The paradox of “wonderful children”: The case of child abuse

In our society young children are generally considered to be “wonderful”. This dominant concept pervades not only parental thinking, but professional thinking as well. In the case of child abuse, however, profound contradictions can arise as a result. Professionals are primarily focused on children's welfare, while parents' views are much more ambiguous.

In our example of a Family Centre these contradictions are clearly illustrated, and we hope to draw conclusions as to what change in theory and practice could result from an analysis of contradictions.     

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.     

A Couplehood Typology for Spouses of Institutionalized Persons With Alzheimer's Disease: Perceptions of “We”–“I”*

A qualitative analysis of 68 community‐dwelling spouses of institutionalized patients with Alzheimer's disease was conducted. The goal was to ascertain to what degree they perceived themselves as married. Five groups representing different degrees of couplehood emerged. Ranging from strong couplehood to no couplehood, groups were given the following terms: “’Til Death Do Us Parts,”“We, but …,”“Husbandless Wives/Wifeless Husbands,”“Becoming an I,” and “Unmarried Marrieds.” Ways to interpret this typology and implications for both further research and practitioners are described.     

“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.     

“We're Very Careful …”: The Fertility Desires and Contraceptive Behaviors of Cohabiting Couples

A growing proportion of nonmarital births are to cohabiting couples, though childbearing is more common among moderately educated cohabitors than among cohabiting college graduates. In this study reasons for social class divergence in fertility behavior are explored. Data are from semistructured interviews with 30 working‐class and 31 middle‐class cohabiting couples. The authors inquired about readiness for parenthood, contraceptive usage, and concurrence about childbearing plans and contraception. Middle‐class couples generally utilized the most effective methods, often relied on two methods, concurred regarding fertility goals, and reported contracepting consistently. Among the moderately educated, contraceptive utilization was lower and reliance on less effective methods greater; they expressed greater ambivalence about preventing conception and discussed contraception less than their middle‐class counterparts. Less educated respondents also mentioned forgetfulness and cost as reasons for sporadic contraceptive use. The study results highlight the need to deepen understanding of how relational processes and couple dynamics contribute to pregnancy avoidance or conception.     

“If Only Someone Had Told Me …”: Lessons From Rural Providers

Purpose: Health care providers face challenges in rural service delivery due to the unique circumstances of rural living. The intersection of rural living and health care challenges can create barriers to care that providers may not be trained to navigate, resulting in burnout and high turnover. Through the exploration of experienced rural providers’ knowledge and lessons learned, this study sought to inform future practitioners, educators, and policy makers in avenues through which to enhance training, recruiting, and maintaining a rural workforce across multiple health care domains. Methods: Using a qualitative study design, 18 focus groups were conducted, with a total of 127 health care providers from Alaska and New Mexico. Transcribed responses from the question, “What are the 3 things you wish someone would have told you about delivering health care in rural areas?” were thematically coded. Findings: Emergent themes coalesced into 3 overarching themes addressing practice‐related factors surrounding the challenges, adaptations, and rewards of being a rural practitioner. Conclusion: Based on the themes, a series of recommendations are offered to future rural practitioners related to community engagement, service delivery, and burnout prevention. The recommendations offered may help practitioners enter communities more respectfully and competently. They can also be used by training programs and communities to develop supportive programs for new practitioners, enabling them to retain their services, and help practitioners integrate into the community. Moving toward an integrative paradigm of health care delivery wherein practitioners and communities collaborate in service delivery will be the key to enhancing rural health care and reducing disparities.     

Partitioned association-linkage test: distinguishing “necessary” from “susceptibility” loci

Marker allele-disease association and linkage between a disease locus and a marker locus are two different phenomena. Linkage without evidence of association and association without evidence of linkage are possible observations. Linkage analysis uses marker loci and the phenomenon of recombination to look for disease-related loci which are presumably major contributors to disease expression (“necessary” loci). However, the phenomenon of association is more complex. One explanation for the existence of an association is that there is a “necessary” locus in linkage disequilibrium with a marker locus. Another explanation is that the marker locus itself (or a closely linked locus in linkage disequilibrium with the marker) is a “susceptibility” locus, which increases the probability of contracting the disease but is not necessary for disease expression. Although there are other possible explanations for the existence of an association, these two can lead to different results when family data from a disease showing association are analyzed for linkage between the associated marker and the disease. If the linkage disequilibrium hypothesis is correct, there will be evidence for linkage. If the susceptibility locus hypothesis is correct, there may be strong evidence against linkage. In this work, we explore a method that could indicate whether an association is due to a susceptibility locus or a necessary locus. We show that, by dividing families based on the presence or absence of the associated marker allele in a randomly chosen affected sib, calculating lod scores, and then calculating a heterogeneity statistic, we could distinguish whether linkage data came from a susceptibility locus or a necessary locus. © 1996 Wiley-Liss, Inc.     

“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.     

The Sexuality and Disability Unit: Applications for Group Training

In 1976, the Sex and Disability Unit of UCSF's Human Sexuality Program received two three-year grants from the National Institute of Mental Health and the Department of Health, Education, and Welfare to train two specific population segments. The NIMH grant funded the development and training of a year-long socio-sexual, peer counselor-educator project in the field of sexuality and disability. The DHEW family life education training module targeted nationwide participants working with special education populations in a four-day workshop format. In this presentation I will discuss those two projects and necessity for the existence of such projects in the field of sexuality and disability today.