Targeted Invitations to Tailor: Establishing Fertility as Relevant in U.S. Sex Education.

The United States faces troubling fertility trends that include high percentages of unintended pregnancies, as well as record-low fertility rates and individuals having fewer offspring than they desire. To address these problems, scholars and public health advocates have argued for the implementation of fertility information into existing sex-education curricula. In this study, we draw from 32 semi-structured interviews with secondary school sex educators to gain insight into their experiences on this front. They contended that one of the greatest barriers to their successfully teaching fertility related material was that students do not find fertility information relevant. Participants described three appeals that they employ to communicate fertility information as persistently relevant to the adolescents in their classes. Our interviews revealed that all three of these relevance appeals employ targeted invitations for students to tailor fertility information in ways that fit them personally. These findings suggest a need to re-conceptualize targeting and tailoring research in ways that connect with the goals of in situ, relevance-oriented communication, and they indicate how a focus on teaching health educators to establish fertility as relevant would help to situate future generations for better sexual and reproductive health over a lifetime.

The First Publication on Contraception in a US Medical Journal, 1928: Hannah Mayer Stone's Case for Contraceptive Care Before the Pill.

Today, as access to women's reproductive health care in the United States has proven less than ensured, it behooves scholars of public health to explore how US medical contraceptive care was successfully established and perpetuated initially in the early to mid-twentieth century. This article highlights the work of Hannah Mayer Stone, MD, in building and advocating such care. From the moment she accepted the position of medical director for the first contraceptive clinic in the country in 1925 until her untimely death in 1941, Stone campaigned relentlessly for women's access to the best contraceptive regimes available, all the while navigating extensive legal, social, and scientific challenges. In 1928, she published the first scientific report on contraception in a US medical journal, thereby legitimating the provision of contraception as a medical endeavor and providing empirical grounds for clinical contraceptive work in the years that followed. Her scientific publications and professional correspondence provide insight into the processes through which medical contraceptive care became increasingly available in US history and offer guidance for a contemporary era when reproductive health care hangs in the balance. (Am J Public Health. 2023;113(4):390-396. https://doi.org/10.2105/AJPH.2022.307215).

Chemistry in the mail: Stamps from around the globe and public science communication in the twentieth century.

Postage stamps are designed to convey messages that reverberate symbolically with broad swaths of the public, and their content has been employed as a window into how members of the public understand the ideas represented therein. In this rhetorical analysis, we analyze Philadelphia's Science History Institute's Witco Stamp Collection, which features 430 stamps from countries around the globe dating from 1910 to 1983, to identify how chemistry is portrayed in this ubiquitous medium. We find the vernacular of science reflected and supported by these images functions to (a) define chemistry in terms of its invisibility and abstraction; (b) uphold chemical operations as instrumental and daedal, or exceptional, in nature; and (c) delineate practitioners of chemistry as-on the whole-privileged and preternatural. Our findings reveal some of the overarching communicative tools made available to twentieth-century non-experts for articulating chemistry as an enterprise and reveal how those tools positioned chemistry in terms of values related to opacity and exclusivity.

Medicalization's Communicative Infrastructure: Seventy Years of "Brain Chemistry" in the New York Times.

Medicalization theory aims to delineate how and why non-medical issues become demarcated within the realm of medical jurisdiction. The theory postulates that medicalization is marked by diagnostic naming, medical expertise, technological standardization and the de-contextualization of experiential knowledge, and that it is driven by popular media and lay discourse as much as by the communication of health professionals and medical institutions. Although medicalization has been recognized as an inherently rhetorical act, medicalization theory does not attend to the specific communicative means undergirding its orchestration. Drawing from medicalized New York Times coverage of the phrase "brain chemistry" (N = 71), we address this theoretical aperture, identifying through rhetorical analysis the most common communicative devices that emerged across 70 years of coverage and three distinct diagnoses (i.e., mental illness, addiction and overweight/obesity). Our findings reveal three central rhetorical means through which medicalization is communicated including mechanical metaphor, pedagogy of contrast, and moral enthymeme. By tracing content across time, the current study explicates the communicative infrastructure that gives rise to medicalization, thereby extending the literature from questions of why medicalization occurs and what its content is to how it is conveyed and imparted.

Public Perception of Female Fertility: Initial Fertility, Peak Fertility, and Age-Related Infertility Among U.S. Adults.

