“A Conscious Control Over Life and My Emotions:” Mindfulness Practice and Healthy Young People. A Qualitative Study

PurposeAlthough quantitative benefits of mindfulness training have been demonstrated in youth, little is known about the processes involved. The aim of this study was to gain a detailed understanding of how young people engage with the ideas and practices known as mindfulness using qualitative enquiry.MethodsFollowing completion of a six-week mindfulness training program with a nonclinical group of 11 young people (age 16–24), a focus group (N = 7) and open-ended interviews (n = 5) were held and audio-recorded. Qualitative data, collected at eight time points over three months from the commencement of training, were coded with the aid of computer software. Grounded theory methodology informed the data collection process and generation of themes and an explanatory model that captured participants' experiences.ResultsParticipants described their daily lives as beset by frequent experiences of distress sometimes worsened by their unhelpful or destructive reactions. With mindfulness practice, they initially reported greater calm, balance, and control. Subsequently they commented on a clearer understanding of themselves and others. Mindfulness was then described as a “mindset” associated with greater confidence and competence and a lessened risk of future distress.ConclusionsParticipants demonstrated a sophisticated understanding of and engagement with mindfulness principles and practice. Their reported experience aligned well with qualitative research findings in adults and theoretical literature on mindfulness. An encouraging finding was that, with ongoing mindfulness practice and within a relatively short time, participants were able to move beyond improved emotion regulation and gain greater confidence in their ability to manage life challenges.     

“Making Room”: A Thematic Analysis Study of the Process of Postpartum Maternal Adjustment

Maternal and Child Health Journal - Mothers are especially vulnerable to the onset or recurrence of psychological symptoms during the postpartum period. However, protective psychosocial factors may...     

“Power of Mom”: A Mixed Methods Investigation of Mothers’ Influence on Women’s Contraceptive Attitudes and Behaviors

Maternal and Child Health Journal - Unintended pregnancy is an individual and public health problem with significant social and economic consequences. The literature has established that parents,...     

Insulin and the “Thrifty” Woman: The Influence of Insulin During Pregnancy on Gestational Weight Gain and Postpartum Weight Retention

Objectives: To test Neel's hypothesis among pregnant women: a high maternal insulin concentration in early pregnancy increases the risk of weight gain, overweight, and obesity among nondiabetic, low-income gravidas of racial and ethnic minority groups from Camden, New Jersey. Methods: Fasting insulin was obtained from 461 gravidas at entry to prenatal care. Insulin quartile was related to rate of gestational weight gain and excess weight gain during pregnancy (90th percentile) and to retained weight and excess weight retention at 4–6 weeks postpartum (90th percentile). The relationship between excess retained weight and excessive insulin increase (90th percentile) was also examined. Results: Compared with gravidas with an insulin concentration in the lowest three quartiles, gravidas with the highest insulin quartile had a significantly higher rate of gestational weight gain (nonobese women only) and average weight retained postpartum (all women). Compared with an insulin concentration in the lowest three quartiles, the highest insulin quartile was associated with a 2.05-fold (95% confidence interval [CI] = 1.07–3.93) risk of an excessive rate of gestational weight gain and a 3.58-fold (95% CI = 1.87–6.84) risk of excess weight retained postpartum. Excess weight retained postpartum was linked to a 2.63-fold (95% CI = 1.00–6.89) risk of an excessive increase in insulin concentration postpartum. Conclusions: Our results support Neel's hypothesis and suggest that a high maternal insulin concentration is associated with increased gestational weight gain and increased weight retention postpartum. High insulin concentration may contribute to pregnancy-related changes in weight and thus may be linked to maternal overweight and obesity postpartum as well as to future risk of gestational and Type 2 diabetes mellitus.     

