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.     

Defining child abuse in Hong Kong

Definitions of child abuse are culturally driven. Hong Kong, with a predominantly Chinese population, has managed to eradicate much of the societal abuse that children suffer elsewhere in Asia. Professional and government attention has now shifted to child abuse and neglect within the family. The paper, based on interviews with key professionals. analysis of policy documents and practice records examines traditional Chinese parent-child relationships. the status of parental authority and corporal punishment and changes in contemporary Hong Kong family life. It goes on to outline the development of responses to child abuse in Hong Kong, some of the dilemmas that professionals face in defining abuse and areas for future research.     

The Farm Crisis and Mental Health: A Longitudinal Study of the 1980s1

Abstract This paper examines rural/urban differences and trends in mental health during the farm crisis of the 1980s in a large panel sample from a midwestern state. A community research perspective, which attributes differences to life styles, culture, and community context, is contrasted with an economic stress perspective, which focuses on individual differences in economic circumstances as determinants of rural-urban differences in mental health. Survey samples from 1981, 1986, and 1989 are used to examine differences among seven categories of community type. Multiple regression analysis of the trend and panel data provide support for both the individual economic distress and community context models.     

Will taxpayers ever like taxes?: Responses to the U.S. Tax Reform Act of 1986

Major policy changes like the 1986 Tax Reform Act (TRA) in the United States provide natural experiments to study attitudinal and behavior responses to law. Surprisingly, public evaluations of the TRA became increasingly negative after passage, while general support for the tax system became more positive in response to the changes. To explain this puzzle, we propose a dynamic model of taxpayer attitudes that is consistent with the observed loose linkage between logically-connected concepts. We briefly review the political context, objectives and impacts of the 1986 Tax Reform Act, and present several studies testing the impact of self-interest, prior beliefs, and social discussion on changes in attitudes and behavior.Results suggest that the complexity of taxes and difficulty in knowing objective impacts weakens the role of self-interest in attitudinal changes, thereby strengthening the role of prior beliefs and discussion. Evaluations of tax laws are most responsive to more politically-oriented influences.     

“WHAT DOES SHE SEE IN HIM?”: THE EFFECT OF SHARING ON THE CHOICE OF SPOUSE

All husbands and wives share in the spoils of marriage. Sharing makes each partner a residual claimant and encourages spouses to provide marital inputs. However, because each spouse is only a partial residual claimant, each may be inclined to provide a "suboptimal" level of marital inputs. The choice of spouse influences the level of distortion, and under some circumstances the efficient mating is between individuals of equal value     

Evaluation of an educational intervention upon knowledge, attitudes, and behavior concerning drinking/drugged driving.

The Contra Costa County educational program for juveniles found guilty of driving under the influence (DUI) was evaluated. Over 600 juveniles convicted of DUI from 1983 to 1988 formed the study group for this research and of these over 100 participated in the educational program. Assessment of program participants was conducted for knowledge, attitudes and behavior. Participants demonstrated increased knowledge, stronger attitudes against driving under the influence, and less risky alcohol and automobile related behaviors. County juvenile records analyzed by the logit procedure showed that class participants had a significantly lower number of repeat offenses compared to non-program participants that could not be explained by race, offense severity, age or gender.     

Informal Work in Nonmetropolitan Pennsylvania1

Abstract It is well recognized that the informal economy—unregulated economic activities that generate real or in-kind income—features prominently in the day-to-day lives of many in the developing world. Researchers have begun to explore the informal economy in developed countries but this work has focussed primarily on urban areas to the neglect of rural areas. In this paper the nature and correlates of informal work in nonmetropolitan Pennsylvania are described through an analysis of survey data on 505 families. Results indicate that participation in informal activities is widespread, is not more typical of the poor, does not contribute greatly to family income on average but does help many poor families weather difficult economic times, is both economically and noneconomically motivated, and, net of other sociodemographic variables, is positively related to rurality of residence and formal labor supply.     

Naturally occurring play patterns in groups of latency aged children

This study examines the influence of the socialization of aggression among different gender and social class groupings and the influence of psychosocial stage on cognitive developmental play preferences among groups of school aged children. Observations of 143 play groups were coded for play preference (symbolic play, practice play, games with rules) and play performance (cooperative or competitive). Findings of the log-linear data analysis suggest a middle class and masculine bias in Piaget's cognitive model (i.e., that as age increases children prefer more games with rules). This model held only for middle class and affluent boys. Girls (both latency and prepubertal) and lower socioeconomic groups tended to prefer practice play. Girls were more likely to play cooperatively; boys more likely to play competitively. Implications for theory development and clinical practice are explored.     

Estimation of noncentrality parameters

We propose some estimators of noncentrality parameters which improve upon usual unbiased estimators under quadratic loss. The distributions we consider are the noncentral chi-square and the noncentral F. However, we give more general results for the family of elliptically contoured distributions and propose a robust dominating estimator.