Domestic Violence Counseling in Rural Northern China: Gender, Social Harmony, and Human Rights.

Domestic violence (DV) affects over a third of Chinese women in a relationship. Focusing on ethnographic data from six staff members and six DV survivors at a rural, state-affiliated women's center in China in 2010, this article relies on Henrietta Moore's notion of the poststructuralist gendered subject to examine how the staff draw on discourses about gender and social harmony in persuading women to stay in their marriages, rather than on human rights discourses that emphasize survivor safety. It shows that DV survivors are frequently sent back to dangerous homes where their health is placed at risk.

How do peer coaches improve diabetes care for low-income patients?: a qualitative analysis.

PURPOSE: The purpose of the study was to explore the perspectives and roles of peer coaches, who are patients with diabetes trained to provide diabetes self-management support (DSMS) to other patients. METHODS: A focus group and 17 qualitative semi-structured interviews were conducted with community-based peer coaches in San Francisco in order to better understand the process by which these coaches engaged with their patients. Transcripts were coded and analyzed using methods based on grounded theory to develop a theoretical model of peer coach roles. RESULTS: Peer coaches play 3 principal roles in providing DSMS: advisor, supporter, and role model. While working with patients, peer coaches had different approaches to setting emotional boundaries and to allocating responsibility for implementing health behavior changes. Peer coaches were more consistent in how they sought resources from providers. Peer coaches also became empowered to better manage their own diabetes. CONCLUSION: Peer coaches are a highly motivated potential workforce uniquely positioned to teach and empower patients by building trust through shared experiences. The variability in coaching styles suggests an inherent diversity among peer coaches that must be accounted for in future strategies for design, recruitment, training, and oversight of peer coaching programs.

Motivations for sex among low-income African American young women.

African American young women exhibit higher risk for sexually transmitted infections, including HIV/AIDS, compared with European American women, and this is particularly true for African American women living in low-income contexts. We used rigorous qualitative methods, that is, domain analysis, including free listing (n = 20), similarity assessment (n = 25), and focus groups (four groups), to elicit self-described motivations for sex among low-income African American young women (19-22 years). Analyses revealed six clusters: Love/Feelings, For Fun, Curiosity, Pressured, For Money, and For Material Things. Focus groups explored how African American women interpreted the clusters in light of condom use expectations. Participants expressed the importance of using condoms in risky situations, yet endorsed condom use during casual sexual encounters less than half the time. This study highlights the need for more effective intervention strategies to increase condom use expectations among low-income African American women, particularly in casual relationships where perceived risk is already high.

Identifying counseling needs of nulliparous adolescent intrauterine contraceptive users: a qualitative approach.

PURPOSE: To describe the intrauterine contraception (IUC) adoption process among nulliparous adolescents and to identify the role of the medical provider in this trajectory. METHODS: We conducted semistructured interviews with a clinic-based sample of 20 nulliparous adolescents (aged 15-24 years) with a history of IUC use. Interviews were analyzed using modified grounded theory and cross-case analysis to reveal a process model for IUC adoption, with a focus on the role of the medical provider. RESULTS: The model includes the following stages: first awareness, initial reaction, information gathering, adoption, and adjustment and reassessment. It is influenced by personal preferences and experiences, friends, family, sexual partner(s), and medical providers. Interactions with medical providers that study participants found helpful in navigating the adoption process included the use of visuals; tailored counseling to address specific contraceptive needs; assurance that IUC discontinuation was an option; information on a wide range of side effects; medical provider self-disclosure regarding use of IUC; and addressing and validating concerns, both before and after IUC insertion. CONCLUSIONS: Nulliparous adolescents in this study described a complex IUC adoption process in which the medical provider plays a substantial supportive role. Findings from this study may be used to counsel and support future nulliparous adolescents regarding IUC use.

Primary relationship scripts among lower-income, African American young adults.

Research on romantic relationships among lower income, African American young adults has mostly focused on problem behaviors, and has infrequently documented nonpathological relationship processes that are widely studied among middle-class college students, their wealthier and largely European American counterparts [Journal of Black Studies 39 (2009) 570]. To identify nonpathological cultural concepts related to heterosexual romantic relationships, we interviewed 144 low to low-mid income, African American young adults aged 19-22 from the San Francisco Bay Area, CA, metropolitan Chicago, IL, and Greater Birmingham, AL. We identified 12 gender-shared scripts related to the romantic relationship in areas of (1) defining the relationship, (2) processes of joining, (3) maintaining balance, and (4) modulating conflict. Understanding romantic relationship scripts is important as successful romantic relationships are associated with improved mental and physical health among lower income individuals as compared with individuals without romantic partners [Social Science & Medicine 52 (2001) 1501].

Understanding the attitudes of Latino parents toward confidential health services for teens.

OBJECTIVES: To explore the knowledge and attitudes that Latino parents have about confidential health services for their teens and to identify factors that may influence those attitudes. METHODS: Latino parents of teens (12-17 years) were randomly selected from a large health maintenance organization and a community-based hospital to participate in 1-hour focus groups. We conducted eight focus groups in the parent's preferred language. Spanish and English transcripts were translated and coded with intercoder reliability >80%. RESULTS: There were 52 participants (30 mothers, 22 fathers). There is a wide range of parental knowledge and attitudes about confidential health services for teens. Parents believed they had the right to know about their teens' health but were uncomfortable discussing sexual topics and thought confidential teen-clinician discussions would be helpful. Factors that influence parental acceptability of confidential health services include parental trust in the clinician; the clinician's interpersonal skills, clinical competencies, and ability to partner with parents and teens; and clinician-teen gender concordance. Most parents preferred teens' access to confidential services than having their teens forego needed care. CONCLUSIONS: This study identifies several underlying issues that may influence Latino youths' access to confidential health services. Implications for clinical application and future research are discussed.

