Health care risks and access within the community of Michigan over-the-road truckers

This mixed methods study explored health care access problems faced by long-distance truck drivers. Thirty trucking professionals were interviewed at truck-stops in Michigan about health status and health care access. Thirty of the 88 drivers approached participated. The most common illnesses they reported concerned the eye, back, excessive stress at work and painful joints or arthritis. Most respondents had a family doctor; for those who did not, cost was a major contributing factor. More than one third stated their health is "not excellent" because of poor accessibility to healthcare on the road. Almost unanimously, drivers desired to have access to health care clinics in truck-stop areas and described particular access problems; the solution may be as simple as making the existing health care system more amenable to those driving large truck rigs.     

Social psychopathy,social distress,family breakdown,and custody disputes in the 1990s: Implications for mental health professionals

The decade of the 1990s will probably contain more challenges to the role of the mental health practitioner in child custody cases than ever before in history. Because of increasing social stress and family disintegration, custody disputes are destined to become more frequent, bitter, and traumatic for all parties. Mental health professionals, in particular, need to develop a coherent structure regarding their own participation in this process. Issues of moral changes among our leadership and our citizenry are examined and guidelines for the behavior of the mental health practitioner in the courtroom are formulated and illustrated as they pertain to custody decisions. Particular attention is paid to custody decisions as an art rather than a science, the role of empirical research, the need to anticipate certain unintended circumstances, the need for the application of mental health principles on an individual case-by-case basis, the nature of the mental health professional's expertise, and the problems with the concepts of parental unfitness and the use of psychiatric diagnosis as a way of defining such alleged unfitness.     

The production of understanding

While there is little doubt that sociological theory and research has had an important impact on the way people think about health and health care, mental health and medical sociologists are often confronted with challenges concerning the utility of the work that they do. Among the doubters are deans, funding agencies and family members. We are challenged by the ascendency of biological interpretations of human behaviors, by the incompatibility between the contextual view we prefer and the very strong individualistic orientation of our culture, and by the fact that we do not have an applied arm that trains the professionals who treat health and mental-health conditions. How do we respond to this challenge? The title of this paper gives a short answer: "The Production of Understanding." I propose that a powerful but under-recognized value of our work is the generation of explanations about health and mental health matters that help people understand the other side of an "us"/"them" divide. We produce understanding in a context in which misunderstanding is regularly constructed by powerful people who offer victim-blaming explanations for the circumstances experienced by people with less power. The production of understanding serves as an important counterbalance to this tendency. Our work shapes the way people think about problems related to health and mental health, limits the power of inaccurate victim-blaming accounts and provides understanding about why health and mental health are mal-distributed among people from different social circumstances.     

Externalizing problems in young foster children: Prevalence rates,predictors and service use

Objective

Examining the prevalence of externalizing problems, their predictors and mental health service use for these problems by foster children and foster parents in a representative group of foster children aged 3 to 12 in Flanders.

Method

Survey data were collected on 212 foster children, who had been in the foster family for approximately four months. Foster parents filled out a Child Behavior Checklist to measure foster children's externalizing problems. Foster care workers reported on several potential risk variables for externalizing problems and on foster children's and foster parent's mental health service use. Predictors of externalizing problems were identified from a large number of variables using the method of purposeful selection of variables in linear regression.

Results

40.6% of the foster children had externalizing problems. Foster children who were placed because of behavioral problems had more externalizing problems. Only 20.9% of the foster children with externalizing problems and only 13.9% of their foster parents received professional help.

Conclusions

This study showed that externalizing problems are prevalent in this young foster care population, that it is hard to predict which foster children had externalizing problems, and that foster children and their foster parents rarely receive services for these problems. These findings call for a standard protocol of assessment of foster children's externalizing problems. Moreover, from a preventive viewpoint, guidelines are needed to systematically link young foster children with externalizing problems and their foster parents to appropriate services.     

Of pride and prejudice: the role of sociology and social networks in integrating the health sciences

Calls have been issued for understanding the "contexts" or "environment" shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within "big science " to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point.     

Homeless mothers and depression: misdirected policy.

This paper is a critique of recent service-intensive shelter programs for homeless mothers and the policies that underlie these shelters. We first document the process by which mental health problems and family homelessness became so closely but mistakenly linked. We then demonstrate empirically that shelter programs for homeless families nonetheless presume that mental health problems are part of the causal nexus of family homelessness and indiscriminately deliver mental health services to homeless mothers. Simultaneously, shelter programs encourage the isolation of their residents from what they presume to be their "problematic" social networks. We show that, while mental health services had little impact on depression levels among homeless mothers, isolation from social networks did increase depression among homeless mothers. Our findings suggest that policy should put more emphasis on rapid reintegration into the community through providing housing, and it should put less emphasis on providing services.     

