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.     

Myth,allegiances, and the study of social control

That sociology subscribes to certain popular myths and has aligned itself with the welfare of some groups over others complicates research into social control. This is especially so when the research deals with stereotypes and their effects on differential legal treatment. That the discipline has historically taken sides regarding certain commonly held stereotypes and been supportive of certain groups, means that findings that challenge those stereotypes or that are viewed as detrimental to the supported groups are brought into question. Our research on a regulatory mechanism of social control—the Black Book, a list of persons excluded from licensed gaming in Nevada because of their perceived threat to the industry—is illustrative of these complications. Our findings that the Black Book is largely symbolic and is applied discriminatorily challenge not only beliefs in its efficacy but certain myths and allegiances within sociology. That a group sociologically identified with the problem was discriminated against, and that a well-protected group elicited preferential treatment at the hands of regulators who identify with them have been particularly problematic for the acceptance of the findings. We argue here that debunking myth and value neutrality are essential to scientific endeavor and should override such disciplinary tendencies toward the tolerance and protection of some groups over others. Her research has dealt with aspects of culture, organized crime, and social elites. She is currently working on a book on high society and thoroughbred racing. His publications have dealt with issues of labeling and secondary deviation, the role of stereotypes in the legal process, and the legal reaction to corporate crime.     

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.     

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.     

Public Perceptions about Food Safety in the United States and Japan1

Abstract Consumer concerns over pesticide residues and food additives have been growing in industrialized societies, including the United States and Japan. However, little comparative research has been carried out to determine which household characteristics may be significantly associated with these heightened concerns, and whether or not the same factors are useful for understanding variation in these worries in more than one society. This paper examines food safety attitudes in Seattle, Washington, and Kobe, Japan, and discovers that while the absolute level of expressed concern is higher in Kobe, the predictive power of household characteristics in explaining attitudinal differences within countries is similar. Implications for rural areas and future research on family structures in capitalist societies are discussed.     

Mean squares in saturated fractional designs revisited

In a previous paper (Bissell, 1989) some suggestions were offered for interpreting mean squares in saturated fractional designs where no independent estimate of experimental error is available. One of the methods leads to a simple numerical test of homogeneity which provides an objective accompaniment to half-Normal plotting of effects (Daniel, 1959) in 2n designs or exponential plotting of mean squares (Bissell, 1989) in 3n designs. A table of percentage points for a convenient test statistic is provided in this paper.