Factors that influence fathers’ participation in child care

Using the social address model, we examined demographic factors that influence fathers’ participation in child care by comparing trends in two samples: (a) 139 professional women and their spouses and (b) a heterogeneous group of 214 homemakers and employed women and their spouses. Results support previous observations that fathers are more likely to engage in play activities with their children than perform any other type of child care. Mothers continue to be primarily responsible for child care, regardless of their employment status. Parental education level was the most consistent predictor of father participation in both samples. The findings are discussed in terms of moving beyond intrafamily variables as predictors of child care participation to the larger contexts of gender and power.     

Factors Associated with Physicians’ Choice of Working Sector

Objective

To analyse factors affecting physicians’ choice to work in either the public or the private sector.

Method

We undertook a longitudinal data analysis in the years 1988, 1993, 1998 and 2003 (n = 12 909) using a multilevel modelling technique. Factors related to economic factors, physician identity, appreciation as well as demographic factors were hypothesised to influence sector choice.

Results

Physicians seem to make their career choices prior to graduation, at least to some extent. Wage levels, the physician’s personal characteristics and whether or not the physician knew his or her place of work before graduation were the key factors affecting the decision-making process in the years 1988, 1993, 1998 and 2003. Physicians for whom wages were important were less likely to choose the public sector. Also, physicians who regarded themselves as entrepreneurial preferred to work in the private sector. If a physician had worked in the public sector during his or her medical training before graduation, the probability of applying for a vacancy in the public sector was higher.

Conclusion

It is not only economic factors, such as salary, that are involved in the physician’s decision to choose the working sector.     

Occupational Pressure–Targeting Organisational Factors to Ameliorate Occupational Dysfunction

Introduction Chronic pressure at work has debilitating impact on healthcare employers (e.g. reduced productivity, high costs, poor patient care) and on female healthcare employees (e.g. sickness, dysfunction). This paper highlights relationship at work as the key occupational source of work-stress which is organisational in nature. Methods A cross-sectional study (n = 230) was conducted using the Pressure Management Inventory on several female dominated health professions within a large public hospital. Analysis of variance was used to show relationship between sources and outcome of pressure. Linear regressions were used to predict which sources of pressure (IV) was linked to the outcomes of occupational pressure (DV). Results The number one source of occupational pressure is Relationships at work (i.e. with supervisors), and not workload. ‘Relationship’ is also the key predictor of several negative outcomes of pressure at work. Analysis of variance showed significant differences in two sources of pressures, i.e. Workload (P = 0.04) and Home-work balance (P = 0.03). Conclusion This paper provides insights into the occupational pressure of women health professionals by highlighting the organisational sources of pressure and the implications for preventing occupational dysfunction secondary to stress at work.     

Factors Affecting Students’ Evaluation in a Community Service-Learning Program

A community service-learning curriculum was established to give students opportunities to understand the interrelationship between family and community health, the differences between community and hospital medicine, and to be able to identify and solve community health problems. Students were divided into small groups to participate in community health works such as home visits etc. under supervision. This study was designed to evaluate the community service-learning program and to understand how students’ attitude and learning activities affected students’ satisfaction. The results revealed that most medical students had a positive attitude towards social service and citizenship but were conservative towards taking the role to serve people in the community. Students had achieved what they were required to learn especially the training in communication skills and ability to identify social issues. Students’ attitude towards social service did not affect their opinions on the quality of the program and subjective rating on their achievement. The quality of the program was related to the quality of learning rated by the students.     

Clinical Risk Factors for Severe Clostridium difficile�Cassociated Disease

Identifying patients who are at high risk for severe Clostridium difficile–associated disease (CDAD) early in the course of their infection may help clinicians improve outcomes. Therefore, we compared clinical features associated with severe versus nonsevere CDAD by retrospectively reviewing records of hospitalized patients whose fecal assays were positive for C. difficile toxin. Of 336 patients, 12.2% had severe disease and 10.1% died from all causes. Regression modeling showed the following to be significantly associated with severe CDAD (p<0.05): age >70 years (odds ratio [OR] 3.35), maximum leukocyte count >20,000 cells/mL (OR 2.77), minimum albumin level <2.5 g/dL (OR 3.44), maximum creatinine level >2 mg/dL (OR 2.47), small bowel obstruction or ileus (OR 3.06), and computed tomography scan showing colorectal inflammation (OR 13.54). These clinical and laboratory markers for severe disease may be useful for identifying patients at risk for serious outcomes or death.     

