Showing papers in "Journal of Health and Social Behavior in 1991"
TL;DR: There are persistent denominational variations in life satisfaction, but not in happiness: nondenominational Protestants, liberal Protestants, and members of nontraditional groups such as Mormons and Jehovah's Witnesses report greater life satisfaction than do their unaffiliated counterparts, even with the effects of other dimensions of religiosity held constant.
Abstract: This study examines the multifaceted relationships between religious involvement and subjective well-being. Findings suggest that the beneficent effects of religious attendance and private devotion reported in previous studies are primarily indirect, resulting from their respective roles in strengthening religious belief systems. The positive influence of religious certainty on well-being, however, is direct and substantial: individuals with strong religious faith report higher levels of life satisfaction, greater personal happiness, and fewer negative psychosocial consequences of traumatic life events. Further, in models of life satisfaction only, the positive influence of existential certainty is especially pronounced for older persons and persons with low levels of formal education. Finally, there are persistent denominational variations in life satisfaction, but not in happiness: nondenominational Protestants, liberal Protestants, and members of nontraditional groups such as Mormons and Jehovah's Witnesses report greater life satisfaction than do their unaffiliated counterparts, even with the effects of other dimensions of religiosity held constant. Several directions for additional research on religion and psychological well-being are discussed.
1,334Â citations
TL;DR: It is argued that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals.
Abstract: Recent research has assigned a prominent role to labeling and stigma as factors that impair the social and psychological functioning of people officially labeled mentally ill But can the effects of labeling and stigma be overcome by adopting a few simple approaches to coping with these problems? If so, the stigma-induced problems of social awkwardness, demoralization and unemployment emphasized by recent research may not be as severe as claimed Using a sample of psychiatric patients, we examine this issue by assessing whether patients can ameliorate labeling effects by keeping their history of treatment a secret, educating others about their situation, or avoiding situations in which rejection might occur None of these coping orientations were effective in diminishing negative labeling effects on unemployment or on psychological distress/demoralization In fact, the three coping strategies show consistent effects in the direction of producing more harm than good, and with respect to withdrawal-avoidance this effect is significant Based on these results we argue that stigma is powerfully reinforced by culture and that its effects are not easily overcome by the coping actions of individuals Using C Wright Mills's (1967) distinction we conclude that labeling and stigma are "social problems" not "individual troubles"
522Â citations
TL;DR: The critical role played by the social environment in the life stress process involving psychological distress is substantiated and the implications of these and other findings are discussed.
Abstract: The paper focuses on two forces (stressors and resources) in the life stress process as they affect psychological distress. Utilizing three waves of panel data from a representative community sample in upstate New York, six causal models of the life stress process are tested with indicators of two types of stressors (social and physiological) and two types of resources (social and psychological). Both deterring and coping models are tested. Analysis shows that: (1) stressors and resources in the social environment have a direct impact on depressive symptoms, (2) social resources mediate the effects of social stressors on psychological distress, and (3) psychological resources indirectly affect distress by enhancing social resources. The critical role played by the social environment in the life stress process involving psychological distress is substantiated. The implications of these and other findings are discussed.
500Â citations
TL;DR: Analysis of three-wave panel data from a national sample of persons married in 1980 indicates that the crisis model is appropriate for understanding adjustment to divorce, and finds that predivorce resources and outlooks influence the amount of stress experienced in the two years immediately following divorce.
Abstract: While research on adjustment to divorce has been extensive, the paucity of studies assessing stress before and after divorce has kept the relation between psychological stress and martial dissolution unclear. Conflicting findings cast some doubt on the utility of using a crisis model to study divorce. Analysis of three-wave panel data from a national sample of persons married in 1980 indicates that the crisis model is appropriate for understanding adjustment to divorce. Comparisons of divorced persons with married persons show a predivorce rise in stress which then returns to levels comparable to those reported by married individuals. No evidence was found supporting the idea that a high level of psychological stress is a general cause of divorce or that dissolution resulted in more or less permanent elevation of psychological stress. Findings support the hypothesis that predivorce resources and outlooks influence the amount of stress experienced in the two years immediately following divorce. Below median family incomes, no post-high school experience, and wife not in the labor force put divorcing individuals at a disadvantage. Individuals reporting few premarital troubles and beliefs in the immorality of divorce also appear to experience heightened stress in the two years following divorce.
