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An expansive and methodologically varied literature designed to investigate racial disparities in health now exists. Empirical evidence points to an overlapping, complex web of social conditions that accelerate the pace of aging and erodes long-term health outcomes among people of color, especially Black Americans. However, a social exposure—or lack thereof—that is rarely mentioned is time use. The current paper was specifically designed to address this shortcoming. First, we draw on extant research to illustrate how and why time is a critical source of racial disparities in health. Second, we employ fundamental causes theory to explain the specific mechanisms through which the differential distribution of time across race is likely to give rise to unequal health outcomes. Finally, we introduce a novel conceptual framework that identifies and distinguishes between four distinct forms of time use likely to play an outsized role in contributing to racial disparities in health. [ABSTRACT FROM AUTHOR]

This paper investigates how social support differentially benefits self-rated health among men and women hospitalized with heart disease. Using cross-sectional data about patients admitted to a university hospital, we examine the extent to which gender moderates effects for the frequency of contact with family, friends, and neighbors on health and whether these effects differ between those with new versus established diagnoses. We find that gender differentiates the effect of nonmarital family contact on health but only when heart disease is newly diagnosed. When newly diagnosed, more frequent contact with family is associated with better self-rated health for women but not men. Men and women with preexisting diagnoses benefit equally from more frequent contact with family. [ABSTRACT FROM AUTHOR]

The term patient noncompliance emerged in the 1970s as a tool for analyzing why people do not follow medical directives. Despite its early popularity, the term has languished in sociology while flourishing in biomedical arenas. It seems flaccid in a contemporary healthcare context as it overestimates physician authority and is tone-deaf to biomedicalization. I draw from sociological and anthropological traditions, as well as qualitative interviews with terminally ill patients ( N = 26) and their caregivers ( N = 16), to consider facets of a biomedicalized health experience and implications for an updated vision of compliance. First, pathways to care have proliferated under biomedicalization. With increased pathways comes increased need for understanding how treatment plans are socially constituted and assessed. Finally, increased complexity demands a more diverse vocabulary for understanding health related decisions. This paper is a call to sociologists to take the lead in transforming and updating this consequential concept. [ABSTRACT FROM AUTHOR]

This paper uses the case of the uneven use of a robotic technology to explain how physicians with similar training come to engage in different medical practices. I develop a conceptual framework in which their decisions to use advanced technologies are informed by "interdependent career types," a concept that incorporates features of the professional social context of physicians' work and the expertise they use, and reflects how medicine distributes expertise via formal and informal referral structures. I draw on data regarding specialized physicians' differentiated use of this technology over five years as well as interviews with those who continue to use the technology and those who have abandoned it. I argue that interdependent career types stratify physicians' standpoints on multiple dimensions of medical work-including those related to their concerns about reputation, inclinations toward risk, and preferences regarding the use of their bodies. [ABSTRACT FROM AUTHOR]

In recent years, medical sociologists have increasingly paid attention to a variety of interactions between social and biological factors. These include how social stressors impact the functioning of physiological systems, how sociocultural contexts trigger genetic propensities or mitigate genetic defects, and how brains are attuned to social, cultural, and interactional factors. This paper focuses on how both sociocultural and biological forces influence what conditions are contextually appropriate responses or disorders. It also suggests that some of the most obdurate health problems result from mismatches between natural genes and current social circumstances rather than from genetic defects. Finally, it examines how social environments have profound impacts on how much harm disorders create. It shows how sociological insights can help establish valid criteria for illnesses and indicates the complexities involved in defining what genuine disorders are. [ABSTRACT FROM AUTHOR]

In recent years, quickly discharging patients has become a collective goal at hospitals, as excessive medical workups and extended hospital stays have been associated with unnecessary healthcare spending. Physicians, however, frequently encounter numerous barriers when trying to discharge patients. Presenting ethnographic and interview data collected from September 2010 to September 2013, this paper examines one of the most difficult discharge cases physicians encounter on the internal medicine service at a U.S. teaching hospital: resistant patients-patients and families who refuse to leave the hospital. As physicians try to discharge resistant patients, they are met with conflicting financial and professional incentives. Drawing from the sociological literature on professions, managerialism, and consumerism, I analyze the strategies physicians develop to manage these difficult discharge cases. [ABSTRACT FROM AUTHOR]

Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Freese and Powell make a number of critiques of the theoretical assumptions, statistical methods, and use of variables in our paper, which raises questions about the typical use of the equal environments assumption in twin research. We do not find that any of their critiques modify our conclusion that the equal environments assumption cannot be taken for granted but must be subjected to empirical testing. We hope that our paper and the resulting exchange will lead sociologists to become more actively involved in the debate regarding the extent of genetic and environmental influences on social behaviors. [ABSTRACT FROM AUTHOR]

This commentary speaks to several issues that arise from the papers in this special issue. Two articles--Kessler (2002) and Mirowsky and Ross (2002)--focus on a major measurement issue: dimensional versus diagnostic-type assessments. One topic requires greater attention: the correspondence of these measures with the underlying states they supposedly measure--constructs in the psychometric tradition and empirically defined illnesses in the medical or psychiatric tradition. Conclusions about the nature of these unobserved states remain tentative at this time. Three articles--Keyes (2002), Schwartz (2002), and Umberson, Williams, and Anderson (2002)--address the expansion of mental health outcomes. The existing reliance on emotional distress is problematic for sociological research because a single disorder is not a good proxy for estimates of the overall mental health consequences of social arrangements. Although these papers present diverse and sometimes conflicting perspectives, collectively they demonstrate that no one approach to outcomes is best for all research questions. [ABSTRACT FROM AUTHOR]

This paper reviews the sociological controversy over using categorical versus dimensional assessments in the study of psychological distress. The preference of sociologists for dimensional assessments is traced to two assumptions: (1) that the associations of predictors with psychological distress syndromes are most accurately operationalized by using dimensional measures; and (2) that no true discrete mental illnesses can reasonably be inferred to exist that would justify the creation of dichotomous measures. Methods are described in this paper to test both assumptions. An argument is made that the first assumption is the critical one and that dimensional analysis is useful only when it can be demonstrated that the associations of predictors with dimensional scores are constant throughout the relevant dimensional severity range. The paper closes with an argument for the tandem use of categorical and dimensional assessments in future sociological research. [ABSTRACT FROM AUTHOR]

This paper proposes a theoretical framework and an empirical example of the relationship between the civic stratification of immigrants in the United States, and their access to healthcare. We use the 2007 Pew Hispanic Center/Robert Wood Johnson Foundation Hispanic Healthcare Survey, a nationally representative survey of U.S. Latinos (N = 2,783 foreign-born respondents) and find that immigrants who are not citizens or legal permanent residents are significantly more likely to be excluded from care in both the United States and across borders. Legal-status differences in cross-border care utilization persisted after controlling for health status, insurance coverage, and other potential demographic and socioeconomic predictors of care. Exclusion from care on both sides of the border was associated with reduced rates of receiving timely preventive services. Civic stratification, and political determinants broadly speaking, should be considered alongside social determinants of population health and health care. [ABSTRACT FROM AUTHOR]

This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

About 13,000 physicians from the former Soviet Union have found themselves in the saturated medical market in Israel as a result of the latest wave of immigration. This paper examines the gap in professional altitudes and practices between Israeli and Soviet MDs and the cognitive mechanisms employed by immigrant physicians in the process of adjustment to the new medical culture. The study draws on 25 semistructured interviews with recent (about three years in Israel) immigrant doctors who were at various stages of obtaining a local medical license. Reflecting on the need to redefine themselves as professionals and to confront negative stereotypes regarding ex-Soviet doctors, many respondents stressed the strong sides of Soviet medical training and work style. In their collective self-portrait, immigrant doctors emphasized devotion to patients, clinical intuition, manual skills, and empathy, while flaws were regarded as superficial and improvable by technical training. Conversely, the alleged flaws of Israeli doctors were perceived by these informants as pertaining to the core of medicine: "Excessive dependence on technology," "lack of responsibility toward patients," and "weak preventive orientation" of Israeli colleagues were repeatedly criticized. The paper sheds light on the significant conceptual differences between the Soviet and Western medical traditions and provides a vivid example of the sociocultural construction of medicine. Our findings are also indicative of the interpretative processes and coping strategies that immigrants in general may develop in saturated professional markets. [ABSTRACT FROM AUTHOR]

