Navigating the Drinking Self: A Qualitative Study of Beer Consumption Among the Working-Poor in Botswana

Alcohol consumption studies in sub-Saharan Africa have largely focused on social control and regulatory mechanisms in specific settings without particular reference to how drinkers negotiate and navigate their drinking selves. Existing studies do not give enough attention to how consumers enact, make sense and experience drinking in light of state regulatory efforts. Using a constructivist grounded theory approach among twenty (20) beer drinkers, this study identifies how beer drinkers in Botswana experienced alcohol. Our findings demonstrate a theoretical category of Negotiating the Drinking Self where beer drinkers constructed and enacted a drinking self throughout the life-course, from the point of exposure at home through adolescence and up to maturity. The drinking self-constitutes an important part of the drinker’s identity and adapts to each stage of the life-course. Among the working poor in Botswana, beer drinking is complex, situated and embedded in webs of patterned social interactions

Medical Self-Care: Compliance with Recommended Treatment Regimens among Chronically Ill Middle-Aged and Elderly Persons

Examines compliance with medical treatment programs among middle-aged & elderly persons living with arthritis, diabetes, & hypertension using a conceptual model that combines elements of the health belief model, physician-patient relationship, & experience of illness. Face-to-face interview & medical record data from 612 chronically ill middle-aged & elderly health maintenance organization members indicates that, while the majority complied with medication regimens during the week prior to data collection, it varied between ailments. Respondents were considerably less likely to follow medical recommendations regarding diet, exercise, or other treatments. Physicians' interactional styles had more influence on compliance with medications than on other aspects of medical self-care. Among health beliefs examined, only perceived effectiveness of treatment had consistent effects on compliance. Effects of illness experience were mixed. 7 Tables, 1 Figure, 1 Appendix, 23 References. Adapted from the source document

The Life Course Metaphor: Implications for Biography and Interpretive Research

This paper reviews qualitative research in the United States, highlighting the ways research has changed in the era of the third age. With growing attention to positive and uplifting aspects of aging, qualitative research has played a critical role in the exploration of the ways in which older adults are engaging in meaningful ways with others. We describe two key methodological approaches that have been important to examining positive aspects of aging and exploring the extent to which a growing number of years of healthy retirement are redefining the aging experience: ethnographic research and grounded theory research. We also review key topics associated with qualitative research in the era of the third age. These topics fit within two dominant frameworks – research exploring meaningmaking in later life and research exploring meaningful engagement in later life. These frameworks were critically important to raising attention to meaningful experiences and interactions with others, and we propose that the agenda for future qualitative research in the United States should continue contributing to these frameworks. However, we note that a third framework should also be developed which examines what it means to be a third age through use of a phenomenological approach, which will assist in the important task of theory building about the third age

