A growing number of college (postsecondary) students are in recovery from addiction to drugs or alcohol. In this article, we discuss the experiences of students returning to a university campus after long-term addiction treatment. We also explore the role of a Collegiate Recovery Program (CRP) in providing support, and in helping the students develop post-addiction identities that will sustain them. To do so, we draw on Goffman's ideas related to stigma, as well as conceptualizations of identity reconstruction as a practiced, lived experience. Students interviewed faced a double bind; they sought to escape the stigmatized identity of "addict," but could not identify as typical students because of their abstinence from alcohol and drugs. The CRP helped them manage the transition to student life, provided a safe haven on campus, and provided an alternate and positive identity: a student in recovery.

The prevalence of overweight and obesity is increasing in sub-Saharan Africa (SSA). There is a need for theoretical frameworks to catalyze further research and to inform the development of multi-level, context-appropriate interventions. In this commentary, we propose a preliminary ecological theoretical framework to conceptualize factors that contribute to increases in overweight and obesity in SSA. The framework is based on a Causality Continuum model [Coreil et al. Social and Behavioral Foundations of Public Health. Sage Publications, Thousand Oaks] that considers distant, intermediate and proximate influences. The influences incorporated in the model include globalization and urbanization as distant factors; occupation, social relationships, built environment and cultural perceptions of weight as intermediate factors and caloric intake, physical inactivity and genetics as proximate factors. The model illustrates the interaction of factors along a continuum, from the individual to the global marketplace, in shaping trends in overweight and obesity in SSA. The framework will be presented, each influence elucidated and implications for research and intervention development discussed. There is a tremendous need for further research on obesity in SSA. An improved evidence base will serve to validate and develop the proposed framework further.

Introduction: African Americans living in rural USA experience multiple health disparities as a result of both race and rural geography. An increasing literature suggests that social determinants of health, the social contexts in which people live their lives, are key contributors to these health disparities. Ecological theory provides a valuable conceptual framework for exploring social determinants of health in communities, but few US rural health community-based studies have utilized this approach, or engaged ecological theory to explore rural contexts. This exploratory study blended a community-based, qualitative approach with ecological theory with the objective of identifying potential social determinants of health among African Americans in a rural community in the Deep South, from the perspectives of participants.Methods: In-depth interviews were conducted with rural, Deep South African Americans participants who were purposefully sampled to incorporate a range of perspectives. Interview guides structured around five ecological levels (individual, relational, environmental, structural, and superstructural) were used to frame interviews. Iterative content analysis of interview transcripts and field notes identified potential social determinants of health. An 'editing' approach to content analysis was used. Data and analysis quality was tested by triangulation at the level of the researcher, and by member checking with community members.Results: Potential determinants of health were identified at all five levels of the ecological framework. At the individual level, lack of engagement with personal health and health promotion was a recurring theme. Participation in preventive health activities and education was minimal, even when offered in community settings. At the relational level, lack of social capital emerged as another potential social determinant of health, with estrangement between the younger and elder generations as one source, and fractiousness among churches (key institutions in the community) representing another. At the environmental level, the community built environment was an area of concern as it lacked opportunities for physical activity and access to healthy foods. The local job environment was identified as a potential social determinant of health, given the strong ties between income and health. At the structural level, participants complained of cronyism and nepotism favoring Whites in access to jobs, including those where local policies and funding allocations were made (eg funding for the local health department). In education, school system tracking policies were perceived to discourage African Americans from university education. At the superstructural level, high rates of poverty and racism emerged as potential social determinants. Poverty directly limited many African Americans' access to quality health care, and subtle racism was perceived in some delivery of care. Persistent stress from poverty and racism was reported, which creates health risks through physiologic pathways.Conclusion: This study identified potential social determinants of health, at multiple ecological levels, among African Americans in a rural community in the Deep South. The social determinants identified had the ability to impact a variety of health behaviors and health outcomes. The results demonstrate the value of this approach to conducting rural, community-based research. This descriptive and exploratory study highlights the need for quantitative exploration of these issues, as well as the development of context-appropriate, community-based health interventions that address multiple ecological levels.

