In many parts of the world, grandparents live with their grandchildren in ‘skipped-generation households’ in which no parent resides. In Thailand, this living arrangement is more common in rural areas where parents often migrate to find employment. The focus of this article is on how grandparents make the decision to live in skipped-generation households. Our study is based upon open-ended interviews with 48 grandparents who lived in three rural areas of Thailand. Using an interpretative phenomenological approach, the analysis uncovers several factors that contribute to grandparents’ decisions about their living arrangements. These factors include: norms about care-giving and family obligation, inadequate child-care options, the need for financial support, problematic relationships within the family and a desire for companionship. We also identify three different decision-making patterns: grandparents initiating the decision to provide grandchild care, adult children asking grandparents to assume this role and adult children abandoning grandchildren to the grandparents. Based upon these findings, we provide implications for practice that address the conditions of grandparents and their family members.

Background The wide heterogeneity of available cannabis products makes it difficult for physicians to appropriately guide patients. In the current study, our objective was to characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis. Methods We performed a mixed methods analysis of n=1087 cross-sectional survey responses from adults with self-reported chronic pain using cannabis for symptom management in the USA and Canada. First, we qualitatively analyzed responses to an open-ended question that assessed typical cannabis use routines, including administration routes, cannabinoid content, and timing. We then sub-grouped responses into categories based on inhalation (smoking, vaporizing) vs. non-inhalation (e.g., edibles). Finally, we investigated subgroups perceptions of how cannabis affected pain, overall health, and use of medications (e.g., substituting for opioids, benzodiazepines). Substitutions were treated as a count of medication classes, while responses for both pain and health were analyzed continuously, with − 2 indicating health declining a lot or pain increasing a lot and 2 indicating that health improved a lot or pain decreased a lot. Results Routines varied widely in terms of administration routes, cannabinoid content, and use timing. Overall, 18.8%, 36.2%, and 45% used non-inhalation, inhalation, and non-inhalation + inhalation routes, respectively. Those who used inhalation routes were younger (mean age 46.5 [inhalation] and 49.2 [non-inhalation + inhalation] vs. 56.3 [inhalation], F=36.1, p<0.001), while a higher proportion of those who used non-inhalation routes were female (72.5% non-inhalation vs. 48.3% inhalation and 65.3% non-inhalation + inhalation, X2=59.6, p<0.001). THC-rich products were typically used at night, while CBD-rich products were more often used during the day. While all participants reported similarly decreased pain, participants using non-inhalation + inhalation administration routes reported larger improvements in health than the non-inhalation (mean difference = 0.32, 95% CI: 0.07–0.37, p<0.001) and inhalation subgroups (mean difference = 0.22, 95% CI: 0.07–0.37, p=0.001). Similarly, the non-inhalation + inhalation group had significantly more medication substitutions than those using non-inhalation (mean difference = 0.62, 95% CI: 0.33–0.90, p<0.001) and inhalation administration routes (mean difference = 0.45, 95% CI: 0.22–0.69, p<0.001), respectively. Conclusions Subgrouping medical cannabis patients based on administration route profile may provide useful categories for future studies examining the risks and benefits of medical cannabis.

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Many working-age adults in developing countries leave their homes for jobs to support their families and leave their children behind in the care of their own parents. This chapter focuses on these “skipped generation” households, in which grandparents live only with their grandchildren due to the migration of their adult children. The authors explore the experiences of caregivers, including how tasks and responsibilities are distributed within families, the nature of exchanges between grandparents and their adult children and between grandchildren and grandparents, and the ways in which “skipped generation” households cope with separation and the maintenance of family ties. The chapter examines how culturally grounded ethnotheories and religious concepts (i.e., karma and merit-making) factor into decisions to assume the caregiving role and considers the impact of this situation on the grandparents and the complexity of their experience.

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