Gender relations and health research: a review of current practices.

INTRODUCTION: The importance of gender in understanding health practices and illness experiences is increasingly recognized, and key to this work is a better understanding of the application of gender relations. The influence of masculinities and femininities, and the interplay within and between them manifests within relations and interactions among couples, family members and peers to influence health behaviours and outcomes. METHODS: To explore how conceptualizations of gender relations have been integrated in health research a scoping review of the existing literature was conducted. The key terms gender relations, gender interactions, relations gender, partner communication, femininities and masculinities were used to search online databases. RESULTS: Through analysis of this literature we identified two main ways gender relations were integrated in health research: a) as emergent findings; and b) as a basis for research design. In the latter, gender relations are included in conceptual frameworks, guide data collection and are used to direct data analysis. CONCLUSIONS: Current uses of gender relations are typically positioned within intimate heterosexual couples whereby single narratives (i.e., either men or women) are used to explore the influence and/or impact of intimate partner gender relations on health and illness issues. Recommendations for advancing gender relations and health research are discussed. This research has the potential to reduce gender inequities in health.

A randomized trial of teen online problem solving for improving executive function deficits following pediatric traumatic brain injury.

OBJECTIVE: To examine the efficacy of teen online problem solving (TOPS) in improving executive function (EF) deficits following traumatic brain injury (TBI) in adolescence. METHODS: Families of adolescents (aged 11-18 years) with moderate to severe TBI were recruited from the trauma registry of 2 tertiary-care children's hospitals and then randomly assigned to receive TOPS (n = 20), a cognitive-behavioral, skill-building intervention, or access to online resources regarding TBI (Internet resource comparison; n = 21). Parent and teen reports of EF were assessed at baseline and a posttreatment follow-up (mean = 7.88 months later). RESULTS: Improvements in self-reported EF skills were moderated by TBI severity, with teens with severe TBI in the TOPS treatment reporting significantly greater improvements than did those with severe TBI in the Internet resource comparison. The treatment groups did not differ on parent ratings of EF at the follow up. CONCLUSIONS: Findings suggest that TOPS may be effective in improving EF skills among teens with severe TBI.

Young women's responses to smoking and breast cancer risk information.

Current evidence confirms that young women who smoke or who have regular long-term exposure to secondhand smoke (SHS) have an increased risk of developing premenopausal breast cancer. The aim of this research was to examine the responses of young women to health information about the links between active smoking and SHS exposure and breast cancer and obtain their advice about messaging approaches. Data were collected in focus groups with 46 women, divided in three age cohorts: 15-17, 18-19 and 20-24 and organized according to smoking status (smoking, non-smoking and mixed smoking status groups). The discussion questions were preceded by information about passive and active smoking and its associated breast cancer risk. The study findings show young women's interest in this risk factor for breast cancer. Three themes were drawn from the analysis: making sense of the information on smoking and breast cancer, personal susceptibility and tobacco exposure and suggestions for increasing awareness about tobacco exposure and breast cancer. There was general consensus on framing public awareness messages about this risk factor on 'protecting others' from breast cancer to catch smokers' attention, providing young women with the facts and personal stories of breast cancer to help establish a personal connection with this information and overcome desensitization related to tobacco messages, and targeting all smokers who may place young women at risk. Cautions were also raised about the potential for stigmatization. Implications for raising awareness about this modifiable risk factor for breast cancer are discussed.

Wisdom and influence of elders: possibilities for health promotion and decreasing tobacco exposure in First Nations communities.

