Caretaker-child interaction during children's 24-hour dietary recalls: who contributes what to the recall record?

OBJECTIVE: To describe patterns of caretaker-child communication during children's caretaker-assisted dietary recall interviews. DESIGN: Data are from transcriptions of audiotaped, caretaker-assisted, 24-hour dietary recalls. Statements were coded to provide quantified measures of caretaker-child interaction. SUBJECTS/SETTING: Thirty-four children aged 7 to 11 years who were enrolled (with their caretakers) at the San Diego site of the Olestra Post-marketing Surveillance Study. STATISTICAL ANALYSES: Measures of participation for caretaker-child pairs were compared using Mann-Whitney tests; chi 2 tests were conducted to examine within-group differences. Mean numbers of statement types were compared with t tests. Differences between contributions of caretakers and children within caretaker-child pairs were examined using Wilcoxon signed rank tests. RESULTS: Caretakers contributed primarily by adding food details and, secondarily, by prompting children. Children rejected a notable proportion of items added by caretakers, and children's knowledge of food details was considerable. Gender made little difference, although the presence of a male caretaker was associated with a reduced proportion of details contributed by children. APPLICATIONS: In assessing children's dietary intake, questions should be directed toward children, even when caretakers are present. Nutrition professionals must clarify expectations for caretakers from the outset, intervene as needed to limit caretaker participation, probe for children's disagreement with caretakers' additions, and question the basis for caretakers' additions. If feasible, caretakers should be excused toward the end of the interview so children may privately make alterations to the record.

Abortion traditions in rural Jamaica.

Abortion is not condoned in Jamaica. Its meaning is linked to the meanings of kinship and parenthood, which are expressed through procreation and involve altruism and the assumption of responsibility for the well-being of others. Abortion subverts these ideals but indigenous methods for it are known and are secretly used. The inconsistencies between abortion talk and abortion practice are examined, and the structural functions of abortion (and of its culturally constructed, ideological meaning) are discussed. The distinction--and the overlap--between abortion as such and menstrual regulation is explored. The use of the culturally constructed 'witchcraft baby' syndrome to justify abortion is also investigated. Traditional abortion techniques follow from (and can illuminate) general health practices, which focus on inducing the ejection of 'blockages' and toxins, and from ethnophysiological beliefs about procreation and reproductive health, which easily allow for menstrual delays not caused by conception. The latter understanding and the similarity between abortifacients, emmenagogues and general purgatives allows women flexibility in interpreting the meanings of their missed periods and the physical effects of the remedy.

Attitudes toward HIV testing among impoverished inner-city African-American women.

During a study of the perceived benefits of unsafe (condomless) sex, some women's erroneous convictions that they have been tested for HIV seropositivity and most women's reluctance to identify their own sexual behaviors at high-risk when explaining why they had been tested were noted. Many participants assumed that clinicians drawing their blood would check it for HIV when they checked for other matter, and most of those reporting that they have had or would have HIV tests saw the test as part of a routine health check. Factors underlying the women's optimistically biased denial of their own HIV/AIDS risks and their related refiguring of the purposes and conditions of HIV testing are discussed, and the ways in which the women's attitudes critique current policies are described. Because of the culturally promoted strength and importance of women's denial, testing programs that seek to capitalize on an evoked sense of risk cannot succeed; such programs threaten women's faith in their relationships and question women's social and moral standings in a humiliating fashion. Those who promote testing would do better to present HIV screening as routine, because this is how women who accept testing generally portray it. Importantly, clinicians must explain that the test is not automatically administered. Cast as a standard health-related procedure for which permission must be granted, HIV testing will seem more rational, pro-active, and acceptable to the women targeted for testing.

"You ate all that!?": caretaker-child interaction during children's assisted dietary recall interviews.

