Showing papers in "Journal of Health and Social Behavior in 2003"

An attribution model of public discrimination towards persons with mental illness

Abstract: In this study, we build on previous work by developing and estimating a model of the relationships between causal attributions (e.g., controllability, responsibility), familiarity with mental illness, dangerousness, emotional responses (e.g., pity, anger, fear), and helping and rejecting responses. Using survey data containing responses to hypothetical vignettes, we examine these relationships in a sample of 518 community college students. Consistent with attribution theory, causal attributions affect beliefs about persons' responsibility for causing their condition, beliefs which in turn lead to affective reactions, resulting in rejecting responses such as avoidance, coercion, segregation, and withholding help. However, consistent with a danger appraisal hypothesis, the effects of perceptions of dangerousness on helping and rejecting responses are unmediated by responsibility beliefs. Much of the dangerousness effects operate by increasing fear, a particularly strong predictor of support for coercive treatment. The results from this study also suggest that familiarity with mental illness reduces discriminatory responses.

Racial identity, racial discrimination, perceived stress, and psychological distress among African American young adults.

Abstract: This study examines the direct and indirect relationships among racial identity, racial discrimination, perceived stress, and psychological distress in a sample of 555 African American young adults. A prospective study design was used to assess the influence of two dimensions of racial identity attitudes (i.e., centrality and public regard) on other study variables to investigate the relationship between racial identity attitudes and psychological distress. The results show some evidence of a direct relationship between racial centrality and psychological distress, as well as evidence of indirect relationships for both centrality and public regard through the impact of racial discrimination and perceived stress. In addition, racial centrality was both a risk factor for experiencing discrimination and a protective factor in buffering the negative impact of discrimination on psychological distress. Results are discussed within the context of identifying multiple pathways to psychological well-being for African American young adults within the context of racial discrimination.

Coping with perceived discrimination: does ethnic identity protect mental health?

Abstract: Using data (N = 2,109) from a large-scale epidemiological study of Filipino Americans, this study examines whether ethnic identity is linked to mental health and reduces the stress of discrimination. The strength of identification with an ethnic group is found to be directly associated with fewer depressive symptoms. In other words, having a sense of ethnic pride, involvement in ethinic practices, and cultural commitment to one's racial/ethnic group may protect mental health. Self-reports of racial/ethnic discrimination over a lifetime and everyday discrimination in the past month not due to race/ethnicity are associated with increased levels of depressive symptoms. Yet ethnic identity buffers the stress of racial/ethnic discrimination. This suggests that ethnic identity is a coping resource for racial/ethnic minorities that should not be overlooked. The strong link between ethnic identity and better mental health has implications for social-psychological theories on race/ethnicity and assimilation in the United States.

Stressful neighborhoods and depression: a prospective study of the impact of neighborhood disorder.

Abstract: Quantitative and qualitative research suggests that urban disadvantaged environments may be highly stressful to their inhabitants. Social disorganization may be deleterious to both physical and mental health. The relationships among perceptions of one's neighborhood, measures of social support and social integration, and level of subsequent depressive symptoms was examined with a community sample of 818 individuals screened for an HIV prevention intervention, most of whom were current or former drug users. After adjusting for baseline levels of depressive symptoms, perceptions of neighborhood characteristics (vandalism, litter or trash, vacant housing, teenagers hanging out, burglary, drug selling, and robbery) predicted depressive symptoms at a 9-month follow-up interview. Measures of social support and social integration, entered as interactions with neighborhood perceptions, did not buffer the effect of neighborhood perceptions. However, CES-D scores at follow-up for frequent church attendees were lower. The data support theories of social disorganization and social stress and suggest the need for structural intervention.

Status variations in stress exposure: implications for the interpretation of research on race, socioeconomic status, and gender.