OBJECTIVES: This community-based project examined the interpersonal and system influences on smoking practices and exposure to cigarette smoke that place young pregnant and parenting First Nations women and their children at risk. The aim was to work with the community using this information to develop meaningful strategies to support tobacco reduction and reduce exposure to second-hand smoke. METHOD: Ethnographic methods informed by decolonizing approaches were used to study smoking practices and exposure within the context of six First Nations rural reserve villages in the Gitxsan territory in North-Western British Columbia. Data were collected through individual interviews with key community members, individual and group interviews with women, men, youth and older people, including Elders, and participant observation. FINDINGS: Older people, including grandparents and Elders expressed great interest in being more involved in their communities, particularly with youth. Other community members, especially mothers, saw such older people as important in diminishing the tobacco exposure problem, with ideas for their involvement ranging from role modeling non-smoking or respectful smoking to teaching cultural traditions. CONCLUSION: Elders in First Nations communities represent a culturally-relevant resource for health that is currently underused. Communities might draw upon their wisdom and influence to decrease tobacco exposure and promote community health in other ways. This offers a concrete, practical strategy in response to widespread calls for supporting the culture of Aboriginal people as part of health promotion.

A family affair: Aboriginal women's efforts to limit second-hand smoke exposure at home.

OBJECTIVE: The objective of this study was to explore factors influencing smoking in home environments and Aboriginal women's efforts to minimize exposure for their children and themselves. METHODS: A community-based ethnographic research study conducted in the northwest region of BC with the Gitxsan First Nations. The study included individual interviews and focus groups with 26 women ranging in age from 17 to 35, key informants (n = 15), elders (n = 9), middle-age women (n = 7), and youth (n = 6) from six reserve communities. RESULTS: Women experienced unique challenges in establishing smoke-free homes. Themes identified that describe these challenges include social dimensions of smoking in extended families, and the structural and relational influences on women's efforts to minimize household second-hand smoke to protect children's health. Narratives also included stories of success in women's efforts to reduce exposure to second-hand smoke. CONCLUSION: Second-hand smoke presents a multifaceted challenge to Aboriginal women who are motivated to protect their health and the health of their children. Their efforts to implement smoke-free strategies in their homes should be supported.

Breast cancer messaging for younger women: gender, femininity, and risk.

Evidence linking both active smoking and secondhand smoke exposure to premenopausal breast cancer makes the development of health messages specific to younger women a pressing priority. To determine how to communicate information about this modifiable breast cancer risk to young women, we analyzed a selection of 32 recent English-language breast cancer messages and campaigns that targeted young women. In addition, we obtained young women's responses to three breast cancer campaign images during focus group discussions. A visual analysis of messages points to an explicitly gendered discourse within contemporary campaigns, one that entails conflicting messages regarding breast cancer, health, feminine beauty, and risk. Although the intent might be to educate and empower young women to "fight" against breast cancer, paradoxically, the messages employ imagery that sexually objectifies young women's breasts and bodies. Recommendations are made for messaging about tobacco and breast cancer risk to avoid reproducing one-dimensional or stereotypical presentations of gender and femininity.

Brief report: Description of feasibility and satisfaction findings from an innovative online family problem-solving intervention for adolescents following traumatic brain injury.

OBJECTIVE: To describe feasibility and satisfaction findings from an innovative online family problem-solving intervention for adolescents with traumatic brain injury (TBI). METHODS: Nine adolescents who sustained a moderate to severe TBI in the previous 24 months and their families participated in a novel, online, manualized treatment program (Teen Online Problem Solving, TOPS) consisting of 10 web-based sessions providing information and interactive exercises on cognitive, social, and behavioral skills typically affected by TBI. Web-based sessions were followed by synchronous video conferences with a therapist to review target skills and apply the problem-solving process to family goals. RESULTS: All teens and consenting parents completed at least 10 sessions. The website and videoconferences received moderate to high ratings on helpfulness and ease of use. Parents and teens reported increased knowledge regarding targeted knowledge and skills. CONCLUSIONS: Findings support the acceptability of TOPS for adolescent TBI.

Bingo halls and smoking: perspectives of First Nations women.

The purpose of this study was to examine bingo halls as a frequent site for exposure to secondhand cigarette smoke for First Nations women in rural communities. Thematic analysis of interviews with key informants, group discussions with young women, and observations in the study communities revealed that smoky bingo halls provided an important refuge from everyday experiences of stress and trauma, as well as increased women's risk for addiction, marginalization, and criticism. The findings illustrate how the bingo economy in isolated, rural First Nation communities influences tobacco use and second-hand smoke exposure, and how efforts to establish smoke-free bingos can be supported.