Young children's dietary recalls generally are conducted with a guardian present, but how this contributes to data accuracy is unclear. Furthermore, some assumptions underlying the preference for guardian presence may be unfounded. To investigate the range of guardian-child interactions within the diet recall setting, we examined transcriptions of guardian-assisted recalls conducted with 34 children aged 7-11 whose households were enrolled with the San Diego site of the Olestra Post-Marketing Surveillance Study (OPMSS). Although guardians did add to the breadth of data collected, children were quite knowledgeable about their diets. Moreover, they sometimes rejected guardian suggestions, and guardians generally could not provide assistance when children requested it. Guardian-child negotiations reflected cultural understandings regarding children, caretaking, and guardian-child power structures as well as food, and sometimes interviewers had to make very subjective data classification decisions. Suggestions for improving dietary recall methods are provided. Findings are relevant for other research methods involving children.

Inner-city women and AIDS: the psycho-social benefits of unsafe sex.

The paper describes and analyzes findings from a larger study of the links between low levels of condom use and impoverished, urban, African-American women's experiences and understandings of heterosexual relationships. The research identifies and explores psycho-social barriers to safer-sex. This article examines, in detail, HIV/AIDS risk denial and women's strategic use of unsafe (condomless) sex and "monogamy narratives" to build and to maintain this denial. The tendency to view urban African-American women's conjugal affiliations as instrumental is questioned.

Human immunodeficiency virus seropositivity self-disclosure to sexual partners: a qualitative study.

The article examines the process of human immunodeficiency virus seropositivity self-disclosure to sexual partners. The few studies that have been done in regard to this topic are quantitative and epidemiologic in nature and concentrate on urban gay men. In contrast, the findings described here are qualitative, and they are from HIV-positive small-town southwesterners, heterosexuals included. Five basic topics emerged as salient in regard to the self-disclosure process: a disclosee's need to know, nondisclosure conjoined with safer sex practice, disbelief and denial among the seronegative and untested, strategies for evaluating potential disclosees, and rejection or acceptance by the disclosee. According to participants, self-disclosure does not necessarily lead to safer sex because partners often do not want it. Participants see a lack of prophylactic effort in partners as resulting from informed choice, even if self-disclosure, they also experienced rejection. Rejection can be direct or perfidious. Participants compared partners' often problematic reactions with those of children, which they praised. Future research will lead to the creation of formal guidelines for use by health care professionals in promoting secondary prevention practices, such as condom use, and in determining how best to serve HIV-positive clients.

The Jamaican body's role in emotional experience and sense perception: feelings, hearts, minds, and nerves.

When Jamaicans speak of feelings, they literally mean feelings: physical sensations. Emotions, which emerge through social interaction, comprise an unmarked subset of feelings. They can affect the mind in ways that are actualized in behavior. Emotions affect other parts of the body as well, in ways that follow from an equilibrium model of health. Non-emotional feelings index bodily disequilibrium rather than causing it. An example of such is seen in nerves: a chronic feeling-complaint that comes about when the nerves, associated with perception and sensation, are weakened, and which entails visual dimness, jumpiness, and joint trouble. Although exacerbated by certain social situations, and often used in social commentary and manipulations, nerves is experienced and treated as a physical rather than a socially-based disorder. By studying the bodily dimension of nerves and other feelings we may gain insight into the ways in which the body serves as a source of culture (e.g., nerves culture) as well as into how culture influences bodily experience. We may broaden our understanding of the complex interplay between the bodily and mental dimensions of people's lives.

Food avoidance by women at risk for recurrence of breast cancer.

