Screening for patients with alcohol problems: severity of patients identified by the CAGE.

Primary care physicians are well situated to identify patients with substance abuse problems and motivate them to seek appropriate assistance, but active programs are the exception. A study in a community setting was undertaken to assess the CAGE (the first letters of key words in a series of four questions about drinking: cut down; annoyed; guilty; and eye-opener), instrument in the routine screening for alcohol problems in both new and established patients. The screening process identified subjects for a pilot evaluation of a motivational interview designed to encourage problem-solving behavior. This article focuses on the screening results and the use of the CAGE instrument. During June and July of 1990, 687 patients of two primary care physicians belonging to a large group practice were asked to complete a health questionnaire that included the CAGE. Those who responded affirmatively to at least two of the four CAGE questions were requested to participate in follow-up assessment of problems associated with alcohol and health. The type and severity of alcohol problems experienced by patients who scored positive on the CAGE are described. Prevalence of a positive score on the CAGE was 8.6 percent with males, smokers, and blue collar and unemployed persons being more likely to score positive. The positive predictive value was .68. Primarily, persons with moderate alcohol problems were identified. Results show that the CAGE instrument is a useful screening device for identifying those with mild to moderate substance abuse problems, increasing the opportunity for intervention prior to serious medical complications. The instrument is easily administered, and has demonstrated relatively high levels of sensitivity and specificity. When combined with assessment and motivational interviews, the CAGE shows promise in the secondary prevention of substance abuse and related health problems.     

Negotiating Role Definitions and the Working Consensus in Self-Work*

Definitions of social roles and the maintenance of a working consensus are two kinds of background expectations which are important for actors’accomplishment of self-work. Interactionists have traditionally assumed that these background expectations are unambiguously available to social actors as they negotiate situated meanings of selves and situations. Using data from dyadic role-play conversations, this study examines instances where interactants reference these expectations as ambiguous or problematic. The findings show that the situated meanings of role definitions and the working consensus are continually subject to potential negotiation. The implications of these findings for future research and theory on self-work in social interaction are discussed.     

Codependency and Recovery: Gender,Self, and Emotions in Popular Self-Help

Popular contemporary rhetoric of the self advocates knowing the needs of the self and reaching a balance between self and other. As a consequence of economic dependence on men, women have emotional obligations that make meeting these goals unlikely. The recently identified condition called codependency addresses the tensions underlying this situation. Recovering from codependency serves as an aligning action that accounts for past behavior using the quasi-medical rhetoric of addiction. The sick role then allows for small amounts of deviance from female gender role norms in that it permits women to exercise some self-determination in the allocation of their time and emotions. Although critics have ignored the possibility, codependency can provide a tool of resistance for those who have few resources to challenge the status quo.     

EFFECTS OF A PREPAID NONMONETARY INCENTIVE ON RESPONSE RATES AND RESPONSE QUALITY IN A FACE-TO-FACE SURVEY

We conducted a randomized experiment on a face-to-face interviewsurvey in order to test the effects on response rates of a prepaidnonmonetary incentive. Results showed a statistically significantincrease in response rates, mostly through reduction in refusalrates, in the half sample that received the incentive (a gift-typeballpoint pen) as compared with a no incentive control group.The effect appears to be due to greater cooperation from incentiverecipients at the initial visit by an interviewer. Unexpectedly,the incentive group also showed a significantly higher rateof sample ineligibility, possibly due to easier identificationof vacant residences or nonexistent addresses. In addition,evidence suggests greater response completeness among respondingincentive recipients early in the interview, with no evidenceof increased measurement error due to the incentive.     

Generalized Laplacian approximations in Bayesian inference

This paper presents a new Laplacian approximation to the posterior density of η = g(θ). It has a simpler analytical form than that described by Leonard et al. (1989). The approximation derived by Leonard et al. requires a conditional information matrix R_η to be positive definite for every fixed η. However, in many cases, not all R_η are positive definite. In such cases, the computations of their approximations fail, since the approximation cannot be normalized. However, the new approximation may be modified so that the corresponding conditional information matrix can be made positive definite for every fixed η. In addition, a Bayesian procedure for contingency-table model checking is provided. An example of cross-classification between the educational level of a wife and fertility-planning status of couples is used for explanation. Various Laplacian approximations are computed and compared in this example and in an example of public school expenditures in the context of Bayesian analysis of the multiparameter Fisher-Behrens problem.     

CALGARY FAMILY INTERVENTION MODEL: ONE WAY TO THINK ABOUT CHANGE

This article defines and describes the Calgary Family Intervention Model (CFIM). CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional. Examples and discussion of interventions such as storying the illness experience, encouraging respite, and asking interventive questions are presented. CFIM is one way that health professionals can conceptualize about change.     

The Farm Crisis and Mental Health: A Longitudinal Study of the 1980s1

Abstract This paper examines rural/urban differences and trends in mental health during the farm crisis of the 1980s in a large panel sample from a midwestern state. A community research perspective, which attributes differences to life styles, culture, and community context, is contrasted with an economic stress perspective, which focuses on individual differences in economic circumstances as determinants of rural-urban differences in mental health. Survey samples from 1981, 1986, and 1989 are used to examine differences among seven categories of community type. Multiple regression analysis of the trend and panel data provide support for both the individual economic distress and community context models.