415Â citations
TL;DR: It is concluded that if gender roles were more equal, women would experience better health than men, more consistent with their greater longevity.
Abstract: One of the continuing paradoxes facing social epidemiologists concerns sex differences in morbidity and mortality. Although women live longer than men, they apparently get sick more. We hypothesize that women's higher morbidity levels result from less paid work and lower wages combined with more hours spent in household labor, child care, and helping others, and fewer hours of leisure and sleep. Men and women hold different social roles; men hold most of the highly rewarding roles. We operationalize social roles as time commitments to various role-related activities. This approach provides interval-level measures such as time spent in caring for children instead of simple dichotomies such as parent/nonparent. We find that when gender differences in social roles are controlled, being male is associated with poorer health than being female. We conclude that if gender roles were more equal, women would experience better health than men, more consistent with their greater longevity.
249Â citations
TL;DR: Using data from a sample of 1,755 married men and women, regression models which examine the extent to which adult socioeconomic status and current marital quality mediate and/or modify the loss-depression relationship support the utility of life-course approaches to understanding adult mental health.
Abstract: Previous research demonstrates convincingly that childhood parental deaths and parental divorces have implications for adult well-being as defined by levels of depression, educational attainment, early age at marriage, and risk of divorce What this research has failed to examine are the interconnections among these outcomes Specifically, are the socioeconomic and marital outcomes of parental loss implicated in the observed higher levels of depression? This analysis takes a first step in answering this question Using data from a sample of 1,755 married men and women, I estimated regression models which examine the extent to which adult socioeconomic status and current marital quality mediate and/or modify the loss-depression relationship Parental divorce was strongly related to socioeconomic and marital outcomes Furthermore, current marital quality contributed importantly to understanding the higher levels of depressed mood observed among persons from divorced homes Parental death was much more weakly related to socioeconomic and marital outcomes, and these outcomes played little role in explaining its relationship to depression Finally, all of these relationships were stronger among women than men These findings support the utility of life-course approaches to understanding adult mental health
220Â citations
TL;DR: It is found that marital conflict is associated with problem drinking for men and depression for women, indicating the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health.
Abstract: This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health.
209Â citations
TL;DR: Multivariate analyses show that the racial differences are eliminated in some measures of health and health care service utilization after holding constant individual-level socioeconomic characteristics and resources, but even after accounting for differences in socioeconomic status, Black self-rated health is poorer than that of Whites.
Abstract: In this paper we examine the hypothesis that health differences between Blacks and Whites in later life are related to socioeconomic status. Using the 1984 panel of the Survey of Income and Program Participation, we construct four measures of health and two measures of health care service utilization. Multivariate analyses show that the racial differences are eliminated in some measures of health and health care service utilization after holding constant individual-level socioeconomic characteristics and resources. However, even after accounting for differences in socioeconomic status, Black self-rated health is poorer than that of Whites. Further, Blacks report more visits to medical personnel but do not report higher rates of hospitalization when levels of health and economic resources are controlled. Additional analyses suggest that the impact of socioeconomic status on health is different for Blacks than for Whites.
209Â citations
TL;DR: The model suggests that the life quality of couples with fertility problems could be improved if health care providers and couples themselves took steps to reduce such stresses and/or reduce their impact on the marriage factors.
