Pathways between education and health: a causal modelling approach

Summary.  The association of poor education and poor health has been consistently observed in many studies and in various countries. Thus far, studies examining the mechanisms underlying this association have looked at only a limited set of potential pathways. This study simultaneously examines six distinctive pathways, which have been hypothesized to link education and health and found support from previous studies. A causal analysis of education and health was performed using structural equation models. Data were used from six phases of the National Child Development Study, which is based on following up an initial sample of 17416 children who were born in 1958. The association between education and health appears to be explained by a combination of mechanisms: adolescent health and adult health behaviours for men and women, adult social class among men and parental social class among women. We conclude that improvements in population educational attainment may not automatically lead to improvements in population health, and that health policies for improving health and reducing health inequalities need to target specific causal pathways.     

I'm Telling! The Content, Context, and Consequences of Children's Tattling on their Siblings

Tattling on siblings was observed in 40 families with 2- and 4-year-old children. All but 5 children reported sibling misbehaviour to parents with younger siblings tattling largely to recruit parental help in resolving conflict issues, and older siblings tattling both in the context of conflict and merely to inform parents of their siblings' misbehaviour. Parents rarely reprimanded children for tattling, but either ignored it, or responded to information in tattlers' reports regardless of context or whether older or younger children tattled. Children did not tattle equally on all sibling transgressions, but emphasized physical aggression and property damage, issues that also elicited parental discipline. Tattling is discussed in relation to children's understanding of the dynamics and moral standards of family life.     

Physician-nurse migration to the United States: regional and health status origins in relation to legislation and policy

This article examines the origins of physicians and nurses who were admitted as permanent immigrants to the US from 1962-1979. Data are mainly from the Immigration and Naturalization Service. Countries used in the developmental analysis are only those whose population was estimated at 1 million or more as of mid-1979, encompassing 99% of the physicians and 97% of the nurses. Life expectancy at birth is the criterion used to differentiate origin countries by developmental dimension of health status. During the study period, health workers constituted about 30% of immigrants admitted to the US; of these, nurses and physicians constituted 72-82% throughout the study period. The period 1962-1979 has 4 distinct phases, marked by important legislative and/or policy changes; 1) 1962-1965, when the McCarran-Walter Act prevailed; 2) ending in 1968, the 2nd phase covers the transition mandated under the 1965 Immigration Act, which encouraged physician immigration; 3) the 3rd phase, 1969-1976, covers the transition to the 1976 Immigration and Nationality Act amendments; and 4) the 4th stage is 1977-1979. Results show that 1) under the McCarran-Walter Act, North America became the dominant physician source; 2) from 1966-1968, Asia attained dominance as the physician source and became even more predominant after 1968; 3) North America produced relatively few physicians in the early 1970s; 4) Europe produced substantially fewer physicians in the 1970s than in the 1960s; 5) South America, Africa, and Oceania were the lowest contributors of physicians; 6) during the McCarran-Walter years, North America and Europe produced almost 90% of nurses admitted into the US; 7) the 1965 Immigration Act and its aftermath resulted in Asia becoming the dominant source of nurses; 8) prior to the 1965 Immigration Act, Canada generated 20% of the aggregate number of physicians; 9) the Philippines surpassed Canada during the transition and India led after the transition; and 10) Canada supplied 30% of the nurses up through the transition, with the Philippines in the lead 1969-1979. Low health status countries were a relatively minor nurse source. Health status at the origin was a far less significant determinant of physician immigration than that of nurses. English language high and low health status country groups produced substantially more physician and nurse immigrants that their corresponding non-English language counterparts. The US attracted more physicians and nurses from less developed countries than more developed countries after 1968.     

Selecting a family therapy model: the role of personality attributes in eclectic practice*

The expanding knowledge and skill bases within the interdisciplinary family therapy profession pose a significant challenge for evolving practitioners, at whatever stage along the professional development process they find themselves. This challenge raises a basic question regarding whether there are any constraining forces to the level of eclecticism in practice towards which one can aspire. This paper empirically explores the role played by the personality attributes of the family therapist in facilitating and/or inhibiting one's adherence to a variety of approaches to family practice.     

The prediction of learning in family therapy training programs*

Research on family therapy training has produced very little data regarding the kinds of trainees that do best in family therapy training programs. This study attempts to provide some rough and preliminary data on that issue. One hundred and seventy trainees, drawn from seven different structural!strategic training experiences, were evaluated as to how much they learned by taking the Family Therapy Assessment Exercise pre- and posttraining. Their performance was correlated using a hierarchical regression analysis with a number of trainee variables such as amount of conjugal family experience, amount of experience doing family or individual therapy, or prior knowledge of family therapy. The results indicate that, as predicted, conjugal family experience was positively related, and prior knowledge was negatively related to performance. Prior experience doing individual therapy was also positively related to performance.     

Training with o (observing) and T (treatment) teams in live supervision: reflections in the looking glass*

Working with a treatment and observing team at the same time, behind the oneway mirror, offers a variety of ways to: (a) generate multiple realities; (b) work with two different models of family therapy simultaneously; and (c) provide feedback on the teams' own roles, rules and group process. The process that 6 trainees and two supervisors used with T and O teams to examine their own coevolution as a therapeutic system using the Milan model of family therapy and Ericksonian hypnotherapy is described. The article concludes with a discussion of the advantages and pitfalls of this type of dual supervision.     

Socioeconomic, medical care, and public health contexts affecting infant mortality: a study of community-level differentials in Peru

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.