Factors affecting nurses’ decision to get the flu vaccine

The objective of this study was to identify factors that influence the decision whether or not to get the influenza (flu) vaccine among nurses in Israel by using the health belief model (HBM). A questionnaire distributed among 299 nurses in Israel in winter 2005/2006 included (1) socio-demographic information; (2) variables based on the HBM, including susceptibility, seriousness, benefits, barriers and cues to action; and (3) knowledge about influenza and the vaccine, and health motivation. A probit model was used to analyze the data. In Israel, the significant HBM categories affecting nurses’ decision to get a flu shot are the perceived benefits from vaccination and cues to action. In addition, nurses who are vaccinated have higher levels of (1) knowledge regarding the vaccine and influenza, (2) perceived seriousness of the illness, (3) perceived susceptibility, and (4) health motivation than do those who do not get the vaccine. Immunization of healthcare workers may reduce the risk of flu outbreaks in all types of healthcare facilities and reduce morbidity and mortality among high-risk patients. In order to increase vaccination rates among nurses, efforts should be made to educate them regarding the benefits of vaccination and the potential health consequences of influenza for their patients, and themselves.

The Second ICOH International Congress on Psychosocial Factors at Work

Scope of the Conference:The main theme is EAST MEETS WEST-Job Stress Prevention in a Global Perspective.The aspects covered will encom-pass strategies and methods of assessing,preventing and controlling job-related stress and its effects on health in different settings all over the world.Language:English(Some sessions will be offered also in Japanese).Topics:(1)New methodology in Occupational Health Psychology;(2)Recent trends in work organization and their impact on worker health;     

Korean Immigrants’ Knowledge of Heart Attack Symptoms and Risk Factors

Purpose This study assessed the knowledge of heart attack symptoms and risk factors in a convenience sample of Korean immigrants. Method A total of 116 Korean immigrants in a Midwestern metropolitan area were recruited through Korean churches and markets. Knowledge was assessed using both open-ended questions and a structured questionnaire. Latent class cluster analysis and Chi-square tests were used to analyze the data. Results About 76% of the sample had at least one self-reported risk factor for cardiovascular disease. Using an open-ended question, the majority of subjects could only identify one symptom. In the structured questionnaire, subjects identified a mean of 5 out of 10 heart attack symptoms and a mean of 5 out of 9 heart attack risk factors. Latent class cluster analysis showed that subjects clustered into two groups for both risk factors and symptoms: a high knowledge group and a low knowledge group. Subjects who clustered into the risk factor low knowledge group (48%) were more likely than the risk factor high knowledge group to be older than 65 years, to have lower education, to not know to use 911 when a heart attack occurred, and to not have a family history of heart attack. Conclusion Korean immigrants’ knowledge of heart attack symptoms and risk factors was variable, ranging from high to very low. Education should be focused on those at highest risk for a heart attack, which includes the elderly and those with risk factors.     

Factors Influencing Family Physicians’ Contribution to the Child Health Care Workforce

PURPOSE

We wanted to explore demographic and geographic factors associated with family physicians’ provision of care to children.

METHODS

We analyzed the proportion of family physicians providing care to children using survey data collected by the American Board of Family Medicine from 2006 to 2009. Using a cross-sectional study design and logistic regression analysis, we examined the association of various physician demographic and geographic factors and providing care of children.

RESULTS

Younger age, female sex, and rural location are positive predictors of family physicians providing care to children: odds ratio (OR) = 0.97 (95% CI, 0.97–0.98), 1.19 (1.12–1.25), and 1.50 (1.39–1.62), respectively. Family physicians practicing in a partnership are more likely to provide care to children than those in group practice: OR = 1.53 (95% CI, 1.40–1.68). Family physicians practicing in areas with higher density of children are more likely to provide care to children: OR = 1.04 (95% CI, 1.03–1.05), while those in high-poverty areas are less likely 0.10 (95% CI, 0.10–0.10). Family physicians located in areas with no pediatricians are more likely to provide care to children than those in areas with higher pediatrician density: OR = 1.80 (95% CI, 1.59–2.01).

CONCLUSIONS

Various demographic and geographic factors influence the likelihood of family physicians providing care to children, findings that have important implications to policy efforts aimed at ensuring access to care for children.     