Preliminary efficacy of a Web-based family problem-solving treatment program for adolescents with traumatic brain injury.

OBJECTIVE: Preliminary report of the efficacy of a Web-based treatment program to improve adolescent and family psychosocial functioning following traumatic brain injury (TBI). PARTICIPANTS: Families of 9 adolescents with TBI (2 severe and 7 moderate) injured less than 24 months ago participated in this study. INTERVENTION: A Web-based family treatment program designed to enhance family problem solving and adjustment, as well as reduce adolescent behavioral and social problems that are common sequelae of moderate-to-severe TBI was used as intervention. The program consisted of 10 core sessions and up to 4 supplemental sessions, each consisting of self-guided Web exercises followed by a videoconference therapy session. RESULTS: Significant improvements were found in parent-reported adolescent internalizing behaviors, self-reported adolescent depressive symptoms, parental depression, and parent-adolescent conflict. Effect sizes were in the medium-to-high range for these same contrasts. Exploratory analyses suggested that providing audio with the Web site may enhance some outcomes. CONCLUSIONS: This study provides preliminary evidence of the feasibility and efficacy of family-centered online intervention for improving adolescent and family adaptation following pediatric TBI.

Lessons learned: the effect of prior technology use on Web-based interventions.

This study examined the role of regular prior technology use in treatment response to an online family problem-solving (OFPS) intervention and an Internet resource intervention (IRI) for pediatric traumatic brain injury (TBI). Participants were 150 individuals in 40 families of children with TBI randomly assigned to OFPS intervention or an IRI. All families received free computers and Internet access to TBI resources. OFPS families received Web-based sessions and therapist-guided synchronous videoconferences focusing on problem solving, communication skills, and behavior management. All participants completed measures of depression, anxiety, and computer usage. OFPS participants rated treatment satisfaction, therapeutic alliance, and Web site and technology comfort. With the OFPS intervention, depression and anxiety improved significantly more among technology using parents (n = 14) than nontechnology users (n = 6). Technology users reported increasing comfort with technology over time, and this change was predictive of depression at followup. Satisfaction and ease-of-use ratings did not differ by technology usage. Lack of regular prior home computer usage and nonadherence were predictive of anxiety at followup. The IRI was not globally effective. However, controlling for prior depression, age, and technology at work, there was a significant effect of technology at home for depression. Families with technology experience at home (n = 11) reported significantly greater improvements in depression than families without prior technology experience at home (n = 8). Although Web-based OFPS was effective in improving caregiver functioning, individuals with limited computer experience may benefit less from an online intervention due to increased nonadherence.

An online family intervention to reduce parental distress following pediatric brain injury.

This study examined whether an online problem-solving intervention could improve parental adjustment following pediatric traumatic brain injury (TBI). Families of children with moderate-to-severe TBI were recruited from the trauma registry of a large children's hospital and randomly assigned to receive online family problem solving therapy (FPS; n = 20) or Internet resources (IRC; n = 20) in addition to usual care. The FPS group reported significantly less global distress, depressive symptoms, and anxiety at follow-up than did the IRC group after controlling for baseline symptoms. The FPS group also reported significant improvements in problem-solving skills, although the groups did not differ significantly at follow-up. Findings suggest that an online, skill-building approach can be effective in facilitating parental adaptation after TBI.

Men's constructions of smoking in the context of women's tobacco reduction during pregnancy and postpartum.