Drawing from theory on institutionalized organizational environments, this paper analyzes the actions of community-based service programs providing care for people with AIDS. The focus is on the interorganizational relations developed by the lead agencies in demonstration projects attempting to coordinate services in three communities. The paper identifies differential styles of organizational response to developmental and operational issues. These differences are related to the conceptual distinction between organizational responses to technical environments and those to normative, or "institutional," environmental features. Various factors are identified that appear to promote a higher degree of institutionalization in interorganizational relations. Coordination as a reform strategy is seen to have become, in itself, an institutionalized myth to which organizations must subscribe in order to gain legitimacy. [ABSTRACT FROM AUTHOR]

Few investigations have examined the referral of minority adolescents to community mental health clinics. This issue is especially critical in light of the increased attention given to mental health services for children and adolescents in recent years. The present study uses mental health clinic data from a large metropolitan area to explore whether African Americans and Mexican Americans entering mental health care do so through referrals that are more coercive than those made for Whites. The total sample consists of 2,460 adolescents aged 13-17; the results indicate that African-American adolescents are more likely than Whites to be referred by an external agency. When types of external agencies are considered, African Americans enter community mental health care more often than Whites through referrals from social agencies; Mexican Americans enter more often than Whites through school referrals. This paper suggests that African-American adolescents' overrepresentation in community mental health clinics may in part be due to their disproportionate contact with social and legal agencies and the propensity of these agencies to rely more often on the mental health system than on families or schools. Among all variables considered in the analyses for this paper, poverty status demonstrated the most consistent and powerful association with coercive referrals. [ABSTRACT FROM AUTHOR]

Building on a detailed study of the Woburn, Massachusetts, childhood leukemia cluster, this paper examines lay and professional ways of knowing about environmental health risks. Of particular interest are differences between lay and professional groups' definitions of data quality, methods of analysis, traditionally accepted levels of measurement and statistical significance, and relations between scientific method and public policy. This paper conceptualizes the hazard-detection and solution-seeking activities of Love Canal, Woburn, and other communities as popular epidemiology: the process by which lay persons gather data and direct and marshal the knowledge and resources of experts in order to understand the epidemiology of disease, treat existing and prevent future disease, and remove the responsible environmental contaminants. Based on different needs, goals, and methods, laypeople and professionals have conflicting perspectives on how to investigate and interpret environmental health data. [ABSTRACT FROM AUTHOR]

Further progress in understanding the significance of stress for psychological well-being requires improved strategies for controlling both inter- and intra-event variability across subjects studied. This paper reports on an innovation in stress measurement suggested by a proposition drawn from crisis theory that recognizes life events as representing opportunities as well as hazards. The crucial contingency is hypothesized to be the outcome of the event with respect to the extent of its resolution in emotional and practical terms. This paper examines the possibility that life events that have been resolved successfully may not contribute to individual stress. Data was gathered from community samples of physically limited individuals and of non-limited comparison subjects. Results from separate analyses of these data generally support this hypothesis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

This paper is based on ethnographic research in a rural Taiwanese village in which married women with children are a major source of labor for local industry. Responsibility for job and home exposes these women to repeated stressors that can increase their susceptibility to illness. Existing explanatory models linking employment and women's health, however, do not explain adequately the women's response to their wage labor and the consequences of the social aspects of their work on their health. This paper describes women's work and its meaning, and discusses the way in which micro phenomena such as meanings and health states are linked to macro phenomena such as national political-economic processes and the world capitalist system. [ABSTRACT FROM AUTHOR]

This paper probes two aspects of the medical profession in Singapore: its structure and its social position. The first section reviews the relevant concepts concerning the structure and the social position of the professions that may be applied to medicine in Singapore. The second section looks into the structure of the medical profession in Singapore from an historical perspective. The third section deals with the internal organization of the medical profession. The fourth section focuses on its social position. The paper concludes with a summary of the main points and a brief comparison of the situation in Singapore with that in other countries. [ABSTRACT FROM AUTHOR]

This paper presents a critical overview of current concepts and analytic practices in stress research and considers how they can be changed to make the research more consistent with core sociological interests. An overarching concern of the paper is the analytic use of basic information about people's social and institutional affiliations and statuses. It is important that such information be treated not simply as data that need to be controlled statistically; we must examine the bearing of these data on each domain of the stress process: the exposure to and meaning of stressors, access to stress mediators, and the psychological, physical, and behavioral manifestations of stress. The conceptualization and measurement of stressors should move away from their focus on particular events or chronic strains and should seek instead to observe and assess over time constellations of stressors made up of both events and strains. Moreover, the effects of the mediators—coping and social support—are evaluated most fruitfully in terms of their effects in limiting the number, severity, and diffusion of stressors in these constellations. Finally, sociological stress researchers should not be bound to outcomes that better serve the intellectual interests of those who work with biomedical and epidemiological models of stress, nor should the research be committed exclusively to a single outcome. [ABSTRACT FROM AUTHOR]

