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.     

Dependency—Bond as Construct

This article is a discussion of reality construction of dependency-bonds by oppressed groups with an oppressor. In this model of dependency-bond processes, it is suggested that oppressed people, when possible, attempt to translate the power-dependency equation from one of coercion and objectification into a less onerous, more agreeable bond; that is, subordinate people strive to establish and to reinforce dependency relationships as a strategy of control whereby the power of superiors is deflected from coercive measures against them into lines of obligation toward them. It is further proposed that the secondary effects of this process include the social construction of subordinate identity as dependent and of subordinate place as dependent place.     

Using the lessons learned from US and English law to create a regulatory framework for charities in evolving democracies

The evolving democracies of Eastern Europe and the former USSR republics are keenly interested in establishing charities. They have little law on this issue because their former governments did not encourage the development of charities. This article compares US and English regulation of charities and proposes a regulatory framework based on what the authors believe are the best attributes of both. Although the framework is based on the common law system, it can be adapted to the civil law systems of the Eastern European nations and the former USSR republics. The article includes such issues as developing a body of law, tax relief and creating a regulatory agency.Mr Hopkins is a lawyer with Powers, Pyles & Sutter, 1275 Pennsylvania Ave., N.W., Washington, D.C. 20007, and author ofThe Law of Tax-Exempt Organizations (1992a).Ms Moore is also a lawyer, 5908 N. 35th St., Arlington, Virginia 22207.The authors would like to thank Mssrs Kersi Shroff and Stephen F. Clarke, Senior Legal Specialists, American-British Law Division, Library of Congress, and Mr. William H. Morris, an attorney at Steptoe & Johnson, Washington, D.C., for their kind assistance during the researching of this article.     

Applying Image Norms Across Super's Career Development Stages

D. E. Super's (1957) theory of career development has long been of interest to careers researchers (M. Savickas, 1994; S. C. Whiston & B. K. Brecheisen, 2002). Its insightful illustration of career stages has made it widely applied by careers practitioners. Image norms may influence the career decisions and developmental tasks inherent in each stage. An image norm is the belief that individuals must present or possess a certain image, consistent with occupational, organizational, or industry standards, in order to achieve career success. Understanding the effects of image norms across D. E. Super's (1957) career stages has important implications for individuals, organizations, and career counseling professionals.     

Coping Trajectories from Adolescence to Young Adulthood: Links to Attachment State of Mind

The objective of this study was to examine the links between coping and attachment. In a longitudinal study of 112 participants, coping behavior was assessed at five points in time during adolescence (starting at the age of 14 years) and early adulthood. In addition, at the age of 21 years, state of mind regarding current and earlier attachment experiences was assessed by employing the Adult Attachment Interview (AAI). In both adolescence and early adulthood, differences in coping styles were found to be related to differences in attachment. Individuals classified as secure dealt with their problems more actively by using their social network during adolescence and at the age of 21 years. Both secure and dismissing individuals used more internal coping than those with a preoccupied state of mind. Latent growth curve modeling revealed that differences in active and internal coping between secure and insecure individuals applied to the rate of change in these coping styles between 14 and 21 years, with participants in the secure group showing much steeper growth in both coping styles. Only minor differences were found with respect to withdrawal as a coping style. The results represent first evidence that coping trajectories during adolescence and young adulthood are linked with attachment state of mind.     

Use of Technology in Delivering Career Services Worldwide

The authors review the trends in the use of computers in the delivery and support of career guidance and counseling identified at the symposium International Perspectives on Career Development. The papers presented emphasized that 20th‐century computer‐based systems continue to be used, mainly delivered via the World Wide Web. These systems are enhanced through audio, video, graphics, strategies to provide needs assessment, and support by cybercounselors or expert system design. The papers also revealed a new trend: the use of elegant Web sites to store and search immense libraries of resources needed by professionals and clients and to facilitate communication and collaboration among professionals in cyberspace. Concerns, issues, and resources related to many areas, including the readiness of clients to use computer‐based systems, were also raised; existing sources of guidelines are noted.     

Gender,lineage, and fertility‐related outcomes in Ghana

A growing literature examines the empirical relationship between the joint reproductive preferences of marital partners and reproductive outcomes in Africa. Less explored is how spousal power in decision making may be influenced by lineage type. Using pooled data from Ghana, we investigate how lineage affects gendered reproductive decision outcomes and find some evidence that matrilineal women are more able than nonmatrilineal women to translate their reproductive preferences into action consistent with their goals.     

How Welfare Policies Affect Adolescents' School Outcomes: A Synthesis of Evidence From Experimental Studies

Using data from 8 random assignment studies and employing meta‐analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low‐income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow‐up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment‐related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment.     

A simultaneous-equations model of the relationship between public sector bargaining legislation and unionization

This paper estimates a simultaneous-equations model with public sector bargaining laws and union membership treated as jointly-determined variables. The extent of public sector unionization has a significant positive influence on the passage of prolabor bargaining legislation and bargaining legislation has strong, independent effects on the extent of public sector unionization. We gratefully acknowledge the research support provided by Minbo Kim and Parisun Chantonahom.     

Four‐Month Attentional Regulation and Its Prediction of Three‐Year Compliance

The extent to which 4‐month attentional regulation during an infant‐mother still‐face situation and 12‐month attachment security during the Strange Situation predicted rates of compliance and noncompliance during a cleanup task at 36 months was examined longitudinally in 70 infant‐mother dyads. Hierarchical multiple regression analyses indicated that infants who showed more attentional regulation during the still‐face situation with mothers later showed a higher rate of committed compliance and a lower rate of situational compliance during cleanup with mothers. Furthermore, lower levels of attentional regulation were later associated with higher rates of assertive behavior, but only for infants in an insecure attachment relationship.