Family Discussion Groups for Patients with Chronic Pain: A Pilot Study

This pilot study investigated the benefits of discussion groups for patients with chronic pain and their family members. Nineteen patients with chronic pain and 41 relatives participated in four consecutive groups. Most patients and family members found their participation clearly helpful for themselves and for the family. The group helped them to improve communication, support and mutual relationships, and to better cope with the pain. Reported beneficial factors were experiencing communality, having a place to discuss things with each other, gaining insights, and learning from fellow‐sufferers and their own family. Post treatment, patients also felt less distressed by the pain, less depressed, less insufficient and showed an increase in life‐control and social activities. Moreover, some aspects of the family climate improved, but only in the perception of the family members. The present study points to the value of a multifamily format in chronic pain therapy and suggests the appropriateness of further controlled investigation.     

Using Time Intervals Between Expected Events to Communicate Risk Magnitudes

Because members of the public have difficulty understanding risk presented in terms of odds ratios (e.g., 1 in 1000) and in comparing odds ratios from different hazards, we examined the use of time intervals between expected harmful events to communicate risk. Perceptions of the risk from a hypothetical instance of naturally-occurring, cancer-causing arsenic in drinking water supplies was examined with a sample of 705 homeowners. The risk was described as either 1 in 1000 or 1 in 100,000 and as present in a town of 2000 people or a city of 200,000 people. With these parameters, the time intervals ranged from 1 expected death in 3500 years (1 in 100,000 risk, small town) to 1 death every 4 months (1 in 1000 risk, city). The addition of time intervals to the odds ratios significantly decreased perceived threat and perceived need for action in the small town but did not affect response for the city. These framing effects were nearly as large as a 100-fold difference in actual risk. Instances when this communication approach may be useful are discussed.     

Probabilistic Risk Analysis for a High-Level Radioactive Waste Repository

A probabilistic risk analysis (PRA) for a high-level radioactive waste repository is very important since it gives an estimate of its health impacts, allowing comparisons to be made with the health impacts of competing technologies. However, it is extremely difficult to develop a credible PRA for a specific repository site because of large uncertainties in future climate, hydrology, geological processes, etc. At best, such a PRA would not be understandable to the public. An alternative proposed here is to develop a PRA for an average U.S. site, taking all properties of the site to be the U.S. average. The results are equivalent to the average results for numerous randomly selected sites. Such a PRA is presented here; it is easy to understand, and it is not susceptible to substantial uncertainty. Applying the results to a specific repository site then requires only a simple, intuitively acceptable "leap of faith" in assuming that with large expenditures of effort and money, experts can select a site that would be at least as secure as a randomly selected site.     

Block diagrams and splitting criteria for classification trees

Various aspects of the classification tree methodology of Breiman et al., (1984) are discussed. A method of displaying classification trees, called block diagrams, is developed. Block diagrams give a clear presentation of the classification, and are useful both to point out features of the particular data set under consideration and also to highlight deficiencies in the classification method being used. Various splitting criteria are discussed; the usual Gini-Simpson criterion presents difficulties when there is a relatively large number of classes and improved splitting criteria are obtained. One particular improvement is the introduction of adaptive anti-end-cut factors that take advantage of highly asymmetrical splits where appropriate. They use the number and mix of classes in the current node of the tree to identify whether or not it is likely to be advantageous to create a very small offspring node. A number of data sets are used as examples.     

The Nature and Correlates of Sibling Influence in Two‐Parent African American Families

Guided by research and theory on sibling similarities and differences, this study explored the nature and correlates of 2 processes of sibling influence—social learning and sibling differentiation—during adolescence. Participants included 2 adolescent‐age siblings (M = 16.29 years for older siblings and M = 12.59 years for younger siblings, respectively) from 166 two‐parent African American families. Significant nonlinear associations between these two influence dynamics and some sibling relationship qualities were discovered. For sibling differentiation, but not social learning, these links were further moderated by gender composition of the sibling dyad. Additional analyses revealed that youths' reports of social learning were generally linked to smaller differences between siblings, whereas differentiation processes were linked to greater differences in siblings' individual characteristics.     

EMPLOYER CHOICES IN EAP DESIGN AND WORKSITE SERVICES

In today's complex private healthcare market, employers have varied preferences for particular features of behavioral health products such as Employee Assistance Programs (EAPs). Factors which may influence these preferences include: establishment size, type of organization, industry, workplace substance abuse regulations, and structure of health insurance benefits. This study of 103 large employer purchasers from a single managed behavioral healthcare organization investigated the impact of such variables on the EAP features that employers select to provide to workers and their families. Our findings indicate that for this group of employers, preferences for the type and delivery mode of EAP counseling services are fairly universal, while number of sessions provided and choices for EAP-provided worksite activities are much more varied, and may be more reflective of the diverse characteristics, organizational missions and workplace culture found among larger employers in the US.     

Ties,sites and irregularities: pitfalls and benefits in using respondent-driven sampling for surveying a homeless population

Respondent-driven sampling (RDS) is a survey method for hidden populations and, as such, it offers a suitable approach for sampling the homeless. Surprisingly, the practical use of RDS in surveying homeless populations has only sporadically been described in the professional literature so far, and the specifics of using RDS for sampling this group have not been reflected in depth. The goal of the article is to investigate how three specific concerns, namely the transitional character of social ties among the homeless, problems with locating the interview site, and the irregular use of coupons, affect the sampling process. The findings of the article are based on experience using RDS for creating two independent samples of homeless persons in two Czech cities. Worries of poor referral effectiveness were disproved, but poor validity of the network size indicator, tendency towards irregular use of coupons, and negative effects arising from selecting service centres for the homeless as survey sites were confirmed.