From housing wealth to well‐being?

The positive health effects of owner-occupation, compared to renting, are well documented. But home ownership is itself heterogeneous, as is the health profile of its incumbents, and this is less well recognised. Drawing from a mixed-methods study, which includes 150 qualitative interviews with a cross-section of UK mortgage holders, this paper examines the health implications of a definitive feature of owned housing: its role as a financial tool. In particular, we ask whether there is anything about the process of accumulating wealth into housing or spending from this resource, that enhances well-being (or that adds to psycho-social stress). This question is timely, coming at the end of a long-wave of house-price appreciation, in a setting where it is easy to borrow from housing wealth, under a policy regime that looks increasingly to owned homes as an asset base for welfare. The answer casts light on whether, in what circumstances, to what extent, and by what mechanism, home ownership – the dominant housing tenure of the English-speaking world – might enhance the well-being of individuals, communities and societies.     

“Caregiving is a full‐time job” impacting stroke caregivers' health and well‐being: A qualitative meta‐synthesis

Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well‐being. We conducted a qualitative meta‐synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, ‘caregiving is a full‐time job’ was identified, encompassing four sub‐themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution‐based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well‐being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.     

“Cloud chasers” and “substitutes”: e‐cigarettes,vaping subcultures and vaper identities

The use of e‐cigarettes is increasing, a practice denoted as vaping. We explore user motives, self‐identity as vapers and involvement in vaping subcultures, drawing on sociological theory of stigma, subcultures and symbolic boundaries. Based on analyses of semi‐structured interviews with 30 Norwegian vapers, we find that there is a vaping subculture in Norway. We identify two dominant vaper identities. The first is labelled cloud chasers. These were dedicated vapers who identified with symbols and values in the subculture. Many were politically engaged in improving vaping regulation regimes and felt a sense of belonging to a vaping community. The second group is labelled substitutes. These were former daily smokers who used e‐cigarettes for smoking cessation in a more pragmatic and defensive manner, to avoid health risks, to escape the stigma of smoking and to manage nicotine addiction. In this group, self‐identity as a vaper was generally lacking. Vaping was often symbolically linked to the stigmatised smoker identity they wanted to escape, and was restricted to private contexts. The perceived symbolic meaning of e‐cigarettes varies: for some, they are a symbol of pleasure and community. For others, they connote the stigmatised status of the addicted smoker seeking an alternative to cigarettes.     

Why and How Schools Make Nutrition Education Programs “Work”

BACKGROUND

There are many potential health benefits to having nutrition education programs offered by expert outside sources in schools. However, little is known about why and how schools initiate, implement, and institutionalize them. Gaining this understanding may allow the impact and reach of nutrition and other health education programs in schools to be extended.

METHODS

A total of 22 school community members from 21 purposefully selected New York City public elementary schools were interviewed using a semistructured interview protocol about their schools' experiences initiating, implementing, and institutionalizing nutrition education programs. Interviews were audiotaped and transcribed. Chronological narratives were written detailing each school's experience and passages highlighting key aspects of each school's experience were identified. These passages (N = 266) were sorted into domains and themes which were regrouped, resorted, and adjusted until all researchers agreed the domains and themes represented the collective experiences of the schools.

RESULTS

The interviews elicited 4 broad domains of action: building motivation, choosing programs, developing capacity, and legitimizing nutrition education. Within each domain, themes reflecting specific actions and thoughts emerged.

CONCLUSIONS

The identified domains of action and their themes highlight specific, practical actions that school health advocates can use to initiate, implement, and institutionalize nutrition education programs in schools.     

“I Fell Off [the Mothering] Track”: Barriers to “Effective Mothering” Among Prostituted Women

Ecological theory and basic assumptions for the promotion of effective mothering among low‐income and working‐poor women are applied in relation to a particularly vulnerable population: street‐level prostitution‐involved women. Qualitative data from 38 street‐level prostituted women shows barriers to effective mothering at the individual, community, and societal levels. Suggestions for enhancing the lives and long‐term well‐being of prostituted women with children are included.     

Reframing “participation” and “inclusion” in public health policy and practice to address health inequalities: Evidence from a major resident‐led neighbourhood improvement initiative

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.     

