Evaluation design for a community prevention trial. An environmental approach to reduce alcohol-involved trauma

The Community Prevention Trial was 5-year effort to reduce alcohol-involved injuries and death through a comprehensive program of community awareness and policy activities. The three experimental communities were of approximately 100,000 population each (one in Northern California, one in Southern California, and one in South Carolina). Matched comparison communities were used for each experimental community. This article describes the evaluation approach used in a program that sought to change environmental factors not a specific population or target group. This approach demanded unique evaluation approaches for determining overall community aggregate effects, that is, distal outcomes, as well as changes in key mediating variables, that is, process effects. The problem of trending and lagged effects of community prevention programs are discussed.     

Summing up. Recommendations and experiences for evaluation of community-level prevention programs

This article provides recommendations and observations about evaluation of a locally based prevention project to reduce problems at a total community or aggregate level. The shift from targeting specific individuals or subpopulations to the overall structure and environment of a community is most demanding. Evaluation tools and analysis techniques have lagged behind program development because community-level interventions are not linked to a specific target group who can be separately studied. Thus assumptions about using random assignment and/or comparison communities as means to control for confounding variables are weakened when the unit of analysis is the community itself and dependent measures are subject to trending and the effects of history.     

Net worth and the economic diversity of the elderly

Using data from the 1984 panel of the Survey of Income and Program Participation (SIPP), this article examines characteristics of the older population disaggregated by net-worth quintiles. The authors argue that income is not a sufficient measure of economic status for current policy discussions on issues such as changing Medicare co-payments, increasing the taxation of social security benefits, or means-testing under Medicaid. Net worth is a better measure of economic status, particularly for the elderly, because it represents the net value of assets accumulated over the life course. Their results indicate that there is considerable diversity in the economic status of the older population, which is masked by aggregate statistics (such as means and medians) typically used to summarize the economic status of population groups. Stereotypical views of the elderly based on such aggregates result in misdirected policy formulation. In the future, policymakers will need to formulate policies and programs using information on the distributions of income and assets among the older populations rather than relying on statistical aggregates.     

How well is debt managed by nonprofits?

Little is known about why nonprofits accrue debt, how much they owe, and whether the funds they borrow are used productively. This article distinguishes between productive, problematic, and deferred debt. Employing a data base representative of 114,726 tax-filing charitable nonprofits in the United States in 1986, it examines the pervasiveness of nonprofit debt and the relation between this debt and nonprofit financial health. The analysis finds that over 70 percent of the nonprofits hold debt, the distribution of this debt is highly concentrated, and the level of debt and leverage varies with asset size and type of activity. Nonprofits with higher leverage and absolute debt levels are financially healthier than those with lower levels. While the analysis does not determine whether financially stronger nonprofits are better able to borrow, the results support the view that borrowing in the nonprofit sector is economically efficient.     

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.     

Scientific management and class relations

Conclusion It has been the contention of this article that the true significance of the scientific management movement lies in what it can tell us about the engineering profession. Scientific management was not simply capitalist ideology, nor were the engineers who developed it simply the prisoners of capitalist ideology. Instead, scientific management was the product of the insertion of once-independent engineers into the complex, collective labor process in large corporations. It reflects both their inability to break loose fully from the dominant ideology and the fact that their interests as engineers were in conflict with the interests of their capitalist employers.The significance of this point, however, lies beyond the experience of turn-of-the-century shop culture engineers. For, if even as unpromising a group as the scientific managers could develop a program with implications inimical to the interests of capital, what of other, less commercialized groups? We have already seen that the early school-based engineers initiated a professionalizing project that included a claim to autonomy that was incompatible with the needs of their employers. It seems clear that the engineer's status as an employee, albeit an employee in an ambiguous position in the labor process, constitutes a basis for the development of conflicts with capitalist employers. This has been the thrust of our earlier discussion of the process of class formation. Gramsci's analysis of the situation of engineers in capitalist class relations, then, may not be without foundation:With the urban intellectuals it is another matter. Factory technicians do not exercise any political function over the instrumental masses, or at least this is a phase that has been superseded. Sometimes, rather, the contrary takes place, and the instrumental masses, at least in the person of their own organic intellectuals, exercise a political influence on the technicians.It may very well be that engineers, given a more militant labor movement, a more penetrating ideology, or a weaker capitalist class, could find themselves on the same side as more subordinate employees in conflicts with their employers.It is all the more important, then, that we understand the process by which American engineers have been domesticated. This has not happened automatically; far from it. Although there are ambiguities in the engineer's situation that make this process easier, the rapprochement of engineers with capital has had to be made. In this regard, the active intervention of business interests has been of particular importance, especially their efforts in fostering among engineers a safe variant of professionalism.Nor does this historical lesson apply only to engineers. For, there are other professional occupations that, increasingly, find themselves in situations comparable to engineers. Accountants, nurses, teachers, even certain kinds of lawyers have long been employed in large numbers by complex organizations. More recently, even doctors have begun to experience the condition of being an employee. For each of these occupations, we must avoid the easy assumption that there is something inherent in their social structural position that leads them into an accommodation with capital. On the contrary, as with engineers, we must stress the existence of real conflicts generated by capitalist relations of production, and then examine each occupation historically, asking what specific circumstances explain why its members do or do not enter into explicit conflict with their employers. However, while we must be aware of the possibility that professionals can (and sometimes do) enter into conflict with their employers, we also need to be sensitive to the complexity of the structural position of many professionals. Many professionals find themselves in positions of authority of some kind - either over subordinate workers in the case of engineers, or over clients in the case of doctors. This can be conducive to the attitude that the professionals' interests are different from those of the groups over which they have authority, or that their interests are the same as their employers'. Alternatively, as we saw in the case of engineers, this structural ambiguity may promote the formation of narrow occupational ideologies among professionals - i.e., the idea that their interests differ from those of both employers and subordinates. Therefore, while we need to be aware of the existence of employer/ professional conflict, we also need to recognize the existence of barriers to, and complexities within, the evolution of such conflicts.It is with this in mind that this article has stressed the importance of developing an adequate approach to the process of class formation. To restate briefly some of the arguments made earlier, the process of class formation in capitalist society is set in motion by the antagonisms inherent in capitalist relations of production. This is not, however, all that we need to know about the process of class formation - we also need to recognize the existence of both objective and historical barriers to this process. Nevertheless, one must be clear about what exactly these barriers are. There is, for example, an important difference between the relations of production that constitute class in the first place and workers' functions in the labor process. Similarly, one should not confuse barriers to the process of class formation with full-fledged class divisions. If we fail to distinguish among these various factors, we will be in danger of artificially placing a class barrier between engineers and other forms of wage-labor. If, on the other hand, we do make these distinctions, we will be able to account for both engineers' opposition to their employers and their domestication.

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Demographic changes as a problem for social security systems

The relationship between demographic changes and the social security system is explored. The focus is on the current situation in the Federal Republic of Germany, but consideration is also given to comparable developments in other developed countries. Emphasis is placed on how changes in the age distribution of modern populations affect the relative proportion of the productive and the dependent populations.