A bargaining theory of sexual behavior in women's adolescence

NICHD Grant P30 HD06268-19 AND NICHD Grant RO1 4D1926

Contraceptive behavior among unmarried young women: A theoretical framework for research

Adoption of the most effective methods of contraception requires individual decision-making and negotiation with contraceptive providers. In order to take account of both behavioral elements, a two-dimensional framework for understanding contraceptive adoption and continuation by unmarried young is proposed, incorporating a "social-psychological model" of individual decision-making and an "interpersonal model" of factors affecting provider-client interaction. The social-psychological model is based on an earlier value-expectancy theory of behavior motivation as applied to health-related behaviors. The interpersonal model is derived from conflict-bargaining perspectives on professional-client interaction; it is suggested that expectations for this interaction are based on a limited number of internalized "models": the "professional"; the "bureaucratic"; the "commercial"; and the "parental." Insofar as client and professional "models" disagree, communication may break down and client understanding and/or acceptance of provider advice cannot be assured. The components of the social-psychological and interpersonal models are described in detail, and a combined framework is proposed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/43514/1/11111_2005_Article_BF01255864.pd

Crisis and Change: The Making of a French FDA

Policy Points:Introducing a recent special issue of The Lancet on the health system in France, Horton and Ceschia observe that “the dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others.”1In that spirit, this manuscript presents a detailed case study of public health policy transformation in France in the early 1990s. It casts light on processes of policy change in a political and cultural environment very different from that of the United States, showing how the public health policy process is shaped by multiple contingencies of history, ideology, and politics.More specifically, we describe the transformation of a disease catastrophe into a political crisis and the deployment of that crisis to precipitate reform of the French public health system.ContextUntil the last decade of the 20th century, France had no equivalent to the US Food and Drug Administration. In this paper we describe and interpret the complex series of events that led to the passage by the French Parliament in December 1992 of a law incorporating such an agency, the Agence du Médicament (literally, “medicines agency”). The broad aim of this project was to learn how public health policy change comes about by detailed analysis of a specific instance. More specifically, we aimed to better understand the circumstances under which public health crisis leads to significant public health policy reform.MethodsThis paper is based on detailed analysis of primary documents (eg, archived French health ministry papers, recorded parliamentary debates, government reports, newspaper articles) and oral history interviews covering a period from 1988 to 1993. Thematic analysis of these materials was initially grounded in theories of organizational change, moving to constructs that emerged from the data themselves.FindingsPolicy entrepreneurs positioned to frame adverse events and seize opportunities are key to public health policy reform. However, whether these entrepreneurs will have the requisite institutional power is contingent both on political structure and on the power of competing institutional actors. Health crises may catalyze institutional reform, but our analysis suggests that whether reform occurs, or even whether adverse episodes are labeled as crises, is highly contingent on circumstances of history, political structure, and political ideology and is extremely difficult to predict or control.ConclusionsActors positioned to shape public health policy need to have a detailed understanding of the circumstances that facilitate or impede policy reform. Health crises are now more often global than not. Comparative, theoretically grounded, cross-national research that looks in detail at how different countries respond to similar health crises would be extremely valuable in informing both policymakers and researchers

Construction of a Policy Arena: The Case of Public Health in France

In this article we examine the transformation over the past two decades of public health as a policy arena in France from a backwater of little interest to politicians, bureaucrats, the media, and the public into a central preoccupation of the state. Recent dramatic health crises (the scandal over HIV-contaminated blood, mad cow disease, etc.) have substantially raised the political profile of (and corresponding state investment in) public health in France, offering opportunities and incentives for political actors not traditionally associated with public health to enter the field and challenging more traditional actors to galvanize themselves and compete for this newly attractive policy terrain. We use the occasion of the passage of a public health law in 2004, labeled by its proponents as the “first” public health law in one hundred years, to show how, in a context of national struggle to contain both risks and costs, “public health” — chameleonlike — has taken on various meanings and forms to serve highly conflicting political interests. (Résumé éditeur

Crisis and Change: The Making of a French FDA

Policy Points:Introducing a recent special issue of The Lancet on the health system in France, Horton and Ceschia observe that “the dominance of English as the language of science and, increasingly, global health too often closes the door on the history and experiences of others.”1In that spirit, this manuscript presents a detailed case study of public health policy transformation in France in the early 1990s. It casts light on processes of policy change in a political and cultural environment very different from that of the United States, showing how the public health policy process is shaped by multiple contingencies of history, ideology, and politics.More specifically, we describe the transformation of a disease catastrophe into a political crisis and the deployment of that crisis to precipitate reform of the French public health system.ContextUntil the last decade of the 20th century, France had no equivalent to the US Food and Drug Administration. In this paper we describe and interpret the complex series of events that led to the passage by the French Parliament in December 1992 of a law incorporating such an agency, the Agence du Médicament (literally, “medicines agency”). The broad aim of this project was to learn how public health policy change comes about by detailed analysis of a specific instance. More specifically, we aimed to better understand the circumstances under which public health crisis leads to significant public health policy reform.MethodsThis paper is based on detailed analysis of primary documents (eg, archived French health ministry papers, recorded parliamentary debates, government reports, newspaper articles) and oral history interviews covering a period from 1988 to 1993. Thematic analysis of these materials was initially grounded in theories of organizational change, moving to constructs that emerged from the data themselves.FindingsPolicy entrepreneurs positioned to frame adverse events and seize opportunities are key to public health policy reform. However, whether these entrepreneurs will have the requisite institutional power is contingent both on political structure and on the power of competing institutional actors. Health crises may catalyze institutional reform, but our analysis suggests that whether reform occurs, or even whether adverse episodes are labeled as crises, is highly contingent on circumstances of history, political structure, and political ideology and is extremely difficult to predict or control.ConclusionsActors positioned to shape public health policy need to have a detailed understanding of the circumstances that facilitate or impede policy reform. Health crises are now more often global than not. Comparative, theoretically grounded, cross-national research that looks in detail at how different countries respond to similar health crises would be extremely valuable in informing both policymakers and researchers

Female labor force participation and female mortality in Wisconsin 1974-1978

The following research question is addressed in the study: what effect will the entrance of women into the labor force have on female mortality rates for all causes of death combined as well as specific causes relating to occupational stress, behavioral factors and physical hazards associated with occupation? This question is examined through comparisons of age, marital status and occupation-specific death rates for all causes of death combined and for selected causes of death. Death certificates provided by the Wisconsin Bureau of Health Statistics for the years 1974-1978 and population data provided by the 1976 Survey of Income and Education were used to construct death rates. The death rates of the white civilian female population of Wisconsin 16-64 years of age were examined using exploratory data analysis techniques (schematic plots and median polish) and standard errors. In general, the death rates of women in the labor force are substantially lower than those of housewives. These results may indicate that the role of housewife exposes women to health hazards. In addition, the results of this study may suggest some selectivity of healthy women into the labor force or a protective effect of labor force participation. In a limited number of instances, labor force participants' mortality rates exceed those of housewives. In the 60-64 year old population, white-collar workers, specifically, sales workers, managers and professionals, experience significantly higher death rates than housewives. In addition, specific groups of labor force participants experience significantly higher death rates than housewives for accidental deaths (i.e. laborers 16-44 and 45-54), deaths due to heart disease (i.e. laborers 45-54 and sales workers 60-64) and deaths due to malignant neoplasms (i.e. white-collar workers 60-64 years of age). The possibility that these instances indicate the direction of future mortality trends should be considered.