The effect of compliance-improving interventions on the cognitive-behavioural treatment of pathological gambling

This exploratory study investigated the effect of interventions designed to improve compliance and reduce dropout rates during the outpatient treatment of pathological gambling at a University-based gambling treatment clinic. Forty subjects (29 males, 11 females, mean age = 37.6) meeting DSM-IV criteria (APA, 1994) for pathological gambling were randomly assigned to either a cognitive-behavioural treatment or a cognitive-behavioural treatment combined with interventions designed to improve treatment compliance. Compliance was indicated by the completion of all treatment sessions. Outcome measures were DSM-IV criteria assessed by structured clinical interview, South Oaks Gambling Screen scores, and percentage of income gambled. Logistic regression analyses identified pretreatment characteristics predicting compliance and outcome. Compliance-improving interventions significantly reduced dropout rates, resulting in superior outcomes at posttreatment compared to the cognitive behavioural treatment alone. At 9-month follow-up, there was no difference in outcome between treatments, although both produced clinically significant change. Comorbid problem drinking, drug use, and problem gambling duration predicted poor compliance. Poor outcome was predicted by comorbid problem drinking. The clinical implications of these results are discussed in light of the exploratory nature of the study and the need for future research to address compliance, outcome, and comorbidity issues.     

Young Mother (in the) Hood: Gang Girls' Negotiation of New Identities

This article examines the experiences of young women in street gangs who become mothers. Drawing on qualitative interviews with 65 young women in the San Francisco, CA, Bay Area, we examine their narratives about the transition to motherhood. In particular, we focus on the ways these young women negotiate femininities and attempt to reconcile their identities as young mothers and gang girls-both stigmatized identities. For many of the young women, motherhood entails a retreat from the street and a renewed emphasis on time spent in the home. While many receive (financial and childcare) support from their families, this also often means a diminution of the autonomy they experienced while more heavily involved in the gang. Issues of respect and respectability remain important for the young women, but the dimensions on which these are based change.     

Conformity to masculine norms among treatment-seeking male problem gamblers

Men are more likely than women to engage in so-called ‘strategic’ forms of gambling, particularly wagering and casino table games, but the reasons for this preference are unclear. Previous research on male gender roles found that behaviours that are effective at establishing masculinity are those perceived as being risky, skill-based and public – which are also characteristic of these ‘strategic’ forms of gambling. The aim of the current study was to examine the possibility that men may be drawn to wagering and casino table games because these strategic forms of gambling are associated with masculinity. Seventy male treatment-seeking problem gamblers completed a survey on their perceptions of various forms of gambling, and a measure of conformity to masculine norms. Participants reported that being seen as skilled and intelligent, and acting in public were important motivators for both wagering and playing casino table games. Furthermore, individuals who engaged in wagering and casino table games displayed higher levels of conformity to masculine norms than those who preferred gambling on gaming machines. The findings have important implications for the regulation of gambling promotion, the encouragement of help-seeking, and the treatment of gambling disorders in men.     

An empirical assessment of the Above the Influence advertising campaign

This study evaluated the efficacy of Above the Influence (ATI), a national media-based health persuasion campaign to deter youth drug use. The campaign uses public service anti-drug prevention messages and targets youth between the ages of 14 and 16, a period of heightened susceptibility to peer influences. The evaluation utilized mall intercepts from geographically dispersed regions of the country. Theoretical impetus for the campaign combines elements of the theory of reasoned action (TRA), persuasion theory, and the health belief model. A series of structural equation models were tested with four randomly drawn cross-validation samples (N = 3,000). Findings suggest that awareness of ATI is associated with greater anti-drug beliefs, fewer drug use intentions, and less marijuana use. Congruent with the TRA, changes in beliefs and intentions are intermediate steps linking campaign awareness with behavior. This study provides further evidence of positive campaign effects and may strengthen reliance on mass media health persuasion campaigns as a useful adjunct to other programs targeting youth.     

Young-onset dementia: a review of the literature and what it means for clinicians

It is estimated that more than a half million people in the United States are living with young-onset dementia and another half million with mild cognitive impairment, a precursor of dementia. Relatively little has been written about the psychosocial needs of these people, but information can be extrapolated from the literature on dementia in older adults and the developmental tasks and roles of middle age. This article synthesizes this literature and provides information to help psychiatric nurses and other health care professionals better understand individuals living with young-onset dementia.     

Physicians' understanding of consent requirements for phase I clinical trials in cognitively impaired or highly vulnerable populations

We investigated physicians' attitudes about entering patients who cannot give informed consent or who are of a vulnerable population into clinical trials. A survey instrument asked a nationwide sample of practicing physicians about whether ten hypothetical patients could be enrolled in a phase I clinical trials. The impact of demographic variables on the number of scenarios viewed as completely or somewhat acceptable was analyzed via student's T tests or analysis of variance (ANOVA) as applicable. All significant (p<0.01) variables were entered into a multiple logistic regression model. Eighty-four percent of respondents indicated that at least one case scenario was acceptable. A majority of those who conduct clinical trials (62%), who had training in the ethics of clinical research (78%), and who sit on institutional review boards (IRBs) (83%) approved of at least one case scenario. Physicians approved of the entry of some patients who cannot give informed consent or who are of a vulnerable population into clinical trials. More effective education on the guidelines involving clinical research should be available to practicing physicians, residents, and medical students. There should also be assurance that physicians who conduct clinical trials or who sit on IRBs have the requisite knowledge about the ethics of clinical research.     

The effects of management practices on union election returns

This paper examines the importance of management suppression tactics on union activity in the United States. NLRB data on individual certification elections which have recently become available for the period 1972–1976 are merged with structural, demographic, and industry characteristics of the 96 largest SMSAs to ascertain the role of strategy versus structure in explaining union outcomes. The measures of election-generated membership outcomes are voter participation, the margin of pro-union votes, and union wins. Union suppression practices under study include consent elections, election delays, formal objections after unions win a certification election, elections overruled because of management unfair labor practices, elections held by management petition, and the number of unfair labor practice charges per representation election. Five of the six measures of suppression are significant determinants of some facet of union expansion after adjusting for structural characteristics of the area work force.     

The transmission of socioeconomic status and prestige in Great Britain and the United States

We analyze male occupational attainment using separate models in which occupational level is measured by indigenous socioeconomic index (SEI) scales, indigenous prestige scales, and a common prestige scale. Other than some consistent societal differences, the SEI scales produce highly similar results in both societies. In sharp contrast, both indigenous and common prestige scales indicate a stronger relative effect of origin (compared with education) on occupation in Great Britain. The dimensions of prestige and socioeconomic status thus seem to tap different aspects of the social mobility process, and the societies differ in the transmission of prestige but not socioeconomic status.