Perceptions of fertility are thought to impact reproductive behaviors, yet little is known about how lay people conceptualize the female fertility timeline. In this research, public perception of the female fertility timeline was assessed via a national survey of U.S. adults (N = 990) ranging in age from 18 to 89 years. Although there is no scientific consensus on the makeup of the female fertility timeline, results from this research indicate that the U.S. public posits fertility onset at (approximately) 13 years, peak fertility at 22, ideal first pregnancy age at 23, too late for pregnancy at 46, and infertility at 49. Regression analysis revealed that perceived peak fertility and ideal pregnancy age were positively correlated such that participants perceived the ideal pregnancy age as directly following peak fertility. Education was significantly related to fertility perceptions; those with more education perceived initial fertility to be lower and peak fertility and ideal pregnancy age to be higher. In other words, more highly educated individuals perceived fertility to manifest over a longer period of time as compared to individuals with less education. Black and Hispanic participants and participants with lower income perceived ideal first pregnancy age as significantly lower than did White participants and participants with higher income. These differences may suggest that the seeds of health disparities associated with phenomena such as adolescent pregnancy are lurking in fertility timeline perceptions.

Occupational Stigma Communication: The Anticipatory Socialization of Sex Educators.

Controversies about sex education have complex, yet often overlooked, occupational implications related to stigma for teachers. In this study, we interviewed 26 future sex educators in their last year of certification about how their anticipatory socialization experiences spoke to the management of potential occupational stigma. Our analysis revealed two stigma management communication (SMC) strategies future sex educators learned, strategies we term cooperation and opportunism, and identified the ways in which those strategies were responses to stigma content cues of responsibility and peril, respectively. We contend that the interactivity of stigma communication is an important site for the theorizing of as-yet-unidentified SMC strategies, strategies that can be enlisted in a diversity of health education and healthcare contexts.

Justifying an ideal first pregnancy age: Vernacular science knowledge and the facilitation of lay argument.

Members of the lay public often draw from vernacular science knowledge-or metaphors, images, and terms related to technical science-to make normative assessments about behavior. Yet, little is known about vernacular science knowledge in terms of its forms and functions. In a national survey, US adults ( N = 688) were asked to identify an ideal age for first pregnancy, and to explain their decision. Participants drew from arguments related to hormonal processes, the language of risk, and the quality and quantity of "eggs" to navigate and identify an ideal timeline for first pregnancy. Their responses illustrated patterns of justification that involved the (a) employment of scientific concepts as heuristic cues for critical analysis, (b) conflation of details, and (c) synecdochal explication. These findings reveal some of the key ways in which vernacular science knowledge may shape the trajectory of lay argument in a range of contexts.

Conflicted Identification in the Sex Education Classroom: Balancing Professional Values With Organizational Mandates.

Despite enormous resources spent on sex education, the United States faces an epidemic of unplanned pregnancy and sexually transmitted infections among young people. Little research has examined the role sex educators play in alleviating or exacerbating this problem. In this study, we interviewed 50 sex educators employed by public schools throughout a Midwestern, U.S. state about their experiences in the sex education classroom. Twenty-two interviewees communicated feelings of conflicted identification and provided examples of the ways in which they experienced this subjectivity in the context of their employment. We find these interviews shed light on the as-yet-understudied communicative experience of conflicted identification by delineating key sources of such conflict and discursive strategies used in its negotiation. Our results suggest that those who experience conflicted identification and who have a sense of multiple or nested identifications within their overarching professional identity may be safeguarded to some extent from eventual organizational disidentification.

The authoritative metaphor and social change: Surgeon General C. Everett Koop's Direct Mailer, "Understanding AIDS".

In 1988, Surgeon General C. Everett Koop published "Understanding AIDS," the nation's first and only direct mailing sent to every private home in the country. His appeals therein were driven by what we label authoritative metaphors. Communicated by and/or attributed to persons of authority, authoritative metaphors capitalize on the symbolic force of sanctioned power by appealing to the ethos of office. In "Understanding AIDS," we find that Koop drew from his positions as a surgeon and a general, respectively, to equate AIDS with an unprecedented plague and an unprecedented war. He created new authoritative metaphors out of the vestiges of familiar metaphors related to disease and public health and thereby portrayed AIDS as a recognizable but decisively unique dilemma requiring distinct preventative behaviors.

