BLACK-WHITE DIFFERENCES IN HEALTH AND MORTALITY:

An important segment of social science research focuses on differences in health and mortality between the African American and non-Hispanic white populations in the United States. This article begins by documenting some of the current health and mortality differences. I then review and critique the three major theoretical approaches that are most often used to explain such differences: racial genetic, cultural/behavioral, and socioeconomic. Finally, I present an alternative conceptual framework for the study of black-white differences in health and mortality. This reorientation of the importance of race for health and mortality moves beyond narrow genetic, cultural/behavioral, or socioeconomic representations to include, most importantly, multiple forms of racism as crucial sociological determinants of health and mortality differentials. Key sets of intervening, or proximate, variables are also identified to specify the process by which the health and mortality differentials are created. While no single future study may encompass all of the factors highlighted in the proposed framework, data collection and research efforts in this area can be guided by a model that organizes into a relatively parsimonious framework the seemingly endless number of factors involved in the creation of such differences.     

A MODEL OF RACIAL RESIDENTIAL HISTORY AND ITS ASSOCIATION WITH SELF-RATED HEALTH AND MORTALITY AMONG BLACK AND WHITE ADULTS IN THE UNITED STATES

We construct a dynamic racial residential history typology and examine its association with self-rated health and mortality among black and white adults. Data are from a national survey of U.S. adults, combined with census tract data from 1970–1990. Results show that racial disparities in health and mortality are explained by both neighborhood contextual and individual socioeconomic factors. Results suggest that living in an established black neighborhood or in an established interracial neighborhood may actually be protective of health, once neighborhood poverty is controlled. Examining the dynamic nature of neighborhoods contributes to an understanding of health disparities.     

THE RELEVANCE OF THE CONCEPT OF DISSOCIATION IN CHILD PROTECTION

This paper explores one aspect of unresolved trauma, namely dissociation. Its relevance to child protection is discussed with reference to two aspects: emotional neglect and choice of partner. There is an exploration of the implications for both assessment and treatment. The central place of shame in relation to dissociation is also explored. It is argued that dissociation is an important concept in child protection assessments and that social work assessments should be alert to this.     

EMERGING TRENDS IN THE PROVISION AND CONSUMPTION OF HEALTH SERVICES

Health services are examined in terms of emerging trends for the new millennium. On the one hand, centralization is increasing as payers tighten control over disbursements through managed care and more restrictive health insurance. On the other hand, health services are decentralizing as patients acquire more information and take more control of some aspects of treatment. Health services markets now also show signs of becoming global in nature, possibly benefiting both bulk purchasers of care and individual consumers. Any tendencies toward increased patient control are likely to be ephemeral, however: In the absence of reforms sparked by yet-to-be-experienced crises, advances in technology, particularly in medical informatics, will likely be used to strengthen the profit positions of insurance providers, not to provide more comprehensive health care services for patients.     

NEIGHBORHOOD CONTEXT AND THE GENDER GAP IN ADOLESCENT VIOLENT CRIME

Although researchers consistently demonstrate that females engage in less criminal behavior than males across the life course, research on the variability of the gender gap across contexts is sparse. To address this issue, we examine the gender gap in self-reported violent crime among adolescents across neighborhoods. Multilevel models using data from the Project of Human Development in Chicago Neighborhoods (PHDCN) indicate that the gender gap in violent crime decreases as levels of neighborhood disadvantage increase. Further, the narrowing of the gender gap is explained by gender differences in peer influence on violent offending. Neighborhood disadvantage increases exposure to peer violence for both sexes, but peer violence has a stronger impact on violent offending for females than for males, producing the reduction in the gender gap at higher levels of disadvantage. We also find that the gender difference in the relationship between peer violence and offending is explained, in part, by (1) the tendency for females to have more intimate friendships than males, and (2) the moderating effect of peer intimacy on the relationship between peer violence and self-reported violent behavior.     

IN SICKNESS AND IN HEALTH: THE IMPACT OF ILLNESS ON COUPLES' RELATIONSHIPS

When illness or disability strikes a couple's relationship, a number of significant structural and emotional skews are likely. A normative, preventive framework that addresses the special strains on couples can counteract dysfunctional relationship patterns and enhance opportunities for increased intimacy. This paper addresses key issues regarding intimacy and communication and then identifies key skews and treatment priorities to help couples rebalance their relationship. These include skews regarding (a) whose problem it is, (b) boundary issues, (c) patient-caregiver roles, (d) togetherness/separateness, (e) psychosocial recovery, (f) cognitive impairment, (g) gender, (h) sexuality, (i) belief systems, and (j) life cycle. Particular dilemmas for gay and lesbian relationships are noted. Dealing with these skews can promote a couple's resilience in the face of loss     

THE VERTICAL CHAIN OF RESEARCH AND DEVELOPMENT IN THE PHARMACEUTICAL INDUSTRY

This paper examines the relationship between basic and applied pharmaceutical research. We focus on three stages of research and development (R & D): government-funded basic research; publication in medical journals; and industry-finded applied R&D. We estimate that a one percent increase in basic research in a particular therapeutic category causes a 0.76 percent increase in industry R&D in that category, and a 1.71 percent increase in other categories, mer seven years. We also find that research incentives differ across government, academic and industry researchers. For example, government funding favors diseases that are less prevalent and more debilitating than industry funding.     

