Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Benefits of preventive dentistry in children: Cost factors and public policy

Dental caries in children is now recognized as a preventable disease. The use of fluoride and sealants has produced a major reduction in caries prevalence among school aged children in the United States and other countries. A portion of the child population who are educationally and socioeconomically disadvantaged are not fully receiving these benefits. Public policy, insurance and medicaid groups must be made aware of these preventative measures and strategies developed to implement them.     

Implications of temporal aggregation on the relation between two time series

Using a simple theoretical model and giving an empirical example it is investigated if it matters whether we use (monthly) averages or end-of-period (month) data in performing Granger-causality tests. It is shown that no major problems are to be expected if the two series are temporally aggregated in the same way, but non-trivial problems can occur if the two series have different kinds of temporal aggregation.     

A SCALE IN SEARCH OF A CONSTRUCT: COMMENTS ON GAVIN AND WAMBOLDT

The article examines some issues raised in Gavin and Wamboldt's (1992) recent study on the Family-of-Origin Scale (FOS) (Hovestadt, Anderson, Piercy, Cochran, & Fine, 1985). The discussion centers on unresolved concerns regarding the validity and utility of the FOS and on unsubstantiated and potentially misleading claims made in the Gavin and Wamboldt article. A case is made for conceptual and methodological precision in the study of family phenomena.     

Multicultural perspectives on counseling survivors of rape

The dominant Euro-American culture is a rape-prone culture, as defined by Sanday. Within that culture, rape is both a tool and a consequence of interlocking systems of oppression based on race, ethnicity, class, and sexual orientation. The impact of rape on an individual survivor can only be fully understood in the context of the survivor's own culture, religious beliefs, and experience as an immigrant or refugee. Issues of race, culture, class, and sexual orientation influence every step in the counseling of a rape survivor. Knowledge about the client's culture is essential if accurate assessment and culturally appropriate service are to be provided. Specific examples of the impact of these issues are presented. Ways in which the cultural values implicit in the crisis counseling model may conflict with the client's values and needs are examined.     

A simultaneous-equations model of the relationship between public sector bargaining legislation and unionization

This paper estimates a simultaneous-equations model with public sector bargaining laws and union membership treated as jointly-determined variables. The extent of public sector unionization has a significant positive influence on the passage of prolabor bargaining legislation and bargaining legislation has strong, independent effects on the extent of public sector unionization. We gratefully acknowledge the research support provided by Minbo Kim and Parisun Chantonahom.     

Dimensions of Participation in a Professional Social-Movement Organization

Differential participation after recruitment remains a black box in the social-movement and voluntary-association literatures. This paper identifies several dimensions of membership participation in a professional social-movement organization (SMO) with a national membership and analyzes the determinants of differential involvement in these forms. In general, members' ideological beliefs, social and organizational ties, perceptions about their SMO, and communication with SMO officials all predict participation across the various forms. Our findings extend previous work on differential participation in three ways. First, we statistically isolate cultural dimensions of postrecruitment participation and, in so doing, complement recent ethnographic research. Second, our findings suggest that the distinct dimensions of external and internal participation found by Knoke (1988) in a national sample of voluntary associations may not generalize to national SMOs studied individually. Third, our results indicate that models combining ideological and microstructural factors should explain the multiple forms of participation in SMOs lacking these distinct dimensions.