Work stressors and cardiovascular disease

Over the past 20 years, an extensive body of research evidence has documented that psychosocial work stressors are risk factors for hypertension and cardiovascular disease. These stressors, which appear to be increasing in prevalence, include job strain (the combination of psychological job demands and low job control), imbalance between job efforts and rewards, threat-avoidant vigilant work, and long work hours. This article reviews the evidence linking these stressors with hypertension and CVD, and the physiological and social psychological mechanisms underlying the associations. Also described are methods for measuring work stressors and new, more accurate techniques for measuring blood pressure. Finally, strategies for reducing work stressors and preventing hypertension and CVD are reviewed. These include clinical assessment, worksite health promotion, work organization interventions, legal approaches and work site surveillance.     

The devil is in the details: examining the evidence for "proven" school-based drug abuse prevention programs

In an effort to promote evidence-based practice, government officials, researchers, and program developers have developed lists of model programs in the prevention field. This article reviews the evidence used by seven best-practice lists to select five model prevention programs. The authors' examination of this research raises questions about the process used to identify and publicize programs as successful. They found limited evidence showing substantial impact on drug use behavior at posttest, with very few studies showing substantial impact at longer follow-ups. The authors advocate additional long-term follow-up studies and conclude by suggesting changes in the procedures for developing best-practice lists.     

Connective complexity: African American adolescents and the relational context of kinship foster care

Attempts to address racial disproportionality in child welfare must include a focus on the benefits and challenges facing children in kinship care. African American children not only are overrepresented in the child welfare system, but also are placed disproportionately in kinship foster care. Using a sample of 18 African American adolescents ages 11 to 14, this article explores how the relational context of care experienced by adolescents in kinship foster care differs from that of adolescents in nonkinship foster family placements. Findings are presented regarding the stability of relationships as well as complex role dilemmas experienced by kinship youth as they relate to caregivers and birthparents in the child welfare context. Implications are given for practice with kinship families.     

The impact of body-mass index and steps per day on blood pressure and fasting glucose in older adults

The purpose of this study was to investigate the combined impact of obesity and physical activity (PA) on the health of older adults. Pedometer-determined steps/d, body-mass index (BMI), resting blood pressure, and fasting glucose (FG) were assessed in 137 older adults (69.0 +/- 8.9 yr). The active group (>4,227 steps/d) had lower systolic blood pressure (SBP; p = .001), diastolic blood pressure (DBP; p = .028), and FG (p < .001) than the inactive group (< or = 4,227 steps/d). The normal-BMI group (18.5-24.9 kg/m2) had lower SBP (p < .001) and DBP (p = .01) than the obese group (> or =30 kg/m2). There were no differences in SBP (p = .963) or DBP (p = 1.0) between active obese and inactive normal-BMI groups. The active obese group, however, had a more favorable FG than the inactive normal-BMI group (chi 2 = 18.9, df = 3, p = .001). Efforts to increase PA of older adults should receive the same priority as reducing obesity to improve BP and FG levels.     

A case study comparing a randomized withdrawal trial and a double-blind long-term trial for assessing the long-term efficacy of an antidepressant

Assessing long-term efficacy in psychiatric drugs involves a number of complex questions, and the priaority of these questions is different for different disorders and for different stakeholders. Therefore, it is essential that we not adopt a one-method-fits-all approach, but rather adapt the specific details of the designs and analysis of data from long-term trials to individual disease states. Randomized withdrawal (RW) designs, even though addressing a specific question of particular interest, face some difficult methodological and ethical challenges. A less common alternative design, termed the double-blind long-term efficacy (DBLE) design, is logistically similar to traditional responder extension designs. However, use of an analytic approach that includes all randomized patients rather than only the selected subset that continued beyond acute treatment avoids the major criticism of the extender design. The present paper illustrates the attributes of the RW and DBLE designs by analyzing data from trials adopting these designs. The RW and DBLE designs address different questions, and are thus not directly comparable. Potential benefits of the DBLE design include: (1) the parsimonious use of patients and the resultant reduced exposure to placebo as each patient can contribute to multiple developmental objectives; (2) the results are generalizable to actual clinical practice as the design matches treatment guidelines; and, (3) results of safety assessments are meaningful as they involve all randomized patients. Our case study suggests that the DBLE design can provide definitive answers to important questions and may be a useful design for assessing long-term treatment effects.     

Beyond the Core: The Hot Topic(al) Alternative to the Survey-Based Introduction to Sociology Course

In the following paper we argue that the conventional “Introduction to Sociology” survey course should be restructured because such courses try to survey an unsurveyable body of knowledge and they do not teach the application of sociological research. The conventional intro course should be replaced with an intro course that surveys the types of social dynamics that sociologists typically research and the methods they use to do so. We propose a semester-long intro course with four case study learning-units that are chosen for their coverage of the underlying sociological dynamics, methods, and core concepts. We contend that case study learning-units which concentrate on topical issues and core sociological concepts are better suited for an introduction course.     

College student suicide in the United States: 1990-1991 through 2003-2004

Suggestions that there is a growing epidemic of suicide among college students in the United States are false. The National Survey of Counseling Center Directors reports 1,404 student suicides over a 14-year period and an adjusted suicide rate of 6.5, half the rate of the general US population (12.6 for all races) during this period when matched for gender and age. Counseling centers appear effective in treating suicidal students, for although the suicide rate for students who were currently or previously clients at campus counseling centers is 3 times the rate of other students, student clients have 18 times the risk of suicide compared to students in general. Identifying and referring students at elevated risk for suicide could further reduce the crude and relative rate of student suicide. However, even programs that do this only moderately well may require substantial increases in counseling staffing.     

Widowhood and Mortality: A Meta-Analysis and Meta-Regression

The study of spousal bereavement and mortality has long been a major topic of interest for social scientists, but much remains unknown with respect to important moderating factors, such as age, follow-up duration, and geographic region. The present study examines these factors using meta-analysis. Keyword searches were conducted in multiple electronic databases, supplemented by extensive iterative hand searches. We extracted 1,377 mortality risk estimates from 123 publications, providing data on more than 500 million persons. Compared with married people, widowers had a mean hazard ratio (HR) of 1.23 (95% confidence interval (CI), 1.19–1.28) among HRs adjusted for age and additional covariates and a high subjective quality score. The mean HR was higher for men (HR, 1.27; 95% CI, 1.19–1.35) than for women (HR, 1.15; 95% CI, 1.08–1.22). A significant interaction effect was found between gender and mean age, with HRs decreasing more rapidly for men than for women as age increased. Other significant predictors of HR magnitude included sample size, geographic region, level of statistical adjustment, and study quality.