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.     

Negotiating Role Definitions and the Working Consensus in Self-Work*

Definitions of social roles and the maintenance of a working consensus are two kinds of background expectations which are important for actors’accomplishment of self-work. Interactionists have traditionally assumed that these background expectations are unambiguously available to social actors as they negotiate situated meanings of selves and situations. Using data from dyadic role-play conversations, this study examines instances where interactants reference these expectations as ambiguous or problematic. The findings show that the situated meanings of role definitions and the working consensus are continually subject to potential negotiation. The implications of these findings for future research and theory on self-work in social interaction are discussed.     

Codependency and Recovery: Gender,Self, and Emotions in Popular Self-Help

Popular contemporary rhetoric of the self advocates knowing the needs of the self and reaching a balance between self and other. As a consequence of economic dependence on men, women have emotional obligations that make meeting these goals unlikely. The recently identified condition called codependency addresses the tensions underlying this situation. Recovering from codependency serves as an aligning action that accounts for past behavior using the quasi-medical rhetoric of addiction. The sick role then allows for small amounts of deviance from female gender role norms in that it permits women to exercise some self-determination in the allocation of their time and emotions. Although critics have ignored the possibility, codependency can provide a tool of resistance for those who have few resources to challenge the status quo.     

Generalized Laplacian approximations in Bayesian inference

This paper presents a new Laplacian approximation to the posterior density of η = g(θ). It has a simpler analytical form than that described by Leonard et al. (1989). The approximation derived by Leonard et al. requires a conditional information matrix R_η to be positive definite for every fixed η. However, in many cases, not all R_η are positive definite. In such cases, the computations of their approximations fail, since the approximation cannot be normalized. However, the new approximation may be modified so that the corresponding conditional information matrix can be made positive definite for every fixed η. In addition, a Bayesian procedure for contingency-table model checking is provided. An example of cross-classification between the educational level of a wife and fertility-planning status of couples is used for explanation. Various Laplacian approximations are computed and compared in this example and in an example of public school expenditures in the context of Bayesian analysis of the multiparameter Fisher-Behrens problem.     

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.     

EDITH WHARTON'S SICK ROLE

In this article, we conduct a textual analysis of Edith Wharton's 1911 novel, Ethan Frome . We offer three readings. The first presents Wharton's account of illness through a framework developed foru decades later by Talcott Parsons. Wharton's sick role was less medico-centric than Parsons; it emphasized the importance of class, gender and community in defining and legitimizing the sick role. Our second reading explores the socially constructed nature of roles in illness. The sick role as portrayed by Wharton is not the social fact later conceived by Parsons, but a social construct with no determinate reference beyond that which the local community is willing to grant it. Our third reading examines the social context, particularly the power relations, within which this story of illness has been constructed.     

Influence of behavioural tactics on recruitment and reproductive trajectory in the kittiwake

Many studies have provided evidence that, in birds, inexperienced breeders have a lower probability of breeding successfully. This is often explained by lack of skills and knowledge, and sometimes late laying dates in the first breeding attempt. There is growing evidence that in many species with deferred reproduction, some prebreeders attend breeding places, acquire territories and form pairs. Several behavioural tactics assumed to be associated with territory acquisition have been described in different species. These tactics may influence the probability of recruiting in the breeding segment of the population, age of first breeding, and reproductive success in the first breeding attempt. Here we addressed the influence of behaviour ('squatting') during the prebreeding period on demographic parameters (survival and recruitment probability) in a long-lived colonial seabird species: the kittiwake. We also investigated the influence of behaviour on reproductive trajectory. Squatters have a higher survival and recruitment probability, and a higher probability of breeding successfully in the first breeding attempt in all age-classes where this category is represented. The influence of behaviour is mainly expressed in the first reproduction. However, there is a relationship between breeding success in the first occasion and subsequent occasions. The influence of breeding success in the first breeding attempt on the rest of the trajectory may indirectly reflect the influence of behaviour on breeding success in the first occasion. The shape of the reproductive trajectory is influenced by behaviour and age of first breeding. There is substantial individual variation from the mean reproductive trajectory, which is accounted for by heterogeneity in performance among individuals in the first attempt, but there is no evidence of individual heterogeneity in the rate of change over time in performance in subsequent breeding occasions     

WOMEN ATHLETES AS FALSELY ACCUSED DEVIANTS: Managing the Lesbian Stigma

As the behavior of women athletes is often interpreted to violate gender norms, women athletes are frequently devalued and stigmatized. The present study examines the manner in which such devaluation and stigmatization impact on women athletes and how these athletes manage the lesbian label attached to their sport participation. In-depth telephone interviews were conducted with 24 intercollegiate athletes from three Division I universities. Processes underlying athletes' responses parallel Becker's construction of the "falsely accused deviant" and Goffman's conceptualization of "stigma management." Factors leading to false accusation of lesbianism are discussed, as well as the various mechanisms utilized by athletes to manage the lesbian label.