Coping strategies, satisfaction with life, and quality of life in Crohn's disease: A gender perspective using structural equation modeling analysis.

OBJECTIVE: To identify coping strategies and socio-demographics impacting satisfaction with life and quality of life in Crohn's disease (CD). METHODS: 402 patients completed the Patient Harvey-Bradshaw Index, Brief COPE Inventory, Satisfaction with Life Scale (SWLS), Short Inflammatory Bowel Disease Questionnaire (SIBDQ). We performed structural equation modeling (SEM) of mediators of quality of life and satisfaction with life. RESULTS: The cohort comprised: men 39.3%, women 60.1%; P-HBI 4.75 and 5.74 (p = 0.01). In inactive CD (P-HBI≤4), both genders had SWLS score 23.8; men had SIBDQ score 57.4, women 52.6 (p = 0.001); women reported more use of emotion-focused, problem-focused and dysfunctional coping than men. In active CD, SWLS and SIBDQ scores were reduced, without gender differences; men and women used coping strategies equally. A SEM model (all patients) had a very good fit (X2(6) = 6.68, p = 0.351, X2/df = 1.114, SRMR = 0.045, RMSEA = 0.023, CFI = 0.965). In direct paths, economic status impacted SWLS (ß = 0.39) and SIBDQ (ß = 0.12), number of children impacted SWLS (ß = 0.10), emotion-focused coping impacted SWLS (ß = 0.11), dysfunctional coping impacted SWLS (ß = -0.25). In an indirect path, economic status impacted dysfunctional coping (ß = -0.26), dysfunctional coping impacted SIBDQ (ß = -0.36). A model split by gender and disease activity showed that in active CD economic status impacted SIBDQ in men (ß = 0.43) more than women (ß = 0.26); emotional coping impacted SWLS in women (ß = 0.36) more than men (ß = 0.14). CONCLUSIONS: Gender differences in coping and the impacts of economic status and emotion-focused coping vary with activity of CD. Psychological treatment in the clinic setting might improve satisfaction with life and quality of life in CD patients.

Knowledge and attitudes related to AIDS among African-American women.

We explored knowledge and perceptions related to AIDS prevention among African-American women who reside in a low-income urban community. The results are based on a short survey and discussions of three focus groups, divided according to the respondents' ages. Results of the study indicate that the respondents were less knowledgeable about AIDS than women from a national survey. Respondents also expressed very little trust in condoms and found it difficult to make their sexual partners use them. Issues raised during the focus groups included fear of contracting AIDS as a result of medical care, mistrust and dislike of condoms, difficulties convincing men to use condoms, inability to affect the sexual behavior of their sons and daughters, and a wish to have AIDS prevention programs in the community. Implications for practice are discussed.

Psychological responses to blood vengeance among Arab adolescents.

OBJECTIVE: The goal of this study was to investigate the well being of Arab adolescents who live under the threat of ongoing blood vengeance, and to assess the impact of socio-demographic characteristics, cultural context, and family functioning as a mediators factors. METHOD: The sample consisted of 100 adolescents in grades 6-8. Self-reported standardized measures were used to assess the participants' level of self-esteem (Rosenberg's scale), mental health (the Brief Symptom Inventory BSI), and perceived family functioning (the McMaster Family Assessment Device FAD). RESULTS: The participants of this study demonstrated higher levels of distress and symptomatic behavior as compared to the Israeli norms. In a series of multiple regression, General Family Functioning emerged as the major predictor associated with mental health. Female participants reported a higher anxiety level than their male counterparts. Male participants, on the other hand, were more willing to continue the feud of blood vengeance. CONCLUSION: The findings suggest that there are similarities among children and adolescents who live in war zones and those who live under a threatening blood vengeance. Family functioning appears as the major mediator of well being. Implications for practice are discussed.

The long-term impact of AIDS-preventive interventions for delinquent and abused adolescents.

