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Social action theory for a public health psychology.

Many illnesses can be prevented or limited by altering personal behavior, and public health planners have turned to psychology for guidance in fostering self-protective activity. A social theory of personal action provides an integrative framework for applying psychology to public health, disclosing gaps in our current understanding of self-regulation, and generating guidelines for improving health promotion at the population level. A social action view emphasizes social interdependence and interaction in personal control of health-endangering behavior and proposes mechanisms by which environmental structures influence cognitive action schemas, self-goals, and problem-solving activities critical to sustained behavioral change. Social action theory clarifies relationships between social and personal empowerment and helps explain stages of self-change.

Attitude to Health↗

Decisions and attitudes concerning child sexual abuse: does the gender of the perpetrator make a difference to child protection professionals?

OBJECTIVE: An investigation was conducted into whether child protection investigators, specifically social workers and the police, are as likely to take seriously a case of child sexual abuse if it had been perpetrated by a female rather than a male. Also, to examine whether the decisions relating to female-perpetrated abuse were predicted by participants' sex role perceptions of women and their attitudes concerning women's sexualized behavior towards children. METHOD: Participants advocated decisions in response to four hypothetical case of child sexual abuse in which the perpetrator was either male or female. The female perpetrators were then rated on femininity and masculinity characteristics and attitudes concerning women's sexualized behavior toward children were assessed. RESULTS: Following male--rather than female--perpetrated sexual abuse, case registration and imprisonment of the perpetrator was considered more appropriate by all participant groups; male social workers also considered social services involvement and investigation as more appropriate. A substantial number of decisions concerning female perpetrated abuse were predicted by participants' attitudes. CONCLUSION: While child protection professionals considered child sexual abuse perpetrated by females to be a serious issue warranting intervention, a number of advocated decisions suggested that they did not consider female-perpetrated abuse to be as serious as male-perpetrated abuse. The implication is that victims of sexual abuse perpetrated by a woman may be less likely to receive the protection afforded victims of male-perpetrated abuse. Furthermore, professionals' practices may be inadvertently perpetuating the view that female child sexual abuse is rare or less harmful than abuse carried out by males.

Adult↗

Neuropsychological impairments and deficits in theory of mind and emotion recognition in a non-autistic boy.

A 9-year-old non-autistic boy revealed marked deficits in visuo-spatial and visuo-motor skills, in planning and organizational capacities and in impulse inhibition. Particular strengths were his verbal comprehension and reasoning abilities. This neuropsychological pattern of assets and deficits fitted the nonverbal learning disability syndrome as described by Rourke (1989). On a battery of Theory of Mind (TOM) and emotion recognition tests he performed rather poor on several first-order TOM tasks and on all second-order TOM and emotion-matching tasks, compared to samples of autistic and normal subjects. It is suggested that his visuo-spatial and cognitive shifting deficits account for his social cognitive failures, while his superior verbal skills protect him from severe social handicaps.

Affect↗

Healthy practices, social relationships and dental perceptions among US dentate adults.

OBJECTIVE: This study explored and described the effects of healthy practices and social relationships on dental perceptions among U.S. dentate adults. METHODS: Guided by the Alameda County Study: Health and Ways of Living, weighted data from the Third National Health and Nutrition Examination Survey of 8,449 U.S. dentate adults aged 18-64 years were analyzed with SUDAAN 7.5.3. RESULTS: Healthy practices and social relationships showed protective effects against unfavorable dental perceptions after controlling for socio-demographic characteristics, dental access, and related clinical dental status. Besides healthy practices and social relationships, education, family income, having dental visit in the past 12 months, having dental decay, having defective tooth condition, and number of natural teeth helped explain unfavorable dental perceptions in the adjusted model. Compared with persons who had high social relationships and high healthy practices, those who had low social relationships with very low, low and medium healthy practices were about five, times (OR=5.07; 99% CI=3.24, 7.91), almost four times (OR=3.61; 99% CI=2.22, 5.87), and two times (OR=2.24; 99% CI=1.37, 3.67) more likely, respectively, to have unfavorable dental perceptions. In the adjusted model, these odds ratios decreased to three (OR=3.30; 99% CI=2.01, 5.41), two (OR=2.06; 99% CI=1.15, 3.69) and non-significant difference, consecutively. CONCLUSIONS: Influence of healthy practices and social relationships on dental health may encourage dental health professions to participate in general health behavior modifications and social actions to foster social relationships, in addition to preventive dental care.