HIV/AIDS in Botswana: President Festus G. Mogae's narrative of secular conversion.

Over the last decade, Botswana has been identified as a model for countries fighting against annihilation from HIV/AIDS. The country had the highest rate of HIV infections in the world in 2000, but by the end of Festus G. Mogae's presidential term in 2008 Botswana's situation had improved significantly, as residents were increasingly likely to get tested, obtain treatment, and discontinue practices of discrimination against the infected. This study seeks to contribute to a growing body of literature focusing on the communicative elements that played a role in Botswana's successes. More specifically, the purpose of this study is to explore Mogae's national speeches about HIV/AIDS to consider how his rhetoric may have encouraged Botswana's residents to alter their health-related beliefs and behaviors. We find that Mogae used a narrative of secular conversion (i.e., discourse with a pseudoreligious structure that positions problems as rooted in existing values and offers a new guiding principle as an antidote), and we identify such narratives as persuasive health communication tools. The analysis offers public health advocates, scholars, and opinion leaders a framework for persuasively communicating about diseases such as HIV/AIDS without drawing exclusively from a biomedical framework.

Sex educators and self-efficacy: toward a taxonomy of enactive mastery experiences.

Enactive mastery experiences have been identified as the most influential source of self-efficacy beliefs. Yet little is known about enactive mastery experiences, including how such experiences manifest in naturally occurring situations (as opposed to simulated situations). This study draws from semistructured interviews (N = 50) with sex educators working in public secondary schools throughout Indiana to explicate distinct categories of enactive mastery experiences. Three types of enactive mastery experiences--growth, interactive, and endorsed--emerged from the data and are delineated. This formative taxonomy provides detailed targets for those working to foster individuals' perceived self-efficacy in a variety of contexts, including the health education classroom.

Low-income women describe fertility-related expectations: descriptive norms, injunctive norms, and behavior.

Social norms surrounding sexuality, pregnancy, and childbearing may help guide women's health-related behaviors. In this study, we explore low-income women's perceptions of fertility-related norms by allowing women to describe their experiences with normative expectations. Semistructured interviews (n = 30) suggested that women in low-income subject positions articulate descriptive norms that generally correspond with mainstream descriptive norms, identify two major sources of injunctive norms concerning fertility and sexuality- authoritative and peer-oriented-and often align their behaviors according to subgroup expectations communicated in the form of peer-oriented injunctive norms. We discuss these results in light of the extant literature on social norms.

Fertility-related perceptions and behaviors among low-income women: injunctive norms, sanctions, and the assumption of choice.

In this article we explore elements of the theory of normative social behavior (TNSB) through interviews with low-income women (N = 30) in a Midwestern U.S. state about their experiences with and perceptions of fertility-related norms. Using grounded theory and matrix analysis as analytical lenses, we found that individuals sometimes learn of injunctive norms and social sanctions separately, might be more likely to comply with a norm if they learn about norms and sanctions in concert, and might be more likely to engage in norm compliance if they learn about two different types of sanctions, short- and long-term, along with the injunctive norm. We also found that a number of important barriers can limit one's ability to choose to comply with a norm. In conclusion, we discuss implications for continued theorizing of the TNSB in light of the experiences of traditionally marginalized populations.

Male patient perceptions of HIV stigma in health care contexts.

Individuals living with HIV may have a heightened sensitivity to the behaviors of others that may signal bias or discrimination. Identifying and avoiding these potentially problematic behaviors may be especially important for service providers, such as health care personnel, who regularly interact with HIV-positive clientele. This study examines the experiences of 50 male American military veterans living with HIV and their perceptions of HIV stigma within health care contexts. Participants described a variety of behaviors performed by health care personnel that they perceived to be indicative of HIV stigma, ranging from ambiguous nonverbal cues (e.g., minimal eye contact) to blatant discrimination (e.g., physical abuse of HIV-positive patients). These findings extend previous research on HIV stigma in health care settings by (1) focusing on health care personnel's actual behaviors rather than their attitudes and beliefs about HIV-positive patients, (2) including patients' perceptions regarding the behaviors of both clinical and nonclinical health care personnel, and (3) identifying behaviors patients perceive as stigmatizing that are unique to health care contexts. Combined, these findings provide health care personnel a tangible list of behaviors that should either be avoided or further explained to HIV-positive patients, as they may be interpreted as stigmatizing.