Relationship between Eating Behavior, Breakfast Consumption, and Obesity Among Finnish and Greek Adolescents

ObjectiveTo investigate the relationship between eating-related behaviors, particularly breakfast consumption, and weight status in Finnish and Greek adolescents.MethodsA total of 6,468 16-year-old Finnish adolescents and 2,842 17- and 18-year-old Greek adolescents, based on the latest follow-up of 2 population-based cohorts, were studied. Univariate analysis examined the associations between breakfast consumption, family meals, emotional eating, bingeing, and weight status in both populations. Multiple logistic regression models focused on the relationship between breakfast consumption and overweight/obesity taking potential confounders into account.ResultsDaily breakfast consumption was associated with lower levels of overweight/obesity among Finnish and Greek boys, but not among girls. Adjusting for confounders did not change the result among Greek boys, but adjustment for father's body mass index, weight control, and fear of getting fat attenuated the association among Finnish boys.Conclusions and ImplicationsThis study highlights the importance of breakfast consumption, particularly among male adolescents, in obesity prevention programs.     

Integrating HIV Risk Reduction into Family Programs for Women Offenders: A Family Relationship Perspective

Although HIV risk reduction interventions and family programs are crucial elements of the rehabilitation process for women offenders, these programs have operated in isolation from each other. HIV interventions for women offenders have not attended to family relationships, and family programs for women offenders have not focused on HIV‐related issues. Because the number of women under correctional sanction has increased dramatically and HIV infection and risk for HIV infection in women offenders are growing concerns, we argue that family programs need to consider HIV‐related issues within a family relationship perspective.     

An investigation of scale effects in family substance abuse treatment programs

This short report investigates scale effects in family substance abuse treatment programs. In Massachusetts, the family substance abuse treatment programs were much more costly than other adult residential treatment models. State officials were concerned that the "scale" or size of these programs (averaging just eight families) was too small to be economical. Although the sample size (just nine programs) was too small to permit reliable inference, the data clearly signalled the importance of "scale effects" in these family substance abuse treatment programs. To further investigate scale effects in family substance abuse treatment programs, data from the Center for Substance Abuse Treatment's (CSAT's) Residential Women and Children and Pregnant and Postpartum Women (RWC-PPW) Demonstration were re-analyzed, focusing on the relationship between cost per family-day and the estimated average family census. This analysis indicates strong economies of scale up until an average family census of about 14, and less apparent scale effects beyond that point. In consideration of these and other study findings, a multidisciplinary interagency team redesigned the Massachusetts' family treatment program model. The new programs are larger than the former family treatment programs, with each new program having capacity to treat 11 to 15 families depending on family makeup.     

The Discipline of Family Science and the Continuing Need for Innovation

The discipline of family science is entering a new phase, the evaluation and innovation stage. With shrinking academic budgets and threats of departmental dissolution or mergers, it is imperative for administrators of family science programs to be able to articulate the distinctiveness of the discipline, the worth of the unique skills and perspectives afforded by family science programs, the challenges affecting the field, and the solutions and resources necessary to propel family science to new levels of relevance and application. This article reviews the history of the development of the field of family science and then reports survey results from representatives of family science programs related to each of these matters. Innovative strategies for advancing the field and family science programs are discussed.     

The contribution of social science research to population policy and family planning program effectiveness

Social science research has made important contributions to population policy and to the effectiveness of family planning programs. Social science concepts, theories, and methods potentially are relevant to all aspects of reproductive behavior, including actual fertility, proximate variables, and desired family size. Social science research also contributes to the understanding of the social, economic, and political institutions that potentially affect, either directly or indirectly, the whole biosocial reproductive system and family planning programs. At least as important as its specific theories and findings is the role of social science in testing how to adapt such knowledge to distinctive national and local cultural circumstances of family planning programs. A central point is that carefully monitored pilot projects are desirable before launching full-scale national programs, as well as being continuing resources for program development. The research on early programs in Asia has been important, because those programs encountered and overcame some of the presumed obstacles to new programs.     