Abstract: Life events checklists have been the predominant method for estimating variations in stress exposure. It is unknown, however, whether such inventories are equally meaningful for estimating differences in exposure between men and women, African Americans and whites, and those in lower and higher socioeconomic categories. In this paper, we employ a wider range of measures of stress--recent life events, chronic stressors, lifetime major events, and discrimination stress--to examine the extent to which these dimensions collectively yield conclusions about status variations in stress exposure that are similar to or different from estimates based only on a life events checklist. Our analyses of data collected from 899 young men and women of African American and non-Hispanic white ancestry suggest that status differences in exposure to stress vary considerably by the measure of stress that is employed. Although women are more exposed to recent life events than men, males report more major events and discrimination stress than females. Our results also reveal that life event measures tend to substantially under-estimate differences between African Americans and non-Hispanic whites in exposure to stress. A similar pattern also holds for socioeconomic status. When stress is more comprehensively estimated, level of exposure profoundly affects ethnic differences in depressive symptomatology, accounting for almost half of the difference by socioeconomic status but contributing little to the explanation of the gender difference in distress. The implications of these findings for the debate over the relative mental health significance of exposure and vulnerability to stress are discussed.

Has the future of marriage arrived? A contemporary examination of gender, marriage, and psychological well-being.

Abstract: Thirty years ago, sociologist Jessie Bernard argued that the gap in men’s and women’s marital experiences was so great as to constitute “his” and “her” marriages (Bernard 1972). Bernard further proclaimed that, “marriage introduced such profound discontinuities into the lives of women as to constitute genuine emotional health hazards” (p. 37). A year later, Gove and Tudor (1973) introduced and tested a similar theory, arguing that married women are at greater risk for mental illness than their male counterparts because the adult roles of married women are less valued and more frustrating than those of married men. According to Bernard, the gendered nature of marriage places women in a double-bind: Although family roles are less beneficial and, in some ways, more harmful to women than men, gendered socialization processes encourage women to highly value and identify with the role of wife and mother. Therefore, marital quality should be more important to women’s mental health than to men’s, while simply being married should be more important to men’s mental health than to women’s (Gove, Hughes, and Style 1983). The idea that marriage benefits men more than women while marital quality affects women more than men forms the cornerstone of sociological research on gender, marriage, and mental health and continues to drive much of the research conducted in this area today. For the past thirty years, this idea has contributed to research and theory on a range of related topics, including explanations of marital dissolution, gender differences in mental health, the gendered division of household labor, and the physical and mental health consequences of women’s multiple roles. Despite Bernard’s caustic assessment of the current state of marriage at the time, she speculated that shifts in marital and gender roles gaining momentum in the early 1970s could lead to a “future of marriage” that provided equal advantages to women and men. Demographic and cultural changes in the United States have, in fact, significantly altered women’s status and roles both within and outside of the family. Has the future of marriage that Bernard envisioned arrived? The present study addresses this question using panel data from three recent waves of a nationally representative survey. In addition to providing a contemporary assessment of gender differences in the effects of marital status and marital quality on psychological well-being, the analysis extends previous research in several ways. First, the effects of continuity in an unmarried status are separated from the effects of transitions into and out of marriage in order to assess potential gender differences in the processes underlying marital status differences in well-being. Second, both positive and negative dimensions of marital quality and psychological well-being are considered. Finally, the analysis examines whether being unmarried or exiting marriage through divorce or widowhood undermines psychological well-being more than being in a strained marriage, and whether these associations differ by gender.

Status inequalities, perceived discrimination, and eudaimonic well-being: do the challenges of minority life hone purpose and growth?

Abstract: Considerable prior research has investigated links between racial/ethnic status and diverse aspects of mental functioning (e.g. psychological disorders, quality of life, self-esteem), but little work has probed the connections between minority status and eudaimonic well-being. Derived from existential and humanistic perspectives, eudaimonia describes engagement in life challenges and is operationalized with assessments of purpose in life, personal growth, autonomy, environmental mastery, self-acceptance, and positive relations with others. Using Midlife in the United States (MIDUS), a national survey of Americans aged 25-74, plus city-specific samples of African Americans in New York City and Mexican Americans in Chicago, minority status was found to be a positive predictor of eudaimonic well-being, underscoring themes of psychological strength in the face of race-related adversity. Perceived discrimination was found to be a negative predictor of eudaimonic well-being, although such effects were gender-specific: it was women, both majority and minority, with high levels of discrimination in their daily lives whose sense of growth, mastery, autonomy, and self-acceptance was compromised.

Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women's physical and emotional health.