Growth into manhood: identity development among female-to-male transgender youth.

This study aims to understand the process by which female-to-male transgender young people come to identify as transgender through in-depth interviews with 13 self-identified female-to-male transgender youth. A grounded theory was created of the process that young people go through in coming to identify as transgender. We identified three stages: (1) a growing sense of gender: school, puberty, sexuality and exposure to diverse gender options impact upon each young person's sense of his own gender; (2) recognition of transgender identity: a young person experiences a growing sense of discomfort with his female birth gender and comes to recognise himself as transgender; and (3) social adjustment: after becoming aware of himself as transgender, a young person adapts to life as a male. Although individual experiences may vary, understanding the typical trajectory of the female-to-male transgender experience can help inform appropriate health care and support services.

Romantic relationships and their social context among gay/bisexual male youth in the Castro District of San Francisco.

This article examines the culture of romantic relationships among gay/bisexual male youth in the Castro District of San Francisco. The article seeks to specify the cultural ideology that informs these relationships, drawing upon ethnographic observation, autobiographical accounts, and informant cultural exegesis. The article also seeks to link thinking and experience inside romantic relationships (e.g., bonding, jealousy) to patterns of social behavior associated with romantic relationships (e.g., relationship sequestering, cheating), showing how both are informed by shared assumptions which make these emotions and gestures intelligible to the group. Beliefs about love, compatibility, and monogamy are explored. Reciprocity, including its degradation into negative forms, is examined with focus on the units of value that are exchanged in romantic relationships, in particular sentimental gifts. Gestures of commitment that mark commencement of a romantic relationship as well as extension of the dynamics of a relationship after "breakup" (as in "revenge sex" and "rebound relationships") are examined. Cultural systems that challenge adherence to a romantic ideology, such as a prestige economy associated with sex linked to an ethos of sexual exploration/recreation, are weighed against the pull of romance. "Drama," a hallmark of gay youth, is viewed in the context of romantic culture.

Where does reproductive health fit into the lives of adolescent males?

CONTEXT: To develop interventions to promote responsible sexual behaviors and design reproductive health services for adolescent males, we need a better understanding of the context of reproductive health in adolescent males' lives. METHODS: A total of 32 males (mean age, 15.5 years) were recruited from two urban high schools. At each school, three group sessions, consisting of both individual free-listing activities and focus group discussions, were conducted; each addressed issues related to one of three domains-masculinity, responsibility and priorities. Data from the focus groups were examined through standard content analyses. RESULTS: Participants identified school, family, future career and sports as their current life priorities; health was not a top concern. Pregnancy and sexually transmitted infections (STIs) were not seen as interrelated health concepts. STIs were considered a health issue, whereas pregnancy was perceived as a negative event that could prevent achievement of specific life goals. At times, notions regarding how a male behaves reflected traditional masculine beliefs: that violence is justified as a way to protect oneself, that having sex is part of a male's role in a relationship and that males should handle health issues by themselves. CONCLUSIONS: To meet the reproductive health needs of adolescent males, program developers should consider how other life priorities and traditional masculine beliefs may serve as barriers to care and how to ensure that services reflect the adolescent male's perspective.

Differences in altruistic roles and HIV risk perception among staff, peer educators, and students in an adolescent peer education program.

This qualitative study examines how adolescent peer educators understand and communicate HIV prevention messages. Semistructured ethnographic interviews were conducted with 21 program participants, including staff, peer educators, and students. Interviews were transcribed and analyzed using concept analysis, a method for identifying shared concepts among interview subjects. We found (a) similar beliefs about HIV transmission and risk reduction across groups; (b) different, but strong, altruistic roles among staff and peer educators; and (c) differences in HIV risk perception across the three groups. Altruistic roles took two forms. Staff acted as life skills mentors, whereas peer educators acted as HIV educators. Students were more passive, receiving counseling but not passing it on to others. Staff contextualized HIV risk, whereas peer educators and students emphasized risk. Although similar HIV knowledge across groups suggests program efficacy, stronger altruistic roles or contextualization of HIV risk may affect how prevention messages are delivered.

Youth homelessness in San Francisco: a life cycle approach.

HIV risk behaviors and seroprevalence are particularly high among street youth. Though many programs have been designed to serve them, street youth have low rates of service utilization. The aim of this street-based, ethnographic project was to study the social and cultural context of street life in this population. Data were collected by participant observation, exploratory interviews and semi-structured interviews. Twenty street youth (15-23 years old; six female), recruited from street sites in San Francisco, participated in the interviews. Field notes and transcriptions were analyzed using an inductive technique for model building. This analysis yielded a proposed model of the life cycle of youth homelessness. In the first on the street stage, youth face an intense psychological feeling of outsiderness, and an urgency to meet basic needs. These stresses either lead to an escape from street life or to a process of acculturation to the street. Initiation to the street is facilitated by street mentors, who provide youth with survival skills. In the stasis stage, youth reach a tenuous equilibrium in which they can meet their basic needs. A strong street ethic allows youth to rationalize significant conflicts and frequent physical suffering. Youth in stasis are repeatedly thrown into disequilibrium, crises that frequently cause them to come into greater contact with mainstream society. After repeated episodes of disequilibrium, some youth extricate themselves from street life, finding a new identity in mainstream society. Otherwise, youth return to the street, in an episode of recidivism. The life cycle model suggests that street youth who are most open to intervention are those who are in transitional states, i.e., those who have just arrived on the street or those who are in crisis (disequilibrium). If this model is validated in a larger population of youth, programs that are aimed at these two stages in the life cycle could potentially effectively complement existing programs, which are usually focused on youth in stasis.