Comparisons of Prevention Programs for Homeless Youth

There are six HIV prevention programs for homeless youth whose efficacy has been or is currently being evaluated: STRIVE, the Community Reinforcement Approach, Strengths-Based Case Management, Ecologically-Based Family Therapy, Street Smart, and AESOP (street outreach access to resources). Programs vary in their underlying framework and theoretical models for understanding homelessness. All programs presume that the youths’ families lack the ability to support their adolescent child. Some programs deemphasize family involvement while others focus on rebuilding connections among family members. The programs either normalize current family conflicts or, alternatively, provide education about the importance of parental monitoring. All programs aim to reduce HIV-related sexual and drug use acts. A coping skills approach is common across programs: Problem-solving skills are specifically addressed in four of the six programs; alternatively, parents in other programs are encouraged to contingently reward their children. Each program also engineers ongoing social support for the families and the youth, either by providing access to needed resources or by substituting a new, supportive relationship for the existing family caretaker. All of the interventions provide access to health and mental health services as basic program resources. A comparison of HIV prevention programs for homeless youth identifies the robust components of each and suggests which programs providers may choose to replicate.     

Developing Online Family Life Prevention and Education Programs

Although numerous online family life education programs have been developed over the past few years, there has been little discussion about best practices in the development of these programs. This article presents a framework to assist family life educators in the development and improvement of online programs from the initial problem analysis and creation of program content through instructional design to implementation and evaluation. The emphasis is on the unique program development issues that are critical to developing family life education and prevention programs within online delivery systems.     

Graduate education in family practice: a ten-year review.

Assessment of the progress of graduate education in family practice after ten years shows that the original goals established for residency training in this specialty are being effectively met. There are now more than 360 approved family practice residencies in the United States with over 6,000 residents in training. Student interest in these programs has remained at a high level, and attrition has been low. Graduates of these programs have favored partnership and group family practice, and are well distributed in rural, suburban, and metropolitan areas. Heavy emphasis has been placed upon quality control mechanisms for both internal and external review of family practice residency programs. This paper outlines some concerns regarding the present status of family practice residencies, and suggests some directions for future development of these programs.     

Family‐Oriented Program Models and Professional Helpgiving Practices*

The relationship between different models of family level interventions and two components of practitioner helpgiving (relational practices and participatory practices) was examined in two studies of parents of young children involved in different kinds of family oriented helpgiving programs. Relational and participatory aspects of helpgiving were found to be practiced less often in professionally centered programs compared to other kinds of family oriented programs. Participatory helpgiving practices that provided parents with (a) choices and options and (b) opportunities to be involved in both solutions to problems and acquisition of knowledge and skills that strengthen functioning were more likely to be found in programs that were family centered. Findings are discussed in terms of the importance of the models used to structure social and human services program practices.     

Beyond Parenting Practices: Family Context and the Treatment of Pediatric Obesity*

Abstract: Many family‐based treatments for pediatric obesity teach specific parenting practices related to weight management. Although youth in these programs show increases in positive health behaviors and reductions in the extent to which they are overweight, most remain overweight after treatment. A recent trend is to create tailored programs for subgroups of families. We examine the possibility of tailoring based on family context, highlighting 3 aspects of family context that have been studied in relation to pediatric obesity: parenting style, family stress, and family emotional climate. We argue that family context may moderate treatment outcomes by altering the effectiveness of health‐related parenting practices and discuss the implications of this argument for designing and evaluating tailored programs.     

Asia's family planning programs as low fertility is attained

The dramatic demographic changes in Asia during the three decades from 1970 to the end of the twentieth century were matched by major changes in government population policies and programs. Fertility declines occurred in widely different economic, sociocultural, and political settings. The extent to which they were attributable to family planning programs, established in most countries of the region by 1970, is hotly debated. The 1970s were the heyday of family planning programs, which were created in a climate of urgency because of concerns over the "population explosion." Issues faced by programs at that time are discussed. Over time, programs generally have moved to a simpler "service" approach. As increasing numbers of countries reach replacement-level fertility, and as policies are formed against the background of the 1994 International Conference on Population and Development held in Cairo, the role of family planning programs is increasingly debated and questioned. This article examines the responses of Asian countries and the population challenges that remain.     