This study examines whether cognitive/behavioral interventions that produced immediate changes in AIDS-related knowledge, attitudes, and intentions for coping with AIDS-risk situations among delinquents and abused adolescents, are capable of producing long-term benefits assessed at 9-12 months follow-up. Adolescents (N = 218) from 15 residential centers received an intensive nine-session HIV prevention program. Centers were randomly assigned to skills training, discussion-only, or control groups. Results showed that one intervention model, discussion groups, produced a long-term increase in knowledge about AIDS and higher reported intentions to cope with AIDS-risk situations. However, both skills-training and discussion groups did not produce a long-term reduction in the level of engagement in high-risk behaviors. Several reasons for these results are discussed, with emphasis on an explanation based on the theoretical perspective of life chances or life options.

Social and psychological adjustment of Soviet-born and Israeli-born adolescents: the effect of the family.

This study examined the impact of family functioning on the educational, social and emotional behavior of Soviet-born and Israeli-born adolescents in Israel. The parents of the Israeli-born adolescents were born in Russia; thus, this study controlled for their national background. The results showed that the two groups were similar in their perception about the way their families function. Both groups perceived that social and psychological well-being among adolescents were significantly related to family functioning. Multivariate analysis revealed that family functioning was the major factor predicting the level of self-esteem and peer relationships among adolescents, as well as a myriad of psychological symptoms. Directions for future research are discussed.

HIV prevention for youths in independent living programs: expanding life options.

The incidence of human immunodeficiency virus (HIV) infection among adolescents is increasing. Youths who were abused and neglected and in out-of-home care are among those at highest risk of acquiring HIV. The concurrence of sexual activity and school failures contributes to their high-risk status. Research suggests that changing behaviors of troubled youths requires programs that not only include HIV-related knowledge, attitudes, and skills, but also incentives and skills for educational planning that will expand the future life options of these youths.

Abortions among Israeli women after interruption in contraceptive use.

Seventy-two Israeli women who underwent abortions were interviewed. Most of those interviewed had used modern contraceptives previously, but not before their most recent pregnancy. The interruption in contraceptive use resulted from adverse side effects of the contraceptives and instability in partner relationships.

PIP: At least 1/3 of Jewish women in Israel have had induced abortions. The 72 women who participated in this study had received abortion approval from a medical committee. (Abortions for social reasons are not legal in Israel; there are therefore many illegal abortions.) 82% were between 17-28; 62% were single; 62% were born in Israel of North African descent; 26% had 9 or less years of education, and 74% had 10 or more years of education. 62.5% had used medically prescribed contraceptives in the previous 2 years, buy only 11% had used them in the previous 6 months; 47% had used rhythm or withdrawal in the previous 6 months; and 26% had not used any method in the previous 6 months. Of the 13 women who had never used any kind of contraception, only 1 did not know about it; 6 thought that they did not need it. Of the 14 women who had never used any method except withdrawal, rhythm, condoms, or cream, most said that they feared cancer and weight gain from pills and bleeding and uterine damage from IUDs. Of the total sample 62% said that they had stopped using prescribed contraceptives because they feared the side effects. 32% said that they had stopped because they had an unstable relationship with their sex partner. Women of low socioeconomic status tended to use natural methods because they cost nothing. 86% of the women said that they feared the pain and adverse side effects of abortion, but evidently less than they feared those of effective contraceptives. Effective contraceptives should be made more available to poor women, and social practitioners should educate all women in the correct use of contraceptives and the dangers of discontinuing their use.

The experiences of women who face abortions.

Seventy-two Israeli women who were about to have abortions were interviewed. These women experienced intense emotions of sadness, ambivalence, confusion, and fear. To help them deal with this crisis, the women expressed a need for a professional counselor who provides information such as where to go, how to get money for the abortion, and how the operation is performed. The women also wished that the professional counselor would support them emotionally throughout the pregnancy experience and the abortion procedure.