IntroductionFew studies have focused on overweight and obesity among rural African American youth in the Deep South, despite disproportionately high rates in this group. In addition, few studies have been conducted to elucidate how these disparities are created and perpetuated within rural communities in this region. This descriptive study explores community-based risks for overweight and obesity among African American youth in a rural town in the Deep South.MethodsWe used ecological theory in conjunction with embodiment theory to explore how upstream ecological factors may contribute to risk of overweight and obesity for African American youth in a rural town in the Deep South. We conducted and analyzed in-depth interviews with African American community members who interact with youth in varying contexts (home, school, church, community).ResultsParticipants most commonly stated that race relations, poverty, and the built environment were barriers to maintaining a healthy weight.ConclusionFindings suggested the need for rural, community-based interventions that target obesity at multiple ecological levels and incorporate issues related to race, poverty, and the built environment. More research is needed to determine how disparities in obesity are created and perpetuated in specific community contexts.

Georgia's Southeast Public Health District (SEPHD), like many rural public health districts, is struggling to cope with drastic cuts in funding and staff. Furthermore, like many rural public health districts, the SEPHD covers a vast geographic area. Effective communication and administration are ongoing challenges. A staff meeting or training may require practitioners to drive hundreds of miles. Besides being inefficient, this is unsustainable and environmentally unsound. In response to these challenges, the SEPHD has implemented a program that harnesses telehealth technology to connect SEPHD health departments and has been able to eliminate most administrative travel. To our knowledge, this is the first evaluated use of telehealth technology for this purpose. An evaluation showed that, each month, telehealth saves the SEPHD roughly $31 500 in mileage reimbursements and salary, SEPHD staff spends 650 fewer hours on the road, and 35 000 miles of driving are avoided.

Prematurity and low birth weight (LBW) are important causes of infant morbidity in Georgia and the United States. Georgia county-level data were used to explore the relationships between prematurity and LBW and two social and economic determinants of health: race and poverty status. Spearman rank correlations and Friedman and Wilcoxon signed rank tests were used. Prematurity and LBW were positively associated with poverty status and the presence of large African American populations. While causation cannot be inferred from correlative data, this analysis highlights the need to consider the role of social and economic factors in infant morbidity. It also highlights the need to target interventions and services to geographic areas most in need.

Little attention has been paid to illness meanings held by those with HIV in the presence of highly active antiretroviral therapy (HAART). This article illustrates how elucidating illness meanings might aid our understanding of HAART adherence and other important health behaviors. Using multiple qualitative methods, including in-depth interviews, free lists, and drawings, I explore meanings surrounding the concept of AIDS among women with HIV in New Orleans, Louisiana. Illness meanings of AIDS reflect the women's negotiation of physical, social, and emotional threats posed by HIV. HIV-positive women displace death and stigma away from an HIV diagnosis to an AIDS diagnosis, creating a sense of safety and normalcy for themselves. Women with AIDS diagnoses, however, struggle to construct illness meanings of AIDS that resist its association with ostracism and death. Drawings produced by the women provide rich insights and illustrate the value of drawings as a visual method in exploring illness meanings.

This paper provides an account of how young, HIV-positive women manage their lives on limited budgets in four United States cities: New York City, New Orleans, Miami, and Chicago. The study findings elucidate city-to-city variability in housing assistance, and how this manifests in locality specific differences in the experience of HIV. Our research suggests that the receipt of housing assistance has ramifications for women’s engagement in care, and for their health. Women not receiving aid often move frequently in and out of homelessness, or “double up” with others in complex household arrangements to share costs. Women with long-term housing assistance, while still struggling financially, possess a stable base from which to approach daily life and HIV care. This account suggests a need for empirical research assessing the impact of local variations in housing assistance on specific health outcomes for those with HIV. It also highlights the importance of understanding local contexts when designing housing interventions at both the individual and structural levels.