When I began my psychiatric residency training in Boston in the late 1950s, sociologists and other social scientists were active members of many major academic departments of psychiatry. Collaboration between psychiatrists and sociologists and anthropologists was widespread and had considerable influence on theory and clinical practice. NIMH had established its Laboratory of Socio-Environmental Studies under the leadership of John Clausen. Sociologists and anthropologists were active in policy-making and research activities at NIMH and at many foundations. The influential works of Stanton and Schwartz (1954), Hollingshead and Redlich (1958), and Greenblatt, Levinson, and Williams (1957) reflect this period of collaboration. Over the subsequent three decades, the relationship between sociology and psychiatry changed considerably. Now relatively few academic departments of psychiatry have social scientists on their full-time faculty. Interaction between psychiatrists and social scientists, in many instances, has become adversarial. This adversarial quality, I believe, is reflected in the paper by Mirowsky and Ross. Their paper illustrates a genre of social science criticism of psychiatry which challenges the scientific validity of the concept of mental illness and raises important issues in measurement. Mirowsky and Ross, however, go beyond the scientific issues; they offer a social criticism of recent changes in psychiatry which they perceive to be the "legacy of nineteenth-century epidemiology and microbiology." Mirowsky and Ross are correct in their perception that significant shifts have occurred within psychiatry over the past decade. Yet their historical reconstruction of those changes and their understanding of the scientific basis for current research and clinical practice are seriously limited; they reflect their ideological commitment more than an appreciation of the increased sophistication of recent theoretical discourse and empirical research in psychiatry. In my commentary I will attempt to correct this imbalance by reconstructing the recent history and by explicating the rationale behind the current approach to psychiatric diagnostic categories. [ABSTRACT FROM AUTHOR]

Cadaver stories are narratives describing "jokes" played by medical student protagonists on unsuspecting and emotionally vulnerable victims. In these stories, medical students physically (and thus symbolically) manipulate whole cadavers or certain cadaver parts-often extremities or sexual organs-for the dual purpose of shocking their intended victims and deriving humor from their victim's distress. The victims in cadaver stories are either lay people or what the narratives portray as emotionally vulnerable medical students. Cadaver stories circulate most freely among medical student aspirants and initiates, and are told as true accounts of actual events. They are also told with the expectation that peers will view their telling as a source of humor. in this paper, cadaver stories are viewed as part of the oral culture of medical training. Two questions are raised: Under what conditions do we find these stories being told (and thus what do these stories, and their telling, tell us about the experience of anatomy lab)? What functions are served by the telling of cadaver stories? A central focus of this paper is the role of cadaver stories in the emotional socialization of medical students. [ABSTRACT FROM AUTHOR]

This paper provides a critical review of the social science literature regarding maltreatment of patients in nursing homes. First, two conceptual issues are addressed: problems in defining maltreatment and a rationale for sociological study of the phenomenon. Next, the paper presents a theoretical model of potential causes of patient maltreatment, including exogenous variables, nursing home environment, and staff and patient characteristics. An agenda for research is outlined based on the model. [ABSTRACT FROM AUTHOR]

This paper reports a study of the premedical student culture at a major university, based on fieldwork and interviews with 30 premedical students. The paper examines the role of stereotypes in the premedical culture; specifically, the common belief in "cut-throats" among premedical students. Cut-throats are described as excessively competitive, selfish, gradehungry students who cheat, steal books and lab reports, and sabotage lab experiments. Despite the widespread belief, our findings suggest cut-throats are a myth. We found more evidence for cooperative than cut-throat behavior. The myth emerges from the competitive and pressured situation of premedical students and the uncertainty of the medical school admission process, and is in part a manifestation of students' collective anxiety. More significantly, it provides cultural explanations for failure and success for premedical students. We discuss its connection to the general premedical stereotype and its relation to pre-medical education. [ABSTRACT FROM AUTHOR]