Factors Contributing to Background Television Exposure in Low-Income Mexican–American Preschoolers

Objective Background television (TV) exposure is harmful to young children, yet few studies have focused on predictors of exposure. This study’s objectives were to elucidate demographic, environmental, and behavioral correlates of background TV exposure in low-income Mexican–American preschoolers and to explore caregiver beliefs about the impact of such exposure. Methods A convenience sample of low-income Mexican–American female primary caregivers of preschoolers (3–5 years old, n = 309), recruited in safety-net clinics, were surveyed by phone. Caregivers reported the frequency of their child’s exposure to background TV and responded to questions on the home media environment, TV use, and whether they had thought about background TV exposure and its impact on their child. Results Background TV exposure was common; 43 % reported that their child was often, very often, or always exposed to background TV. More hours of TV viewing by the caregiver and greater frequency of TV viewing during meals were associated with an increased frequency of exposure to background TV. Only 49 % of participants had ever thought about the impact of background TV. Believing that background TV is not harmful was associated with higher levels of background TV exposure. Conclusions Findings suggest that background TV exposure is frequent and caregiver awareness of its potential impact is low in low-income Mexican–American families. Beliefs that background TV is not harmful may predict risk of exposure. Potential targets for interventions focused on reducing background TV exposure in this population include increasing caregiver awareness of the potential negative impact of such TV exposure.     

Factors affecting place of death in Washington State, 1968–1981

A study was carried out to determine factors affecting place of death (home, hospital, nursing home or other places) among all 426,115 resident deaths in Washington State during 1968–1981, using death certificate information. Sixteen percent of deaths occurred at home, 74% in institutions (51% in hospitals, 23% in nursing homes) and 9% at other places. Age, marital status and cause of death all strongly affect place of death. Further, the effect of each factor was strongly dependent on the others. Sex had no effect on place of death after controlling for other factors. Elderly people died relatively more frequently in nursing homes, infants and middle aged people in hospitals and young adults in other places. The frequency of deaths at home was quite constant by age. Hospitals were the most common place of death following both vascular disease (including heart attack) and neoplasms, and nursing homes were the most common place of death following cerebrovascular disease (including stroke). Race, socioeconomic status and urban or rural residents affected the place of death only slightly or not at all. The place of death pattern changed little during the time period 1968–1981, except for a slight increase in frequency of home deaths and a corresponding decrease in the frequency of deaths in other places.Among cancer patients, the likelihood of death at home was positively associated with longer periods of survival after diagnosis. Cancer patients of hospitals serving targeted populations, such as veterans, were relatively more likely to die in a hospital and less likely to die in a nursing home compared to other cancer patients, suggesting that the targeted hospitals are sometimes serving a nursing home function. There was a marked difference in the terminal cancer caseload by hospital. The number of cancer deaths per cancer diagnosis varied widely across hospitals (0.1 to 1.6) and was unrelated to size of the hospital or level of services offered.Intervention aimed at affecting place of death, such as increasing the number of deaths at home, will need to take account of the joint effect of age, marital status and disease.Lincoln Polissar, Ph.D., is Associate Member, Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, Seattle, WA and Associate Professor, Department of Biostatistics, University of Washington in Seattle. Richard K. Severson, M.S., is the Project Coordinator, Fred Hutchinson Cancer Research Center. Norman K. Brown, M.D., is Clinical Professor of Medicine, School of Medicine, University of Washington.This research was supported by NCI Grant Nos. NCI-SR18, CA 29770–03 Requests for reprints should be sent to Lincoln Polissar, Ph.D., Fred Hutchinson Cancer Research Center, 1124 Columbia Street, Seattle, WA 98104     

Message Sensation and Cognition Values: Factors of Competition or Integration?

Using the Activation Model of Information Exposure and Elaboration Likelihood Model as theoretical frameworks, this study explored the effects of message sensation value (MSV) and message cognition value (MCV) of antismoking public service announcements (PSAs) on ad processing and evaluation among young adults, and the difference between high sensation seekers and low sensation seekers in their perceptions and responses toward ads with different levels of sensation and cognition value. A 2 (MSV: high vs. low) × 2 (MCV: high vs. low) × 2 (need for sensation: high vs. low) mixed experimental design was conducted. Two physiological measures including skin conductance and heart rate were examined. Findings of this study show that MSV was not a distraction but a facilitator of message persuasiveness. These findings contribute to the activation model. In addition, need for sensation moderated the interaction effect of MSV and MCV on ad processing. Low sensation seekers were more likely to experience the interaction between MSV and MCV than high sensation seekers. Several observations related to the findings and implications for antismoking message designs are elaborated. Limitations and directions for future research are also outlined.     

