SYSTEMIC TREATMENT OF SUBSTANCE ABUSE: A GRADUATE COURSE

Today, family therapists should have an understanding of the development and maintenance of substance abusing patterns in families. In this paper, the authors describe a graduate course for teaching therapists about the contributions that have been made to the understanding and treatment of substance abuse by family researchers, theorists and clinicians. Course purpose, student selection, instructional methods and course content are delineated.     

Qualitative computing: Approaches and issues

This paper reviews three approaches to using computers to perform qualitative analysis. These approaches are distinguished by the way they represent knowledge in the computer—as text, things, or concepts—and the operations they permit on that knowledge. These approaches are compared and the advantages and disadvantages of each are identified based on the way they perform basic tasks of qualitative research. Finally, fundamental issues and problems likely to influence qualitative computing for years to come are discussed.This research was conducted while the author was on sabbatical leave from the University of Missouri and a post-doctorate fellow on NIH grant LM 07006 from the National Library of Medicine. This paper has benefited greatly from the comments of Peter Hall.     

Comparing Equal-Tail Probability and Unbiased Confidence Intervals for the Intraclass Correlation Coefficient

The conventional confidence interval for the intraclass correlation coefficient assumes equal-tail probabilities. In general, the equal-tail probability interval is biased and other interval procedures should be considered. Unbiased confidence intervals for the intraclass correlation coefficient are readily available. The equal-tail probability and unbiased intervals have exact coverage as they are constructed using the pivotal quantity method. In this article, confidence intervals for the intraclass correlation coefficient are built using balanced and unbalanced one-way random effects models. The expected length of confidence intervals serves as a tool to compare the two procedures. The unbiased confidence interval outperforms the equal-tail probability interval if the intraclass correlation coefficient is small and the equal-tail probability interval outperforms the unbiased interval if the intraclass correlation coefficient is large.     

Abstinence and Birth Control Among Rural Adolescents in Impoverished Families: A Test of Theoretical Discriminators

This was a study of 357 adolescents who resided with AFDC families in ten rural counties in Arkansas. The study examined predictors of birth control from sociodemographic variables, control, strain and differential association theories. This was the first theoretically-based investigation of abstinence and birth control among adolescents living with families on welfare in impoverished rural communities. Bivariate analyses indicated that all of the study factors, with the marginal exception of attachment to father, showed significance variance between the three groups of adolescents who had not had sexual intercourse, those who always used birth control, and those who did not always use birth control. The first function of the discriminant analysis discriminated between youth who had not had sexual intercourse and those who were sexually active, and indicated that the former (in order of discrimination) were younger, had fewer sexually active friends or family members, were more religious, had more fear of giving birth if sexually active, and had stronger beliefs in the moral validity of societal laws and norms. The second function discriminated between those who always used birth control and youth who did not always use birth control. The significant discriminators (in order of discrimination) showed that adolescents who always used birth control attended church more often, were more likely to be persons of color than Caucasian, had closer attachments to their mothers, and presently did not desire a baby to love. Social work implications of these findings are discussed from an ecological perspective.     

Confidence intervals for variance components in unbalanced one-way random effects model using non-normal distributions

In scenarios where the variance of a response variable can be attributed to two sources of variation, a confidence interval for a ratio of variance components gives information about the relative importance of the two sources. For example, if measurements taken from different laboratories are nine times more variable than the measurements taken from within the laboratories, then 90% of the variance in the responses is due to the variability amongst the laboratories and 10% of the variance in the responses is due to the variability within the laboratories. Assuming normally distributed sources of variation, confidence intervals for variance components are readily available. In this paper, however, simulation studies are conducted to evaluate the performance of confidence intervals under non-normal distribution assumptions. Confidence intervals based on the pivotal quantity method, fiducial inference, and the large-sample properties of the restricted maximum likelihood (REML) estimator are considered. Simulation results and an empirical example suggest that the REML-based confidence interval is favored over the other two procedures in unbalanced one-way random effects model.     

Beyond GDP: Classifying Alternative Measures for Progress

Both the potential pitfalls of macro-economic policies focused on stimulating economic growth and the problems involved in using GDP as a measure of well-being or economic welfare have long been recognized by economists and researchers from other social sciences. Therefore, it is no surprise that alternative measures for policy-making have been developed and promoted since the early 1970s. Over the past 5?years, the development of these measures has gained momentum both politically and academically. However, most research efforts concentrate on the development and promotion of individual indicators, while paying less attention to the wide range of indicators already available and to theoretical insights. As a result, few classification schemes of alternative measures exist today to help policy-makers in selecting a proper set of indicators. This paper first looks into the different classification schemes available in the literature and outlines the weaknesses in each of these. Afterwards, an alternative classification scheme is introduced that draws on the notions of well-being, economic welfare and sustainability. A further sub-categorization is built on the different approaches that are used to quantitatively capture the notions. By focusing on the underlying concepts that the different measures aim to quantify, the alternative classification scheme overcomes the drawbacks of the existing schemes. Finally, 23 alternative measures for policy-making are reviewed and organized into the newly developed classification scheme.     

Identifying Male College Students' Perceived Health Needs,Barriers to Seeking Help,and Recommendations to Help Men Adopt Healthier Lifestyles

Abstract

Seven focus groups at a university campus were formed to identify college men's health concerns, barriers to seeking help, and recommendations to help college men adopt healthier lifestyles. Content analysis was used to identify and organize primary patterns in the focus-group data. Results of the study revealed that the college men were aware that they had important health needs but took little action to address them. The participants identified both physical and emotional health concerns. Alcohol and substance abuse were rated as the most important issues for men. The greatest barrier to seeking services was the men's socialization to be independent and conceal vulnerability. The most frequently mentioned suggestions for helping men adopt healthier lifestyles were offering health classes, providing health information call-in service, and developing a men's center. Implications of the results are discussed.     

Treatment-competing events in dynamic regimes

A dynamic treatment regime is a sequence of decision rules for assigning treatment based on a patient’s current need for treatment. Dynamic regimes are viewed, by many, as a natural way of treating patients with chronic diseases; that is, treating patients with adaptive, complex, longitudinal treatment regimens. In developing dynamic treatment strategies, treatment-competing events may play an important role in the overall treatment strategy, and their effects on subsequent treatment decisions and eventual outcome should be considered. Treatment-competing events may be defined generally as patient-specific, random events which interrupt the ongoing treatment decision process in a dynamic regime. Treatment-competing events censor later treatment decisions that would otherwise be made on a particular dynamic treatment regime had the competing events not occurred. For example, in therapeutic studies of HIV, physicians may assign treatment based on a patient’s current level HIV1-RNA; this defines a treatment assignment rule. However, the presence of opportunistic infections or severe adverse events may preclude a strict adherence of the treatment assignment rule. In other contexts, the “censoring”-by-death phenomenon may be viewed as an example of a treatment-competing event for a particular dynamic treatment regime. Treatment-competing events can be built into the dynamic treatment regime framework and counting processes are a natural mechanism to facilitate this development. In this paper, we develop treatment-competing events in a dynamic infusion policy, a random dynamic treatment regime where multiple infusion treatments are initiated simultaneously and given continuously over time subject to the presence/absence of a treatment-competing event. We illustrate how our methodology may be used to suggest an estimator for a particular causal estimand of recent interest. Finally, we exemplify our methods in a recent study of patients undergoing coronary stent implantation.