This is a "state of the issue" paper about gender and physical health. It organizes the hypotheses proposed for male-female differences in physical health status, therapeutic health behaviors, and longevity and it summarizes empirical research, especially sociological research, on the topic over the past 10-15 years. Capsule summaries of sex differentials in health and of recent trends in health and morality are also presented for American (U.S.) men and women. The central theoretical viewpoint of this paper is that sex differences in health are principally the outcome of differential risks acquired from roles, stress, life styles, and preventive health practices. Psychosocial factors—how men and women perceive and evaluate symptoms, and their readiness and ability to take therapeutic actions—are important as well, but typically secondary to acquired risks. Other factors such as prior health care, biological risks, health reporting, and caretaker effects (for example, physician sex bias) have even smaller importance. We hypothesize that the relative weight of acquired risks and psychosocial factors varies for different types of health problems as follows: (1) Psychosocial factors have their greatest weight in responses to chronic, nonfatal, or low severity diseases and injuries and (2) gender differences are also greatest in responses to these; that is, men and women differ more in their perception, evaluation, and treatment of prolonged, mild conditions than of acute, life-threatening, or severe ones. The paper suggests some strategies for social science research on male-female health differences in the next decade or two. [ABSTRACT FROM AUTHOR]

This paper analyzes data from a nationally representative survey of adults in the United Kingdom (Understanding Society, N = 37,253) to explore the marital status/health nexus (using categories that include a measure of relationship distress) and to assess the role that sleep problems play as a potential mediator. Findings indicate how it is not just the “form” marital status takes but also the absence or presence of relationship distress that is essential to self-rated health. We demonstrate two further findings that: (1) sleep problems act as a mediator of the link between marital status/relationship distress and self-rated health, most notably for those in cohabiting relationships with medium/high distress or who have a history of relationship loss, and (2) the mediating role of sleep problems differs for divorced men and women. [ABSTRACT FROM AUTHOR]

Education has a large and increasing impact on health in America. This paper examines one reason why. Education gives individuals the ability to override the default American lifestyle. The default lifestyle has three elements: displacing human energy with mechanical energy, displacing household food production with industrial food production, and displacing health maintenance with medical dependency. Too little physical activity and too much food produce imperceptibly accumulating pathologies. The medical industry looks for products and services that promise to soften the consequences but do not eliminate the underlying pathologies. This “secondary prevention” creates pharmacologic accumulation: prolonging the use of medications, layering them, and accruing their side effects and interactions. Staying healthy depends on recognizing the risks of the default lifestyle. Overriding it requires insight, knowledge, critical analysis, long-range strategic thinking, personal agency, and self-direction. Education develops that ability directly and indirectly, by way of creative work and a sense of controlling one’s own life. [ABSTRACT FROM AUTHOR]

Analyses of the 2008 National Study of the Changing Workforce demonstrate that job pressure is associated with greater anxiety and job dissatisfaction. In this paper we ask, What conditions protect workers? The conventional buffering hypothesis in the Job-Demands Resource (JD-R) model predicts that job resources should attenuate the relationship. We test whether the conventional buffering hypothesis depends on socioeconomic status (SES). Support for conventional buffering is evident only for job dissatisfaction—and that generalizes across SES. When anxiety is assessed, however, we observe an SES contingency: Job resources attenuate the positive association between job pressure and anxiety among workers with lower SES, but exacerbate it among those with higher SES. We discuss the implications of this SES-contingent pattern for theoretical scenarios about “resource reinforcement,” “resource substitution,” and the “stress of higher status.” Future research should consider SES indicators as potential contingencies in the relationship between job conditions and mental health. [ABSTRACT FROM PUBLISHER]

This paper takes a comparative approach to the topic of work time and health, asking whether weekly work hours matter for mental health. We hypothesize that these relationships differ within the United States and Germany, given the more regulated work time environments within Germany and the greater incentives to work long hours in the United States. We further hypothesize that German women will experience greatest penalties to long hours. We use data from the German Socioeconomic Panel and the National Longitudinal Survey of Youth to examine hours effects on mental health score at midlife. The results support our initial hypothesis. In Germany, longer work time is associated with worse mental health, while in the United States, as seen in previous research, the associations are more complex. Our results do not show greater mental health penalties for German women and suggest instead a selection effect into work hours operating by gender. [ABSTRACT FROM PUBLISHER]