Factors affecting functional impairment among elderly Germans — Results of a longitudinal study

Objective

To investigate causal factors of functional impairment in old age in a longitudinal approach.

Design

A population-based prospective cohort study.

Setting

Elderly individuals were recruited via GP offices at six study centers in Germany. They were observed every 1.5 years over six waves.

Participants

Three thousand two hundred fifty-six people aged 75 years and older at baseline.

Measurements

Functional impairment was quantified by the Lawton and Brody Instrumental Activities of Daily Living scale (IADL) and the Barthel-Index (BI).

Results

Fixed effects regressions revealed that functional impairment (IADL; BI) increased significantly with ageing (β=-.2; β=-1.1), loss of a spouse (β=.5; β=-3.1), not living alone in private household (β=-1.2; β=-5.5), depression (solely significant for IADL: β=.6) and dementia (β=-2.3; β=-18.2). The comorbidity score did not affect functional impairment.

Conclusion

Our findings underline the relevance of changes in sociodemographic variables as well as the occurrence of depression or dementia for functional impairment. While several of these causal factors for functional decline in the oldest old are inevitable, some may not be, such as depression. Therefore, developing interventional strategies to prevent depression might be a fruitful approach in order to delay functional impairment in old age.

     

The Role of Socioeconomic Factors in Black–White Disparities in Preterm Birth

Objectives. We investigated the role of socioeconomic factors in Black–White disparities in preterm birth (PTB).Methods. We used the population-based California Maternal and Infant Health Assessment survey and birth certificate data on 10 400 US-born Black and White California residents who gave birth during 2003 to 2010 to examine rates and relative likelihoods of PTB among Black versus White women, with adjustment for multiple socioeconomic factors and covariables.Results. Greater socioeconomic advantage was generally associated with lower PTB rates among White but not Black women. There were no significant Black–White disparities within the most socioeconomically disadvantaged subgroups; Black–White disparities were seen only within more advantaged subgroups.Conclusions. Socioeconomic factors play an important but complex role in PTB disparities. The absence of Black–White disparities in PTB within certain socioeconomic subgroups, alongside substantial disparities within others, suggests that social factors moderate the disparity. Further research should explore social factors suggested by the literature—including life course socioeconomic experiences and racism-related stress, and the biological pathways through which they operate—as potential contributors to PTB among Black and White women with different levels of social advantage.Higher rates of preterm birth (PTB) among Blacks than Whites have been documented in the United States since at least the early 20th century.1–3 This racial disparity is of great concern because PTB strongly predicts infant mortality4,5 and adverse health and neurodevelopmental outcomes in childhood,4,6,7 and has been linked with chronic disease, disability, and premature mortality in adulthood.8–10The underlying reasons for the racial disparity in PTB are not well understood.4 A range of socioeconomic factors—including income, wealth, and education at the individual, household, and area levels—vary across racial/ethnic groups11–16 and are biologically plausible underlying causes of PTB.4,17–20 Socioeconomic effects on health, including PTB, could operate independently of and in concert with the effects of stressful experiences related more directly to racial discrimination.4,16,21,22 Many studies have observed different PTB risks associated with socioeconomic or socioeconomically linked characteristics of the geographic areas where women reside,4,11,23–32 including area-level measures of poverty, unemployment,26 segregation,24,28 and crime rates.25 Various individual-, household-, and neighborhood-level socioeconomic factors could plausibly affect PTB through diverse causal pathways, including those involving poor nutrition or prepregnancy health status, adverse health-related behaviors, lack of medical care, social isolation, stress, and hazardous physical exposures in the home, neighborhood, workplace, or in transit.4 Biological pathways leading from stressful experiences to PTB through neuroendocrine processes have been described.33–36A systematic review17 of studies examining relationships between adverse birth outcomes and socioeconomic factors found that 93 of 106 studies reported a significant association, overall or within a subgroup, between a socioeconomic measure and a birth outcome; effects varied, however, across racial/ethnic groups and socioeconomic measures. Several birth outcome studies have examined interactions between variables reflecting racial/ethnic group and socioeconomic factors, with inconsistent results. Some studies have found minimal or no Black–White differences in PTB among highly disadvantaged women.37–39 Others have observed a significant racial disparity among socioeconomically disadvantaged women, but an even greater disparity among more socioeconomically advantaged women.24,40,41 Some other studies, however, have not reported differences in the racial disparity in PTB across socioeconomic subgroups.4 Although the biological mechanisms for low birth weight are thought to be distinct from those for PTB,4 several studies42–49 have observed relatively smaller—but not necessarily small—racial disparities in low birth weight or infant mortality within socioeconomically disadvantaged versus more advantaged subgroups.In some studies, the Black–White disparity in PTB has persisted after adjustment for socioeconomic and other known or suspected risk factors,31,50–52 leading some researchers to conclude that the Black–White disparity in PTB reflects underlying genetic differences.53–56 Others have challenged this, noting that the disparity may reflect significant unmeasured socioeconomic factors and other social experiences including those related to racial discrimination throughout life, not only during pregnancy.18,21,57–62 With few exceptions,30,31,39,63,64 however, most studies of the Black–White disparity in PTB have had limited socioeconomic information, and few have examined systematically how the disparity may vary at different socioeconomic levels.The goal of this study was to investigate the role of socioeconomic factors in the Black–White disparity in PTB by using a unique population-based data source on California births with more extensive information than generally available in previous PTB research, including multiple socioeconomic measures at the individual, household, and area levels and a wide range of covariables reflecting potential confounders suggested by the literature. The aim was to assess the combined contribution of multiple socioeconomic factors—representing different dimensions of social advantage and disadvantage—to the racial disparity in PTB, and to examine whether and how these socioeconomic factors might moderate the relationship between racial group and PTB.     