Abstract: Stress associated with the inability to have a child is linked to four aspects of marriage and to five dimensions of life quality. Data come from 157 couples who met a standard medical definition for infertility. Wives and husbands were interviewed independently, and most of the following findings apply to both. A causal model suggests that fertility problem stress has direct effects that increase marital conflict and decrease sexual self-esteem, satisfaction with own sexual performance, and frequency of sexual intercourse. Also, fertility problem stress has both direct and indirect effects (via the marriage factors) that decrease evaluations of life-as-a-whole, self-efficacy, marriage, intimacy, and health. The negative effects on life quality are stronger for wives than for husbands. The model suggests that the life quality of couples with fertility problems could be improved if health care providers and couples themselves took steps to reduce such stresses and/or reduce their impact on the marriage factors.
178Â citations
TL;DR: On the structured silence of personal bodily experience and on the unfinished paradigmatic challenge of feminism as a way of leading to a new praxis in medical sociology.
Abstract: This paper is a revision of an address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on August 14, 1990 to The Medical Sociology Section of the American Sociological Association during its annual meetings, held in Washington, DC. Herein I reflect on the structured silence of personal bodily experience and on the unfinished paradigmatic challenge of feminism as a way of leading to a new praxis in medical sociology.
158Â citations
TL;DR: In this article, the authors assessed the relative influence of psychological barriers, SES, and ethnic differences in mammography use for a community sample of 586 White, 227 Black, and 150 Hispanic women.
Abstract: This study assessed the relative influence of psychological barriers, SES, and ethnic differences in mammography use for a community sample of 586 White, 227 Black, and 150 Hispanic women. Confirmatory factor analyses with latent variables indicated plausible factor structures for all groups on items related to barriers to mammography. Summed indicators of SES, fear of radiation, embarrassment, pain, anxiety, and cost concerns were correlated significantly with mammography use for the pooled group. Separate analyses by ethnicity indicated a substantial relationship between mammography use and cost concerns by White and Black women, and fear of pain by Black and Hispanic women. Use of mammography was associated more highly with SES among Hispanic women. Pooled logistic regression analyses controlling for SES and ethnicity showed that the psychological barriers, especially concern about cost, remained important independent predictors of mammography use. We explore sociocultural explanations for less mammography use by Hispanic women, especially those less acculturated.
TL;DR: It is concluded that the mortal health risks associated with the stress of being widowed can be partially offset by affectionate relations with adult children.
Abstract: This analysis examines the association between affectional solidarity in older parent-child relationships, and the parents' length of survival over a 14-year interval. It is hypothesized that close intergenerational relations have the capacity to reduce pathogenic stress among elderly parents, thereby enhancing their ability to survive. Direct and buffering effects of affectional solidarity, as expressed by 439 elderly parents, are tested using data from the U.S.C. Longitudinal Study of Generations collected between 1971 and 1985. Buffering effects are examined in the context of social decline and social loss experienced by the older parent. Hazard regression models indicate that greater intergenerational affect increases survival time among parents who experienced a loss in their social network, particularly among those who were widowed less than five years. Neither a direct effect of affection nor a buffering effect in the presence of social decline were found. It is concluded that the mortal health risks associated with the stress of being widowed can be partially offset by affectionate relations with adult children.
TL;DR: In an analysis of focused interviews with 55 seropositive gay men, three major adaptive challenges are identified: dealing with the possibility of a curtailed life span, dealing with reactions to a stigmatizing illness, and developing strategies for maintaining physical and emotional health.
Abstract: With improved understanding of the natural history of HIV/AIDS and the availability of effective early intervention, HIV infection recently has come to be conceptualized as a chronic illness. As we enter the next phase of the epidemic, insights into the challenges of daily living faced by seropositive persons will aid in designing appropriate interventions to educate for adaptive success and to ameliorate adaptive difficulties. In our analysis of focused interviews with 55 seropositive gay men, we identified three major adaptive challenges: dealing with the possibility of a curtailed life span, dealing with reactions to a stigmatizing illness, and developing strategies for maintaining physical and emotional health. The men's descriptions of these adaptive challenges are discussed in the context of adaptation to other chronic illnesses.
