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.     

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.     

“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.