Community,Family, and Race/Ethnic Differences in Health Status in Rural Areas1

Abstract Many race-specific differences in health outcomes that have been observed in previous research have been attributed to class and racebased group differences which either facilitate or constrain health opportunities and behaviors. These include such variables as different rates of poverty, health insurance coverage, and access to medical care. However, these relationships have been inadequately examined in rural communities where minority status may be even more detrimental to health than in urban areas, due to various constraints on access to health care. We present an analysis that assesses the effects of community, family structure, sociodemographic, and medical care variables on self-reported health status among Hispanics, Mrican Americans, and non-Hispanic whites in six rural communities in Florida. Community structural characteristics had a significant effect on self-reported health, as did some of the measures of how respondents “experience” community. These relationships held even when other sets of variables were added to the models. Family/household characteristics and sociodemographic and medical care variables were less important in explaining self-reported health status. These findings suggest that community continues to be important in explaining differences in health status in rural areas.     

Analgesia produced in women by genital self-stimulation

This study investigated the relative effectiveness of specific genital regional self-stimulation in elevating pain thresholds. Anecdotal reports in humans suggest that sexual activity and orgasm decrease a wide variety of human responses to pain and touch, but the phenomenon has not been evaluated objectively. Two types of self-stimulation, pressure and pleasurable, were applied by 10 women to the anterior vaginal wall, the posterior vaginal wall, and the clitoris. Significant increases in pain thresholds but not tactile thresholds occurred when pressure stimulation was applied to the anterior wall of the vagina or when "pleasurable" self-stimulation was applied to any of the three areas. Tactile thresholds were not significantly affected by any genital stimulation condition. However, there was a significant increase in tactile threshold but not pain thresholds in the distraction control condition. On the basis of these findings, we conclude that (a) a sensation of pleasure evoked by genital stimulation can elevate pain thresholds, (b) these pleasurable stimuli were not general "distractants" because they elevated pain thresholds but not tactile thresholds differentially, and (c) genital pleasurable stimuli activate an analgesic process that is distinct from a distraction process.     

Patient assertiveness in ethnically diverse older women with breast cancer: Challenging stereotypes of the elderly

Patients' views of patient-physician interactions—particularly the perspectives of older, ethnically diverse women—are poorly understood. The older patient's attitude toward and understanding of the medical encounter, however, are essential to the design of strategies to improve patient-physician communication. To date, investigations have primarily emphasised the ways in which the therapeutic relationship is influenced by immutable patient characteristics. This qualitative study extends previous research findings by looking beyond the effect of ascribed categories (such as age, race, and gender) and focusing on aspects of patient behavior, specifically assertiveness. Focus groups were conducted with older African-, Chinese-, European-, and Hispanic American breast cancer patients from sites in the eastern and western United States. The study explores the potential of a form of patient activation for challenging stereotypes of the elderly and changing health care practitioners' behavior.     

Calculating the total vote where the district magnitude is greater than one: A test of some algorithms using British local election data

Electoral analysis using aggregate data relies on the availability of accurate voting statistics. One vital piece of information, often missing from official electoral returns, particularly British local government elections, is the total number of valid ballot papers. This figure is essential for the calculation of electoral turnout. When voters have a single vote and official information about the number of ballot papers issued is missing, a figure for the total vote can still be derived. However, local elections in Britain frequently use a system of multiple-member wards, where voters have as many votes as there are seats to be filled. In such cases, calculating the total vote and, hence, the turnout does present a real problem. It cannot be assumed that all voters will use their full quota of votes or that voters will cast a ballot in favour of a single party. This paper develops and tests diff erent algorithms for calculating the total vote in such circumstances. We conclude that the accuracy of an algorithm is closely related to the structure of party competition. The findings of this paper have a number of important implications. First, the difficulties in calculating the turnout in multiple-member wards are identified. This will inform the debate about public participation in the local electoral process. Second, the method for deriving a figure for the total vote has an important bearing on a number of other statistics widely employed in electoral analysis.     

Statistical Methods and Graphical Displays for Analyzing How the Association Between Two Qualitative Variables Differs Among Countries, Among Groups, Or Over Time: A Modified Regression-Type Approach

Many interesting sociological questions pertain to how the association between two variables depends on a third variable. In sociological applications, the third variable often pertains to countries, to subgroups of a population, or to time periods. We propose a regression-type approach that specifies that the log-odds- ratios that describe the two-way association of interest are a linear function of latent scores for the third variable. Additive and multiplicative models currently in use by researchers are special cases of the regression-type model. To illustrate the utility of the regression-type approach, we apply this approach to analyze (1) data on occupational mobility in the United States, Britain, and Japan (comparing mobility in these countries) and (2) data on the association between religion and voting behavior in U.S. presidential elections from 1968 to 1992 (comparing this association in the different elections). We also introduce here graphical displays that can be used to obtain worthwhile information about goodness-of-fit and to aid in substantive interpretation.     

Media Technologies, Images of Drugs, and an Evocative Telepresence

I regard electronic media technologies as framing devices for how viewers perceive issues associated with illegal drugs. Controllers of electronic media technologies produce and disseminate images of illegal drugs and users of such drugs to which viewers respond. People who control the images of electronic media production create an evocative telepresence, or a visual context that relies on appeals to authority and emotion. However, viewers do not merely respond to images of illegal drugs; rather, they actively interpret such images and draw their own conclusions. To demonstrate the complex relationship between electronic stimuli and viewer responses, I report on a classroom experiment comparing those who saw and heard a heroin user with those who only heard this user. I also report findings from student perceptions of and reactions to four drug films. Results of the experiment and the readings of films indicate that viewers, especially those who can see and hear electronic displays, are sophisticated consumers who respond to immediate stimuli while making reference to distal stimuli. In the main, I contend that electronic images of illegal drugs and users in an evocative telepresence are powerful stimuli, but they do not cause viewer perceptions.     

Organizational effectiveness. Primary care and the congruence model

The congruence model is a framework used to analyze organizational strengths and weaknesses and pinpoint specific areas for improving effectiveness. This article provides an overview of organizations as open systems, with examples in the primary care arena. It explains and applies the congruence model in the context of primary care issues and functions, including methods by which the model can be used to diagnose organizational problems and generate solutions. Changes needed in primary care due to the managed care environment, and areas of potential problems and sensitivities requiring organizational changes to meet market and regulatory demands now placed on PCOs are examined.     

Making the journey into the networked enterprise, Part 2

In the May issue of Physician Executive, the authors described the difficulties other industries have had with vertical integration and why so many corporations have abandoned it for other organizational structures. In this second part of the series, they explore the ways health care organizations can make the shift into integrated delivery systems, avoiding the trap of the hierarchical, vertically integrated monolithic structures that will become the dinosaurs of the future.