This paper takes a comparative approach to the topic of work time and health, asking whether weekly work hours matter for mental health. We hypothesize that these relationships differ within the United States and Germany, given the more regulated work time environments within Germany and the greater incentives to work long hours in the United States. We further hypothesize that German women will experience greatest penalties to long hours. We use data from the German Socioeconomic Panel and the National Longitudinal Survey of Youth to examine hours effects on mental health score at midlife. The results support our initial hypothesis. In Germany, longer work time is associated with worse mental health, while in the United States, as seen in previous research, the associations are more complex. Our results do not show greater mental health penalties for German women and suggest instead a selection effect into work hours operating by gender. [ABSTRACT FROM AUTHOR]

Drawing on the stress paradigm and using data from the Duke Mental Health Study, this paper investigates the links between violence by and against persons with severe mental illness and their caregivers' financial burden (e.g., number of financial contributions and perceived financial strain). In addition to violence, substance use and medication noncompliance are included in a series of multivariate regression models predicting caregiver financial burden that include measures for disruptive behaviors, personal needs, social supports, and caregiver characteristics. The findings show that violent perpetration and violent victimization increase the number of financial contributions and perceived financial strain. Nonviolent victimization, in contrast, decreases caregiver financial burden. Number of financial contributions and perceived financial strain are greatest when the family member is violent and extremely disruptive or needs assistance with personal care. Neither substance use nor medication noncompliance contributed to caregiver financial burden. Co-residence, female sex, parenthood, and instrumental social support were also associated with financial burden. [ABSTRACT FROM AUTHOR]

Given the rapid aging of the U.S. population and reductions in federal funding, elder care has become a major issue for many families. This paper focuses on a long-term consequence of elder care by asking how caring for elderly parents affects women's subsequent risks of living in poverty. Using longitudinal data from the Health and Retirement Study, we examine whether and how caregiving for parents in 1991 increases women's risks of living in households with incomes less than the poverty threshold, receiving public assistance, and receiving Medicaid in 1999. Our findings illustrate that caregiving in earlier life raises women's poverty risks in later life by intensifying the negative effects of stopping work and declining health on women's economic well-being. [ABSTRACT FROM AUTHOR]

This paper focuses on financial strain across the life course as a condition underlying health inequalities observed in later life. The analysis is based on data from 1167 adults 65 years and older collected as part of the 'Aging, Stress and Health Study". Relying on retrospective data about hardship experienced over the life course, we find that long-term financial hardship is reflected in a range of health outcomes at late life, even after controlling for the effects of current financial circumstances. Moreover, the sheer persistence of hardship matters more than its episodic occurrence or timing, so that the health effects of early hardship may be obviated if followed by no further hardship. This pattern offindings is consistent with the notion of allostatic load, the cumulative damage done to health and well-being under the burden of an unrelenting stressor in a critically important life domain. [ABSTRACT FROM AUTHOR]

This paper examines how multiple roles affect the mental health of the elderly in Japan and the United States, two countries with vastly different cultures. Hypotheses were drawn based on the cultural differences in role experiences, and these hypotheses are tested by analyzing nationally representative samples of the elderly in these countries. The results show that Americans are more likely to be involved in roles related to family, work, and community, while the Japanese are more likely to be involved in only those roles related to family and work. Multiple roles are also found to be less beneficialfor the mental health of Japanese elderly compared to American counterparts. National differences in the effects of individual roles and role configurations on mental health are also documented. Overall, the results show the importance of broad cultural contexts for understanding the relationship between roles and mental health. [ABSTRACT FROM AUTHOR]

Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain con troversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories-functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers- to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. [ABSTRACT FROM AUTHOR]

This paper examines the impact of changes in the medical marketplace on medicalization in U S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process. [ABSTRACT FROM AUTHOR]

This paper presents an institutional analysis of organizational change and inertia in the US. field of long-term care. We employ a dialectic approach to concentrate on the contest between interests aligned with two templates of organization (archetypes) that draw from distinctive sets of beliefs and values (interpretive schemes) to specify appropriate structural forms, roles, and resource distributions. It is shown that the long-term care field was historically characterized by a nursing home archetype which legitimates the provision of care in residential facilities under the con trol of medical professionals. After a century of reformers' efforts to build legitimacy and resource support for alternative home and community-based services that maintain consumers' independence, the field now accommodates both the nursing home archetype and a home and community-based services archetype. While this new institutional framework reflects aspects of change, especially the establishment of the home and community-based services archetype, it also displays inertia including the continued dominance of the nursing home archetype. Roles played in these contested dynamics are traced along a key process of change in each archetype: (1) the growth of large multi-facility (chain) nursing home corporations, and (2) political advocacy for home and community-based services. [ABSTRACT FROM AUTHOR]