BACKGROUND: This cross-sectional study examined self-reported restriction of foods by middle-aged and older women at risk for breast cancer recurrence, who were participating in an intervention study, and by women without breast cancer. METHODS: Data examined were height, weight, dietary intake, and avoidance of specific food types in women with breast cancer (n = 56) and a comparison group of women without breast cancer (n = 51). Data were analyzed with t-tests and chi-square analysis. RESULTS: The broad food categories of meat, dairy foods, and sweets were restricted by women both with (53%, 74%, and 62%, respectively) and without breast cancer (47%, 63%, and 63%, respectively). Significantly more women with breast cancer avoided cakes, butter, and milk, compared with women without breast cancer (p < 0.05). Women in both groups attained a mean consumption of >75% of the Recommended Dietary Allowance for many nutrients; however, mean consumption for calcium was <75% of the RDA for the two groups. CONCLUSIONS: Analysis of food avoidance by women with breast cancer who participate in diet-intervention studies and by women without breast cancer may provide information about adherence to dietary guidelines and adequate nutrient consumption among these populations.

Developing indicators for emergency medical services (EMS) system evaluation and quality improvement: a statewide demonstration and planning project.

BACKGROUND: The state of California, like every other state, has no system for assessing the quality of prehospital emergency medical services (EMS) care. As part of a statewide project, a process was designed for the evaluation and quality improvement (QI) of EMS in California. Local EMS agency (LEMSA) representatives made a commitment to submit data from both the providers and the hospitals they work with. INDICATOR SELECTION AND DEVELOPMENT: For conditions such as cardiac chest complaints, standardized indicators had already been developed, but for many other areas of interest there was either little literature or little consensus in the literature. Definitional differences were often linked to local-practice protocol differences. A related comparison challenge lay in the fact that care protocols may differ across systems. Some aspects of care may not be offered at all, which may reflect resource shortages or variable medical direction. DATA COLLECTION PROCEDURES: Each indicator was precisely defined, and definition sheets and data troubleshooting report forms were provided to participants in three data-collection rounds. Participants were given 1 month to collect the data, which consisted of summary-level elements (for example, average time to defibrillation for all patients 15 years or older who received defibrillation in 1998). Data were then aggregated, analyzed, and prepared for display in graphs and tables. ACCESS AND MEASUREMENT ISSUES: Numerous data collection problems were encountered. For example, not all participants could actually access data that they thought would be available. Linking data on patients as they travel through the continuum of EMS care (dispatch, field, hospital) and linking EMS data to hospital outcomes was also difficult. Yet even when data were easily available, challenges arose. The need for specificity, the potential misfit between definitions and the available data, and the challenges of data retrieval remained salient for the duration of the project and made cross-LEMSA and cross-provider comparison problematic. RECOMMENDATIONS AND LESSONS LEARNED: The project led to formal policy recommendations regarding development of a state-defined minimum data set of structure, process, and outcome indicators and their associated data elements; provision in the minimum data set for both local-level and statewide indicators; and provision of technical assistance at the local-provider level. EPILOGUE: Since the project's conclusion in June 2000, many regional and local EMS groups have begun to collect data on indicators. Many of the project's recommendations have been incorporated into the work plan of the state's System Review and Data Committee.

Eating pathology and obesity in women at risk for breast cancer recurrence.

OBJECTIVE: This cross-sectional study investigated the relationship among obesity, depressive symptoms, eating attitudes and behaviors, and dietary intake. It compared women at risk for recurrence of breast cancer and women who had not been diagnosed with breast cancer and were recruited from the same community and age group (middle-aged and older). METHOD: Body mass index (BMI), dietary intake, self-reported depressive symptoms, and eating disorder psychopathology (assessed with the Eating Disorder Examination - Questionnaire [EDE-Q]) were examined in women who had been diagnosed with breast cancer (n = 56) and the comparison group of women with no breast cancer history (n = 52). Multivariate regression analysis was used to identify factors independently associated with global and subscale EDE-Q scores and BMI. RESULTS: BMI and depressive symptoms were significantly and independently associated with global and subscale EDE-Q scores in women at risk for breast cancer recurrence and women with no breast cancer history. Dietary restriction was also significantly associated with EDE-Q scores in the group with no breast cancer history. CONCLUSIONS: An association among obesity, depressive symptomatology, and abnormal eating attitudes and behavior may affect response to standard nutritional interventions in women at risk for breast cancer recurrence.