Influential Factors of Puerto Rican Mother–Child Communication About Sexual Health Topics

Introduction Latina mothers play a central role in raising and socializing their children; however, few studies have examined the cultural, socio-cognitive and neighborhood-related variables influencing the level of communication between Puerto Rican mothers and their children about sexuality and sexual health. This cross-sectional study sought to examine these influences. Methods Puerto Rican mothers with children aged 10–19 years (n = 193) were selected randomly for an ethnographic interview as part of a community participatory action research project in a U.S. urban northeastern community. Results Bivariate analyses found statistically significant associations between the child’s age (p = 0.002), the mother’s past communication about traditional gender role norms of women (marianismo) (p < 0.001), her positive outcome expectations for communications with her child (p < 0.025), and her perceptions of the physical condition (p < 0.001) and sexual health problems (p = 0.047) in the neighborhood. In a multivariate model, all of these variables remained significant except sexual health problems, and mother’s attitudes toward the obligations of children to parents (familismo) emerged as a factor associated with a decrease in the number of sexual health topics that mothers raised with their children. No significant effects were found for mother’s spiritual and religious experience (religiosidad). Discussion Our study highlights the importance of marianismo as a framework within which Puerto Rican mothers communicate sexual health information as well as the need to improve mothers’ confidence discussing sexual health issues with their children. Future public health interventions to promote communication about sexuality and sexual health among Puerto Rican mothers should consider addressing this issue as a part of comprehensive neighborhood improvement projects.     

Factors contributing to inconsistent condom use among heterosexual men in Curaçao

This study explored, from a public health perspective, factors that contribute to inconsistent condom use by men in Curaçao through semi-structured face-to-face interviews with 21 heterosexual men. The findings show that there is an important disconnect between what is considered culturally appropriate sexual behaviour for men and women and condom use, that diverging from prescribed notions of masculinity and femininity in order to use condoms consistently is difficult, and that condom use is particularly problematic in the context of concurrent partnerships and sexual economic exchanges. Participants further reported that Caribbean family structures, whereby mothers assume the role as primary caregiver and fathers contribute biologically but, to a much lesser extent socially, also have an impact on condom use. Additionally, consistent condom use was reported to be impeded by a cultural taboo on talking seriously about sex and sexual health. In their totality, findings provide important input from men for the development of sexual health promotion interventions that are cognizant of the cultural context in which inconsistent condom use occurs, and that are geared not only to the individual level but also to the interpersonal and structural levels.