Made in Finland: Infertility doctors' representations of children

The aim of this study was to analyse how Finnish infertility physicians talk about children by conducting semi-structured theme interviews. It is of general interest to study how children are represented in the age of assisted reproduction technologies (ARTs), a time when the medical solution to childlessness is preferred over other solutions. Infertility physicians' discourses on children are of particular interest because they are the ones who try to produce children for couples. An understanding of professional agency is crucial to the understanding of how, why and in what context women make reproductive choices. The physicians considered the first choice for infertile couples to be to have their own biological child, with the second choice being to have a child with the help of donated Finnish gametes or embryos, and the last option being to adopt a child. The socially most desirable children were considered to be genetically and culturally Finnish, white and newborn, and therefore likely to be more healthy and socially acceptable than the adopted child who represents the Other, the socially less appropriate child. The adopted child is usually of foreign cultural and family origins, non-white, older and likely to temporarily have compromised mental and physical health. In this sense some doctors felt that the use of a donated Finnish embryo in IVF is more secure in terms of a child's 'quality'. The physicians' negative talk about adopted children draws lines between us and strangers, between those outside and inside the borders of nations and families. A key value was the ability to know about and thus control the genetic and social characteristics of the child.     

Expanding the availability and improving delivery of natural family planning services and fertility awareness education: providers' perspectives

Despite the recognized benefits for clients and programs of providing natural family planning (NFP) services, few family planning programs offer NFP and few provide fertility awareness education. Furthermore, many non-governmental organizations (NGOs) that provide only NFP actually reach a very small percentage of the potential NFP users in the areas they serve. This paper discusses the results of interviews with selected family planning providers that were conducted to explore reasons why NFP and fertility awareness education are not offered in their programs, and with NFP providers to get their opinions on how to improve service delivery. The interviews were structured around some of the lessons learned from the successful incorporation of the lactational amenorrhea method (LAM) into several multimethod family planning programs. There is agreement that the need for NFP services is far from being met and that most clients lack the information and skills they could learn through fertility awareness education. The providers interviewed also acknowledged that offering these services would improve the quality of reproductive health services in general. Presented here are some ideas about why these services are not offered, as well as suggestions for integrating NFP and fertility awareness education into existing family planning programs.     

‘Virtuoso ideal daddy’: Finnish children's perceptions of good fatherhood

Changes in family structures, such as the increase in the number of cohabiting couples, divorces, and blended families pose new challenges for fatherhood and research on fatherhood has been mainly adult-centred. This research studied how Finnish children perceive good fatherhood and what expectations they set for fathers. The following research questions were set for the study: (1) How do Finnish children describe a good father? and (2) How do Finnish girls' and boys' perceptions of a good father differ from each other? The participants of this study comprised pupils (n?=?39; 21 girls and 18 boys aged 10–12 years) from 3 to 6 grades at a typical northern Finland school. This was a narrative study in which pupils' narratives of a good father were used as the data. The pupils' narratives of a good fatherhood could be categorised into seven main types which are introduced as findings of the study. Also a metanarrative of a good father was composed based on the children's narratives. In conclusion, a good father's virtues as the basis on a good father–child relationship are discussed.     

Methodologic issues in population planning: studies of alternative patterns of administrative organization

A systematic framework for the organization of family planning programs includes the specification of the problems, the assessment of the resources available, and then the establishment of objectives regarding the program structure, process, and result. Some of principals involved in administration of family planning programs are the needs for 1) development in a national context; 2) marketing methods; 3) central policy planning; 4) operations-oriented research; 4) political support; and 5) evaluation. No single system of organization for family planning programs is optimal, but this analysis may help to define problems involved administration.     

Unaccompanied Evacuation and Adult Mortality: Evaluating the Finnish Policy of Evacuating Children to Foster Care During World War II