Establishing a mental health service for young children in out-of-home care: The Gumnut Clinic for 0 to 5 year olds in Western Sydney

Objective

Children aged 0 to 5 years in out-of-home care represent a vulnerable population at high risk of social, emotional and developmental problems, yet there are few services specifically addressing their psychological needs. This paper is the first of two concerning the establishment of The Gumnut Clinic, a specialist mental health assessment clinic in Western Sydney for this population. The current paper provides the rationale for the development of the clinic and detail of the referral and assessment processes.

Method

The paper describes the establishment of The Gumnut Clinic at Redbank House in Sydney, Australia, the approach to assessment of these young children and their carers, and the challenges encountered.

Conclusions

Young children are overrepresented in child protection and out-of-home care services. Their social, emotional and developmental needs are under-recognized. Development of a specialist mental health service is a step towards improving health outcomes for these children.     

The Impact of Age and Health on Vehicle Choices among Elders

We examine older Americans’ choice of vehicle types and the impact of age and health status on this choice. Using the 1998 and 2000 Health and Retirement Study (HRS) and the 2001 HRS Consumption and Activities Mail Survey (CAMS), we estimate a multinomial logit model of older Americans’ choice of vehicle types. We find that both age and health status influence the type of vehicle purchased or leased. Compared to Americans aged 50–59, those aged 70 or older prefer passenger cars to trucks and sport utility vehicles (SUVs). We also find that elders with health problems are more likely to prefer SUVs to passenger cars than those without health problems.

A Loss of Credibility: Patterns of Wrongdoing Among Nongovernmental Organizations

This paper analyzes, from a cross-national perspective, publicized incidents of wrongdoing by nongovernmental organizations (NGOs). A content analysis of media reports of scandals over the past four years involving NGOs was conducted to identify issues and trends in governance and management problems. The analysis is confined to NGOs that are involved in the financing and/or delivery of health and human services in order to facilitate comparisons. International and U.S. cases of wrongdoing, covering the gamut of embezzlement to mismanagement, are identified and the common elements and unique features of these cases are examined. The underlying problems that allowed these cases to occur and their implications in regard to NGO credibility and public trust are identified and options for enhancing accountability explored.     

Increasing health inequality in China: An empirical study with ordinal data

This paper employs a recently introduced method of income-health matrix to study health inequality in China. The method overcomes the problems associated with ordered self-reported health (SRH) responses when the conventional tools of inequality analysis are used. Applying the new method to the China Health and Nutrition Survey (CHNS) data, we find that over the study period of thirteen years, health inequality has increased by more than one hundred percent in spite of the multifold increase in average income. We conclude that the most likely explanations for the recent increase in China’s health inequality are: aging population, worsening income inequality and poverty, division between urban and rural, and environment deterioration.     

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.     

School Violence and Adolescent Mental Health in South Africa: Implications for School Health Programs

This study examines the perceptions of high-school adolescents about gang violence in a periurban community near Cape Town and the implications for school health in South Africa. Using the qualitative focus group discussion (FGD) guide, data were collected from 60 high-school adolescents, between 10 and 20 years of age. Trained moderators conducted nine FGDs with small groups of six to eight students. The constant comparative ethnographic method was used to analyze the data. Results indicate that gang violence is very common among high-school adolescents living on the Cape Flat. Gangs, perceived by many as part of the rite of passage among adolescents, are a major threat to the public health, mental well-being, general welfare, happiness, and development of high-school populations on the Cape Flat. Gang activity interlock with many other social problems, including drug and alcohol abuse, school unrest and violence, and the increasing prevalence of sexually transmitted diseases, especially HIV and AIDS. These findings suggest an urgent need for concerted efforts to develop mechanism to protect school pupils from gangs and develop healthier social alternatives to gang-related activites. Ties among government, school, parents, and community education and participation are urgently necessary to implement a school-based approach to adolescent health promotion.     

Very Public Scandals: Nongovernmental Organizations in Trouble

This paper analyzes, from a cross-national perspective, publicized incidents of alleged wrongdoing on the part of nongovernmental organizations (NGOs). Data were derived from daily, weekly, or monthly newspapers and special nonprofit newsletters accessible through websites. Analysis of media reports of scandals involving NGOs was conducted to identify issues and trends in governance and management problems associated with this sector. The paper focuses on NGOs involved in the financing or delivery of health and human services. After highlighting some of the precedent-setting cases of NGO improprieties in the United States during the 1990s, prominent global cases of wrongdoing during the period 1998–2000 are reviewed. The underlying problems that allowed these cases to occur and their implications regarding NGO credibility and public trust are identified, and strategic options for enhancing accountability presented.     

Research in mental health: social etiology versus social consequences

This article differentiates a social etiology model focused on identifying the social antecedents of one particular mental disorder from a social consequences model concerned with the overall mental health consequences of various social arrangements. In the social etiology model, people with disorders other than the one particular disorder singled out for investigation are implicitly classified as "well." This disorder-specific model is inappropriate for the more general sociological task of identifying the consequences of various social arrangements, such as concentrated poverty, racial segregation, and gender stratification. It is problematic because these consequences are typically nonspecific, not limited to one particular disorder. From this perspective, persons classified as "well" in the disorder-specific model who have a different disorder are misclassified. Consequently, the impact of social arrangements is underestimated, and estimates of causal effects are biased. To address these problems, the full range of theoretically derived mental health outcomes needs to be simultaneously analyzed.     

