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.     

EFFECTS OF A PREPAID NONMONETARY INCENTIVE ON RESPONSE RATES AND RESPONSE QUALITY IN A FACE-TO-FACE SURVEY

We conducted a randomized experiment on a face-to-face interviewsurvey in order to test the effects on response rates of a prepaidnonmonetary incentive. Results showed a statistically significantincrease in response rates, mostly through reduction in refusalrates, in the half sample that received the incentive (a gift-typeballpoint pen) as compared with a no incentive control group.The effect appears to be due to greater cooperation from incentiverecipients at the initial visit by an interviewer. Unexpectedly,the incentive group also showed a significantly higher rateof sample ineligibility, possibly due to easier identificationof vacant residences or nonexistent addresses. In addition,evidence suggests greater response completeness among respondingincentive recipients early in the interview, with no evidenceof increased measurement error due to the incentive.     

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.     

CALGARY FAMILY INTERVENTION MODEL: ONE WAY TO THINK ABOUT CHANGE

This article defines and describes the Calgary Family Intervention Model (CFIM). CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional. Examples and discussion of interventions such as storying the illness experience, encouraging respite, and asking interventive questions are presented. CFIM is one way that health professionals can conceptualize about change.     

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.     

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.     

MONEY DEMAND DURING HYPERINFLATION AND STABILIZATION: BOLIVIA, 1980–1988

This paper examines the demand for money in Bolivia during the 1980s, a decade of extreme instability with annual inflation rates reaching over 20,000 percent, and a subsequent stabilization, with annual rates falling to less than 25 percent and remaining so for more than five years.
Our empirical analysis makes use of error-correction approaches, time-varying-parameter estimation with Kalman filtering, and GARCH models of expected inflation and inflation variance. We find that expected inflation and inflation uncertainty both matter for money demand. Time-varying estimates show that the reaction to monetary disequilibria was significantly faster during hyperinflation.