcomes (e.g. truancy, early sexual initiation and fighting) is most common for African American adolescents, especially young African American men.

Our findings suggest that multi-factorial interventions which address the interrelationships between all of the behaviors are relevant regardless of gender or ethnicity. However, the ethnic and gender differences in the likelihood of specific patterns of interrelationships highlight the importance of considering the ethnic and gender composition of a population when developing future research and interventions.     

Promoting exercise in patients with depression: lessons learned from a brief educational intervention

Introduction: Depression is a leading cause of disability worldwide. It is recommended that exercise is incorporated into the management of patients with depression, but it is not clear how best to implement this recommendation in clinical practice.

Objective: The objective of this study was to evaluate a pragmatic educational intervention promoting exercise to a group of patients diagnosed with depression, in a community setting.

Methods: Participants were convenience sampled from community based psychiatry clinics. WHO 5 Wellbeing and International Physical Activity Questionnaire scores were measured for each participant at baseline, and again three months after receiving the educational intervention on exercise. Open ended questions were used to elicit participants’ beliefs and barriers to exercise and responses were thematically analysed.

Results: Thirty-five patients with depression were enrolled. Three months after the educational intervention, there were no significant changes in patients’ activity levels or well-being scores (P > 0.05). Participants’ responses to open ended questions revealed their varied, and often contradictory, beliefs on physical activity and exercise. Following from this, their suggestions on ways to improve the uptake of exercise advice highlighted the need for an individualized approach, with persistent patient encouragement and positive reinforcement.

Conclusion: This study has generated valuable information on how to improve the promotion of exercise to patients with depression. Advice framed in a positive light, with persistent encouragement and tailoring to individual circumstances, is desired by patients to support their behavioural change.     

The influence of ethnicity on patient satisfaction

Methods

Results

Conclusion

To investigate the influence of ethnicity on patient satisfaction with hospitalization care.

We conducted a random selection, cross-sectional study. Data were collected by telephone interviews over a three-year period utilizing a 16-question survey. Patients were excluded from the study if they were admitted for an obstetric visit, physical rehabilitation, or psychiatric illness or if we were unable to reach them by telephone. We used logistic regression to compare ethnicity with the responses for each of the 16 questions while controlling for three confounders (age, gender, and insurance status). For each question, patient responses of excellent and very good were considered satisfied. Patient responses of good, fair, and poor were considered not satisfied.

We surveyed 7,795 patients. Compared to African-Americans, non-Hispanic white Americans were significantly older, included more males, and were insured by Medicaid less often (p?

African-Americans reported significantly lower rates of satisfaction compared to non-Hispanic white Americans for six of 16 questions regarding satisfaction during hospitalization care.     

Incidence of mental disorders in second-generation immigrants in sweden: a four-year cohort study

Methods

Results

Conclusions

Few studies have investigated mental health among second-generation immigrants who have reached adulthood. The aim of this study was to examine whether second-generation adult immigrants have a higher risk of being hospitalised for mental disorders than the Swedish majority population after adjustment for socio-economic status.

In total 1.9 million Swedish-born women and men aged 16–34 were followed from 1 January 1995 to 31 December 1998 for first hospital admissions for mental disorders, categorised in four main diagnosis groups. Second-generation immigrants comprised four groups and the Swedish majority population was used as reference group. Cox proportional hazard models were used to analyse the data.

Second-generation immigrants with one parent born in Sweden and second-generation Finns had higher risks of being hospitalised for psychotic disorders, affective disorders, neurotic disorders, and personality disorders than the Swedish majority population. For second-generation Finns the age- and sex-adjusted hazard ratio for psychotic disorders was 2.42 (CI?=?2.09–2.80). No significant hazard ratios were found for second-generation labour immigrants. For second-generation refugees the risk of being hospitalised was higher than for the Swedish majority population but only for psychotic disorders. All results remained significant and decreased only slightly after adjustment for income and education.

Many groups of second-generation immigrants have a higher risk of being hospitalised for mental disorder than the majority population. With increasing global migration it is crucial for all industrialised countries to take measures to improve mental health among second-generation immigrants.     

Meanings of food,eating and health among African Nova Scotians: ‘certain things aren't meant for Black folk'

Objective. Most research on food, ethnicity and health in Canada is focused on the dietary acculturation of first of second generation migrants. ‘Failure’ to adopt nutritional guidelines for healthy eating is generally understood as lack of education or persistence of cultural barriers. In this study we explore the meanings of food, health, and well-being embedded in the food practices of African Nova Scotians, a population with a 400-year history in Canada.

Design

Design. Qualitative interviews were conducted with 2 or 3 members of each of 13 families who identified as African Nova Scotian. Interviews asked about eating patterns; the influence of food preferences, health concerns, cost, and culture; perceptions of healthy eating and good eating; how food decisions were made; and changes over time. In addition, research assistants observed a ‘typical’ grocery shopping trip and one family meal.

Results

Results. Participants readily identified what they perceived to be distinctively ‘Black ways of eating.’ Beyond mainstream nutrition discourses about reduction of chronic disease risk, participants identified three ways of thinking about food, health, and well-being: physical well-being, emphasizing stamina, energy and strength; family and community well-being; and cultural or racial well-being, emphasizing cultural identity maintenance, but also resistance to racism.