Abstract: This study uses longitudinal data to examine the causal relationships between perceived work discrimination and women's physical and emotional health. Using data on 1,778 employed women in the National Longitudinal Survey of Mature Women, we investigate the structural and individual characteristics that predict later perceptions of discrimination and the effects of those perceptions on subsequent health. We find that perceptions of discrimination are influenced by job attitudes, prior experiences of discrimination, and work contexts, but prior health is not related to later perceptions. However, perceptions of discrimination do impact subsequent health, and these effects remain significant after controlling for prior emotional health, physical health limitations, discrimination, and job characteristics. Overall, the results provide even stronger support for the health impact of workplace discrimination and suggest a need for further longitudinal analyses of causes and consequences of perceived discrimination.

Critical race theory speaks to the sociology of mental health: mental health problems produced by racial stratification.

Abstract: The sociology of mental health focuses on the epidemiology, etiology, correlates, and consequences of mental health (i.e., psychiatric disorder and symptoms, psychological distress, and subjective well-being) in an attempt to describe and explain how social structure influences an individual's psychological health. Critical race theory describes and explains iterative ways in which race is socially constructed across micro- and macro-levels, and how it determines life chances implicating the mundane and extraordinary in the continuance of racial stratification (i.e., racism). This paper invoked critical race theory to inform the sociology of mental health's approach to studying race and mental health by conceptualizing five hypothetical mental health problems that could exist because of racial stratification. These problems were: (1) nihilistic tendencies, (2) anti-self issues, (3) suppressed anger expression, (4) delusional denial tendencies, and (5) extreme racial paranoia. Mental health problems such as these and undocumented others can only be recognized given awareness of the social and personal implications of racial stratification.

Racial differences in DSM diagnosis using a semi-structured instrument: the importance of clinical judgment in the diagnosis of African Americans.

Abstract: Schizophrenia is diagnosed more frequently among African Americans while mood disorders are identified more often among whites. Such findings have raised serious questions about the accuracy of clinical judgment. This article analyzes data on 665 African American and white psychiatric inpatients using a semi-structured diagnostic instrument. The paper explores the relationship of patient race to schizophrenia, schizoaffective disorder, major depression, and bipolar disorder. The paper also explores the extent to which patient race is related to the manner in which clinicians link individual symptoms to diagnoses. Results indicate some significant race differences in diagnosis remain even when a semi-structured instrument and DSM criteria are used, whites, were more likely than African Americans to receive a diagnosis of bipolar disorder and less likely to be diagnosed with schizophrenia. There were no race differences in major depression. Some patterns of symptom attribution differed by race. The results are consistent with previous sociological research showing that patient race is related to diagnosis even when standardized diagnostic criteria are used. These findings underscore the importance of clinical judgment within the context of cross-race and cross-ethnic diagnosis. Clinical training programs must reduce ethnocentric bias by teaching the appropriate use of the socio-cultural information necessary to employ DSM-IV's Cultural Formulation.

Moving beyond poverty: Neighborhood structure, social processes, and health

Abstract: We investigate the impact of neighborhood structural characteristics, social organization, and culture on self-rated health in a large, cross-sectional sample of urban adults. Findings indicate that neighborhood affluence is a more powerful predictor of health status than poverty, above and beyond individual demographic background, socioeconomic status, health behaviors, and insurance coverage. Moreover, neighborhood affluence and residential stability interact in their association with health. When the prevalence of affluence is low, residential stability is negatively associated with health. Neighborhood affluence also accounts for a substantial proportion of the racial gap in health status. Finally, collective efficacy is a significant positive predictor of health but does not mediate the effects of structural factors.

Problem drinking patterns among African Americans: the impacts of reports of discrimination, perceptions of prejudice, and "risky" coping strategies.

Abstract: This research builds on a series of recent studies that have reported independent effects of personal experiences of racial discrimination on poor mental health outcomes. We suggest that for one mental health outcome, problem drinking, discrimination experiences have an impact not only via abridged socioeconomic attainment and the frustrations associated with institutionally limited opportunity structures, but also by directly increasing the likelihood of problem drinking. Moreover, we argue that personal experiences with discrimination help to foster a set of beliefs about the utility of drinking as a means of reducing stress that in the alcohol literature is referred to as "escapist" drinking. Escapist drinking is proposed as an intervening mechanism that is associated with a higher probability of alcohol-related mental health problems. Using data from the 1999-2000 National Survey of Black Workers, we find that, independent of socioeconomic attainment, personal reports of discriminatory experiences have direct influences on problem drinking. Consistent with our hypotheses, we also find that the effects of personal reports of discrimination are at least partially mediated by the endorsement of beliefs that drinking provides an effective coping mechanism. We conclude that racial impacts on mental health outcomes reflect more than the "simple" effects of constrained socioeconomic attainment.