Objectives. I examined associations between evacuation of Finnish children to temporary foster care in Sweden during World War II and all-cause mortality between ages 38 and 78 years.Methods. I used a Cox proportional hazards model to estimate mortality risk according to whether the individual was evacuated during childhood or not. I used within-sibling analysis to control for all unobserved socioeconomic and genetic characteristics shared among siblings. Individual-level data for Finnish cohorts born in 1933 to 1944 were derived from wartime government records, Finnish census data from 1950 and 1970, and death cause registry from 1971 to 2011.Results. I found no statistically significant association between evacuation and all-cause mortality when all exposed individuals were included in the analysis. However, subgroup analysis showed that men evacuated before age 4 years had a 1.31 higher mortality risk (95% confidence interval = 1.01, 1.69) than their nonevacuated counterparts.Conclusions. In the aggregate, individuals do not have elevated mortality risk as a consequence of foster care during early childhood owing to the onset of sudden external shocks (e.g., wars).The unaccompanied minors displaced because of armed conflicts, human rights abuses, and natural disasters are a particularly exposed group of refugees. According to the United Nations Refugee Agency,l unaccompanied minors tend to account for roughly 2% to 5% of each refugee population and, in 2012, more than 21 000 children lodged asylum claims. A feature common to all forms of family disruption is that the policies aimed at remediating the children deal with 2 competing goods: family preservation and child protection. Although adverse childhood experiences such as wars and natural disasters, as well as the child neglect that may follow from these, are harmful to child development,2–6 separation from one’s biological parents is known to be traumatic as well.7–12 Determining the size and the direction of long-term health consequences of interventions that aim at remediating children who face family disruption is important for the social and medical sciences and policy.During World War II, between 1941 and 1945, roughly 49 000 Finnish children aged between 1 and 10 years from the whole range of socioeconomic backgrounds were evacuated to Swedish foster families for an average period of 2 years. In 1941, the Finnish government stated the following eligibility criteria to screen the most exposed families: (1) family displaced from the areas ceded to the Soviet Union in 1940 (Karelia), (2) father was wounded in battle, (3) family’s home destroyed in bombings, and (4) father had died in the war or parents were lost in bombings.13 Children of mothers working full time or those at risk for air raids were also considered eligible from 1942 onward. This policy of evacuation to foster care offers a fruitful setting to study the long-term consequences of removal from the biological family and placement in foster care as a result of war or other external causes.From a life course epidemiology perspective, the examination of the chronic disease risk of removal from one’s biological family and placement in foster care in a foreign country during early childhood (i.e., an environmental intervention shifting most aspects of the family environment, including language, family income, parenting strategies, and neighborhood peer quality) is intriguing. A priori, the question of the direction of any potential causal effect of the intervention is nontrivial because both family preservation and children’s protection from the adversities related to war (air raids, malnutrition, death of family members) cannot be satisfied at the same time. Thus, the aggregate effect of evacuation may be protective or adverse depending on which of the 2 conflicting needs outweighs the other or null if they cancel each other out.The main challenge to estimating the effect of foster care placement on life outcomes is to identify a credible comparison group. Both the earlier mentioned eligibility criteria of the program and empirical evidence13,14 suggest that confounding bias may contaminate means comparisons, that is, children from more adverse backgrounds participated in the program and may have had worse outcomes than the nonexposed children regardless of exposure. This confounding problem and the use of small and unrepresentative samples are the foremost reasons for why the association between the Finnish policy of evacuation to foster care during World War II and life outcomes remains incompletely characterized.15–18This cohort study used a stable within-sibling design to evaluate the associations between evacuation to temporary foster care during early childhood and all-cause mortality between ages 38 and 78. For this purpose, I obtained representative data for the whole Finnish population of cohorts born between 1933 and 1944 and followed up to adulthood. The research design substantially reduced the confounding bias by holding constant all observable and unobservable aspects of the family environment shared among the siblings, in addition to 50% of their genome.19     

Attitudes of employers toward family policy and increased paternal involvement in child care

Thirty-six Israeli personnel directors were interviewed regarding their attitudes about parental role in the family and their support of maternal policy and family policy programs. Most agreed that the combined family and work load of mothers is larger than that of fathers, but many believed that fathers can do well in child care. Nevertheless, fewer subjects supported sex-neutral family policy programs, much less than those supporting maternal policy programs. It is suggested that researchers' attempts to influence family policy should be directed not only to senior policymakers, but to those institutions and individuals that play a significant role in everyday life, such as employers.Based on a paper presented at the Biennial Meeting of the Society for Research in Child Development, Detroit, 1983. Thanks are due to Aharon Cohen for assistance in data collection and Rachel Dvir for data analysis. The editorial comments of Drs. Michael E. Lamb and Peter Pecora are deeply appreciated.     

Teaching interpersonal skills in family practice: results of a national survey.

The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.     

Attitudes of urban Sudanese men toward family planning

Using data from the Male Attitude Survey of 1985, this paper shows that Sudanese men play a major role in family planning decision-making. Attitudes regarding family planning issues are presented for 1,500 men aged 18 years and over, living in urban areas of Khartoum, the capital of Sudan. The decision not to practice family planning is found to be male-dominated, and husbands are responsible for providing contraceptives when family planning is practiced. Widespread misconceptions about vasectomy, along with a very low acceptance rate, exist among the men in the sample. It is concluded that the involvement of men in family planning programs will give these programs a better chance of success in the future.