Adolescent↗

Ethical assumptions and ambiguities in the Americans With Disabilities Act.

The Americans With Disabilities Act (ADA) promotes social justice by protecting disabled persons from discrimination and prejudice. It seeks equality of opportunity for them and protects their well being by giving them fair access to goods, services and benefits. These rights are circumscribed in the ADA, however, by constraints of cost, efficiency, utility, and certain social mores. The ADA offers little direction about how to set priorities when these values come into conflict, or about whether equality or opportunity favors equivalent or preferential treatment for disadvantaged people. Until these ambiguities and potential value conflicts are resolved, a central moral and social problem remains unresolved: How can we demonstrate commitment to the rights and welfare of those with severe disabilities while placing fair limits upon their claims? Five special concerns are discussed: (1) eligibility and the allocation of health care; (2) the meaning of 'qualified but disabled' in employing people with mental disabilities; (3) equal opportunity and problems of envy and malingering; (4) ADA accommodation and public protection through testing and licensure; and (5) ADA protection and problems of backlash. Rather than simply wait to see what courts and administrative agencies decide, we should evaluate the moral conflicts, articulate criteria, and help make some difficult choices on morally defensible grounds.

Beneficence↗

Effects of traumatic events, social support, and self-efficacy on adolescents' self-health assessments.

The purpose of this study was to examine the relationship between adolescents' exposure to traumatic events and their self-health assessments, and to examine the protective effects of social support and self-efficacy on this relationship. Survey results (N = 1,427) indicated that experiencing violent and nonviolent negative life events and being exposed to a disaster were inversely associated with adolescents' positive health assessments. As social support and self-efficacy decreased, adolescents' health assessments worsened. Female and Black adolescents had less favorable health assessments than their male and White counterparts. Findings suggest that traumatic events are predictive of adolescents' health assessments and that social support and self-efficacy prevent adolescents' health assessments from declining following traumatic events.

Adolescent↗

Social risks and child development in South Africa: a nation's program to protect the human rights of children.

Poverty, violence, social inequality, rapid urbanization, the HIV epidemic, and an erosion of traditional values create a challenging environment for development in South Africa. The nation has responded with a range of efforts to promote child welfare, often through efforts to strengthen family functioning. The nation's struggles, failures, and successes at safeguarding the developmental rights of children and providing for their needs offer lessons to others about what can and must be done if they are to live up the obligations assumed as signatories to the United Nations Conventions on the Rights of the Child.

Child↗

Clinicians and caseworkers: issues in consultation and collaboration regarding protective service clients.

From a social systems and family systems perspective, this paper considers the relationships among protective service clients, caseworkers in protective service agencies and clinicians asked to provide mental health services. It argues that effective clinical services often depend on the clinician's understanding of the role of the caseworker, the caseworker's role-related stresses, and the larger system that serves as context for the caseworker-client relationship. Dynamics leading to inappropriate or collusive involvement of clinicians with families and caseworkers are discussed. Special consideration is given to four stress-related issues: issues of assessment and investigation; needs for validation; problems of responsibility and authority; and feelings towards clients. Strategies to help clinicians become more effective collaborators with caseworkers are suggested and the use of a team approach to the provision of clinical services is reviewed.

Burnout, Professional↗

Protective environments and health status: cross-talk between human and animal studies.

Although aging populations tend to have increased prevalence of a diversity of diseases and disabilities, there are substantial numbers of people who, nevertheless, maintain good health into old age. Human studies frequently demonstrate associations between environmental factors, particularly supportive social environments, and positive states of health. Identifying the pathways from protective social environments to reduced disease risk necessitates the use of animal models as a basis of explanation and a source of suggestions for further human research. We present two examples of this kind of cross-talk: (i) the possibility that the success of well-being therapy following pharmacological treatment for depression as a means of preventing recurrent depressive episodes is based on the stimulation of enrichment of dendritic networks in the hippocampus and spine retraction in the basolateral amygdala; (ii) the possibility that the release of intracerebral oxytocin is a mediating factor between persistently supportive social environments and reduced disease in later life, as exemplified by low levels of allostatic load.

Animals↗

Motivational and emotional aspects of the self.