Psychological Distress among Black and White Americans: Differential Effects of Social Support, Negative Interaction and Personal Control

Abstract: This study examines the relationships among social support, negative interaction, financial strain, traumatic events, personal control, personality, and psychological distress among African American and white adults. These analyses: (1) test the overall adequacy of various models (i.e., main, mediator, and artifactual effects) of these effects, (2) examine the role of social support and negative interaction within the context of financial strain and traumatic events, and (3) verify possible indirect effects of social interaction on distress by assessing their impact on personal control. Data from The National Comorbidity Survey were used to examine these relationships using structural equation modeling techniques. Findings indicated different models of these relationships for African Americans and whites. Overall, personal control mediated the relationship between negative interaction and psychological distress. For whites, negative interaction was an overall stronger predictor of distress and contributed to the impact of financial strain and traumatic events on psychological distress. Among African Americans, social support was a stronger predictor of distress. The findings suggest that the underlying models of these relationships are different for African Americans and whites.

Race and ethnic differences in depressed mood following the transition from high school.

Abstract: Young adulthood is a period of increased mental health risk, with evidence linking psychological disorder to problematic role transitions. To our knowledge, there has been little or no research that examines the forces shaping minority mental health at this time. Using a diverse, urban sample of young adults who are followed over a two-year period, this paper examines the link between race/ethnicity and depressed mood and the transitional roles and interpersonal experiences that mediate this association. Findings indicate that blacks and Hispanics have elevated depressed mood relative to whites and Asian Americans, independent of socioeconomic background factors. The underrepresentation of blacks and Hispanics in four-year colleges largely explains the differences in depressed mood between members of these groups and Asian American youth. In contrast, comparisons of black and Hispanic youth to white youth highlight problems in peer and parental relations among individuals in the former groups. Overall, findings suggest that the heightened depressed mood among Hispanics and blacks relative to whites and Asian Americans reflects their increasingly disadvantaged pathways into adulthood, characterized by poorer prospects for educational advancement and more problematic relationships subsequent to the high school years.

Histories of poverty and self-rated health trajectories.

Abstract: This paper investigates the dynamic relationship between poverty histories and self-rated health trajectories. We are interested in patterns of change in individuals' health over time and the ways in which such patterns are structured by continuity and change in poverty experiences. Data, collected for adults aged 25 and older in 1984 (N = 7,258), are from the 1968-1996 annual waves of Panel Study of Income Dynamics (PSID). Individual growth curves allow us to investigate health trajectories as continuous processes, as well as individual and group heterogeneity in these trajectories. We find that, on average, health deteriorates slowly over time, but there is significant variation in health in 1984 and the rate at which health declines. Histories of poverty partly accounted for the sources of individual differences in self-rated health in 1984, but they were not related to health change over time. Although increasing incomes were better for self-rated health than falling incomes, current economic circumstances did not erase the health effects of earlier poverty experiences.

Financial strain and health among elderly Mexican-origin individuals.

Abstract: In this paper we examine the associations among perceived financial strain and various health measures--including self-rated health, self-reported functional capacity, performance-based mobility, and mortality--in a sample of older Mexican-origin individuals. We employ the Hispanic Established Population for Epidemiological Studies of the Elderly, an eight-year longitudinal survey of over 3,000 Mexican-origin individuals in five southwestern states who were initially interviewed in 1993 and 1994. Although financial strain is associated with actual income and poverty, it is also associated with cognitive capacity, depression, and self-esteem, and while it is strongly associated with subjective measures, it has a weaker association with more objective measures, such as performance-based mobility and mortality. Financial strain appears to be part of a package of cognitions and emotions indicative of low morale or demoralization that has adverse effects on subjective health.

Race differences in depressive symptoms: a dynamic perspective on stress exposure and vulnerability.

