The Association of Survey Setting and Mode with Self-Reported Health Risk Behaviors among High School Students

This study examined whether the prevalence of self-reportedhealth risk behaviors among high school students varied by surveysetting (school versus home) and mode of administration (paperand pencil versus computer). Students in grades 9 and 11 wereassigned randomly to one of four conditions—school paper-and-pencilinstrument (PAPI), school computer-assisted self-interview (CASI),home PAPI, and home CASI. During the spring of 2004, 4,506 studentscompleted identically worded questionnaires based on the YouthRisk Behavior Survey questionnaire. Logistic regression analysescontrolling for sex, grade, and race/ethnicity revealed thatsetting was associated significantly with the reporting of 30of the 55 risk behaviors examined, and mode was associated significantlywith the reporting of 7 of the 55 behaviors. For all behaviorswith a significant setting main effect, the odds of reportingthe behavior were greater among students who completed questionnairesat school than among students who completed questionnaires athome. For all behaviors with a significant mode main effect,PAPI mode students had lower odds of reporting the behaviorthan CASI mode students. Because social measurement researchassumes that higher prevalence estimates are more valid thanlower estimates, methodological factors shown to increase estimates,such as setting and mode, should be considered when planningsurveys.     

A comparison study of realtime fatality rates: severe acute respiratory syndrome in Hong Kong, Singapore, Taiwan, Toronto and Beijing, China

Summary.  In an outbreak of a completely new infectious disease like severe acute respiratory syndrome (SARS), estimation of the fatality rate over the course of the epidemic is of clinical and epidemiological importance. In contrast with the constant case fatality rate, a new measure, termed the 'realtime' fatality rate, is proposed for monitoring the new emerging epidemic at a population level. A competing risk model implemented via a counting process is used to estimate the realtime fatality rate in an epidemic of SARS. It can capture and reflect the time-varying nature of the fatality rate over the course of the outbreak in a timely and accurate manner. More importantly, it can provide information on the efficacy of a certain treatment and management policy for the disease. The method has been applied to the SARS data from the regions affected, namely Hong Kong, Singapore, Toronto, Taiwan and Beijing. The magnitudes and patterns of the estimated fatalities are virtually the same except in Beijing, which has a lower rate. It is speculated that the effect is linked to the different treatment protocols that were used. The standard estimate of the case fatality rate that was used by the World Health Organization has been shown to be unable to provide useful information to monitor the time-varying fatalities that are caused by the epidemic.     

ISOLATION, INTEGRATION, AND ETHNIC BOUNDARIES IN RURAL GUATEMALA

We investigate two perspectives about the effects of reduced discrimination and greater social and economic opportunities on ethnic identity in rural areas of contemporary Guatemala. Our analysis contrasts the effects of new opportunities in Indigenous communities on language use and dress, using data from the 1995 Encuesta Guatemalteca de Salud Familiar (EGSF). While the use of both dress and language has changed substantially in recent years, language use has changed considerably more than dress. We conclude that, in this context, economic opportunities have not necessarily diminished ethnic solidarity, but may have instead reshaped it.     

When Strategic Approaches get Stuck: Maps out of the Mire

Using a biopsychosocial model, a three dimensional map provides guidelines for changing from strategic therapy when progress in this approach falters. The method is pragmatic and atheoretical, and brings together ideas from various schools which empirically have been found useful. Practical and inclusive guidelines are offered for family (and individual) therapy which address two important issues: reinforcement of change when progress is occurring, and a shift from an interactional to another dimension when stuck points are reached. The multi-dimensional approach is clear, can be used by individuals or teams, lends itself to teaching and is of particular value for entrenched and complex problems. Four case histories are presented to highlight the approach.     

Fitting In and Fighting Back: Stigma Management Strategies among Homeless Kids

Using data collected during a four‐year ethnographic study, this article examines the stigma management strategies of kids who are homeless in the San Francisco Bay area. We focus specifically on strategies of inclusion and exclusion. Strategies of inclusion are attempts by homeless kids to establish harmonious relationships with both peers and strangers. The most common are forging friendships, passing, and covering. Strategies of exclusion are aggressive and nonconciliatory attempts to gain social acceptance. They include verbal denigration and physical and sexual posturing. Some of these strategies successfully protect the kids’ sense of self, while other strategies had the unintended effect of reinforcing their spoiled identities. We argue that these stigma management strategies are both informed by and interpreted through their disadvantaged social structural location.