Influence of Behavioral and Environmental Factors on the Development of Obesity in Three-year-old Children —A Case-Control Study Based on Toyama Study—

Obesity in children seems to be a risk factor for chronic diseases in adulthood. From the viewpoint of preventive medicine, factors influencing the development of obese children should be removed early in life. The purpose of this study was to the elucidate relationship between obesity in 3-year-old children and both behavioral and environmental factors by conducting a case-control study. Subjects were selected from the Toyama study. Matched-pair comparisons were performed between obese children whose Kaup’s index was 18 or more (N=117) and control children (N=234) . Multivariate stepwised logistic regression analysis also applied to assess influence of confounding factors. The results indicated that the following 6 factors significantly influenced the development of obese 3-year-old children in exact Fisher’s method analysis (p<0.05): person other than the mother responsible for taking care of the child, short sleep duration (9 hours or less), physical inactivity, eating snacks irregularly, overweight father (BMI≥24), and overweight mother (BMI≥24). For both sexes, after adjusting for confounders by multivariate stepwise logistic analysis, overweight mother (OR 2.54, 95 % CI 1.64-3.95), birth overweight (birth weight≥3,500g; OR 1.76, 95 % CI 1.15-2.69), the mother not responsible for taking care of the child (OR 1.65, 95% CI 1.10-2.48), overweight father (OR 1.62, 95%CI 1.09-2.40), eating snacks irregularly (OR 1.56, 95% CI 1.04-2.33), and gender (female;OR 0.51, 95% CI 0.34-0.77) had significant relationships with obesity in childhood. For boys, overweight mother (OR 2.53, 95 % CI 1.47-4.35), birth overweight (OR 2.03, 95%CI 1.22-3.39), eating snacks irregularly (OR 1.94, 95 %CI 1.19-3.18), and birth month (36-41 months; OR 0.47, 95 % CI 0.23-0.96) had significant relationships. For girls, overweight mother (OR 2.62, 1.28-5.35), and short sleep duration (OR 2.24, 1.11-4.52) had significant relationships. In neither Fisher’s exact method nor multivariate logistic models, time to wake up, bedtime, duration of playing outdoors, regularity of meals, care about salty food, or frequency of eating snacks had significant relations with obesity in 3-year-old children (p<0.05).     

Body Sovereignty and Body Liability in the Wake of an “Obesity Epidemic”: A Poststructural Analysis of the Soda Ban

Public discourse about the 2012 soda ban proposal and its eventual dissolution offers a useful context for interrogating how discursive processes constitute and regulate normality, risk, and obesity. Using poststructural sensibilities, I critique the soda ban and public discourse about it. Although architects of the soda ban and its proponents challenged the neoliberal narrative of free choice by self-governing citizens, their efforts were stymied by (1) arguments that offered a minimalist role for the state in regulating health, and (2) contemporary anxieties about losing the ability to self-determine what to let into the body. This analysis renders visible power struggles that inform cultural understandings of what produces good health and who is responsible for its maintenance. Ultimately, I argue that soda ban discourse constructs the body as a liability and is situated in a current cultural fixation on body sovereignty. My analysis of these two axes has implications regarding the limits of biopower and the ways the body is configured in the current political economy and the conventional neoliberal imaginary.     

Living on the Edge of Being Overstretched—A Norwegian Qualitative Study of Employed Pregnant Women

In this study, our aim was to explore female employees’ experiences of work during pregnancy and their expectations of becoming a mother for the first time. We conducted 10 interviews and analyzed the data using qualitative content analysis. The main finding, living on the edge of being overstretched, contained two themes: being exhausted by adapting to professional life and being prepared for becoming a mother. In order to increase the well-being of pregnant employees, women should be provided with information from their supervisors and health care services about pregnancy-related life changes.     

“It Makes You Rethink Your Choice of the Pill”: Theory-Based Formative Research to Design a Contraceptive Choice Campaign

Half of all pregnancies in the United States remain unplanned despite improved access to highly effective long-acting reversible contraception, including the intrauterine device and the implant. This study conducted theory-based formative research to develop a contraceptive choice campaign aimed at increasing long-acting reversible contraception uptake by women ages 18–44 years in Charleston, South Carolina, an urban area in the southeastern United States. Researchers developed and tested message concepts and designs. Six focus groups and 18 interviews were conducted among reproductive-age women (n = 79). Qualitative data analysis revealed messages and designs that resonated with these women. Emphasizing long-acting reversible contraception as the healthy option, highlighting long-acting reversible contraception effectiveness, including relatable and trustworthy characters, and using language of control emerged as themes. Women reported a preference for statistics illustrating effectiveness combined with empowering messages of control over contraceptive decision making. Findings from this study offer practical recommendations for developing contraceptive choice campaigns targeting long-acting reversible contraception use and further the goal of reducing unintended pregnancy among women.     