Abstract: The existence, nature, and strength of race differences in mental health remain unclear after several decades of research. In this research, we examine black-white differences in the relationship between acute stressors and depressive symptoms. We reframe the stress exposure and differential vulnerability hypotheses in the context of long-term trajectories of stress and depression, and we hypothesize that trajectories of stress growth will be associated with trajectories of depressive symptom growth. Using latent growth curve analysis of a sample of 1,972 older persons interviewed three times at three-year intervals, we test the hypotheses that (1) growth in exposure to loss-related events will predict growth in depressive symptoms, and (2) African Americans will experience greater stress growth than whites. Results support the hypotheses. Stress growth exhibited a linear increase for blacks but not for whites, and predicted depression growth for both races, but explained more variance for blacks than for whites.

Misgivings of medicine?: African Americans' skepticism of psychiatric medication.

Abstract: Research has consistently documented black-white differences in rates of voluntary psychiatric treatment that cannot be reduced entirely to differences in either need or access. A variety of explanations have been offered for the gap that remains, but the empirical testing of alternative propositions has thus far been minimal. Using the 1998 General Social Survey's Pressing Issues in Health and Medical Care module (n = 1,387), I find consistent and substantial black-white differences in a variety of beliefs about psychiatric medications, one of the most common treatments for mental illness, and the predisposition to use them. Specifically, blacks express less willingness to use psychiatric medications themselves or to administer them to a child for whom they are responsible. Neither socioeconomic status, knowledge, religious involvement, nor trust in medicine appears to explain this reluctance. Rather, it stems almost entirely from blacks' beliefs about psychiatric medications' efficacy and side-effects. The results indicate, first, that researchers should not assume that African Americans will use psychiatric medications at rates similar to whites if offered equal access. Second, the results indicate that blacks' skepticism of psychiatric medications may be rooted in specific beliefs about psychiatric medications, rather than general ideologies about medical practice. Health beliefs about psychiatric treatment, therefore, will continue to play an important role in understanding race differences in the use of psychiatric medications.

A "good death" for whom? Quality of spouse's death and psychological distress among older widowed persons.

Abstract: Ethicists, policy makers, and care providers are increasingly concerned with helping the dying elderly to experience a "good death." A "good death" is characterized by physical comfort, social support, acceptance, and appropriate medical care, and it should minimize psychological distress for the dying and their families. I identify the predictors of death quality and evaluate how the quality of an older adult's death affects the surviving spouse's psychological adjustment six months after the loss. Analyses use Changing Lives of Older Couples (CLOC) data, a prospective study of married persons ages 65 and older. Positive spousal relationships during the final days increase survivors' yearning yet reduce their anger. Having a spouse die a painful death is associated with elevated anxiety, yearning, and intrusive thoughts. The perception of physician negligence is associated with elevated anger. These findings suggest that improved end-of-life care and pain management will benefit both the dying and their bereaved spouses.

A research agenda for the black middle class: work stress, survival strategies, and mental health.

Abstract: In this article we discuss the social position of the black middle class and two forms of work stress that appear unique to this group: token stress and social rejection. We outline a research agenda for studying: (1) the relationship between these stressors and mental health in the context of the work environment, and (2) the type of strategies that appear especially efficacious (or problematic) with regard to these problems. We begin the paper with a contextual discussion of the black middle class. We then offer a set of theoretical predictions about the relationship between work stress and mental health among middle class African Americans. We conclude the article with recommendations for future research, and we identify the implications of the research agenda for social policy efforts to diversify the workplace.

Race, ethnicity, and depression in Canadian society.

Abstract: This study examines racial/ethnic differences in mental health using data from the 1996-97 National Population Health Survey. Three hypotheses are tested. First, a socioeconomic hypothesis tests if differences in family income, education, and low income explain racial/ethnic mental health variation. Second, a social resources hypothesis tests if differences in social support explain racial/ethnic mental health variation. Finally, an interaction hypothesis tests if mental health variation stems from specific interactions of race/ethnicity with economic and social factors. Although there are socioeconomic, social resource, and interaction effects, the analysis shows that they do not fully explain racial/ethnic mental health variation. Overall, our results suggest that East and Southeast Asian, Chinese, South Asian, and black Canadians have better mental health than English Canadians. Jewish Canadians have poorer mental health than English Canadians. All other racial/ethnic groupings have similar mental health as English Canadians.

Rethinking twins and environments: possible social sources for assumed genetic influences in twin research.