Conclusion

Conclusion. While culturally traditional eating patterns are often understood as costly in terms of health, it is equally important to understand that adopting healthy eating has costs in terms of family, community, and cultural identity. Dietary change unavoidably entails cultural loss, thus resisting healthy eating guidelines may signify resistance to racism or cultural dominance. Several suggestions are offered regarding how community strengths and beliefs, as well as cultural meanings of food and health, might inform effective healthy eating interventions.     

Pap smear receipt among Vietnamese immigrants: the importance of health care factors

Objective. Recent US data indicate that women of Vietnamese descent have higher cervical cancer incidence rates than women of any other race/ethnicity, and lower levels of Pap testing than white, black, and Latina women. Our objective was to provide information about Pap testing barriers and facilitators that could be used to develop cervical cancer control intervention programs for Vietnamese American women.

Design. We conducted a cross-sectional, community-based survey of Vietnamese immigrants. Our study was conducted in metropolitan Seattle, Washington, DC. A total of 1532 Vietnamese American women participated in the study. Demographic, health care, and knowledge/belief items associated with previous cervical cancer screening participation (ever screened and screened according to interval screening guidelines) were examined.

Results. Eighty-one percentage of the respondents had been screened for cervical cancer in the previous three years. Recent Pap testing was strongly associated (p<0.001) with having a regular doctor, having a physical in the last year, previous physician recommendation for testing, and having asked a physician for testing. Women whose regular doctor was a Vietnamese man were no more likely to have received a recent Pap smear than those with no regular doctor.

Conclusion. Our findings indicate that cervical cancer screening disparities between Vietnamese and other racial/ethnic groups are decreasing. Efforts to further increase Pap smear receipt in Vietnamese American communities should enable women without a source of health care to find a regular provider. Additionally, intervention programs should improve patient–provider communication by encouraging health care providers (especially male Vietnamese physicians serving women living in ethnic enclaves) to recommend Pap testing, as well as by empowering Vietnamese women to specifically ask their physicians for Pap testing.     

Turkish and German patients' recall of diagnosis and therapy before and following informed consent

Objective. Adequate patient knowledge is essential for good compliance, effective doctor–patient communications and is the basis for informed consent. The purpose of the study was to examine differences in recall of informed consent procedures between patients with different ethnicity and to identify potential explanatory factors.

Design. We analyzed 579 patients, attending and released from a gynecology department in Berlin, Germany, between March 1997 and October 1998. To assess actual understanding of disclosure information, Turkish and German patients' perceptions were compared with documented data of their diagnoses and therapy.

Results. Overall, patients correctly identified 69% of their diagnosis and 76% of their therapy. On discharge overall patients' recall decreased significantly. Whereas German patients' knowledge increased, Turkish patients showed significant decreases in diagnosis and therapy recall.

Conclusion. The results reflect socio‐demographic differences between ethnic groups and indicate deficiency of the informed consent process for patients belonging to an ethnic minority.

Fragestellung. Ein ausreichend gutes und adäquates Wissen der Patienten ist wichtig für eine gute Compliance, eine effektive Arzt‐Patienten‐Beziehung und stellt die Basis für den sogenannten informed consent dar. Zielstellung der Studie war die Feststellung von Unterschieden im Wissensstand von Patientinnen verschiedener Ethnizität vor und nach der Aufklärung auf einer gynäkologisch‐operativen Station und die Identifizierung von Erklärungsfaktoren für eventuelle Differenzen.

Patientinnenkollektiv und Methodik. Es wurden 579 Patientinnen in die Studie einbezogen, die zwischen März 1997 und Oktober 1998 auf einer gynäkologischen Station in Berlin behandelt und mit einem Fragebogen befragt wurden. Zur Feststellung des jeweiligen aktuellen Informationsstandes wurden die Angaben der deutschen und der türkischstämmigen Patientinnen mit den dokumentierten Daten zu Diagnose und Therapie in den Krankenakten verglichen.

Ergebnisse. Insgesamt konnten 69% aller Patientinnen ihre Diagnose und 76% die Therapie richtig wiedergeben. Der Kenntnisstand am Ende des stationären Aufenthaltes war insgesamt signifikant schlechter als am Anfang. Während die deutschen Patientinnen besser Bescheid wussten, zeigten die türkischstämmigen Patientinnen signifikante Defizite hinsichtlich ihres Wissens über ihre Diagnose und Therapie.

Zusammenfassung. Die Ergebnisse reflektieren soziodemographische Unterschiede zwischen ethnischen Gruppen und zeigen Defizite im Informationsprozess vor und während des Klinikaufenthaltes insbesondere bei den Migrantinnen auf.     

Book Reviews

Removing Disabling Barriers Gerry Zarb (ed.). London: Policy Studies Institute. 1995. 136 pages. ISBN 085374 667 2.

Independent Lives: Community Care and Disabled People Jenny Morris. London: Macmillan. 1993.

Resource List: A Parent Ability Guide to Pregnancy, Birth and Parenthood for People with Disabilities and the Emotions and Experiences of Some Mothers with Disabilities The National Childbirth Trust. London.

Lorraine Gradwell is the Chair of the Greater Manchester Coalition of Disabled People and works for Healthy Manchester 2000.