Deborah A. Sullivan

Snowbirds Seasonal Migrants to the Sunbelt

The recent interest in the mobility of the elderly overlooks the temporary migration patterns of retirees. The focus of this article is on the seasonal migration of retirees to travel trailer and m...

Satisfaction with maternity care: a matter of communication and choice.

The purpose of this study was to determine the level of satisfaction with maternity care and whether satisfaction was related to the patterns of communication between caretakers and patient and to specific clinical procedures used during labor and delivery. Data, gathered in a statewide survey, indicated widespread satisfaction with prenatal, labor and delivery care. Level of satisfaction was related to both the quality of communication and the fulfillment of preferences about the management of labor and delivery. There was a general consensus among respondents about the desirability of childbirth coaches, controlled breathing and relaxation techniques, and freedom to move around and the undesirability of medication rendering one unconscious for delivery. There was considerable variation in desire concerning medication during labor, use of a fetal monitor, presence of family members and choice of atmosphere. The implications for alternatives in maternity care are discussed.

The Ties that Bind: Differentials between Seasonal and Permanent Migrants to Retirement Communities

This article proposes a typology of migration based on duration of annual residence in planned retirement communities. The categories of the typology-seasonal in-migrant, seasonal out-migrant, seasonal traveler, and year-round resident-are used to classify a sample of households in a southwestern retirement community. The findings suggest that out-of-state children and ties to small towns are inhibiting influences on permanent relocation after retirement. Facilitating factors associated with seasonal migration include: a spouse in the household, higher socioeconomic status, and the absence of health restrictions on activities.

Informal Support Systems in a Planned Retirement Community Availability, Proximity, and Willingness to Utilize

This study evaluates retirement community norms in terms of the hierarchical-compensatory versus the task-specific models of exchange. Data collected in a sample survey indicate that residents form mutual assistance networks for short-term help in lieu of or in addition to distant or nonexistent children and other kin. As hypothesized by the task-specific model, only a minority expect long-term care from local friends. Contrary to both the task-specific and the hierarchical-compensatory models, few rely on any primary group for long-term care. As the community ages, the residual old-old population is made up of individuals with attenuated kin networks or strong reservations about informal support for long-term care. The findings point to the need to develop formal support systems in retirement communities.

Obstacles to the practice of licensed lay midwifery

Intensive interviews with licensed lay midwives in one of ten states that have recently reactivated and revised legislation legalizing such alternative practitioners for low risk clientele revealed a number of obstacles to their practice. The obstacles stem from the same rules and regulations developed by medical practitioners that made their homebirth service legal. Even after surmounting the difficulties of obtaining a license, the midwives find widespread unwillingness among private physicians to provide the required prenatal screening examination and medical back-up. The opposition of physicians to the licensed midwifery program is voiced in terms of concern about the safety of homebirths, particularly those attended by nonphysicians. Yet, the outcomes from the first 4 years of the program give no support for such concerns. Physician reluctance to cooperate with the legal program, combined with restrictions prohibiting the licensed midwives from suturing minor tears and administering a single dose of an antihemorrhagic drug in an emergency transfer, do compromise the overall quality of midwifery care. While accepting their subordinate position to medical practitioners, the midwives are struggling to establish the continuum of care for homebirth women implied in their licensure law.

Utilization and evaluation of maternity care by American Indians in Arizona

Drawing upon a statewide consumer survey conducted in 1979 by the Bureau of Maternal and Child Health, this report focuses on the health service utilization and evaluation of 110 American Indians. The data shows that Indians, in contrast to Anglos, have less prenatal care, a higher incidence of transport to special care facilities, a higher incidence of newborn problems, and unusually high rates of early and late discharge. The Indian women also reported a higher incidence of communication problems with their caretakers and were less satisified with the care that they received. The discussion considers the problems of less continuity of care and personnel shortages as well as cultural differences for delivering the quality of care mandated by treaty and subsequent laws to this impoverished minority group.

A social change model of the obesity epidemic

Purpose – Obesity has reached epidemic levels in the United States and many other affluent countries and is a growing problem in some developing countries. World Health Organization estimates that the global rate will reach 13 percent by 2015. Because obesity increases the risk of many diseases ranging from type 2 diabetes and asthma to cardiovascular disease and some cancers, it threatens to undermine twentieth-century gains in life expectancy. This chapter offers a theoretical model of obesity that postulates the epidemic is a latent dysfunction of macro-structural changes initiated by industrialization that have decreased the physical activity of everyday life and promoted a nutrition transition to a high-calorie diet. Methodology/approach – Comparative and historical population data are presented that generally support the conceptual model, although some significant cultural differences are found in particular race/ethnic groups. Findings – The finding that structural changes in society created and continue to support the obesity epidemic will make it difficult to control by focusing only on health education campaigns aimed at changing individual behaviors. Contribution to the Field – This chapter offers data and analysis that can support policy making needed to change the structural influences.

Environmental Factors in Obesity

Obesity has reached epidemic levels in the United States and some other affluent countries over the past 30 years, and is a growing problem in the urban populations of developing countries. WHO estimates that the global rate of obesity will reach 13% by 2015. It has already reached 34% among American adults and another one-third are overweight. The rapid increase in obesity is linked to macrosocial changes that have fueled international trade and economic growth, increased food production, promoted urbanization, and generally increased the average standard of living, while reducing physical activity. The epidemiology of obesity is complex; it is the outcome of the interaction between genetics and the social, cultural, and physical environment. It is usually higher among women. It is positively associated with higher socioeconomic status in developing countries, but negatively in developed countries, except for African-American women, more than half of whom are obese. Because obesity puts people at risk to many comorbidities, such as cardiovascular disease and diabetes, it threatens to undermine twentieth century gains in life expectancy. Unless effective interventions can be developed and quickly implemented, obesity will be the defining disease of the twenty-first century.