Men's smoking is largely under-examined despite research that has consistently linked partner smoking to pregnant women's smoking and smoking relapse in the postpartum. An on-going qualitative study involving 31 couples in Canada exploring the influence of couple interactions on women's tobacco reduction provided the opportunity to examine men's smoking in the context of women's tobacco reduction or cessation during pregnancy and postpartum. Individual open-ended interviews with 20 men who smoked were conducted at 0-6 weeks following the birth of their infants and again at 16-24 weeks postpartum. Constant comparative methods were used along with social constructivist perspectives of fatherhood and gender to guide data analysis and enhance theoretical sensitivity. Four themes emerged in men's accounts of their tobacco use: (1) expressing masculinity through smoking, (2) reconciling smoking as a family man, (3) losing the freedom to smoke, and (4) resisting a smoke-less life. Men's reliance on and commitment to dominant ideals of masculinity seemed to preclude them from viewing their partner's tobacco reduction or cessation for pregnancy as an opportunity for cessation. Expectant and new fathers who smoke, however, may be optimally targeted for cessation interventions because it is a time when men experience discomfort with their smoking and when discontinuities in everyday life associated with the transition to fatherhood and presence of a new baby provide opportunities for establishing new routines. Implications for gender-sensitive smoking cessation interventions are discussed.

Can devices facilitate a hypnotic induction?

Historically, many devices were believed to have the ability to facilitate a hypnotic induction, but in time such devices proved to have no inherent facilitating properties other than a general placebo effect. To test the efficacy of a device called a "plasma ball" that may facilitate an induction by combining two sensory modalities simultaneously (visual and auditory), 42 college students who scored 6 and below on the Harvard Group Scale of Hypnotic Susceptibility, Form A (HGSHS:A) and completed a scale rating the realness of items, were selected for a second session. Participants were matched on hypnotizability scores and randomly assigned to experimental or standard eye fixation induction control condition. Although hypnotizability scores and realness ratings increased significantly from the initial session, use of the device did not produce higher hypnotizability scores or realness ratings in the experimental compared with the control condition. Results indicate that there is still no evidence that one fixation device works better as a target than any other.

Surviving men's depression: women partners' perspectives.

While men's gendered experiences of depression have been described, the perspectives of women partners who are affected by men's depression have received little attention. Women partners were recruited to explore how men's depression impacts them and its influence on gender regimes. Individual interviews with 29 women spouses were coded and analysed. Although idealized femininity positions women as endlessly patient and caring, our findings reveal significant challenges in attempting to fulfil these gender ideals in the context of living with a male partner who is experiencing depression. The strain and drain of living with a depressed man was a key element of women's experiences. Four sub-themes were identified: (1) resisting the emotional caregiver role, (2) shouldering family responsibilities, (3) connecting men to professional care and (4) preserving the feminine self. The findings suggest that men's depression has great potential to dislocate heterosexual gender regimes, and attention to gender relations should be included to ensure successful care management of men who experience depression.

A randomized trial of teen online problem solving: efficacy in improving caregiver outcomes after brain injury.

OBJECTIVE: To examine the results of a randomized clinical trial (RCT) of Teen Online Problem Solving (TOPS), an online problem solving therapy model, in increasing problem-solving skills and decreasing depressive symptoms and global distress for caregivers of adolescents with traumatic brain injury (TBI). METHOD: Families of adolescents aged 11-18 who sustained a moderate to severe TBI between 3 and 19 months earlier were recruited from hospital trauma registries. Participants were assigned to receive a web-based, problem-solving intervention (TOPS, n = 20), or access to online resources pertaining to TBI (Internet Resource Comparison; IRC; n = 21). Parent report of problem solving skills, depressive symptoms, global distress, utilization, and satisfaction were assessed pre- and posttreatment. Groups were compared on follow-up scores after controlling for pretreatment levels. Family income was examined as a potential moderator of treatment efficacy. Improvement in problem solving was examined as a mediator of reductions in depression and distress. RESULTS: Forty-one participants provided consent and completed baseline assessments, with follow-up assessments completed on 35 participants (16 TOPS and 19 IRC). Parents in both groups reported a high level of satisfaction with both interventions. Improvements in problem solving skills and depression were moderated by family income, with caregivers of lower income in TOPS reporting greater improvements. Increases in problem solving partially mediated reductions in global distress. CONCLUSIONS: Findings suggest that TOPS may be effective in improving problem solving skills and reducing depressive symptoms for certain subsets of caregivers in families of adolescents with TBI.