Article 1 vol VI is 1

Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w V Vo ol lu um me e V VI I I Is ss su ue e 1 1 w ww ww w. .q qu ua al li it ta at ti iv ve es so oc ci io ol lo og gy yr re ev vi ie ew w. .o or rg g 4 Q Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w Abstract This paper reviews qualitative research in the United States, highlighting the ways research has changed in the era of the third age. With growing attention to positive and uplifting aspects of aging, qualitative research has played a critical role in the exploration of the ways in which older adults are engaging in meaningful ways with others. We describe two key methodological approaches that have been important to examining positive aspects of aging and exploring the extent to which a growing number of years of healthy retirement are redefining the aging experience: ethnographic research and grounded theory research. We also review key topics associated with qualitative research in the era of the third age. These topics fit within two dominant frameworks -research exploring meaningmaking in later life and research exploring meaningful engagement in later life. These frameworks were critically important to raising attention to meaningful experiences and interactions with others, and we propose that the agenda for future qualitative research in the United States should continue contributing to these frameworks. However, we note that a third framework should also be developed which examines what it means to be a third age through use of a phenomenological approach, which will assist in the important task of theory building about the third age. Keywords Third age; Qualitative gerontology; Meaning making; Meaningful engagement Appreciating that persons have a "life course" has changed the field of gerontology. Since the emergence of this construct, persons are imagined to have biographies. Rather than passing through discrete stages, in a somewhat linear fashion, their life experiences are cumulative and reflect many changes. Instead of sequenced, the "vocabulary of the life course"-with stages, transitions, and plateaus-suggests that a personal history is integrated but multidimensional © ©2 20 00 05 5--2 20 01 10 0 Q Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w V Vo ol lu um me e V VI I I Is ss su ue e 1 1 w ww ww w. .q qu ua al li it ta at ti iv ve es so oc ci io ol lo og gy yr re ev vi ie ew w. .o or rg g (Holstein, Gubrium 2007: 1-18). At any phase of a person's life, accordingly, a confluence of factors are presumed to be operating. In all, the complexity of any station in a person's life is thought to be revealed through this style of imagery. The conceptual themes that emerge from a life course paradigm are considered to be important in making gerontological studies more holistic. In point of fact, multiple causes, or influences, are now commonly accepted as contributing to a behavioral episode, as well as a course of action (Elder 1978: 17-64). The life of a person thus represents a pattern, with recurring themes and many beginnings. Indeed, a life course is variegated and malleable, but coherent (O'Rand, Kreckler 1990: 241-62). 5 Such a description of personal development, at first glance, appears to be consistent with qualitative or interpretive research. If anything, interpretive researchers strive to be holistic and avoid the reductionism linked traditionally to positivism and other styles of crude empiricism. The idea is that persons are better understood when the myriad of considerations that shape and give meaning to behavior are grasped, along with the context of these elements (Harris, Parisi 2007: 40-58). Especially in the social sciences, such sensitivity has considerable appeal. How persons define themselves and their environment, and integrate these experiences, provide the texture of a life course. According to interpretive researchers, ignoring this wisdom has dire consequences in terms of analyzing adequately the nature of aging, or for that matter any other social phenomenon. But there are problems with the life course analogy that may contradict the aims of interpretive research. The focus of this paper is the metaphors that have been used to describe the life course. These descriptive devices, even after much critical work on this topic, tend to reify personal and collective existence. In other words, the life course is portrayed in such a way that the stages or trajectory of a person's existence can be viewed as natural or inevitable. And when conceived in this way, a life course can be reduced easily to a series of events and a matrix of causes. The unique manner in which this pattern has been constructed and regularly modified can thus be easily obscured. In fact, this strategy is considered to be the state of the art by many quantitative researchers. Such an outcome is inconsistent with gaining insight into the existential character of a person's life. Clearly interpretive researchers are interested in knowing how the various factors that comprise a life course are defined and organized to become a coherent and meaningful existence. At the same time, there is another factor related to reification that contravenes interpretive methods but is not often discussed. Stated simply, the political side of interpretive research is muted! The existential character of the life course presupposes that social reality is not necessarily fixed or stable. This lack of stability, accordingly, has very interesting and powerful political implications with respect to the social impact of interpretive research. These issues, however, have not gone unnoticed by gerontologists (Holstein, Gubrium 2007). Some critics have scrutinized the potential of life course metaphors to reify a person's biography. Nonetheless, their reformulation does not necessarily change anything substantially. Particularly noteworthy is that the ad hoc character of the life course is not clearly illustrated. In this respect, time is treated as a medium rather than the capacity of persons to organize their biographies. The result is that the political promise of interpretive methods is not given any serious attention. Persons may modify their lives, but within very narrow confines. They may be restricted, for example, to acting simply within the contours supplied by the natural transition points (Hittlin, Elder 2007: 170-91). © ©2 20 00 05 5--2 20 01 10 0 Q Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w V Vo ol lu um me e V VI I I Is ss su ue e 1 1 w ww ww w. .q qu ua al li it ta at ti iv ve es so oc ci io ol lo og gy yr re ev vi ie ew w. .o or rg g 6 The purpose of this paper, accordingly, is to extend beyond how the life course has been rethought by these critics. How time has been discussed by writers such as Husserl and Schütz is central to this task. And following this reconceptualization of time, the truly existential thrust of a life course should become clear. Additionally, the politics of interpretive method, which are relatively unexplored, should become apparent. The Life Course The life course perspective or model is eclectic in many