Caring for a young adult with cancer: the impact on mothers' health

That the carers of people with cancer are profoundly affected by their caring role is well established, yet the needs of one particular cohort, i.e. the parents of young adults with cancer, have not been well understood. The majority of carers in this situation are mothers, and it is the impact of the emotional and physical labour entailed by the care of young adults that is the focus of the present paper. Through the analysis of qualitative narrative data contributed by the mothers of young adults with cancer, the aim of this paper is to examine the health effects for women of caring for a young adult son or daughter with a life-threatening illness. The results suggest that there is an impact on the mother's health that results in unspecific, low-grade and chronic psychological and somatic symptoms which the mothers rank as a low priority. The mothers' attempts to appear to be managing may serve to mask their own health needs from health professionals whose primary concern is the health of the son or daughter. Where psychological distress is admitted, the resulting use of prescribed antidepressants may not be experienced as helpful. The conclusions are that, because of the particular circumstances of caring for a young adult son or daughter with cancer, health professionals' attention to the mothers' health throughout the cancer journey may act as a preventative measure for later and more serious ill health.     

Perceived,anticipated and experienced stigma: exploring manifestations and implications for young people’s sexual and reproductive health and access to care in North-Western Tanzania

Abstract

Young people – particularly girls and young women in sub-Saharan Africa – face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people’s sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people’s sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people’s sexual and reproductive health programmes.     

Lives Deferred? Exploring Social Disconnection and Perceived Quality of Life Among Young Adults Residing in a Long-Term Care Facility

This qualitative study explores the perceptions of young adults concerning their experiences in a long-term care facility. Qualitative data were gathered via 15 intensive semistructured interviews with participants ages 18–45. Three dominant themes emerged: (a) social and family disengagement, (b) nonstimulating activities, (c) inadequate finances, and (d) the nature of resident/staff relations. Theoretical implications of empowerment theory, as well as implications for increasing social support and reducing barriers to service delivery for younger underserved residents, are discussed.     

Perceptions About the Impact of Cigarette Filters on the Environment and Smoking-Related Behaviors

PurposeExamine adolescents’ and young adults’ (AYAs) knowledge and perceptions about the composition and environmental harms of cigarette filters and determine how perceptions are associated with support for policy interventions.MethodsCross-sectional, convenience sample from 10 California schools. AYAs (N = 429; 70% < 21 years) were surveyed about tobacco use, perceptions of cigarette filters, their impact on the environment, and cigarette sales bans.ResultsMost agreed that filters are harmful to the environment and not biodegradable (89%, n = 383 respectively); fewer knew filters are made of plastic (43%, n = 185). AYAs who agreed that filters are harmful to the environment were more supportive of cigarette sales bans (OR = 2.78 [95% CI: 1.18, 6.58]).ConclusionsKnowledge of the environmental harms of cigarettes among AYAs may strengthen support for tobacco control. More research is needed to further understand the knowledge and attitudes about the environmental impact of tobacco and to clarify how this might add support for tobacco-related policies.     

河北省未婚青年生殖健康服务需求调查

为了解对未婚青年提供性和生殖健康服务的观念、态度、看法,确定未婚青年对避孕、性和生殖健康服务的需求及向他们提供服务存在的困难,探讨可接受及可行的服务方法,并提出政策建议,河北省计划生育研究所在石家庄对四类未婚青年进行了座谈讨论及个人深入访谈。结果表明:婚前性行为和人工流产的现象是存在的,多数未婚女青年认为是不该发生的事情,未婚男青年则反应平淡;应加强对未婚青年进行性、避孕、性知识方面的教育;未婚青年发生婚前性行为应该使用避孕措施;有必要为未婚青年开设生殖健康咨询服务点;根据调查结果对如何为未婚青年提供生殖健康服务提出了建议。     

Variations in health behaviours among inner city 12‐year‐olds from four ethnic groups

Objectives. To describe factors that contribute to variations in health‐related behaviours and attitudes among inner city 12‐year‐olds. To see if there was an identifiable patterning by ethnic group.

Design. Semi‐structured interviews with a stratified sample of 12‐year‐old students and their parents from four ethnic groups, attending state secondary schools in two inner London boroughs.

Results. Bangladeshi young people were significantly more likely to receive school meals. There was no variation in reported snacking between the groups. Girls and Bangladeshi students were less likely to report exercising outside school (33% of Bangladeshi boys reported not exercising outside school compared to 5% of boys from all other groups). Bangladeshi boys and their parents were more likely to report that bullying or worries about racial violence prevented them from going out after school. White young people were more likely to report experimenting with and the regular use of cigarettes and alcohol. Use of alcohol and cigarettes was also associated with gender, religion and strength of religious observance. White parents were the least likely to report restricting their child's social activities as a way of influencing behaviour and expressed more concerns about their child's potential for health‐damaging behaviour than parents in all other groups.

Conclusion. This study shows that ethnicity alone is insufficient and inadequate in explaining variations in health behaviours among inner city teenagers. A complex mix of personal, cultural and social factors including ethnicity shape the behaviours and attitudes of these young people.     