Abstract: A central sociological problem is the extent to which genetics and the environment influence human behavior. Studies of twins are a core method in attempts to disentangle and to determine the comparative strength of genetic and environmental influences on psychosocial outcomes. A critical assumption of twin studies is that both monozygotic "identical" twins and dizygotic "fraternal" twins share common social environments. Therefore, any greater similarity of monozygotic than dizygotic twins is attributed to genetic influences. This paper tests the equal environment assumption by examining the extent to which greater concordance of adolescent monozygotic compared to dizygotic twins results from social, as well as genetic, influences. Bivariate comparisons indicate that monozygotic twins show greater similarity than dizygotic twins in socially-based characteristics including physical attractiveness, time spent in each other's company, the overlap in friendship networks, and friends' use of alcohol. Multivariate analyses indicate that measures of the social environment sometimes reduce or eliminate apparent genetic effects. In comparison with genetic indicators, social variables are usually stronger predictors of depression and alcohol use and abuse. These findings suggest that past twin studies could overstate the strength of genetic influences because some similarities in behavior among monozygotic compared to dizygotic twins stem from social influences.

Social context and adolescent health behavior: Does school-level smoking prevalence affect students'subsequent smoking behavior?

Abstract: This paper examines the links between individual adolescent smoking behavior and actual and perceived smoking behavior in the individual's school cohort. We hypothesized that students enrolled in schools with higher smoking prevalence among students in their grade are more likely to smoke subsequently. We also expected perceived school-level prevalence of smoking to have a greater impact than actual prevalence because the former is a more direct measure of perceived norms. Adjusting for demographics, actual school-level prevalence at baseline (grade 7) was strongly associated with smoking frequency one year later. However, the association disappeared after adjusting for individual smoking frequency at baseline. School-level prevalence did not moderate the association between individual's baseline and subsequent smoking frequency. Perceived prevalence of smoking among grade 8 students and two measures tapping the behavior of smaller peer groups--cigarette offers and exposure to friends and other peers who smoke--were associated with increased risk of smoking.

The social psychological costs of racial segmentation in the workplace: a study of African Americans' well-being.

Abstract: Although several studies have documented how social-structural constraints impair psychological functioning, few have considered how race-related structural constraints impair African Americans' psychological functioning. This study focuses on an under-studied form of race-related structural constraints: racial segmentation in the workplace. Specifically, I examine the association between perceived workplace racial segmentation, conceived and assessed from a social psychological perspective, and African Americans' psychological well-being. The magnitude and consistency of the relationship is evaluated across both a national sample and a local probability sample of African Americans. Findings across the two samples indicate a modest but consistent negative relationship between perceived racial segmentation and psychological well-being. In addition, this association remains significant after controlling for perceived discrimination as well as sociodemographic and occupational characteristics. Consistent with prior research on relative deprivation, the adverse influence of perceived racial segmentation on well-being was stronger among higher socioeconomic status African Americans than lower socioeconomic African Americans.

Rethinking a universal framework in the psychiatric symptom-disorder relationship.

Abstract: Research on disparities in health and services should include a critical examination of how social, cultural, and contextual factors affect the connection between symptoms and psychiatric disorders. Systematic differences in this connection by these factors will mean that clinicians using a universalist approach to disorders may make more diagnostic errors for certain patients (e.g., ethnic minorities, the poor). Based on the literature on normative clinical decision-making, this study tests for whether the effect of specific psychiatric disorders on key symptoms is the same for certain groups of the population. The data come from the National Comorbidity Survey. Conditional probabilities of disorders and symptoms, the elements feeding into clinical decision-making, are calculated and tested for equivalence across various racial/ethnic, educational, income, and gender groups. We find some significant differences in the relation of key symptoms to disorders across groups. These findings should encourage testing relativistic frameworks in diagnostic nosology as a step to improve clinical decision-making and reduce diagnostic and treatment disparities in mental health services.

Contraceptive self-efficacy: does it influence adolescents' contraceptive use?

