Showing papers in "Journal of Health and Social Behavior in 1978"

The structure of coping.

Abstract: Coping refers to behavior that protects peoplefrom being psychologically harmed by problematic social experience, a behavior that importantly mediates the impact that societies have on their members. The protective function of coping behavior can be exercised in three ways: by eliminating or modifying conditions giving rise to problems; by perceptually controlling the meaning of experience in a manner that neutralizes its problematic character; and by keeping the emotional consequences of problems within manageable bounds. The efficacy of a number of concrete coping behaviors representing these threefunctions was evaluated. Results indicate that individuals' coping interventions are most effective when dealing with problems within the close interpersonal role areas of marriage and child-rearing and least effective when dealing with the more impersonal problems found in occupation. The effective coping modes are unequally distributed in society, with men, the educated, and the affluent making greater use of the efficacious mechanisms.

Exemplification of a method for scaling life events: the Peri Life Events Scale.

Abstract: This paper challenges several arguments for rejecting the rationale of Holmes' and Rahe's Social Readjustment Rating Scale and proposes procedural improvements for three aspects of life-event scale construction: construction of a life-event list, selection of judges, and tests of whether judges agree on their ratings. The proposed procedures are illustrated with the Psychiatric Epidemiology Research Interview (PERI) Life Events Scale. This list of 102 events was developed on the basis of surveys of events actually experienced in various populations. Ratings of the amount of change entailed in these events were collected from a community probability sample. Analysis of these ratings suggests that there are group differences, with more of these differences being due to ethnic background than to sex or social class.

The effect of social support in moderating the health consequences of unemployment.

Abstract: In the context of a longitudinal investigation of the physical and mental health consequences of involuntary job loss, it is hypothesized that social supports modify the relationship between unemployment stress and health responses. As a result of two plant shutdowns, 100 stably employed, married men were interviewed at five stages over a two-year period. Social support was measured by a 13-item index covering the extent of supportive and affiliative relations with wife, friends and relatives. The rural unemployed evidenced a significantly higher level of social support than did the urban unemployed, a difference probably due to the strength of ethnic ties in the small community and a more concerned social milieu. No differences between the supported and unsupported were found with respect to weeks unemployed or to actual economic deprivation. However, while unemployed, the unsupported evidenced significantly higher elevations and more changes in measures of cholesterol, illness symptoms and affective response than did the supported. While health differences between supported and unsupported populations under stress are commonly interpreted as evidence that support buffers the effects of life stress, it is argued that these and other study findings demonstrate the exacerbation of life stress by a low sense of social support.

Life events, social supports, and psychiatric symptoms: a re-analysis of the New Haven data.

Abstract: Lon-aitudinal data on life events and Dsvchiatric symptoms, presented in this journal by Myers et al. in 1975, are reanalyzed using the panel regression technique. This analysis shows that life events are fairly independent of each other over a two-year time period. The effect of recall distortion on the life events-mental disorder relationship is negligible. The data provide some serendipitous evidence that life events are more likely to cause mental disorder if the individual has not experienced similar stresses before. There is also evidence that members of the household provide support in times of crisis that help prevent mental disorder.

Social class and mental illness reconsidered: the role of economic stress and social support.

Abstract: Several bodies of research are reviewed for their contributions to defining the relationship of individual psychological disorder to social structure and process. The specific problem addressed is the relationship of social class to psychological impairment and its mediation. The generic problem is one of locating psychological processes and individual behavior within a societal framework. Recent work focusing on the effects of economic change and unemployment on psychological functioning is examined in relation to studies of the support characteristics of families and social networks pertinent to psychological well-being. An integration of this literature is presented based on the interdependency of stress and support variables and is, in turn, employed in a conceptualization of the relationship between social class and psychological disorder. It is argued that stress and support factors are systematically organized within classes at several levels of analysis and constitute critical conditions of class membership related to psychological functioning.

Competing theories of marijuana use: a longitudinal study.

Abstract: Constructive debate over public policy concerning the use and possession of marvuana is hampered by a lack of adequate empirical tests which assess the relative independent predictive power of theories designed to account for maruuana use. This paper presents a longitudinal study of coliege student maruuana use which allows assessment of the relative utility of certain of these theories. Consistent with prior studies, orientation toward a marijuana-using reference group is the most substantial predictor of mariuana use in this study. Contrary to earlier conclusions based solely on cross-sectional data, maruuana use at follow-up is not related to initial lack of commitment to conventional institutions, directly or indirectly, when statistical controls for other theoretical variables are applied. In addition, psychological distress at follow-up is associated with lower levels of initial marijuana use, when other spurious effects are removed. Finally, degree of involvement in conventional activities is not related to marijuana use. The implications for reinterpretation of previous data are discussed.

Subjective stress and serious illness of a spouse: wives of heart patients.