TL;DR: The longitudinal interrelationships among general drug use, psychological distress, and physical symptoms were investigated in a three wave panel study of a community sample of adolescents interviewed when they were 12, 15, and 18 years of age, and supported the hypothesis that generaldrug use contributes to physical and psychological impairments over time.
Abstract: The longitudinal interrelationships among general drug use, psychological distress, and physical symptoms were investigated in a three wave panel study of a community sample of adolescents interviewed when they were 12, 15, and 18 years of age. Results did not provide any support for the hypothesis that adolescents use drugs in general to cope with pre-existing psychological distress and physical symptoms. In contrast, the results supported the hypothesis that general drug use contributes to physical and psychological impairments over time. However, such drug-induced psychological distress and physical symptoms only occurred in later adolescence (from ages 15 to 18), and no evidence of impairments due to general drug use or specific alcohol use was found in early adolescence (from ages 12 to 15). Psychological distress and physical symptoms influenced each other over time, and physical symptoms partially mediated longitudinal changes in psychological distress. However, general drug use did not mediate any longitudinal changes in psychological distress and physical symptoms.
TL;DR: When examined separately by gender, males but not females were found to be vulnerable to the process of social selection, supporting the hypothesis that the expression of distress is less role-appropriate for men and therefore more likely to invite social sanctions.
Abstract: A wide body of literature documents the effect of social networks and social supports on mental health. Fewer studies, however, have examined the reciprocal effect of mental health on social relationships. This problem is examined using data from a national panel survey of adults aged 20-64. For the sample as a whole, support was found for a social selection process, since psychological distress predicted decreases in primary, but not secondary, social relationships. The extent of primary relationships also were found to be associated with subsequent distress, providing evidence that the relationship between mental health and social environment may be transactional. When examined separately by gender, males but not females were found to be vulnerable to the process of social selection, supporting the hypothesis that the expression of distress is less role-appropriate for men and therefore more likely to invite social sanctions. Social causation effects also were observed only among males.
TL;DR: This model exhibits a considerably better fit than both a no-factors model and a model in which the dimensions are uncorrelated, and several exogenous constructs expected to be associated with pregnancy anxietyexert significant effects on dimensions of the model or on a second-order factor.
Abstract: This paper presents a measurement model of a ten-item scale of maternal anxiety during pregnancy. Using confirmatory factor analysis, its reliability and validity are examined in a hospital sample of mothers (N = 266) surveyed postpartum in Galveston, Texas. According to several indices of overall fit as well as individual parameter estimates, a latent internal structure of three interrelated dimensions is confirmed for the scale items. These first-order constructs are anxiety about being pregnant, childbirth, and hospitalization. This model exhibits a considerably better fit than both a no-factors model and a model in which the dimensions are uncorrelated. Finally, several exogenous constructs expected to be associated with pregnancy anxiety--age, marital status, and worry over health--exert significant effects on dimensions of the model or on a second-order factor.
TL;DR: Maternal mastery was related to fewer reported behavior problems among children and lower involvement with people and higher involvement with things, as well as low physical activity, were related significantly to higher levels of perceived problems.
Abstract: We assess the impact of maternal sense of mastery and maternal working conditions on maternal perceptions of children's behavior problems as a means to study the transmission of social control across generations. We use a sample of 521 employed mothers and their four-to six-year-old children from the National Longitudinal Survey's Youth Cohort in 1986. Regarding working conditions, we consider mother's hourly wage, work hours, and job content including involvement with things (vs. people), the requisite level of physical activity, and occupational complexity. We also consider maternal and child background and current family characteristics, including marital status, family size, and home environment. Maternal mastery was related to fewer reported behavior problems among children. Lower involvement with people and higher involvement with things, as well as low physical activity, were related significantly to higher levels of perceived problems. In addition, recent changes in maternal marital status, including maternal marriage or remarriage, increased reports of problems; stronger home environments had the opposite effect. We interpret these findings as suggesting how maternal experiences of control in the workplace and personal resources of control can influence the internalization of control in children.