Spousal Problems and Family-to-Work Conflict Among Employed US Adults

Using data from the 2011 National Survey of Midlife Development in the United States Refreshed Sample (N?=?980), this paper examines how three types of spousal problems—poor physical health, poor mental health, and behavioral disorders—are related to respondents’ family-to-work conflict (FWC) among employed adults aged 25–61. Results suggest that all three types of their spouses’ problems were related to respondents’ higher FWC, with their spouses’ poor mental health having the strongest association. These associations were not significant after controlling for respondents’ role overload, financial strain, and relationship strain. There were few variations by respondents’ gender and parental status in these associations. Relationship strain played the primary role as a mediator, which was stronger for men than women. These findings support the idea of stress proliferation, suggesting that one’s problems can be linked to a series of other stressors including one’s spouse’s FWC.     

Health of Immigrants in European countries

The health of older immigrants can have important consequences for needed social support and demands placed on health systems. This paper examines health differences between immigrants and the native-born populations aged 50 years and older in 11 European countries. We examine differences in functional ability, disability, disease presence and behavioral risk factors, for immigrants and non-immigrants using data from the Survey of Health, Aging and Retirement in Europe (SHARE) database. Among the 11 European countries, migrants generally have worse health than the native population. In these countries, there is a little evidence of the "healthy migrant" at ages 50 years and over. In general, it appears that growing numbers of immigrants may portend more health problems in the population in subsequent years.     

Characteristics of substance-abusing women on welfare. Findings from the evaluation of CASAWORKS for Families pilot demonstration

AIM: To describe and compare the characteristics and needs of substance-abusing women on Temporary Assistance to Needy Families (TANF) who enroll in a multi-service "welfare to work" program (n = 673) with two other relevant groups: (a) women from the general TANF population in the same locales (n = 157) and (b) a sample of substance-abusing women on TANF who entered standard outpatient substance-abuse treatment programs (n = 520). DESIGN: A field study with repeated measures and intent-to-treat sampling. INTERVENTION: The CASAWORKS for Families (CWF) program was delivered in 11 sites in 9 states across the country. The CWF intervention featured integration of substance-abuse treatment and employment-work readiness services, using case management to tailor needed services (parenting, victimization, mental health, physical health, legal, and basic needs). MEASUREMENT: The Addiction Severity Index, supplemented with subject-appropriate questions, was used at treatment admission. FINDINGS: The CWF sample exhibited multiple serious problems in the areas of substance abuse, victimization, medical and psychiatric health, and basic needs. The severity of their lifetime problems and their recent service needs were significantly higher in all these areas, except physical health, than were those of the general welfare sample of women in the same locales. Compared with women on TANF from standard addiction-treatment programs, CWF women exhibited similar substance-use problems but generally more severe co-occurring problems.     

Problem drinking patterns among African Americans: the impacts of reports of discrimination, perceptions of prejudice, and "risky" coping strategies

This research builds on a series of recent studies that have reported independent effects of personal experiences of racial discrimination on poor mental health outcomes. We suggest that for one mental health outcome, problem drinking, discrimination experiences have an impact not only via abridged socioeconomic attainment and the frustrations associated with institutionally limited opportunity structures, but also by directly increasing the likelihood of problem drinking. Moreover, we argue that personal experiences with discrimination help to foster a set of beliefs about the utility of drinking as a means of reducing stress that in the alcohol literature is referred to as "escapist" drinking. Escapist drinking is proposed as an intervening mechanism that is associated with a higher probability of alcohol-related mental health problems. Using data from the 1999-2000 National Survey of Black Workers, we find that, independent of socioeconomic attainment, personal reports of discriminatory experiences have direct influences on problem drinking. Consistent with our hypotheses, we also find that the effects of personal reports of discrimination are at least partially mediated by the endorsement of beliefs that drinking provides an effective coping mechanism. We conclude that racial impacts on mental health outcomes reflect more than the "simple" effects of constrained socioeconomic attainment.     

In search of the highest attainable standard of mental health for children

The United Nations Convention on the Rights of the Child (CRC) may be a leading example of psychological jurisprudence. By its emphasis on promotion of the "child's sense of dignity and worth," the CRC offers a framework for comprehensive child policy in a manner that is consistent with the promotion of mental health and prevention of mental health problems.     

Social support needs of families adopting special needs children

A grounded theory begins to explain parental practices in seeking social support. Interviews with 20 parents who had adopted children with special needs and 5 health care providers indicated that parents lacked awareness of available resources; preferred informal support systems; sought help only when "failing" to solve problems; and perceived that health care providers lacked knowledge of adoption issues, family dynamics, and common health issues. Parents preferred informal to formal supports, and felt upset when formal supports were judged ineffective or non-existent.