Biographical disruption, redefinition, and recovery: Illness identities of women with depression and diabetes.

The rich conceptual literature on illness experiences has been based largely on singular diseases/conditions. However, over the last few decades, more complex disease patterns and increased longevity have complicated our understanding of how people experience illness. This study builds upon existing theoretical constructs (e.g. biographical disruption) to more robustly capture the illness experiences of those living with multi-morbid conditions. In-depth interviews, examining the post-diagnostic experiences of women living simultaneously with common somatic (diabetes) and psychiatric (clinical depression) conditions, revealed participants' evolving socially embedded illness identity, as they engaged in (re-)constructing new biographies. Socially contextualized situations shaped and were shaped by their illness identity as they managed social relationships, medication use, and choice of providers. Although diagnosed for years, many continued to have lives in upheaval. While most experienced crumbling self-images and described disrupted biographies, others experienced different trajectories with corresponding illness identities. A new typology emerged, extending Bury's concept of disrupted biographies to encompass redefined, and recovered, biographies, within and across the comorbid conditions.

Situated Motives of Lay Participants in Community Collaboratives for Children's Mental Health.

Publicly funded programs in many industrialized countries increasingly require the participation of citizens. In this article, I explore the "situated motives" of family members who participated alongside professionals in implementing children's mental health programs in two communities in the United States. I conducted in-depth interviews with family members and observed monthly meetings of Community Collaboratives to assess how family members understood their participation. The inductive data analysis demonstrates that family members participated (a) as a therapeutic outlet, (b) to pay it forward, (c) to gain new skills, (d) to have a voice, and/or (e) to empower the community. I then use Giddens' concepts of "life politics" and "emancipatory politics" to explore how these accounts variously reflected lay members' orientations as consumers, empowered individuals, and/or citizen advocates. In the absence of articulated and specific objectives for family participation, these "situated motives" were salient and had implications for how policy was implemented.

Healthicization and Lay Knowledge About Eating Practices in Two African American Communities.

In this manuscript, we expand upon sociological research in lay knowledge about health and healthicization by examining socially mediated ways in which 40 African American adults in two communities acquired information about eating practices. Participants employed a variety of socially informed information-seeking strategies. Many, but not all, used socially prescribed sources exhorting them to maximize their own health and reported an amalgam of experiences concerning their interpretation of healthist messages. Participants variously accepted messages about healthy eating or engaged in strategies of micro-resistance that decentered and/or reinterpreted health promotion discourse. Furthermore, participants used emic community-based resources including those that prioritized familial engagement over individual responsibility in eating practices or that drew upon alternative health practices. We discuss the implications our work has for further research on healthicization and lay knowledge about eating practices, in which community members are actively engaged in meaning-making within local socio-structural contexts.

Evaluation of an innovative tool for child sexual abuse education.

Child sexual abuse poses a serious threat to public health and is often unreported, unrecognized, and untreated. Prevention, early recognition, and treatment are critically important to reduce long-term effects. Little data are available on effective methods of preventing child sexual abuse. The current research demonstrates a unique approach to promoting awareness and stimulating discussion about child sexual abuse. Qualitative methods have rarely been used to study child sexual abuse prevention. Qualitative inductive analyses of interviews from 20 key informants identified both positive and negative assessments with six emergent themes. The themes revealed inherent tensions in using narrative accounts to represent the complex cultural context within which child sexual abuse occurs. More research is needed, but the program shows potential as a methodology to raise awareness of child sexual abuse.

'Wrong parents' and 'right parents': shared perspectives about citizen participation in policy implementation.

Government policies, both in Europe and the U.S., increasingly mandate that community-based citizens partner with professionals to plan and implement policy-relevant programs. In the U.S., parents of children with serious emotional disturbances may participate in Community Collaboratives which are charged with implementing children's mental health policy in local communities. This qualitative study examined three Community Collaboratives and identified organizational features associated with how the groups prioritized lay involvement, among other competing goals which they legitimately could pursue. Thirty-four key informants participated in in-depth interviews. Although the overall study identified several factors which permitted greater and lesser degrees of family involvement, this paper reports on one: the symbolic meaning shared by members about lay participation in their shared perspectives about "wrong parents" and "right parents." Furthermore, two alternate types of "right parents" identified a psychologized version of parents as consumers, and a civic vision of parents as partners. Results from this study are applicable to a wide array of lay-professional partnerships. This study suggests that in order to foster lay-professional partnerships in policy initiatives, lay participants must possess additional, civic-based skills, beyond those needed in the service delivery arena. Furthermore, organizational and professional change may be required to address professional dominance. Within mental health, lack of acceptance of nationally touted recovery-based models is a significant barrier. Finally, sociological implications of developing a civic-based framework for lay-professional partnerships are discussed.

Measuring ethnicity in New Zealand: developing tools for health outcomes analysis.

OBJECTIVE: This study examines the development of new tools for analysing links between ethnicity and health outcomes. In a New Zealand context, it focuses on (1) how ethnicity is increasingly articulated as a social construct, (2) how individuals belonging to more than one ethnic group have been recorded and reported in research, and (3) health research and policy implications of the growing proportion of New Zealanders who claim multi-ethnic affiliations. DESIGN: New Zealand provides a microcosm in which to consider ethnicity, indigeneity, migration and intermarriage, and their interacting effects on society, culture, identity and health outcomes. Against a backdrop of historical debates about the measurement of race, and then ethnicity, the paper explores recent changes in the recording and reporting of ethnicity in the five-yearly Census of Population and Dwellings, and in death registrations. These changes are then considered in relation to the study of ethnic health disparities and the development of policies to overcome them. RESULTS: In the 2001 Census, of those who responded to the ethnicity question, at a level 1 classification 7.9% gave more than one response. In relation to the indigenous people of New Zealand, of all those who recorded Maori as one or more of their ethnic groups, only 56% recorded Maori only. In the younger age groups, less than half the Maori ethnic group were Maori only. Single ethnic categories disguise considerable within-group diversity in outcomes. CONCLUSION: While single ethnic group disparity studies have been useful in the past, we suggest that more sophisticated ways of conceptualising and analysing ethnicity data in relation to health disparities are now required in New Zealand. Based on the New Zealand experience, we also suggest that as international migration continues, and as intermarriage becomes more frequent in most countries, there will be pressure to move from single group race-based measures towards culturally-based complex ethnicity measures.

Human growth hormone and the temptations of biomedical enhancement.

It is likely that humans have sought enhancements for themselves or their children for as long as they have recognised that improvements in individuals are a possibility. One genre of self-improvement in modern society can be called 'biomedical enhancements'. These include drugs, surgery and other medical interventions aimed at improving the mind, body or performance. This paper uses the case of human growth hormone (hGH) to examine the social nature of enhancements. Synthetic hGH was developed in 1985 by the pharmaceutical industry and was approved by the FDA for very specific uses, particularly treatment of growth hormone deficiency. However, it has also been promoted for a number of 'off label' uses, most of which can be deemed enhancements. Drugs approved for one treatment pave the way for use as enhancements for other problems. Claims have been made for hGH as a treatment for idiopathic shortness, as an anti-ageing agent and to improve athletic performance. Using the hGH case, we are able to distinguish three faces of biomedical enhancement: normalisation, repair and performance edge. Given deeply ingrained social and individual goals in American society, the temptations of biomedical enhancements provide inducement for individuals and groups to modify their situation. We examine the temptations of enhancement in terms of issues such as unnaturalness, fairness, risk and permanence, and shifting social meanings. In our conclusions, we outline the potentials and pitfalls of biomedical enhancement.