Recent theory and research are reviewed regarding self-related motives (self-enhancement, self-verification, and self-expansion) and self-conscious emotions (guilt, shame, pride, social anxiety, and embarrassment), with an emphasis on how these motivational and emotional aspects of the self might be related. Specifically, these motives and emotions appear to function to protect people's social well-being. The motives to self-enhance, self-verify, and self-expand are partly rooted in people's concerns with social approval and acceptance, and self-conscious emotions arise in response to events that have real or imagined implications for others' judgments of the individual. Thus, these motives and emotions do not operate to maintain certain states of the self, as some have suggested, but rather to facilitate people's social interactions and relationships.

Anxiety↗

Genetic testing for the BRCA1 gene and the need for protection from discrimination: an evolving legislative and social issue.

Genetic testing for the BRCA1 gene is available commercially and clinically. The information gained from this test impacts not only on the individual tested, but on family members as well. The test can offer an individual and their family the opportunity to gain valuable information about their risks of developing certain forms of inherited breast cancer and other inherited cancers. In addition to its emotional and psychological impact, this information is associated with significant social and economic issues. This includes the potential for denial, loss, or increased rates for health insurance as well as denial and loss of employment based on genetic test information. The risk for such discrimination can lead to fear of seeking testing and can discourage participation in and potential benefit from prevention, screening, and treatment programs. Therefore, misuse of this information carries significant risk for the individual being tested and for their family members. It is imperative that the potential benefits of genetic testing and genetic information be afforded to all without this risk and fear. In addition to protecting all individuals from genetic discrimination, there is a need to protect the confidentiality of genetic information and an individual's right to privacy. This article discusses protection currently available through legislation at the federal and state level, focusing on the experience in North Carolina in developing and passing a genetic antidiscrimination bill. Although progress has been made, troublesome issues still remain.

Journal Article↗

Social ties and mental health.

It is generally agreed that social ties play a beneficial role in the maintenance of psychological well-being. In this targeted review, we highlight four sets of insights that emerge from the literature on social ties and mental health outcomes (defined as stress reactions, psychological well-being, and psychological distress, including depressive symptoms and anxiety). First, the pathways by which social networks and social supports influence mental health can be described by two alternative (although not mutually exclusive) causal models-the main effect model and the stress-buffering model. Second, the protective effects of social ties on mental health are not uniform across groups in society. Gender differences in support derived from social network participation may partly account for the higher prevalence of psychological distress among women compared to men. Social connections may paradoxically increase levels of mental illness symptoms among women with low resources, especially if such connections entail role strain associated with obligations to provide social support to others. Third, egocentric networks are nested within a broader structure of social relationships. The notion of social capital embraces the embeddedness of individual social ties within the broader social structure. Fourth, despite some successes reported in social support interventions to enhance mental health, further work is needed to deepen our understanding of the design, timing, and dose of interventions that work, as well as the characteristics of individuals who benefit the most.

Adolescent↗

High-quality television links for home-based support for the elderly.

Since 1991, 17 elderly people have been connected via a broadband video communication system to a telecare centre. The new services used videophones based on domestic television sets, including set-top boxes with cameras and a microphone. The services had the overall aim of promoting the ability of elderly and mobility-impaired people to live independently and to reduce the demand on social service resources required to implement this. Service components included: remote response to emergencies; active information and care; information and assistance service; remote care on demand; remote access to expertise (counselling); training and exercise service; and support for carers. Some 14,000 calls have been made. The important qualitative aspects were: clients' satisfaction; replacement of direct social contacts; privacy and data protection; and improving the effectiveness of social services. For a successful market implementation of video-based social support and telecare services, it is essential to integrate them into existing outpatient services.

Aged↗

[Abortion according to paragraph 218ff. of the German penal code and life support of premature infants from the viewpoint of the pediatrician].

The actual reality of abortion in the Federal Republic of Germany is shocking: in 1984, 100 000-340 00 abortions took place. In contrast to the goals established in the reform of criminal law in Para. 218ff. (StGB) from 1976, unborn life is not protected. Moreover, for "social indications" abortion is being carried out more and more frequently, which results in the killing of new life. Even if the basic laws seem to provide unborn life with a high measure of protection, court decisions regarding abortion according to Para. 218ff. (StGB) indicate that in practice, there is very little protection. The so-called "test-tube baby" enjoys more legal protection than the child begotten in the natural manner. To a certain extent, the paediatrician is confronted with demands to save life. Prematures with a very low birth weight should be kept alive. According to the 1984 records of the Federal Office for Statistics, in the Federal Republic of Germany an average of 147.9 abortions were performed per 1000 children born. For the most part the abortions were performed on account of social indications. Since life begins when the sperm and egg fuse, which is also recognized by basic law 14 days after conception, the paediatrician in particular must feel himself responsible for life yet unborn. However, the paediatrician must also stand up for the disabled child and its right to life, because Para. 218ff. did not intend to eliminate disabled children from society.