TL;DR: Results show a slight trend to increased use in formal help over time, and use of formal helpers was greater in situations combining high level of older person's need, high levels of caregiver's personal burden, and insufficient support from the informal network.
Abstract: We used a national longitudinal probability sample of frail older persons and their caregivers to examine three questions: 1) What are the probabilities of transition to use of formal helpers over a two-year period? 2) What is the role of predisposing, enabling, older person's need, and caregiver's need variables in changes in the use of formal helpers? 3) Do determinants of change in the use of formal helpers vary by level of caregiver's burden? Results show a slight trend to increased use in formal help over time. Personal burden, but not interpersonal burden, had a lagged effect on increased use of formal services. Use of formal helpers was greater in situations combining high levels of older person's need, high levels of caregiver's personal burden, and insufficient support from the informal network.
TL;DR: The effect of race on reaction to impaired appearance is explored in a sample of 158 patients with vitiligo, a disfiguring skin disease, and self-esteem and perceived stigmatization are associated significantly with degree of disturbance among both Blacks and Whites.
Abstract: The effect of race on reaction to impaired appearance is explored in a sample of 158 patients with vitiligo, a disfiguring skin disease. Blacks and Whites do not differ in degree of disturbance by the disorder. Psychological coping resources and variables related to negative labeling of the stigma are associated with variation in degree of disturbance. Self-esteem and perceived stigmatization are associated significantly with degree of disturbance among both Blacks and Whites. Gender, age, and visibility of the condition are not related to difference in degree of disturbance within either race, although there is some evidence that they may have an indirect relationship to degree of disturbance. Importance of appearance is associated with degree of disturbance for Whites only, because of the threat of the depigmentation induced by vitiligo to the racial identity of Blacks. The implications of these findings for theory and practice are discussed.
TL;DR: It is suggested that some chronic environmental stressors may increase the impact of acute social stressors, and highlight the importance of examining contextual factors in the stress and health process.
Abstract: Data are presented on the interactive effects of an enduring environmental stressor with acute, daily social stressors on psychological distress. A cross-sectional study of males in urban India and a longitudinal study of male and female American college students examined the interplay of these two types of stressors. In India, social hassles in the home predicted psychological symptoms only among residents of crowded homes, after statistically adjusting for income. In America, the interaction between social hassles and crowding was replicated in analyses adjusting for prior psychological symptoms, prior social acquaintanceship with housemates, and income. A six-month follow-up study with the American sample replicated the interaction. In all three analyses of the social hassle-crowding interaction, there was a main effect of crowding but no main effect of social hassles on psychological symptoms. These findings suggest that some chronic environmental stressors may increase the impact of acute social stressors, and highlight the importance of examining contextual factors in the stress and health process.
TL;DR: Empirical evidence on the impact of health changes on informal helping networks with longitudinal data obtained from a probability sample of older people living in the community suggests that networks respond to diminishing health by increasing the scope of assistance provided but neither increase nor decrease in size as a consequence.
Abstract: This paper examines the impact over time of changes in older people's health and functional capacity on the size and effectiveness of their informal helping networks. Theoretical perspectives on networks differ in their predictions regarding the impact of declines in health on network size. Previous empirical studies have not examined the effects of changes in health on the size of networks. We examine empirical evidence on the impact of health changes on informal helping networks with longitudinal data obtained from a probability sample of older people living in the community. Results suggest that networks respond to diminishing health by increasing the scope of assistance provided but neither increase nor decrease in size as a consequence. The results also suggest that declines in functioning can produce increases in needs which exceed the capacity of informal networks.
TL;DR: The hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector is explored.
Abstract: This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder. Language: en
TL;DR: It appears likely that female reporting bias and gender differences in illness perception are underestimated in general population surveys because even under extreme conditions, men are less likely than women to report symptoms.