RESIDENTIAL STABILITY, NEIGHBORHOOD RACIAL COMPOSITION, AND THE SUBJECTIVE ASSESSMENT OF NEIGHBORHOOD PROBLEMS AMONG OLDER ADULTS

This study investigates the effects of neighborhood racial composition and residential stability—as measured by the percentage of individuals who have lived in the same location for the past five years—on perceived neighborhood problems. Among a sample of older black and white adults, findings indicate that the patterns are contingent upon residents' race. For whites who reside in neighborhoods with a low percentage of black residents, greater residential stability is associated with fewer perceived neighborhood problems net of individual- and neighborhood-level disadvantage. For blacks, greater residential stability is associated with fewer neighborhood problems, but the percentage of black residents is associated with more neighborhood problems. In both cases, individual- and neighborhood-level socioeconomic disadvantages contribute to those patterns. These findings have implications for theories about the personal and social effects of residential stability and neighborhood racial composition, as well as race differences in the links between neighborhood context and the subjective assessment of neighborhood problems.     

THE CONCEPT OF COMPETITION IN ROBERT PARK'S SOCIOLOGY*

This article examines Robert Park's concept of competition and the way in which it appears in his analysis of civilization and social change. Conventional interpretations of his writings have tended to emphasize that he radically separated presocial, ecological processes from interaction based on communication. Although Park does attempt such a separation, I argue that his thoughts on social change reflect an ambivalence about the relative degree of autonomy of social and cultural processes. Consequently, Park's evaluation of these processes reflects the judgment that contemporary forms of competition are instrumental for societal progress.     

GENDER AND THE HEALTH BENEFITS OF EDUCATION

Does education improve health more for one sex than the other? We develop a theory of resource substitution which implies that education improves health more for women than men. Data from a 1995 survey of U.S. adults with follow‐ups in 1998 and 2001 support the hypothesis. Physical impairment decreases more for women than for men as the level of education increases. The gender gap in impairment essentially disappears among people with a college degree. Latent growth SEM vectors also show that among the college educated, men's and women's life course patterns of physical impairment do not differ significantly.     

DETERMINANTS OF INDIVIDUAL NEIGHBORHOOD TIES AND SOCIAL RESOURCES IN POOR URBAN NEIGHBORHOODS

Studies on life in poor urban neighborhoods suggest the importance of kin and non-kin ties for support. Research also notes the dearth of certain ties that are important to locate economic and social resources. This research evaluates the determinants of certain types of social resources for residents in poor urban neighborhoods. Specifically, I consider the relationship between five types of neighborhood ties for residents--religious, kin, friendship, neighbor, and informal jobs--as well as race/ethnicity, and neighborhood poverty and social resources. Using the Urban Poverty & Family Life Survey and OLS and logistic regression analyses, results show religious and friendship ties are important predictors of individual social resources and support. Also, neighborhood poverty is insignificant in most of the analyses and when it is important, residents in more impoverished areas are more likely to seek out social resources than their counterparts in non-poor and moderately poor areas. These findings support variants of Compression and Composition theories as possibleexemplars for explaining ways in which residents secure social resources in poor urban neighborhoods.     

EFFECTS OF RESIDENTIAL SEGREGATION AND NEIGHBORHOOD OPPORTUNITY STRUCTURE ON THE EMPLOYMENT OF BLACK AND WHITE YOUTH

The object of this article is to consider the impact of local labor market opportunities on the employment of youth, and to evaluate the extent to which residential segregation is detrimental to the employment of young blacks. In the study, labor force statistics for white and black youth are related to job availability estimates derived from Dun and Bradstreet business data for 74 neighborhood communities in the city of Chicago. The findings underscore the unique role of local labor markets, especially for youth enrolled in school. Job availability has a strong impact on the employment ratio of blacks, but affects the employment of white youth only slightly. It appears, however, that when job availability is controlled, blacks benefit somewhat from segregation. The implications for job redistribution and its possible effect on the racial employment gap are discussed.     

TECHNOLOGIES OF THE SELF AND THE AESTHETIC PROJECT OF ALTERNATIVE HEALTH

Utilizing ethnographic materials and data from thirty-eight interviews, this article investigates the relevance of alternative health bodily regimes as a source of involvement in public life. These regimes, we argue, have an aesthetic core, a quest for perfect harmony and balance, that step by step makes people available for participation in public life. The article seeks to overcome the neglect of aesthetic sources of participation in public life as well as the neglect of the body as a symbol of risk and a source of resistance to dominant institutional arrangements. Foucault's later writings on "technologies of the self"are used to interpret alternative health regimes and open up their politicizing potential.     

PERCEPTIONS OF MARRIAGE AND RATIONALITY BY LEVELS OF PERCEIVED HEALTH IN THE FAMILY OF ORIGIN*

The family therapy field has witnessed a beneficial dedication to the study of the transmission of pathology (Mueller & Pope, 1977). Of late however, there is a concern that pathology has been overly stressed (Stachowiak, 1975). It is perhaps with this overemphasis in mind, and that the absence of pathology does not necessarily equal health (Kleiman, 1981), that researchers have recently pursued the study of family health (Olson, Russell & Sprenkle, 1983; Walsh, 1982). The concept of family health has particular significance when considering the family of origin. Bowen (1978) and Framo (1981), in particular, have described the transmission of pathology from one generation to the next. It is less clear, however, whether health follows a similar transmission process, although the notion seems appealingly logical. Anderson (1981) pointed to the dearth of investigations studying the consequences of health in the family of origin and offspring characteristics. This study addresses these concerns by investigating the extent to which subjects' rational thinking and perceptions of marriage are associated with their level of perceived health in their families of origin.