This study explores stigma in the lung cancer experience by interviewing 18 oncology social workers employed at cancer centers across the United States who provide care to people diagnosed with lung cancer and their family members. A content analysis of the interviews suggests stacked stigma exists with respect to cigarette smoking. Poor prognosis and disparity in advocacy efforts emerged as stigmatizing events that are linked with smoking stigma, particularly in the arenas of support groups, patient-matching programs, availability of resources, and the lung cancer population itself. Emotional phenomenon resulting from this stigma experience may increase the illness burden for people with lung cancer and explain the variance in distress levels among people with different cancer diagnoses.

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In April 2010, President Obama issued a directive to the Secretary of Health and Human Services (HHS) regarding patient visitation, advance directives, and other initiatives to improve the lives of lesbian, gay, bisexual, and transgender people and their families. The HHS response to this directive has implications for hospital social workers. The purpose of this secondary data analysis was to explore indicators of social work readiness to support implementation of the resulting initiatives. A historical context for the changes is provided, inclusive of the cases that spurred the presidential memorandum. The findings are presented within the framework of the profession's standards for social work practice in health care and end-of-life care. Recommendations for enhancing social work readiness for a critical role in implementation of the new regulations are presented.

What a delight to be transported across time, space, and boundary to that glorious place occupied by strong women. The dimension of age is almost inconsequential to this superb collection. Almost, but not quite. As the editor writes in her introduction, "what is defined as attractive and important depends on who is doing the defining." In this collection, the writers define the women about whom they write-the important, attractive, older women. Part of the beauty of these women's strength is born, no doubt, in the broad descriptor older.The women who occupy these pages are not letting go of life, even if they are taking a well-oiled blackberry vodka glide into the sea, to "nourish the fish that long nourished me" (p. 196) like Ritchie's "Amanda." Rather, they are grabbing life, some for the first conscious time. The challenges of growing older are not ignored. But what to do with them is boldly captured, as in Blomain's "Year End Villanelle"-"woe or hope. The choice is always ours" (p. 139)-or in Cheitman's "Crone/ease," when a woman surveying the scars of a surgeon's staples declares, "When I die I want a rug made of this pelt" (p. 153). In Clift's "Why Vermont," a writer celebrates the quiet vibrancy of "deceleration," and in Jacob's "Late Bloomer," a woman no longer defining herself by the frames of younger women flaunts "the large space I occupy in the world" (p. 91). These women indeed occupy large spaces, some quietly, some defiantly, all with a grace and toughness that comes with a growing awareness of one's own strength. Their tales, like any good "coming-of-age" story, are full of the aches and joys of self-discovery and growth. Each short story and poem offers those moments that shimmer like jewels, the moments when we connect to the page, wisdom passed to us from printed character through eyes that read them life size to hearts that recognize their tears and their dances as our own. This connection to the character manages somehow to transcend age even as it glorifies it. Some niggling questions keep the book from being wholly satisfying. Are the books' divisions-"Strengths," "Challenges," "Joys"-somewhat arbitrary and not mutually excusive? More important, for how many of the women is their strength measured against the presence or absence of a man? Are the voices of women of color and of poverty underrepresented? Why are there no lesbian voices, and why does sexual minority only show up in two pieces as older women grapple with a gay son and a gay grandson? The writers, individually, may approach the subject from a feminist perspective. But the overall collection seems lacking in this area.Still, the book readily retains its relevance. It is an excellent academic text for human behavior and social environment courses and electives on aging and on women. Equally important is its usefulness in clinical practice, recommended reading for women who are coming of a "certain" age, learning to befriend and embrace their own strength.

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