PIP: A female social worker interviewed 72 women from 2 Jerusalem hospitals in Israel who had received approval from a medical committee to undergo an abortion between February-April 1981 and right before the abortion to examine their psychological experiences and determine the types of assistance they wanted to have from social and health professionals. 82% were 17-28 years old. 62% were not married. 56% had attended schools for 10-12 years. The leading reaction (39% of respondents) when they learned of the pregnancy was sorrow of losing the baby and/or of the dilemma they were in followed by surprise and wish to rapidly terminate the pregnancy (21% each) and nervousness (19%). 64% did not consider any other options. 58% of all respondents chose abortion because they were unmarried. 25% made this decision because of health concerns. 86% were afraid of having an abortion, especially of physical side effects such as inability to get pregnant again. 64% stated a need for public service to help women who face an unplanned pregnancy. 50% of them wanted information on where to have an abortion and how to finance it. The other types of services preferred included emotional support and comfort, decision making help, and medical counseling. Indeed 64% of all abortion patients, especially single women (p.001), believed professional counseling before the abortion is needed. 52% of abortion patients supportive of professional counseling wanted information about the abortion, risks, and side effects followed by emotional support and comfort (41%), and good treatment be medical staff (7%). Based on these results, a social worker from Ben-Gurion University of the Negev suggested a 2 phase supportive counseling crisis intervention by social workers or other social practitioners for women faced with an unwanted pregnancy.

AIDS-related knowledge, attitudes, and behaviors among juvenile delinquents in Israel.

Fifty-six Israeli adolescents under the care of probation officers were interviewed about their AIDS-related knowledge, attitudes, and behaviors. The results suggest that these adolescents put themselves at risk of HIV infection. A substantial proportion of the sample demonstrated a lack of knowledge on issues relevant for AIDS prevention. The majority held negative attitudes toward condoms but were also sexually active, and some had experienced unprotected sexual intercourse, anal sex, and drug use. Most of the respondents, moreover, showed a lack of competence in handling situations that pressure them to act unsafely. Implications for practice are discussed.

Delayed abortion among teenagers: can a population at risk be identified?

Although only a small proportion of abortions performed in the United States are second-trimester abortions, teenagers obtain a large percentage of them. Yet the literature on abortion seekers is remarkably lacking in a discussion of who the pregnant teenagers who seek abortions are, particularly those who seek second-trimester abortions. We report a study of 97 adolescents who turned for help to a public abortion clinic in Missouri during 1989. We examined the impact of demographic variables, social-behavioral variables, and pregnancy-related variables (pregnancy, contraception, and abortion histories and attitudes toward abortion) on the stage of pregnancy at which the teens arrived at the clinic. Only contraceptive use and a positive attitude toward abortion were predictive of late arrival at the abortion clinic.

PIP: Only 8-10% of abortions in the US are performed in the second trimester; however, single adolescents are disproportionately represented in this group. To assess the influence of demographic, sociobehavioral, and pregnancy-related factors on this phenomenon, 97 adolescents 13-17 years of age who sought pregnancy termination at a Missouri clinic were interviewed. The median age of study subjects was 16.8 years; 76% were Black. 18% were high school dropouts, 28% were receiving Medicaid, 32% were considered by social workers who interviewed them to have family problems, and 15% had a history of psychiatric treatment. White adolescents were overrepresented among those with school, family, and psychiatric problems. 21% had one previous pregnancy and 7% had had two pregnancies; 18% had given birth and 12% had at least one prior abortion. 70% were pro-choice, 25% were ambivalent, and 4% were anti-abortion. Finally, 27% reported contraceptive use (largely the pill) at the time they became pregnant. The mean age at presentation to the abortion clinic was 10.9 weeks; more than a quarter of the adolescents were in the second trimester of pregnancy. Only two variables--contraceptive use and a pro-choice attitude toward abortion--were significant predictors of late presentation for abortion, but they explained only 10% of the variance in gestational age. Urged are additional studies that investigate more personal factors (e.g., ability to recognize pregnancy symptoms, relationship with partner) that might have a stronger association with late abortion.