How can Primary Care Physicians Best Support Contraceptive Decision Making? A Qualitative Study Exploring the Perspectives of Baltimore Latinas

ObjectivesU.S. Latinas experience disproportionately high rates of unintended pregnancy and low rates of consistent contraception use. Not well known are Latinas' perspectives about how primary care physicians (PCPs) might facilitate or deter contraceptive decision making. The theory of planned behavior has been used previously to explain contraceptive behaviors. This study used the theory of planned behavior as a guide to help describe Latinas' perspectives regarding specific factors that influence their contraceptive decision making and to describe their perspectives about the role of PCPs in the decision making.Study Design and MethodsWe conducted focus groups (n = 3) and interviews (n = 8) of Latinas ages 15 to 24 years, recruited from urban primary care sites in Baltimore, Maryland. Concepts from the theory of planned behavior were used to develop a coding scheme and guide identification of themes.ResultsSixteen Latinas participated; all were immigrants.ThemesThe desire to avoid unintended pregnancy is dominant and, not surprisingly, is the main driver of contraceptive intentions. The role of PCPs in contraceptive decision making is to build strong patient relationships through heightened communication and trust. PCPs should develop trust and foster communication by using a shared decision-making approach in contraceptive counseling. Religious norms rarely operate as barriers to contraceptive use, yet positive reinforcement from family, friends, and schools is viewed as supportive.Conclusions and ImplicationsFor this group of young, immigrant Latinas, there is a pervasive desire for effective communication and trusting relationships with PCPs. Findings suggest that providers can facilitate contraceptive decision making for this population by using a shared decision-making approach to contraceptive counseling.     

Patient Preferences in Surveillance: Findings From a Discrete Choice Experiment in the “My Follow-Up” Study

ObjectivesApproximately 800 000 people die globally from colorectal cancer (CRC) every year. Prevention programs promote early detection, but for people with precancerous lesions, tailoring surveillance to include lifestyle-change programs could enhance prevention potential and improve outcomes.MethodsThose with intermediate or high-risk polyps removed during CRC screening colonoscopy within the Northern Ireland CRC Screening Programme were invited to complete 8 discrete choice questions about tailored surveillance, analyzed using random-parameters logit and a latent class modeling approach.ResultsA total of 231 participants (77% male) self-reported comorbid hypertension (53%), high cholesterol (48%), and mean body mass index of 28.7 (overweight). Although 39% of participants were unaware of their CRC risk status, 30.9% indicated they were already making changes to reduce their risk. Although all respondents were significantly risk- and cost-averse, the latent class analysis identified 3 segments (classes):1. Class 1 (26.8%) significantly favored phone or email support for a lifestyle change, a 17-month testing interval, and noninvasive testing.2. Class 2 (48.4%) preferred the status quo.3. Class 3 (24.7%) significantly favored further risk reduction and invasive testing.ConclusionsThis is the first documented preference study focusing on postpolypectomy surveillance offering lifestyle interventions. Although current care is strongly preferred, risk and cost aversion are important for participants. Latent class analysis shows that some respondents are willing to change diet and lifestyle behaviors, reflecting a teachable moment, with opportunities to personalize and optimize surveillance. Significant discordance between perceived and known risk of recurrence and limited recall of risk information provided within current practice suggest necessary improvements to surveillance programs.     