Abstract: This paper examines stability and change in reported subjective stress during one year among 263 wives whose husbands suffered a first myocardial infarction. Patterns of subjective stress scores remained relatively stable over the study year. Level of severity of illness in the husband had some relationship to stress score at particular points in time, although clear-cut findings did not emerge. Some variations in subjective stress levels were also found between women of different educational and ethnic backgrounds. Reported subjective stress is reviewed as part of a more general stress experience, reflected in emotional volatility and marital unhappiness, rather than as a correlate of such variables as illness burdens in the household, employment of wife, age, and socioeconomic status.

Hospital adoption of innovation: the role of integration into external informational environments.

Abstract: In this paper it is hypothesized that observed variability in hospital adoption of innovation can be accounted for, at least in part, by variability in the development of structural mechanisms which provide access to information about change in the environment. The hypothesis is tested using data from a national sample of hospitals, and on an aggregate basis the results support the theoretical perspective, although certain integration-enhancing mechanisms were much better predictors of innovation than others. The results also illustrate the importance of the relationship between the nature of the innovation and the adopting system and suggest a potential clarification of the relationship between hospital size and innovation.

Pathways to medicine use.

Abstract: Although path analysis has been used to explain physician and hospital use, it has never before been applied to medicine use. This analysis assesses direct and indirect relationships among predisposing, enabling and need-for-care factors on use ofprescribed and nonprescribed drugs. Data are drawn from 2378 adults in the Baltimore SMSA survey of the WHO study of medical care utilization. Principal findings in terms of direct effects are: females and whites are more likely to use both prescribed and nonprescribed medicines; age is positively related to prescribed drug use and negatively related to nonprescribed drug use. Of six enabling factors, only perceived availability of care has a significant, direct effect on drug use (positive for prescribed and inverse for nonprescribed). Perceived morbidity (a need-for-care factor) is the strongest predictor in the model on both outcome variables. Anxiety and physician visits have significant direct effects on prescribed use. The pattern of indirect effects is also discussed. Overall, the model is a better predictor of prescribed than of nonprescribed medicine use, and the analysis suggests that nonprescribed medicine use may substitute for entry into the formal medical care system.

Social status, psychiatric symptomatology, and response bias.

Abstract: A sample of ambiguous items from the Langner screening measure is examined for various types of biases. The items are not related to physiological illnesses that might be associated with age when education is controlled. Non-aggressive social desirability bias does not affect symptom scores independent of acquiescence bias. Two types of acquiescence bias affect symptomatology independent of any otherfactors. With multiple controls for all of these biases, the proposition that status is inversely related to symptomatology is retested. It is found that while class is inversely related to symptomatology, racial and ethnic status are not.

Professional power and professional effectiveness: the power of the surgical staff and the quality of surgical care in hospitals.

Abstract: In order to examine some of the determinants of professional effectiveness in professional organizations, a study was conducted relating the power of the surgical organization in hospitals to the quality of surgical care delivered. Data utilized were from approximately 8,000 patients treated by 500 surgeons in 15 short-term general hospitals in the United States. Several measures were employed to assess two aspects of power: (1) the power of the surgical staff and other major role groups within each hospital, and (2) the power of the surgical staff over individual surgeons. Quality of surgical care was measured by mortality and morbidity data, adjusted for differences among patients in pre-surgical condition. Additional variables were introduced to assess surgeon qualifications, hospital characteristics, and features other than power differences which might relate to outcome. Controlling for those variables which did significantly affect adjusted outcomes, regression analyses revealed that the extent of control exercised by the surgical staff over individual surgeons did relate to the quality of care as predicted. However, the power of the surgical staff relative to other groups did not relate significantly to care quality; rather, higher power by the hospital administration was the factor most strongly associated with quality of surgical care.

Utilization of dental health services by Chicanos and Anglos.

Abstract: This study is a comparative analysis of dental utilization patterns of Chicanos and Anglos, using several socioeconomic variables to explain differences and similarities. It is found that Chicanos not only underutilize dental services, but that the services they do use are primarily those of a "symptomatic" nature. For Chicanos, socioeconomic variables play a negligible role in explaining dental utilization, although they are more important for Anglos. Incorporation of cultural and situational constraints into already existing SES models of explanation is recommended for the fiture research of the dental-utilization practices of this minority population.

Health status, health resources, and consolidated structural parameters: implications for public health care policy.

Abstract: One major assumption underlying much of the health-care policy in the United States is articulated and submitted to empirical test in this study. The test assesses the relative impacts of health service resources and community structure on two measures of physical health status. All constructs are measured by multiple indicators at three points in time: 1950, 1960, and 1970. The parameters of the conceptual model are estimated by multiple regression techniques. A block-recursive test of the static model shows that health resources exert minimal net impacts on health status. The impact of community structure on health status is more pronounced. Further, an examination of beta coefficients shows that the relationship between health service resources and physical health status is not consistent with the postulated notion of how the health system affects health. An evaluation of change data over the twenty-year period was consistent with the static model. Probationary policy implications of the findings are offered.

