Factors influencing older black women's sexual functioning and their disclosure of sexual concerns.

INTRODUCTION: The study of older women's sexual health has been very limited. Most of the available research in this area is on Caucasian older women; a few studies have targeted the sexuality of older Black women. There could be several reasons for this and for the common reluctance of these women to disclose information on their sexual health. The aim of this review was to discuss factors influencing older black women's sexual functioning and their disclosure of sexual concerns. DISCUSSION: In this article, we first briefly reviewed the literature on sexual health among older women, then covered historical and social issues that are likely to influence older Black women's sexuality as well as their common reluctance to disclose intimate details of their lives to their health providers. This information could be important for researchers as well as healthcare professionals. Specific groups of clinicians potentially interested in this discussion are sexual health professionals, couples' counsellors as well as other professionals attempting to address older patients' problems such as relationship, intimacy and sex challenges. Without knowledge of critical issues such as the potentially traumatizing historical events and the multiple societal pressures that are likely to impact these women's sexuality and disclosure of sexual concerns, it would be difficult for researchers and clinicians to get an accurate account of older Black women's sexual needs. CONCLUSION: Older Black women's sexuality is a very delicate and complex topic. We encourage interested professionals to make an effort to become more aware of what is potentially holding back older Black women from disclosing their sexual concerns to them, and have provided some historical information and research suggestions to guide professionals interested in investigating older African American women's sexuality in a more tactful and culturally-sensitive way.

The COPE program: treatment efficacy and medical utilization outcome of a chronic pain management program at a major military hospital.

This study presents a treatment efficacy and medical utilization evaluation of a cognitive-behavioral, outpatient, chronic pain management program in a military hospital setting. A total of 61 nonmalignant chronic pain patients with heterogeneous pain syndromes who participated in sequential group programs were included in the study. Comprehensive and multi-dimensional outcome criteria were used, including pain ratings, relaxation skills, quality of life, satisfaction ratings, and medical utilization. The findings demonstrated improvements on all general indices. Military status had no effect on any of the outcome measures. Most significant was an 87% reduction in outpatient clinic visits in the first 3 months after treatment. This reduction amounts to a projected net annual saving of $78,960 in the first year after behavioral medicine intervention. In light of the increasing cost of health care for chronic pain patients, psychological approaches as an adjunct to traditional medical care seem to present a sound solution for cost savings. This study also supports the notion that a strategic biopsychosocial pain program, which targets the multiple dimensions of persistent pain, provides effective treatment and increases patient satisfaction.

Psychosocial correlates of contraceptive practices during late adolescence.

This article reviews the literature on psychosocial correlates of contraceptive practices among sexually active late adolescents (primarily college undergraduates). It seeks to help identify subgroups of adolescents who either do not use or misuse contraceptive means, putting them at risk for unwanted pregnancy, AIDS, and other sexually transmitted diseases. The intent is to promote further research on those variables with the most potential for predicting contraceptive behaviors, which will assist in the development and implementation of effective prevention and intervention programs.

Older adults' expectations about mental health counseling: a multivariate and discriminant analysis.

The present study aimed at identifying significant predictors of expectations about mental health counseling in a sample of highly educated elderly. This task was achieved by administering the full version of the Expectations About Counseling (EAC) questionnaire to fifty-seven retired professors. We first addressed the issue of the current elderly's under-utilization of formal counseling services, then conducted a literature review on the relationship between elderly's characteristics and their views of counseling. Specific hypotheses were formulated for each of the seven possible predictors of EAC scale scores. Previous counseling experience and marital status were significant predictors of EAC scale scores. Young-old adults (i.e., younger than 75 years of age) had received counseling experience significantly more than their older counterpart; their EAC scores, however, were not significantly different than those of old-old participants. Gender, area of residence, income and religiosity did not predict expectations about counseling significantly. Cell size heterogeneity for some predictors might have been responsible for lack of significance on additional factors. The article ends with a discussion of several clinical implications of the findings.

Pain, disability, and psychological functioning in chronic low back pain subgroups: myofascial versus herniated disc syndrome.

A series of patients with chronic low back pain evaluated at a tertiary referral center were the subjects for this study. Of 250 consecutive patients, 94 were diagnosed as having myofascial pain and 57 as having herniated disc syndrome. Before evaluation and diagnosis, all patients completed the McGill Pain Questionnaire, ratings of pain and disability, and the Symptom Checklist 90-R. Patients were also grouped on the basis of previous surgical history and workers' compensation benefits. Patients suffering from myofascial pain were significantly less likely to report periods of pain relief than patients with herniated disc syndrome. Those receiving workers' compensation benefits reported significantly greater levels of pain, disability, and psychological distress than those not receiving benefits, irrespective of diagnosis. Patients who underwent previous surgery did not differ significantly from those who never underwent surgery. All patients had elevated scores on the Somatization subscale of the Symptom Checklist 90-R. Patients with myofascial pain and workers' compensation benefits demonstrated the highest levels of somatization and phobia. These findings suggest that the effects of low back pain of myofascial origin have comparable, if not worse, consequences than disc herniation. These findings also reaffirm the importance of workers' compensation in understanding the differences in patients with chronic low back pain.

Contraceptive health programs for adolescents: a critical review.

Many adolescents are neither educated about contraception nor consistently practice it as part of their sexual health behavior. Contraceptive education has taken many forms and has been questioned as to its effectiveness. This paper reviews some of the contraceptive education programs that have been designed for adolescents. These programs, although targeting the adolescent population, differ in educational process based on the delivery setting. School-based, community-based, and college/university-based programs are reviewed and discussed in terms of their effectiveness, potential, and limitations. Educating adolescents about contraception should incorporate the cognitive, affective, and skill-based domains of learning, with outcome expectations based on the specific delivery setting. However, not all settings have the freedom to select from a variety of teaching methodologies. Thus, educational accountability in each setting should differ in terms of outcome expectations, particularly if the program evaluation includes behavioral components.