Endometriosis and Organochlorinated Environmental Pollutants: A Case–Control Study on Italian Women of Reproductive Age

Background

Endometriosis is a common gynecologic disease characterized by the ectopic growth of endometrial tissue. In industrialized countries, it affects approximately 10% of women of reproductive age. Its etiology is unclear, but a multifactorial origin is considered to be most plausible. Environmental organochlorinated persistent pollutants, in particular dioxins and polychlorinated biphenyls (PCBs), have been hypothesized to play a role in the disease etiopathogenesis. However, results of studies carried out on humans are conflicting.

Objective

We evaluated the exposure to organochlorinated persistent pollutants as a risk factor for endometriosis.

Methods

We conducted a case–control study in Rome on 158 women comprising 80 cases and 78 controls. In all women, serum concentrations of selected non-dioxin-like PCBs (NDL-PCBs) and dioxin-like PCBs (DL-PCBs), 1,1-dichloro-2,2,-bis(4-chlorophenyl)-ethene (p,p′-DDE), and hexachlorobenzene (HCB) were determined by ion-trap mass spectrometry. DR-CALUX bioassay was employed to assess the 2,3,7,8-tetrachlorodibenzo-p-dioxin toxicity equivalent (TEQ) concentrations of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and DL-PCBs.

Results

We found an increased risk of endometriosis for DL-PCB-118 [odds ratio (OR) = 3.79; 95% confidence interval (CI), 1.61–8.91], NDL-PCB-138 (OR = 3.78; 95% CI, 1.60–8.94), NDL-PCB-153 (OR = 4.88; 95% CI, 2.01–11.0), NDL-PCB-170 (OR = 3.52; 95% CI, 1.41–8.79), and the sum of DL-PCBs and NDL-PCBs (OR = 5.63; 95% CI, 2.25–14.10). No significant associations were observed with respect to HCB or to the sum of PCDDs, PCDFs, and DL-PCBs given as total TEQs.

Conclusions

The results of this study show that an association exists between increased PCB and p,p′-DDE serum concentrations and the risk of endometriosis.     

Grading the “Good” Body: A Poststructural Feminist Analysis of Body Mass Index Initiatives

This article analyzes discourse surrounding Arkansas's legislation requiring public schools to measure students' body mass index (BMI) annually and to send the scores to parents on children's report cards. Using poststructural feminist sensibilities, I explore the tensions experienced by parents, children, educators, and policymakers as this mandate was debated and implemented. The discourse illuminates salient issues about disproportionate disparities in health status that exist in communities with fewer resources, and the potentially unintended gendered consequences of health policies. I explain three dominant threads of discourse: How the economic costs of childhood obesity opened a policy window for the legislation; the presence of tensions between freedom and social control; and how BMI discourses inscribe ideological visions of bodies. Ultimately, the analysis offers insight into the discursive nature of policymaking and how class and gender are implicated in health interventions.     

Physicians’ Decision Making on Adoption of New Technologies and Role of Coverage with Evidence Development: A Qualitative Study

Objectives

To foster value-based pricing and coverage with evidence development in Germany, certain new diagnostic and treatment methods have been subject to a benefit assessment since 2016 to determine their reimbursement. Although this is a paradigm shift, the German approach is limited to some few specific technologies for which reimbursement is requested. As physicians encounter this regulatory instrument, the aim of the study was to understand physicians’ decision making regarding the adoption of new medical technologies and to identify their perspectives on the evidence base and financing with additional reimbursement systems.

“Positive Deviants”: A Qualitative Study of Physically Active Adults in Rural Environments

Rural residents, particularly those in the South, are less physically active than their urban counterparts and often live in areas with limited walkability (e.g., no sidewalks) and minimal access to recreational facilities. The purpose of this study was to gain an understanding of what makes certain rural residents physically active despite their environment. Qualitative interviews (N = 29) were conducted with physically active adults who live in rural areas (e.g., outside of town) in southwest Georgia. Participants were 65.5 % male and 24.1 % African American, with a mean age of 55.9 years. Results suggest that physically active adults in rural areas are motivated by their health and perceive their local surroundings as a resource for physical activity. Understanding how these physically active adults take advantage of their living situations to be physically active has the potential to inform interventions that encourage physical activity in this high-risk population.