Abortion, Induced↗

Relations of gestational length and timing and type of incomplete pregnancy to ovarian cancer risk.

While the protective nature of parity with respect to ovarian cancer has been well documented, whether a history of incomplete pregnancy affects ovarian cancer risk is uncertain. Data collected from 739 epithelial ovarian cancer cases and 1,313 community controls in the Delaware Valley from 1994 to 1998 were used to evaluate the relation between gestational length and timing of first induced or spontaneous abortion and ovarian cancer risk. Incomplete pregnancy was not associated with ovarian cancer among nulliparous women or among ever-pregnant women either before or after adjustment for relevant confounders (for nulliparous women, odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.66, 1.89; for ever-pregnant women, OR = 0.95, 95% CI: 0.76, 1.18). Among unigravid women, one full-term pregnancy was more protective than an incomplete pregnancy (adjusted OR = 0.29, 95% CI: 0.15, 0.57). These results were independent of the type of pregnancy loss. Among ever-pregnant women, a spontaneous abortion before a first birth provided significant protection (adjusted OR = 0.47, 95% CI: 0.30, 0.75), while no significant effect was found for an induced abortion prior to a first birth (adjusted OR = 0.80, 95% CI: 0.44, 1.47). These data do not support an independent association between incomplete pregnancies, either spontaneous or induced, and ovarian cancer risk.

Abortion, Induced↗

Health data use and protection policy; based on differences by cultural and social environment.

On April 22, 1999, the Japanese Ministry of Health and Welfare proposed electronic preservation of all clinical records. Simultaneously, deliberations on legislation on data disclosure and privacy protection were held. To promote these movements, electronic use of Personal Health Data (PHD) is indispensable, and the system development is on its way to meet rising demands. Indigenous Japanese did not have a word to describe the concept of privacy. It was only in the 1960s when we became aware of that. In this article, the protection policy for data use will be discussed from a Japanese perspective compared with those in other nations, giving an example of the hospital management system under construction at the Hiroshima University Hospital.

Confidentiality↗

Risk and protective factors for depressive symptomatology among a community sample of adolescents and young adults.

OBJECTIVES: The study explores the risk and protective factors for current depressive symptomatology in a large community sample of 15-to-24-year-olds. METHODS: The study was designed as a cross-sectional household survey, which used telephone recruitment followed by an anonymous self-report postal questionnaire. The final sample included 3,082 adolescents and young adults from Queensland, Australia. RESULTS: The vast majority of measured risk and protective factors were associated with current depressive symptomatology. Key risk factors included high levels of neuroticism, perceived problems with parents, sexual abuse, relationship break-ups, educational failure and sexual identity conflict. A different profile of protective factors was evident for each of these high-risk groups. Of particular note was the importance of well-developed intrapersonal skills as protective for both males and females. The significance of social connectedness as a protective factor for the males overall and across a range of high-risk groups was a central finding. CONCLUSIONS AND IMPLICATIONS: The implications of these findings in relation to a range of mental health promotion and mental illness prevention and early intervention initiatives are discussed. Supported initiatives include parenting programs that consider the realities of modem families, increasing community awareness of the impact on young people of the breakdown of their intimate relationships, initiatives in educational settings and workplaces to increase tolerance of gay/lesbian and bisexual lifestyles and the enhancement of social connectedness.

Adolescent↗

Homelessness and vulnerability among adults with and without alcohol problems.

While many works compare traits of homeless adults across levels of alcohol use, few specifically consider whether drinking status affects determinants of either homelessness or "vulnerability" to homelessness. This paper relies on a 1986 Chicago, Illinois sample (n = 535) to consider the potential contributions of resources, social network characteristics, disaffiliation, and mental health problems. Results suggest that resource problems may determine homelessness regardless of drinking status. But drinking-associated problems may raise the resource threshold for "vulnerability," reduce the protection afforded by social networks against both homelessness and "vulnerability," increase the deleterious impact of disaffiliation, and spur complicating mental health problems.

Adult↗