ways. This outlook tries to incorporate a variety of disciplines, such as biology, psychology, and sociology. Additionally, persons are assumed to adopt many, and often conflicting, roles during their lives (Karp, Yoels 1982). And finally many transitions are thought to occur throughout a person's life. What the life course orientation does, simply stated, is give a somewhat reasonable portrayal of the aging process. A person's existence is an integrated and dynamic event (Russel 2007: 173-92). Many other theories have existed that include various stages and transitions, such as those in psychology and child development. For the most part, however, they are insensitive to the actual social or contextual conditions of persons. Everyone is presumed, for example, to pass through identical stages at approximately the same time. Specifically, the onset and nature of adolescence or old age is not thought to vary appreciably among persons. Although the aim of life course analysis is to be more holistic than in the past, normative prescriptions have been linked to this model. Assumptions are made regularly, for example, about how persons are expected to behave at any particular stage. Furthermore, violating these norms is often treated as indicative of illness or deviance. Human development is thus considered to follow a particular path, which everyone must traverse with few exceptions. For example, the life course of women is often messier than for men, due to obligations that regularly pull them "off time" The originators of this theory wanted to emphasize the malleability of the life course, but they presupposed a theory of time that would compromise this aim. As will be demonstrated, the life course has been associated, nowadays in a subtle fashion, with a Newtonian theory of time (Arxer, Murphy, Belgrave 2006: 51-60). Within a Newtonian framework, time is imagined to be an independent measure of the location of events and people. Based on the logic of discrete succession, time assigns what was, what is, and what will be. Persons, in the end, are free to make evaluations and adjustments in their lives, but only within an autonomous timeline. Specifically, a base-line is available to orient all people because everyone is located in time. Aging, therefore, is said to be a cumulative event that results from the addition of experiences, changes, and interventions. Again, persons are left to confront a mechanically inspired aging process. Within this temporal viewpoint, aging unfolds along exact and thus universal guidelines, because life now represents a fairly rigid pattern or timetable of events. What this outlook tends to obscure, however, is how aging is a fundamental commitment to potentially different interpretations of existence and not a cumulative process. But because aging is considered a chronological phenomenon, only so much personal variation is possible-namely, moving forward (progress) through time. And if persons' interpretations deviate too much from these natural stages, their views are dismissed as inappropriate or misinformed. How persons might define © ©2 20 00 05 5--2 20 01 10 0 Q Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w V Vo ol lu um me e V VI I I Is ss su ue e 1 1 w ww ww w. .q qu ua al li it ta at ti iv ve es so oc ci io ol lo og gy yr re ev vi ie ew w. .o or rg g 7 themselves, therefore, does not affect appreciably how age is understood. Similar to previous theories, a developmental path is clearly prescribed that everyone is expected to follow. The life course, in the end, reifies development. Because of the image of time that is adopted, "age norms" are introduced with little critique. In fact, due to the dualism that supports the Newtonian position, serious reflection on the life course would not be expected. Rather than situational or contextual, the life course transcends these limitations and thus has universal application. How human growth should proceed, accordingly, is not relative to culture or contingent in any other respect. Although recognized as varying at different stages, times, and places, in any given period or location behavioral norms are unambiguous and applied with little critical analysis. When conceived in this manner, the life course is consistent with the thrust of Western philosophy. This approach to human development, in other words, provides a standardized basis for making comparisons between persons. That is, behavior can be evaluated against a particular course and judged to be either adequate or deficient. But gradually this course becomes a template that overlooks the uniqueness of persons. In more sociological terms, the life course becomes an ideology that disregards how persons perceive and assess their own development. The aging process is thus not viewed as discontinuous and multivalent. Indeed, Bury's (1982) discussion of "biographical disruption", due to chronic illness, highlights the expectation of a smooth life course. Most of the emphasis is placed, instead, on persons conforming to the demands of an institutionalized path. Special emphasis, in fact, is placed on adjustment and so-called productive or successful aging (Butler, Gleason 1985; Within the context supplied by the life course, the study of aging is straightforward. A person's health characteristics or behaviors are compared to the norms operative at a particular stage in life. Any interpretations are treated as subjective opinions that blur the facts. Hence personal or collective experience is dismissed as a distraction. Rather than a life project that reflects commitments and decisions, aging proceeds like a clock. There are no jumps or reverses, but only continuous and unrelenting moments. At this juncture a particular issue becomes important. That is, what about human agency? While this theme is not necessarily the focus of life course theorists, this ability is presupposed by themes such as malleability (Elder 1994: 4-15). But with respect to the assumed Newtonian backdrop, persons do not invent their lives. Those who are intelligent and resourceful, instead, learn how to age gracefully. They internalize the demands of the life course and make rational decisions within these parameters. Persons try their best in an age-appropriate manner and make the most effective use of the time that is available. Any existential angst is thus calmed by the predictability of the life course. In line with the design of the life course, social existence becomes routine and narrow. Of course, such a description is antithetical to the original intention of supporters of life course imagery. And because of the promise of this theory, some writers have tried to reconstruct the life course. The question is whether or not their efforts have truly animated the life course. © ©2 20 00 05 5--2 20 01 10 0 Q Qu ua al li it ta at ti iv ve e S So oc ci io ol lo og gy y R Re ev vi ie ew w V Vo ol lu um me e V VI I I Is ss su ue e 1 1 w ww ww w. .q qu ua al li it ta at ti iv ve es so oc ci io ol lo og gy yr re ev vi ie ew w. .o or rg g 8 A Constructionist Turn Holstein and Gubrium (2000) understand this issue of reification. They