Knowledge, attitudes and behaviors related to AIDS among youth in residential centers: results from an exploratory study.

This study assesses the level of knowledge about and attitudes toward AIDS among youth residing in residential centers. It also assesses the degree to which they engage in high risk behaviors related to AIDS. The study evaluates the impact of a short educational intervention on the youth's knowledge, attitudes, and behaviors related to AIDS. Findings suggest that the respondents are relatively knowledgeable about the disease and how to prevent it. However, a substantial proportion of them do not hold positive attitudes toward prevention and are actually engaging in unsafe behavior. The results also show that a short intervention that provides information about AIDS is ineffective in reducing engagement in high risk activities.

Value patterns and content among families of Soviet immigrants: SYMLOG analysis.

The purpose of this qualitative study is to understand and compare two immigrant families whose children perceived their families to be well-functioning, and two families whose children perceived them to be poor-functioning. The method of analysis used for studying the values of the families is based on SYMLOG. Four families, who immigrated to Israel during the early seventies from the former USSR, and whose adolescents were born in Israel, were interviewed. The results show that in the two "well-functioning" families, there is a high degree of consensus on their values-those that they accept, as well as, those that they reject. The two "poor-functioning" families did not exhibit identical value patterns--neither in the values that they favor, nor in those that they reject. In terms of content, in the well-functioning families, there was a strong expression of two values: friendliness and the desirability of self-sacrifice in order to reach family goals. In contrast, in the poor-functioning families, the value of conservatism was salient. Finally, all four families expressed strong opposition to the values of strong individualism and nonconformity. Suggestions for family intervention are offered.

Stress management consultation to Israeli social workers during the Gulf War.

Social workers operating under emergency conditions may feel overwhelmed and incapacitated by their own stress reactions. During the Gulf War, social work faculty in Israel acted as consultants to help hospital social workers manage stress and regain professional efficacy. The Stress Management Consultation (SMC) was a short-term group intervention designed to enable social workers to work through their stress reactions and to model a method the workers could use with their own target populations. Qualitative feedback from both participants and administrators indicated that the SMC model was effective and could be applicable to a large range of settings and treatment populations.

Problems in financing the care of AIDS patients.

The problem of financing the care of patients with acquired immune deficiency syndrome (AIDS) has reached crisis proportions. How will the United States cope with paying for the care of AIDS patients, many of whom either are denied private insurance or simply do not have money to pay for medical care? This article discusses how each component of the U.S. health care financing system is attempting to minimize its financial exposure to AIDS. It presents remedies that have been suggested in the literature. Finally, it points out the flaws in the current system for dealing with people who suffer from catastrophic illnesses.

Educational options and AIDS-related behaviors among troubled adolescents.

Examined whether educational parameters could predict AIDS-related knowledge, attitude, and behavior, controlling for sociodemographic variables, among delinquent and abused adolescents. 358 adolescents, ages 11-18 years, who were placed in 15 residential centers in Midwestern cities completed self-report questionnaires. Multivariate analyses showed that after controlling for sociodemographic factors, AIDS-related knowledge, attitude, and behaviors were predicted by educational parameters, such as relationship with teachers and educational aspirations. Data indicate that these educational parameters can be used to identify adolescents who are most at risk for HIV infection among already troubled youth. It is suggested, therefore, that the educational difficulties of troubled adolescents cannot be ignored when preventive programs for this population are planned.

A culturally sensitive approach to therapy with immigrant families: the case of Jewish emigrants from the former Soviet Union.

This article is based on accumulated clinical experience in Israel with families that emigrated from the former Soviet Union. It describes a culturally sensitive systemic intervention with two such families: a single-parent family, and a family that exhibited physical violence. Relevant cultural characteristics of family patterns and parent-child relationships in Jewish-Soviet families are reviewed. It is demonstrated how a cross-cultural perspective may affect the interpretation of presented problems and result in a less pathological perspective. It is further illustrated how universal intervention techniques combined with culturally sensitive approaches may produce positive effects in therapy.