“We don't do it for the money” … The scale and reasons of poverty‐pay among frontline long‐term care workers in England

Demographic trends escalate the demands for formal long‐term care (LTC) in the majority of the developed world. The LTC workforce is characterised by its very low wages, the actual scale of which is less well known. This article investigates the scale of poverty‐pay in the feminised LTC sector and attempts to understand the perceived reasons behind persisting low wages in the sector. The analysis makes use of large national workforce pay data and a longitudinal survey of care workers, as well as interviews with key stakeholders in the sector. The analysis suggests that there are at least between 10 and 13% of care workers who are effectively being paid under the National Minimum Wage in England. Thematic qualitative analysis of 300 interviews with employers, care workers and service users highlight three key explanatory factors of low pay: the intrinsic nature of LTC work, the value of caring for older people, and marketisation and outsourcing of services.     

“Abstinence” and “nonabstinence” models for the treatment of bulimia

One of the most controversial dimensions along which developing therapeutic approaches for bulimia can be differentiated is their allegiance to an “abstinence” or “nonabstinence” model. Through analogy to traditional treatment programs for chemical dependency, many self-help and professional programs for bulimia hold that the complete elimination of binge-vomiting behavior is a prerequisite for therapeutic work, and require abstinence from the inception of treatment. In contrast, the nonabstinence model suggests that a more gradual reduction in the frequency of episodes may be preferable in that it provides more opportunities for relapse prevention training and avoids reinforcing dichotomous thinking styles. The present paper reviews the theoretical and clinical arguments that have been advanced by each side, including the case for classifying bulimia as a substance abuse disorder. A strategy for investigating the relative efficacy of the two approaches is proposed. It is suggested that particular attention be paid to such variables as differential attrition, the effect of each modality on the accuracy of self-report, the need for continuing or supplementary therapy, the occurrence of treatment “casualties,” interactions between client characteristics and mode of therapy, and long-term results. In the interim before such data are available, a reasonable clinical recommendation may be the implementation of a “compromise” approach designed to maximize the advantages claimed by each model while minimizing possible risks.     

An “almost exhaustive” search‐based sequential permutation method for detecting epistasis in disease association studies

Due to the complex nature of common diseases, their etiology is likely to involve “uncommon but strong” (UBS) interactive effects—i.e. allelic combinations that are each present in only a small fraction of the patients but associated with high disease risk. However, the identification of such effects using standard methods for testing association can be difficult. In this work, we introduce a method for testing interactions that is particularly powerful in detecting UBS effects. The method consists of two modules—one is a pattern counting algorithm designed for efficiently evaluating the risk significance of each marker combination, and the other is a sequential permutation scheme for multiple testing correction. We demonstrate the work of our method using a candidate gene data set for cardiovascular and coronary diseases with an injected UBS three‐locus interaction. In addition, we investigate the power and false rejection properties of our method using data sets simulated from a joint dominance three‐locus model that gives rise to UBS interactive effects. The results show that our method can be much more powerful than standard approaches such as trend test and multifactor dimensionality reduction for detecting UBS interactions. Genet. Epidemiol. 34:434–443, 2010. © 2010 Wiley‐Liss, Inc.     

Exploration and practice of the “1 + 10 + 1100000” model

The exploration and practice of the “1 + 10 + 1100000” model of local medical consortium includes three aspects: graded diagnosis and treatment, two‐way referral, and dynamic flow; seamless connection between general practice and specialty to realize health management; and establishment of the “community health center‐East Hospital‐Tongji University” teaching platform.     

Understanding “Good Days” and “Bad Days”: Emotional and Physical Reactivity Among Caregivers for Elder Relatives*

Abstract: Using a daily diary design, we examined fluctuations in caregiver well‐being; how day‐to‐day variations in stressors related to the caregiving experience are linked to fluctuations in well‐being; and whether caregivers who are women, or high on certain personality traits (e.g., neuroticism) are more susceptible to emotional/physical health fluctuations in the face of daily stressors. Sixty‐three caregivers reported on eight consecutive days. Multilevel analyses (Hierarchical Linear Modeling) indicated significant within‐person reactivity. On days when caregivers faced more tasks than usual, more care recipient behavior problems, or more family disagreements regarding care, they experienced more depressive symptoms, feelings of burden, and physical symptoms. Some within‐person patterns of reactivity were moderated by gender and personality. Implications for community interventions for caregivers are discussed.     