This paper uses an institutional perspective (Scott, 1994; 2001; DiMaggio and Powell, 1991) to analyze the history and current state of the American health care field in terms of the alignment of its normative, cognitive, and regulatory elements. I depict the relation between institutional elements in each of three historical eras of the health care field (Scott et al 2000): the era of professional dominance (1945-1965), the era of federal involvement (1966-1982), and the era of managerial control and market mechanisms (after 1983 to the present). I argue that a weakening of alignment between these elements, beginning in the 1970s and increasing in the 1980s, led to consumer and provider dissatisfaction with managed care, and that the state of the field in the beginning of the 21st century suggests that a new era is emerging with renewed alignment between normative beliefs and values, cognitive models, and regulation. Implications for the future of health care and institutional theory are discussed. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [ABSTRACT FROM AUTHOR]

The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control In this context, the papers of this special issue are then introduced. [ABSTRACT FROM AUTHOR]

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance. [ABSTRACT FROM AUTHOR]

Research on the social determinants of health has increasingly sought to understand the relative importance of different features of socioeconomic status. Much of the ensuing debate has wavered between education and income, with recent research leaning increasingly toward income. This research has not, however; consistently explored interactions between different features of socio economic status and, in trying to understand the independent effects of different components of socioeconomic status, may have missed important features of socioeconomic position. With an eye toward examining how features of socio economic status combine and coalesce, this paper examines variation in the income-health association by level of education. Theories derived both from medical sociology and health economics suggest synergistic interactions between income and education, but they are unclear as to the direction and magnitude of these interactions. Results from two large and nationally representative data sets (the 1996-1997 Community Tracking Study and the 1972-2000 General Social Survey) indicate that the positive relationship between income and health varies substantially in both its strength and shape by level of education. Education improves health, and its effects are larger at lower levels of income. Moreover; education reduces the strength and curvature of the income-health relationship. Consequently, those with more education have better health for all levels of income, and fewer income-based disparities exist among the well educated than among the less well educated. The linear "gradient" relationship between income and health is, thus, more characteristic of groups with higher levels of education. Additional analyses indicate that these interactions existed in the United States in each of the last three decades. The results are discussed in light of theory regarding the perpetuation of health disparities, as well as current debates regarding the apparent incompatibility of distributive versus aggregative goals in health policy. [ABSTRACT FROM AUTHOR]

Cross-functional teams (CFTs) play an increasingly important role in health care. However, despite their potential, CFTs often fail to function effectively. This paper contributes to the literature in medical sociology by examining how the steep and well-defined hierarchy characteristic of the health occupations proves to be dysfunctional in the CFT setting. Previous research has shown that status differences among members of work teams negatively affect their functioning. Yet the specific mechanisms that connect variations in status to poor team functioning remain unclear. We hypothesize that it is the suppression of participation among low status team members that leads to poor CFT functioning. Our theoretical model integrates status characteristics theory and the value attainment theory of job satisfaction to link team members' statuses to participation in team decision-making and, ultimately, to their attitudes about the job. We use causal modeling to test our hypotheses. Our results indicate that relationships between health professionals defined in broader social contexts affect status, roles, and functions within CFTs, and these, in turn, affect the team's interpersonal processes. We suggest changes in organizational structure and in team leadership styles that might make CFTs more effective. [ABSTRACT FROM AUTHOR]

In this paper I examine the association between subjective time pressure and depression and consider whether time pressure mediates the relationship between roles and depression, whether social and economic resources moderate the association between time pressure and depression, and whether time pressure explains gender differences in depression. Results of a telephone survey of 790 respondents indicate that time pressure is significantly associated with distress for men and women, and that subjective time pressure accounts for the significantly higher depression of employed women. Time pressure mediates the impact of housework and the volunteer role among women and it partially explains the differential depression of divorced men. Several resources moderate the impact of time pressure on depression: income among both men and women and perceived co-worker social support among men. Results suggest that the subjective experience of time pressure can be thought of as a potentially important mechanism by which lived experience is transformed into depression. However, in spite of the ubiquity of time pressure in the North American context, the depressing consequences of this subjective experience are not distributed equitably, suggesting that the capacity to manage time pressure and avoid depression may be another benefit associated with strategically advantageous social locations. [ABSTRACT FROM AUTHOR]

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 cognition and emotions indicative of low morale or demoralization that has adverse effects on subjective health. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]