People who attend for contraceptive advice have usually formulated an idea of the type of contraceptive that will suit them best. They may wish to use a method that is long, short or medium acting. These are defined as follows: Long-acting method requires renewal no more frequently than every 3 months (e.g. injectable or intrauterine). Short-acting method used daily or with every act of intercourse (e.g. pills, condoms) Medium-acting method requires renewal weekly or monthly (e.g. ring, patch). For men the choice is limited to condoms or vasectomy. Some women do not wish to use hormonal preparations or have an intrauterine device (IUD) or implant inserted. There may also be cultural influences making certain methods of contraception unacceptable. Each of these factors influences the final decision of which method of contraception is decided upon. In addition to taking a full medical and sexual history to identify any risks to the individual's health, which might be increased by a particular contraceptive, time must be spent discussing the options available. It is important to ensure that there is a full understanding of the advantages and disadvantages of each method. The most successful contraceptive method is likely to be the one that the woman (or man) chooses, rather than the one the clinician chooses for them. Access for women to contraception can be improved by having convenient clinic times and service developments such as nurse prescribing and Patient Group Directions.

Millions of women worldwide use combined oral contraception (COC). Most of them are in good health and have no contraindications to using any contraceptive method. Although extremely safe for the vast majority of women and even though the absolute risk of complications is very small, COC is associated with an increased relative risk of serious conditions including cardiovascular disease and breast and cervical cancer. In many countries, breast and pelvic examinations are routinely undertaken annually for all women using hormonal contraception. Breast and pelvic examination have low detection rates for abnormality and may yield clinically irrelevant results, causing anxiety and inconvenience to the patient for no obvious gain. There is no good evidence to support routine breast or pelvic examination either for women starting hormonal contraception or for monitoring long-term use.

Some women find pelvic examinations distressing. Some doctors use this as an excuse not to do them. Most professional organizations recommend the presence of a chaperone for every pelvic examination. In family-planning clinics, usually staffed predominantly by women, the provision of a chaperone for every pelvic examination is a burden to the efficient running of clinics and may not be necessary. Views about pelvic examinations and chaperones were sought from 1000 women attending a family-planning clinic and 98 health-care professionals. The majority of women (59%) do not mind being examined, and when the examiner is female most women do not particularly want a chaperone. One-third of women (34%) actively object to a chaperone. Health professionals are not good at predicting women's feelings and expectations about pelvic examinations. Young women (under 25) and nulligravid women are more likely to find pelvic examinations distressing but not more likely to want a chaperone present. Chaperones should be offered to, but not inflicted upon, women undergoing pelvic examination. Younger women need a particularly sensitive approach. Providers should not be deterred from doing pelvic examinations if they are clinically indicated in the mistaken belief that women will object.

AreaVolume 35, Issue 1 p. 101-105 On the case? Dilemmas of collaborative research Rob Macmillan, Rob Macmillan Department of Geography, University of Durham, Science Laboratories, Durham DH1 3LE Email: r.a.macmillan@durham.ac.ukSearch for more papers by this authorAlison Scott, Alison Scott Department of Geography, University of Durham, Science Laboratories, Durham DH1 3LE Email: r.a.macmillan@durham.ac.ukSearch for more papers by this author Rob Macmillan, Rob Macmillan Department of Geography, University of Durham, Science Laboratories, Durham DH1 3LE Email: r.a.macmillan@durham.ac.ukSearch for more papers by this authorAlison Scott, Alison Scott Department of Geography, University of Durham, Science Laboratories, Durham DH1 3LE Email: r.a.macmillan@durham.ac.ukSearch for more papers by this author First published: 21 March 2003 https://doi.org/10.1111/1475-4762.00115Citations: 14Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume35, Issue1March 2003Pages 101-105 This article also appears in:Methods RelatedInformation

Unwanted pregnancies can be terminated by either medical or surgical methods. Although both procedures are safe, complications may occur and it is important to inform patients of the potential risks during their pre‐operative counselling. The most common complication is the persistence of fetal and/or placental tissue, more rarely the pregnancy may continue. Both patient and operator factors can contribute to the risk of continuing pregnancy. There are a number of precautions that can be taken prior to, or following, the procedure in order to reduce the risk of these rare, but important, complications.