Boater training, drinking and boating, and other unsafe boating practices

OBJECTIVES: Identify associations between lack of formal boater training, drinking and boating, and other unsafe boating practices. METHODS: A telephone survey queried respondents (age 16 or older in continental United States) about boating experience, type of boat used, and training. RESULTS: Of the 3,042 boaters surveyed (70% response), most had no formal training (73%). Boaters with formal training failed to use PFDs about as often as those without formal training and were equally or more likely to use alcohol while boating. CONCLUSIONS: The unexpected association between formal training and unsafe boating practices is probably due to reduced risk perception and inadequacies of boater training programs. Such programs seldom mention the risks of alcohol use while boating. Decisions to mandate formal training should be informed by these results; if mandated, training should address the risks of alcohol use while boating, and should be renewed frequently enough to offset reductions in risk perception.     

Using Readiness Assessment to Improve Career Services: A Cognitive Information‐Processing Approach

This article begins with a review of the use of readiness assessment measures as a strategy for improving career services. A 5‐step process model for readiness assessment is then proposed and current readiness measures are identified. Although considerable research has been conducted on career decision‐making readiness and numerous measures have been developed, there has been limited literature available on the application of readiness assessment in selecting career interventions to meet specific client needs. This article continues with a theory‐based conceptualization of readiness and then links readiness assessment to the selection of career interventions designed to meet clients' needs.     

A campus-community coalition to control alcohol-related problems off campus: an environmental management case study

The authors report on the effects of a university and community coalition in preventing problems related to college students' off-campus drinking. The Albany, New York, Committee on University and Community Relations used strategies based on an environmental-management approach that focuses on changing the environment in which individuals make decisions about alcohol consumption and related behaviors. Committee initiatives included improving enforcement of local laws and ordinances, creating a safety-awareness campaign for off-campus students, and developing a comprehensive advertising and beverage-service agreement with local tavern owners. The initiatives were associated with a decline in the number of alcohol-related problems in the community, as indicated by decreases in the number of off-campus noise ordinance reports filed by police and the number of calls to a university-maintained hotline for reporting off-campus problems. An environmental management approach, the authors suggest, has promise as an effective means of preventing alcohol-related problems among college students.     

Sexual Orientation Discrimination and Its Challenges for Nonprofit Managers

In the wake of the recent New Jersey Supreme Court decision, Dale v. Boy Scouts of America and Monmouth Council Boy Scouts (1999), this article examines the issue of sexual orientation discrimination and the challenges it presents nonprofit managers. Because of regional shifts in public opinion, the enactment of nondiscrimination laws at the state and local level, and now a state Supreme Court interpreting state law to include the Boy Scouts of America (BSA) as a “public accommodation,” nonprofit managers may face a more complex legal and moral environment. It is hoped that this article will challenge nonprofit managers to carefully reexamine their membership and personnel policies with respect to lesbians and gay men and begin preparing their organizations for this cultural change.     

Cost-benefit and cost-effectiveness analysis of drug abuse treatment services

The foundations of cost-benefit analysis and cost-effectiveness analysis (CB/CEA) for drug abuse treatment are developed. An economic model of addict choice and drug markets is presented. This model is synthesized with the current "cost of illness" methods used to measure the burden of the disease to society. The problem of doing cost-effectiveness studies in the presence of large nonhealth benefits is examined, and guidance is offered to clinical studies with a cost-effectiveness component or to stand-alone cost-effectiveness studies. References and an extensive bibliography on drug abuse treatment-related CB/CEA studies are appended.     

Physician credentialing. A centralized verification system

The current system for credentialing physicians in the U.S. is staggeringly redundant, prone to error, and expensive. The process for establishing a recent graduate's practice can involve an average of five applications to have privileges at several hospitals and HMOs. A centralized verification system needs to be developed to streamline this process. The amount of information that would have to be stored for all physicians in the country would be immense. However, the technology currently exists to store such information on a much grander scale. Credit unions, banks, and insurance companies utilize such computer systems effectively and with reasonable confidentiality.     

Generalists or specialists--who does it better?

Managed care companies encourage primary care physicians to limit referrals to specialists and provide as much of the needed services themselves. As a result, generalist and specialist physicians are now in direct competition with one another. Is the care provided by generalist and specialist physicians different in terms of quality and cost? The authors reviewed the literature over the past five years and found 21 articles comparing the care between specialists and generalists. They realized asking who does it better, the generalists or the specialists, is the wrong question to explore. Physicians must come together to design systems of care that maximize the long-term health of patients and deliver care in a coordinated and efficient manner. The emphasis should be on creating value for the consumer across the continuum of providers and through time. Competition between generalists and specialists in a fragmented system only serves to further weaken the position of physicians in the health care industry.     

The levers of influence

Physicians often determine the demand for health care services, as well as control the clinical processes aimed at improving health outcomes at the individual and population level. Given their important role in enhancing health status and improving the health care delivery system, it is critical that physician executives master the tools necessary to positively influence physician behavior. But changing behavior is far more complex than "doing it or not doing it." The Nike slogan "just do it" is motivating, but over-simplified. The roots of human change include: consciousness-raising, emotional arousal, commitment, helping relationships, self-reevaluation, reward, and environmental control. A model to effectively influence behavior is presented and includes setting clear expectations, measuring and monitoring performance, providing feedback, and rewarding and recognizing improvement. If all else fails, try discipline. This five-step approach is based on the science of human behavior and working with physicians in diverse settings, ranging from academic medical centers to small practices.