Reconciling the theory and reality of shared decision‐making: A “matching” approach to practitioner leadership

Shared decision making (SDM) evolved to resolve tension between patients’ entitlement to make health‐care decisions and practitioners’ responsibility to protect patients’ interests. Implicitly assuming that patients are willing and able to make “good” decisions, SDM proponents suggest that patients and practitioners negotiate decisions. In practice, patients often do not wish to participate in decisions, or cannot make good decisions. Consequently, practitioners sometimes lead decision making, but doing so risks the paternalism that SDM is intended to avoid. We argue that practitioners should take leadership when patients cannot make good decisions, but practitioners will need to know: (a) when good decisions are not being made; and (b) how to intervene appropriately and proportionately when patients cannot make good decisions. Regarding (a), patients rarely make decisions using formal decision logic, but rely on informal propositions about risks and benefits. As propositions are idiographic and their meanings context‐dependent, normative standards of decision quality cannot be imposed. Practitioners must assess decision quality by making subjective and contextualized judgements as to the “reasonableness” of the underlying propositions. Regarding (b), matched to judgements of reasonableness, we describe levels of leadership distinguished according to how directively practitioners act; ranging from prompting patients to question unreasonable propositions or consider new propositions, to directive leadership whereby practitioners recommend options or deny requested procedures. In the context of ideas of relational autonomy, the objective of practitioner leadership is to protect patients’ autonomy by supporting good decision making, taking leadership in patients’ interests only when patients are unwilling or unable to make good decisions.     

Teaching thinking skills: The “what” and the “how” of young children's thinking

This review illustrates current perspectives on young children's thinking, from the viewpoint of developmental psychology. Relevant findings from both cognitive developmental and information processing literatures are discussed. Specific abilities of preschoolers are highlighted, and practical suggestions are offered from both perspectives.     

Low‐Income Fathers and “Responsible Fatherhood” Programs: A Qualitative Investigation of Participants' Experiences*

The authors present the voices of 20 low‐income fathers, all participants in a Responsible Fatherhood (RF) program in a large urban area. A hermeneutic phenomenological methodology was used to document participants' memories of becoming fathers, explain participants' perceptions of the benefits and the barriers to remaining involved with the program, and share participants' suggestions for program improvement. The results provide a preliminary evaluation of the program's services, and we discuss how these findings are helpful to future programmatic and policy initiatives.     

Personality and family disturbances in eating-disorder patients: Comparison of “restricters” and “bingers” to normal controls

Presence of DSM-III-R personality disorders was examined in 67 women with eating disorders (anorexic restricters, anorexic bingers, and bulimics with or without a prior history of anorexia nervosa) and in 25 noneating—disordered women. Additional measures of family functioning were available in 55 of the eating disorders (EDs) and 24 controls. Personality and family disturbances (as measured by the Personality Diagnostic Questionnaire-Revised and the Family Assessment Device) were prevalent among the EDs, but “restricter/binger” differences were not indicated on either measure. Hence results did not support a “restricter/binger dichotomy” concept. They also questioned the degree to which personality problems in ED patients may be consequences of eating disturbances, since severity of personality disorder, while related to reported family dysfunction, was unrelated to severity of eating symptoms.     

“Fourteen Dollars for One Beer!” Pre‐drinking is associated with high‐risk drinking among Victorian young adults

Objective : Pre‐drinking entails consuming alcohol before attending licensed venues. We examined the relationship between pre‐drinking, intention to get drunk and high‐risk drinking among Victorians aged 18–24 years, to consider whether reducing pre‐drinking might ameliorate alcohol‐related harm. Methods : Variables within the 2009 Victorian Youth Alcohol and Drugs Survey (VYADS) dataset were analysed and compared with a thematic interpretation of research interviews involving 60 young adults living in Melbourne. High‐risk drinking was defined as consuming 11 or more standard drinks in a session at least monthly. Results : VYADS data show that pre‐drinking was a significant predictor of high‐risk drinking, even after intention to get drunk was controlled for. The most common explanation provided by interviewees for pre‐drinking was because it is cheaper to purchase alcohol at bottle shops than at bars and clubs. This was particularly emphasised by those who drank at a high‐risk level. Conclusions : The study suggests that people pre‐drink because they desire to be intoxicated, but also that pre‐drinking patterns and product choices exacerbate the likelihood of high‐risk drinking. Reducing availability of cheap packaged alcohol has potential to limit both pre‐drinking and high‐risk drinking among Victorian young adults. Implications : The study adds weight to calls to implement minimum alcohol pricing in Australia.