Making choices about support services: disabled adults' and older people's use of information

This paper explores how disabled adults and older people find and use information to help make choices about services. It presents findings from a qualitative longitudinal study in England. Thirty participants had support needs that fluctuated, meaning that additional services might be needed on a temporary basis; and 20 had the sudden onset of support needs resulting from an accident or rapid deterioration in health. Each disabled adult or older person was interviewed three times between 2007 and 2009, using a semi-structured topic guide. They were asked to discuss a recent choice about services, focussing, amongst other things, on their use of information. Interviews were transcribed and coded, then charted according to emergent themes. A wide range of choices and sources of information were discussed. These were dominated by health and to some extent by social care. Key findings are that information was valuable not just in weighing up different service options, but as a precondition for such choices, and that disabled adults and older people with the gradual onset of support needs and no prior knowledge about services can be disadvantaged by their lack of access to relevant information at this pre-choice stage. Timely access to information was also important, especially for people without the support of emergency or crisis management teams. Healthcare professionals were trusted sources of information but direct payment advisers appeared less so. Ensuring that practitioners are confident in their knowledge of direct payments, and have the communication skills to impart that knowledge, is essential. There may be a role also for specialist information advocates or expert lay-advisers in enabling disabled adults and older people to access and consider information about choices at relevant times.     

“The pediatric social worker really shepherds them through the process”: Care team members' roles in transitioning adolescents and young adults with HIV to adult care

Increasing numbers of adolescents and young adults (AYA) with HIV need to transition from pediatric to adult infectious disease care. Little research has examined the roles of the care team members in the transition process. Nineteen pediatric and adult providers with experience caring for HIV-infected AYA were interviewed to explore their perspectives on the roles of care team members on multidisciplinary pediatric and adult infectious disease teams. Interviews were transcribed and coded for emergent themes by independent reviewers. All care team members played important roles in the transition process. Qualitative analyses indicated that pediatric social workers played an especially pivotal role in facilitating the transition of AYA with HIV from pediatric to adult care. Pediatric social workers communicated with other providers and prepared the adolescent and family for the upcoming transition. Both pediatric and adult social workers engaged in assessment of psychosocial functioning and facilitated referrals to community resources. Social workers in the adult infectious disease clinic helped the adolescent and family adjust to the new setting. Pediatric medical providers supported the patient and family during transition and communicated pertinent medical information to the family and medical provider in the adult clinic. Participants stated that the role of the adult medical provider was to welcome the newly transition adolescent into the clinic and to obtain a new comprehensive medical history including sexual behavior. Findings offer insight into the roles held by various members of teams associated with the transition of AYA living with HIV from pediatric to adult care. The effectiveness of medical care teams can influence the quality of care provided to patients and can be improved by understanding team roles.     

Nae job,nae future: young people and health in a context of unemployment*

There is increasing concern about the health, particularly mental health, of young people and the factors that affect it. Drawing on data from the West of Scotland Twenty-07 Study: Health in the Community, this paper describes the pattern of health in a cohort of about 1000 young people between the ages of 15 and 21, within a context of their experience and expectations of unemployment. Contrary to assumptions of healthiness, high levels of poor physical and mental health were found, with a third of males and two-fifths of females exhibiting evidence of psychological morbidity at age 18. Poorer mental health was strongly linked to the experience of unemployment and being at home, the latter predominantly involving females. This effect was confirmed in multivariate analysis, which controlled for prior health. In addition, an expectation of being unemployed in the future was associated with poorer mental health. For many young people entering the labour market, the prospects of limited employment opportunities and associated risks to health are a major public health concern. In setting their needs firmly on the policy agenda, and planning appropriate services, these broader social issues should not be forgotten.     

Teenagers, young people and family planning: a survey in five Romanian high schools

Family planning was for a long time prohibited in Romania. This has reduced the demand for contraceptives. Even though contraceptives were made accessible and their use promoted since the beginning of December 1989, abortion has still been the preferred form of fertility regulation, as the people of Romania are unaware of the advantages of contraception. The purpose of the present survey was to assess the level of sexual knowledge, attitudes and practice of teenagers and young people from urban areas of Romania and to identify if there was any significant difference in terms of age, education and sexual activity. A baseline examination was undertaken in which data were collected from 279 students who attended five high schools and six post high schools from the Moldavia cities, Iassy, Piatra-Neamt and B?rlad. Students were asked to complete a self administered questionnaire, and a 97.5% response rate for the whole survey was achieved. Difference between answers were tested using chi-square test from 2x2 table and median test, average. A P-value <0.05 was considered to be significant. The study established that knowledge, attitudes and practice vary by age (adolescents (< or =19y) vs young people (>19y)) and education (high school vs post high school) in some regards. At the aggregate level, regarding knowledge, a statistically significant difference was found between adolescents and young people; but no statistically significant difference was found between high school and post high school students. Apart from lack of basic knowledge the study confirmed that many false beliefs regarding contraceptives are held by the survey participants. People who were sexually active were no better informed than the rest of survey participants, but they had a significantly higher percentage of positive attitudes regarding effectiveness of pills and withdrawal. Both, the knowledge and attitudes of students necessarily required appropriate sex education which, ideally should be introduced before young people become sexually active.     

Sexual behaviour and self‐reported sexually transmitted diseases (STDs): Comparison between White and Chinese American young people

This study examined the sexual behaviour and self‐reported incidence of STDs of White and Chinese American young people in a nationally representative US sample. 10,419 White and 340 self‐identified Chinese American young people in grade 7 through 12 were selected from the National Longitudinal Study of Adolescent Health. Prevalence of sex initiation, ever having casual sex partners, number of lifetime sex partners, age of first sexual intercourse, and history of self‐reported STD diagnoses were compared between these two groups. Chinese American young people reported significantly lower rates of sexual intercourse than Whites. Among sexually active young people, Chinese Americans were also less likely to report non‐regular sexual partners and to report having a lower number of such sexual partners in the past year. There was no difference in self‐reported STDs between the two groups. Ever having been romantically involved, older age, not living in a two‐parent household, having more relaxed attitudes about sex, and reported substance use were associated with a higher likelihood of sexual intercourse in both groups. Being native‐born was not associated with patterns of sexual behaviour among Chinese Americans.