Effect on behavior problems of teen online problem-solving for adolescent traumatic brain injury.

PURPOSE: To report the results of a randomized clinical trial of teen online problem-solving (TOPS) meant to improve behavioral outcomes of adolescents with traumatic brain injury (TBI). METHODS: A randomized clinical trial was conducted to compare the efficacy of TOPS with access to Internet resources in teenagers with TBI in improving parent and self-reported behavior problems and parent-teen conflicts. Participants included 41 adolescents aged 11 to 18 years (range: 11.47-17.90 years) who had sustained a moderate-to-severe TBI between 3 and 19 months earlier. Teens in the TOPS group received 10 to 14 online sessions that provided training in problem-solving, communication skills, and self-regulation. Outcomes were assessed before treatment and at a follow-up assessment an average of 8 months later. Groups were compared on follow-up scores after we controlled for pretreatment levels. Injury severity and socioeconomic status were examined as potential moderators of treatment efficacy. RESULTS: Forty-one participants provided consent and completed baseline assessments, and follow-up assessments were completed for 35 participants (16 TOPS, 19 Internet resource comparison). The TOPS group reported significantly less parent-teen conflict at follow-up than did the Internet-resource-comparison group. Improvements in teen behavior after TOPS were moderated by injury severity; there were greater improvements in the teens' internalizing symptoms after TOPS among adolescents with severe TBI. Family socioeconomic status also moderated the efficacy of TOPS in improving behavior problems reported by both parents and teens, although the nature of the moderation effects varied. CONCLUSION: Our findings suggest that TOPS contributes to improvements in parent-teen conflict generally and parent and self-reported teen behavior problems for certain subsets of participants.

Couple dynamics during women's tobacco reduction in pregnancy and postpartum.

Smoking cessation during pregnancy is often temporary; many women relapse postpartum. To develop strategies for supporting successful long-term smoking cessation, we conducted a qualitative study to explore the influence of couple interactions on women's tobacco reduction within the context of pregnancy and the postpartum period. A total of 28 women who quit or reduced smoking for pregnancy and their partners were interviewed following delivery and at 3-6 months postpartum. Open-ended, individual interviews elicited the challenges posed by the women's tobacco reduction and how their partners influenced their cessation efforts. The use of constant comparative analytic strategies focusing on women's processes, experiences, and responses revealed that unquestioned expectations for pregnant women's cessation created the social context of compelled tobacco reduction. Women's engagement in tobacco reduction in this context fundamentally altered couples' previously established tobacco-related routines. The intensity of these changes varied depending on the couples' established interaction patterns with respect to tobacco (i.e., disengaged, conflictual, or accommodating) and was a source of conflict for some couples. The findings offer novel ways to understand smoking cessation during pregnancy that provide new directions for research and for tailoring smoking cessation interventions.

A gene-driven ENU-based approach to generating an allelic series in any gene.

N-ethyl-N-nitrosourea (ENU) introduces mutations throughout the mouse genome at relatively high efficiency. Successful high-throughput phenotype screens have been reported and alternative screens using sequence-based approaches have been proposed. For the purpose of generating an allelic series in selected genes by a sequence-based approach, we have constructed an archive of over 4000 DNA samples from individual F1 ENU-mutagenized mice paralleled by frozen sperm samples. Together with our previously reported archive, the total size now exceeds 6000 individuals. A gene-based screen of 27.4 Mbp of DNA, carried out using denaturing high-performance liquid chromatography (DHPLC), found a mutation rate of 1 in 1.01 Mbp of which 1 in 1.82 Mbp were potentially functional. Screening of whole or selected regions of genes on subsets of the archive has allowed us to identify 15 new alleles from 9 genes out of 15 tested. This is a powerful adjunct to conventional mutagenesis strategies and has the advantage of generating a variety of alleles with potentially different phenotypic outcomes that facilitate the investigation of gene function. It is now available to academic collaborators as a community resource.