recognize that the life course can be transformed easily into a naturalistic development path. Therefore, they strive to avoid terms such as stage, phase, or progression when describing the aging process. What they want to overcome is precisely the sort of reductionism these ideas can encourage, whereby a person's existence is little more than an evolving scheme. These authors do not want to make the error of portraying the life course to be autonomous, so that everyday life becomes a faint image of a more fundamental course of development. In order to avert this problem, they try to link the life course with constructionism. Specifically, their strategy is to embed the life course in the Lebenswelt, or "life world" (Husserl, 1970: 113). To borrow from In pursuit of this aim, Holstein and Gubrium (2007: 2-3) rely on phenomenology, particularly writers such as Berger, Luckmann, and Schutz. Basic to phenomenology is intentionality, which Husserl defines as "consciousness is always consciousness of something" (Husserl 1975:13). Although this phrase sounds trite, his point is to undermine the Cartesian distinction between subjectivity and objectivity. With consciousness linked to whatever is known this dualism is passé. Now the influence of consciousness on the production of knowledge becomes the focus of attention. Facts are thus no longer objective, but, as constructionist like to say, a social production. Instead of dealing with the objective or empirical features of phenomena, importance is given to their meaning. Persons do not simply reflect reality, if they are properly trained, but ascribe significance to behavior and events. The emergent reality of human values, beliefs, and commitments is referred to as the life world. This world is living because conscious activity cannot be extracted from reality to reveal a purely independent material realm. All phenomena are material and experienced, but only through the activity of meaning construction. Accordingly, the life course should not consist of stages that are naturally disposed or socially imposed. Each stage, as Holstein and Gubrium (2007: 4) declare, is implicated in this process of ascribing meaning and can be defined or experienced in a host of ways. The result is that age-specific criteria become elusive and gain relevance only as a consequence of particular decisions and commitments. Each stage of life may thus have multiple meanings, none of which should be considered natural. One version may become a "paramount reality", according to phenomenologists, while other possibilities fade into the background, at least momentarily (Schutz 1962: 207-59). This prominent interpretation, furthermore, may eventually be treated as a natural stage in life, but there is nothing inevitable or ultimately real about any phase. Which interpretation becomes relevant pertains, for example, to the social organization of power and the resulting consensus or conflict and the enforcement of age norms. Nonetheless, Holstein and Gubrium are not entirely successful in their attempt to abandon the Cartesian base of the life course. Specifically, their depiction of time may permit the life course to retain a sense of autonomy and re-emerge as a natural progression or series of behavioral expectations. Although language use is difficult and imprecise, Holstein and Gubrium use phrases to recast time that rely on familiar dualistic imagery. They repeat often that the life course behavior exists "through time" (Holstein, Gubrium 2007: 3; 2003: 836; Gubrium, Holstein 1995: 209), "across time" (Holstein, Gubrium 2007: 17), and "in relation to time" (Holstein, Gubrium ibidem). In each case, time appears to be either a medium that carries persons along or a referent that serves to unite a person's life. Time is presented as a phenomenon that remains autonomous, as in the Newtonian tradition, and continues to provide a natural background or logic for aging. Holstein and Gubrium are sensitive to this issue, for they understand that if the life course is autonomous, the ability of persons to construct their lives is severely truncated. Nonetheless, they seem to be uncertain about the role of human action. Contrary to phenomenology, their description represents a weak constructionist position because meaning-construction does not touch the existential core of reality. In Holstein and Gubrium's approach, speech acts are not allowed to "go all the way down", in the manner intended by Stanley Fish (1989: 344), and give shape to reality. In this sense, these two authors seem to retain a measure of dualism that phenomenologists reject. In fact, often Holstein and Gubrium seem to equivocate on this point of dualism. At times language is given its full constructive nature, while at others speech is only given the capacity to describe the world. Sometimes critiques of the life course are invoked to make sense of behavior, while at others behavior is understood as simply conditioned by circumstances (Holstein, Gubrium 2007: 10). In the end, the point is whether their constructionist position allows for behavior to be merely interpretively described or constituted. Can a life's possibilities be merely modified, recast, or relabeled, or do persons have the latitude to (re)invent themselves and construct their lives? (Holstein, Gubrium 2007: 7, 32, 183-84, 205; Gubrium, Holstein 1995: 210). The nature of the life course changes significantly depending on how this question is answered. Some of this confusion could have been avoided, however, if Holstein and Gubrium provided an alternative conception of time. Instead of simply softening the traditional imagery, they could have applied a phenomenological version of time to aging. If this were the case, there would be no justification for the autonomy of time and the accompanying life stages. In fact, adopting the idiom of the life course would not make any sense. If time is constituted, simply put, life is neither progressive nor digressive, but represents a socially maintained montage of possibilities, some actualized and other not. Time and Biography Rethinking time from a phenomenological perspective begins with intentionality. Due to the primordial connection between consciousness and reality, the dualism that supports the autonomy of time is undercut. Hence in view of intentionality, a Newtonian vision is no longer justified. Time, in other words, should not be treated as a medium that traverses space, has direction, and unites locations. Such a decontextualized time is now fictional and, as will be discussed, a viewpoint that frustrates an interpretive account of life experiences such as aging. As Husserl notes, time must exist within the realm deployed by consciousness. The position advanced by phenomenology is more radical than the proposal advanced by Husserl's rendition precludes such dualism because temporality emerges from the vast field of consciousness. When associated with consciousness, time is not first based on notions of "extension" and "length", but shifts in interpretation. What is interesting is that consciousness does not have any inherent divisions, such as