Life change and illness: illness behavior of males in the recovery period of a natural disaster.

Abstract: This research investigates the relationship between stress and the self-reported incidence and prevalence of physical illness and emotional disorders in a sample of middle-aged, working-class men during the recovery period of a natural disaster. Hypotheses concerning the illness behavior of respondents who had and who had not experiencedflooding of their housing unit were tested. The research design entailed personal interviews with a stratified, multistage probability sample of 91 men in two upstate Pennsylvania communitiesflooded in June 1972. In addition to answering questions contained in an interview schedule, all respondents completed the Schedule of Recent Experience and the Gurin Symptom Checklist. Although there were no significant differences in the number and nature of the illnesses experienced by the flood and non-flood respondents, there were significant differences in the duration of illness and self-perceived influence of the flood on the health of the two subsamples of respondents.

Interracial depressive epidemiology in the Southwest.

Abstract: This report is a replication of a recent study dealing with interracial depressive symptomatology in the South. The present study analyzes the depression characteristics of Mexican-American and black females living in a Southwestern city (N=514) and essentially validates the earlier findings from the South after a period of rapid social change. When people become aware of better economic opportunities, the young, the old, the underand uneducated, and the unemployed express more depressive symptoms when they realize there are some structural barriers to a better way of life. Marital status was not a good depression predictor among the poor who were studied, but social alienation helped predict personal depression in one out of every seven Mexican Americans.

Ethnic differences in factors related to drug use.

Abstract: The drug abuse literature indicates that there are ethnic differences in rates and patterns of use of illicit drugs. Two possible explanations for these differences are: variations in rates of antecedent factors, and variations in processes leading to illicit use. This paper focuses on use of six illicit drugs in a ghetto sample of American blacks, West Indian blacks, and whites. Factors investigated are peer group influences, attachment to conventional patterns and attachment to deviant patterns. We find that peer influences are much less powerful in understanding West Indian than American black or white drug use.

Social and psychological correlates of smoking behavior among black women.

Abstract: This paper reports a study offactors associated with smoking behavior among black ferqales. One purpose of the study was to test the applicability of a conceptualization of the process of cessation that combined two of the most commonly applied theoretical approaches used by other researchers in the field. A second goal was to ascertain the factors that best differentiated among four patterns of smoking behavior: continuous smoking, continuous smoking with some modification of amount, Successful cessation, and lifetime abstention. The patterns of association in the data that were analyzed appeared to be consistent with the hypotheses derived from the expanded model, and the combined conceptualization seemed helpful in dealing with difficulties inherent in each of the conceptualizations used by other investigators. It also appeared that the subjects in the study did not differ Substantially from the white males who had been the subjects of most earlier studies. The results indicated that personal relevance of the threat to the individual, the use of communications, and the influence of others close to the respondent differentiated among the four behavior groups studied.

Differential access to preventive services for young children in low-income urban areas.

Abstract: This study, based on a community health survey of populations in five low-income urban areas, examines the use of selected preventive services of preschool children. It is postulated that there are social differences in access to varying health-care facilities. Consequently, the level of preventive services utilized varies from group to group. Multivariate statistical analyses were performedfor the 2,063 children to determine the relative influence of social and access factors on the use of the two types of preventive services. The results show that regular source of care was significant in explaining variation in immunizations and in physical examinations. Those who had no regular source of care were least likely to use preventive services. Regular users of neighborhood health centers and public health clinics had received the same number of immunizations and were as likely to have had a physical checkup in the previous year as users of private physicians. These findings indicate that having a regular source of care is a significant access factor in preventive-services utilization. In many ways the effects of social status and access factors on the two types of preventive care were similar. However, marked differences were foundfor demographic variables, which had a stronger influence on number of immunizations but had a negligible effect on physical examinations.

Life change and psychiatric disturbance in a South American city: the effects of geographic and social mobilty.

Abstract: Geographic and social mobility are important sources of life change for the majority of people in the modern world. On the assumption that such social transitions are potentially stressful, researchers have investigated the relationship between mobility and psychiatric disturbance. Results from these studies are inconsistent and sometimes contradictory, often due to conceptual and methodological differences. This study offers new evidence on this issue. Interviews were conducted with 681 adults residing in a large Colombian city. Analysis focuses on relationships between geographic and social mobility and manifestations of psychiatric symptoms, but also includes consideration of the effects of age, sex, and education. Results indicate significantly higher symptom scores for females and persons with lower educational attainment as well as certain types of social mobility experience. Variations by age and migration experience are minimal. This study casts some doubt about the stressful effects of migration, tends to support the notion that social mobility is related to psychiatric disturbance and, above all, shows that sex and education are factors that override the influence of either type of mobility experience. The paper concludes with the suggestion that these findings can be utilized for purposes of primary prevention and an indication of lines along which future research should be organized.