Abstract: This research investigates the relationship between contraceptive self-efficacy and contraceptive use, measured one year later, among adolescent boys and girls. Data are obtained from the two waves of the restricted use sample of the National Longitudinal Study of Adolescent Health (n = 3,577). Employing multiple regression and logistic regression strategies, we examine whether demographic and background characteristics influence contraceptive self-efficacy, and whether contraceptive self-efficacy increases the likelihood of contraceptive use. We find that adolescents who are female, older, live with step-parents, and whose mothers approve of contraceptive use report higher contraceptive self-efficacy, while adolescents whose mothers did not complete high school report lower contraceptive self-efficacy. Results partially support the expectation that adolescents with higher contraceptive self-efficacy act accordingly by using contraceptives.

Managed care and the rationalization of mental health services.

Abstract: Managed care represents a response to the wider institutional demand for technical rationality and efficiency, and it may be in conflict with professionally generated logics of mental health care which emphasize the delivery of quality care, as well as providing services to all who need care. The organizational and policy conundrum is to balance conflicting institutional demands for efficiency (cost savings) and effectiveness (access and quality). This paper examines managed care in one public sector mental health care system that has attempted to incorporate the principles of managed care into a community based system of care and to overcome the potential contradictions between demands for efficiency and professional logics of care. Both qualitative and quantitative data are used to examine changes in organizational structure and service offerings; providers' experience of managed care, and the effect of managed care on working conditions and work experiences, and changes in the goals of the organization as measured by the specification of client outcomes. I find that, while increased performance accountability and outcome assessment (in keeping with demands for efficiency) have the potential to improve mental health care services, in fact, providers report that the primary effect of managed care has been an emphasis on cost containment, and there has been a corresponding de-emphasis on the provision of community based services for clients with long term care needs. However, there is potential for professional logics to be maintained by larger institutional forces demanding quality care.

Linking early social risks to impaired physical health during the transition to adulthood.

Abstract: The present longitudinal study of 485 youth used structural equation models to investigate the ways in which a combination of social disadvantage in the family of origin and adolescent maladjustment increases risk for physical health difficulties during adulthood. The study examined a theoretical model that proposes that disruptions in the transition to adulthood mediate the effect of earlier social disadvantage and adolescent maladjustment on young adult physical health status. Results show that early risk factors initiate a sequence of negative influences on young adult physical health through early entry into family responsibility, truncated educational attainment, and poor occupational and economic status. These associations prevailed even after controlling for physical health status during adolescence.

The pursuit of socially modifiable contingencies in mental health.

Abstract: The effort to understand the meanings of the well-demonstrated linkages between mental health and one's locations in the social structure has commanded a great deal of research attention over the past half century. Following a brief consideration of my early efforts to make a contribution in this regard, some recent and ongoing work is summarized. In concert with important work by others, these findings support the conclusion that differences in exposure to social stress represent a much more critical contingency in mental health and substance use outcomes than has generally been assumed. In addition, reported results indicate that the lifetime experience of multiple adversities is quite common among young people in South Florida and, presumably, elsewhere and the likelihood that the compelling linkage observed between cumulative adversity and risk for psychiatric and substance disorders is causal in nature. It is suggested that the development of interventions in the service of stress prevention or reduction should command a greater proportion of the attention of researchers and interventionists.

Why do drug treatment organizations use contingent staffing arrangements? An analysis of market and social influences.

Abstract: Contingent staffing arrangements are defined as conditional and transitory work arrangements. In the drug abuse treatment sector, contingent staffing arrangements have the potential to improve treatment if they are used to increase access to needed services. Alternatively, such arrangements could interfere with the development of consistent, long-term client-staff relationships. Unfortunately, little is known about the consequences of or influences on contingent staff arrangements in this sector. The goal of this study is to examine the conditions under which outpatient substance abuse treatment organizations are more likely to use contingent staffing arrangements. Building on previous research on the social organization of health care structures and practices, we develop a conceptual model based in market economics and institutional perspectives to suggest that treatment organizations choose contingent arrangements in response to market conditions and uncertainty, institutional demands, and client needs. Using data from a nationally representative study conducted in 1988, 1990, and 1995, we find limited evidence that drug treatment units use contingent staff in response to market pressures. Labor market and demand uncertainty, however, are systematically associated with greater use of contingent staff. Study results suggest that expectations and norms from the institutional environment, particularly the organizational context of the treatment unit are strong predictors of the use of contingent staff. By considering both market and social influences of contingent staffing, we contribute to a growing body of research on how markets and institutions interact to influence organizational structures and practices in the health care system.