Globalization and medicine in Trinidad

In a qualitative study of urban Trinidadians who work in the medical industry, the concept of medical globalization was provisionally analysed. Two research questions were addressed: what is globalization, in the context of mainstream medicine, and how is this process manifested in everyday practices? Four fundamental principles of medical globalization emerged from in-depth interviews and analysis of observational materials: (1) the notion of history as an autonomous force with globalization as the latest stage, (2) the expansion of 'Total Market' philosophy as a driving social force, (3) the fragmentation of society into atomistic, self-interested, and competitive individuals, and (4) the adoption of a 'centralised' set of ideals as the normative core necessary for social order. In this paper, findings from this investigation and their implications are discussed. In particular, medical globalization is linked with major themes in medical sociological theory including dualism and medicalization

Ethnicity, Social Support, and Injection Drug Use

There is considerable agreement that the prevalence of diagnosed AIDS cases and the prevalence of HIV infection is greater among African American and Hispanic injection drug users (IDUs) than among Anglo (White, non-Hispanic) IDUs. There is less agreement on why this is the case. This lack of knowledge is related, in part, to the paucity of research on the cultural diversity among IDUs and the impact that cultural differences have on injection risk behaviors of those three groups. This analysis examined possible differences in the sources from which each ethnic group obtained their works (IVequipment) in a sample of 711 injecting drug users drawn from six methadone clinics, three residential treatment programs, and one drug detoxification program between June 1987 and August 1988 in South Florida. It was found that African Americans were more likely (69.4%) to acquire their works from street suppliers than were Hispanics (49.4%) or Anglos (36.1%). It is conceivable that "source of works" is a contributing factor to the higher prevalence of AIDS among minority IDUs