Abstract: Gender differences in health risks and symptoms are compared for a survey sample of 100 homeless persons and for the general population. Homeless men appear at greater risk of exhibiting symptoms. Nonetheless, homeless women report more symptoms, a result consistent with general population trends. Predisposing illnesses were the most accurate predictors of the number of reported symptoms, but gender explained a significant amount of variation in reported symptoms after other health risks were controlled. The findings inform the debate on the relative importance of biological factors, acquired risks, illness perception and behavior, and reporting bias in explaining why women report more symptoms in survey research. It appears likely that female reporting bias and gender differences in illness perception are underestimated in general population surveys because even under extreme conditions, men are less likely than women to report symptoms.
TL;DR: A modified rational decision model incorporating salient events and social influences (particularly from sexual partners) is used to analyze adolescent women's consistent use of oral contraceptives over a six-month period, and partner's support of OC use during follow-up and positive side effects of OCs are found to predict OC use among subjects for whom OC use was not the expected decision.
Abstract: women's consistent use of oral contraceptives (OCs) over a six-month period. Data are taken from a panel study of 308 clients of an inner-city family planning clinic. Expected OC use was computedfor each subject on the basis of subjective expected utility (SEU) theory, and is found in multivariate analyses to be a significant predictor of actual OC use. In addition, variables representing baseline and follow-up partner influences, the salience of pregnancy for the subject, and positive side effects of OCs during the first months of use are found to predict OC use. Partner's support of OC use during follow-up and positive side effects of OCs are found to predict OC use among subjects for whom OC use was not the expected decision according to baseline SEU. Implications of the findings for models of adolescents' contraceptive behavior and for clinicians are discussed. Understanding how adolescents make decisions regarding contraception is important for designing educational programs and health services to assist adolescents in preventing unwanted pregnancies and childbearing. Because promotion of more effective contraceptive use is an important prevention strategy, a number of researchers have studied correlates of adolescents' consistent use of contraception over time. Much of this research is based on rational decision models focusing on the
TL;DR: It is argued that doctors who write large numbers of certificates conduct their certifications in Schutz's "world of routine activities" (Schutz 1970), and routinized orientation to certification allows the practitioner to dwell within the "habitus" of the medical collectivity but outside a normative order.
Abstract: Those doctors in a Scottish city who had completed the most death certificates in 1985 were identified, interviewed about their certifying practices, and asked, for comparative purposes, to complete a series of dummy death certificates, based on case summaries. Analysis of the dummy certificates indicated substantial inter-practitioner variations in practice. From the interview data it is clear that the completion of death certificates is a very minor office: for most certifying doctors, death certification is an unsupervised, unreported, invisible, and unconsidered activity. It is argued that doctors who write large numbers of certificates conduct their certifications in Schutz's "world of routine activities" (Schutz 1970). It is this routinized orientation to certification that allows the practitioner to dwell within the "habitus" (Bourdieu 1977) of the medical collectivity but outside a normative order. Death certification may stand as an exemplar of a large number of medical activities, where wide and largely unacknowledged variations in practice occur with each practitioner investing his or her own practices with moral worth. Routinization ensures a moral order in the habitus, but not a normative order.
TL;DR: Results support the hypothesis thatarijuana use and the personality disposition of introspectiveness interact in their effects on psychological well-being and show that marijuana use is associated significantly with psychological distress for highly introspective individuals, while marijuana use has no such association for those low on Introspectiveness.
Abstract: Conflicting evidence suggests that marijuana use may be associated with either positive or negative mental health. This study explores the possibility that the association of marijuana use with mental health differs among various subgroups of users. Specifically, we investigate the hypothesis that marijuana use and the personality disposition of introspectiveness interact in their effects on psychological well-being. Results support this hypothesis and show that marijuana use is associated significantly with psychological distress for highly introspective individuals. In contrast, marijuana use has no such association for those low on introspectiveness. Additional evidence shows that marijuana use involves primarily self-oriented cognitive and emotional experiences for highly introspective individuals, whereas for those low on introspectiveness it is characterized more often by perceptual distortions and sensorimotor sensations.
TL;DR: Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions.
Abstract: This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships.