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This paper reports on a prospective longitudinal study in which various aspects of the stress process were examined. Findings indicate that events perceived to be desirable and, therefore, presenting opportunities for gain or mastery were not stressful. Events that were neither desirable nor within control led to distress, symptoms, and physician visits. A longitudinal analysis demonstrated stability of both health and stress and their relationship to one another. While there was an association between stressful events and poorer health, a much weaker relationship was found in regard to change in health. Poorer health resulted in more stress. The stress-illness relationship was not mediated by either expectations of control or effectiveness of social supports. Locus of control predicted baseline levels of distress but showed no relation to change in distress over time or to symptoms. A reciprocal relationship was found between social supports and stressful events. [ABSTRACT FROM AUTHOR]

This paper examines some major discrepancies in the literature on illness behavior involving psychosocial and organizational factors affecting physician utilization. At issue is why the large-scale multivariate studies find that such factors explain only small amounts of variation, whereas qualitative and more restricted quantitative studies find these predictors to be more influential. Among the factors accounting for discrepancies in results are the interpretation of "illness" measures, differences in concept measurement and data aggregation, and the cross-sectional versus processual analytical approaches to studying this issue. It is suggested that the advantages of both types of studies can be combined, facilitating improved theory and prediction. [ABSTRACT FROM AUTHOR]

This paper addresses the hypothesis that the experience of mattering to others is inversely related to depressive symptomatology. We also assess the extent to which mattering overlaps or is redundant with other measures of personal and social resources. Based on multivariate analyses of two waves of data from a large urban community sample (n = 1,300), we identify three important findings. First, women experience substantially higher levels of mattering than do men. Therefore, if men and women had equal levels of mattering, women would report even higher depression scores relative to men. Second, it is clear that mattering and sub-dimensions of social support are substantially more confounded among men than among women. Finally, analyses confirm that mattering is conditionally predictive of depression by gender. Specifically, variations in mattering are predictive of depression for women, but not for men. This relationship is confirmed both cross-sectionally and over time. [ABSTRACT FROM AUTHOR]

The field of medical sociology has developed rapidly in recent years in sophistication of conceptualization and research techniques. Nonetheless, there remains a considerable amount of "unexplained variance" in knowledge about health and illness behaviors. This paper asserts that to grow further, medical sociology should become more interdisciplinary in conceptualization and design of research projects. The application of research findings from the field of psychoneuroimmunology to explain the effects of placebos as a form of magic is used as an illustration. [ABSTRACT FROM AUTHOR]

This paper examines the social construction of diagnosis and illness in several ways. First, I discuss the centrality of social construction in medical sociology. Next I discuss the major role of diagnosis in social construction, leading to the need for a sociology of diagnosis. I emphasize controversial and conflictual diagnoses, as a first step toward a more general sociology of diagnosis. Then I put forth a typology of social construction, involving four combinations based on whether a condition is generally accepted and whether a biomedical definition is applied. Next I detail a series of stages in the social construction of a condition. In that process, my primary concern is the initial social discovery, which is essentially a matter of diagnosis, with a secondary emphasis on illness experience. This is followed by stages of treatment and outcome, which recursively affect social construction. I conclude by noting the health policy implications of the social constructionist perspective. [ABSTRACT FROM AUTHOR]

Data from health surveys typically s/tow higher rates of morbidity among women than among men, while mortality data show the opposite pattern. Medical sociologists have formulated several key hypotheses to explain this female excess in morbidity-particularly as it occurs in milder forms of illness and disability. In this paper we examine one such hypothesis, using data from (lie Los Angeles Health Survey. According to the 'fixed role obligations" hypothesis, inflexible role obligations contribute to male/female differences in reporting illness and disability. As hypothesized, we find that controlling for such role obligations (particularly employment status) reduces male/female differences in reporting disability days, but that self- reports of chronic conditions continue to show significant male/female differences independent of these roles. These findings suggest that the fixed role obligations hypothesis is most appropriate for explaining male/female differences in sick-role behaviors that compete directly with fixed role obligations. [ABSTRACT FROM AUTHOR]

This paper examines the causal model which recent research suggests as a framework for research in health service utilization. Data from the 1971, 1972 and 1973 Health Interview Surveys are used to determine the effects of the predisposing, enabling, and illness-morbidity characteristics on several measures of health service utilization. Standardized regression coefficients show these characteristics to be substantively unrelated to health service utilization. The implications of these findings for existing theories of health service utilization are discussed. [ABSTRACT FROM AUTHOR]

In this article the author comments on an article named "Measuring Life Events," written by M. Tausig and published in the March 1982 issue of the "Journal of Health and Social Behavior." In a recent paper in this journal, Tausig explored the relationships between the CES-Depression scale and various measures of life-event scales to determine which of the latter is the best predictor of depression. He showed that doubling the number of items in the scale significantly increases the correlation, but he argued that this increase is so small that the cost of adding the items out-weighs the benefit of increased explained variance. The author of this article accepts this, although for particular purposes, one might want to include the additional items. His argument about desirability of events, however, is difficult to understand or accept part of the confusion stems from combining the desirability issue with the issue of whether desirability should be objectively or subjectively determined.

The article presents a suggestion for improving the behavioral model of physician utilization. Medical sociologists D. Machanic argue persuasively that multivariate studies using large samples are powerful statistical techniques have been able to demonstrate only small psychosocial and organizational effects on use of physician services. He point out that this is in contrast to the importance attributed to these factors by small-sample qualitative studies. His paper explores two possible explanation for this discrepancy that many medical sociologists have exaggerated the importance of social and organizational variables and that the lack of such finding in multivariate studies reflects the way issues are conceptualized, the nature of the measures used, the ways in which data are aggregated and the manner in which analysis are performed. The predisposing component represents the notion that some individuals have a propensity to use services more than other individuals, where propensity towards use can be predicted by individual characteristics, which exist prior to the onset of specific episodes of illness.

In his account of the medical profession's ascent, Paul Starr drew a distinction between the social authority of physicians and the cultural authority of medicine-between doctors' capacity to direct others' behavior and the ability of medical institutions and discourses to shape meanings of illness, health, wellness, and treatment. Subsequently, scholars have reflected on the social-structural transformations challenging physicians' social authority but neglected shifts in cultural authority. Focusing on the United States, we find a proliferation and diversification of cultural authority, reflecting a partial movement from the domain of medicine into new terrains of health. This shift is apparent in the resurgence of alternative healing, the advent of new forms of self-care and self-monitoring, the rise of health social movements, and the spread of health information online. We advance a research agenda to understand how the mechanisms and dynamics of cultural authority shape contests to speak in the name of health. [ABSTRACT FROM AUTHOR]

This article presents information on the sociology of mental illness. Research results will appear contradictory rather than complementary when these concepts are treated as alter- native ways of defining mental illness, as opposed to different aspects of a single process and theoretical synthesis of findings will be impeded. However, in the future, the researchers hope that these four conditions of conceptualizing mental illness will be represented as aspects of a single process, whereby the incapacity to deal with potentially stress-inducing circumstances increases the probability of the experience of severe and prolonged subjective distress, the experience of subjective distress will have necessarily personally undesirable consequences, individuals will respond both to their experiences of subjective distress and to the personally undesirable consequences of their distress in ways they consciously or unconsciously anticipate will relieve their distress, and both the consequences of their subjective distress and their more or less effective adaptations to their experiences of subjective distress will evoke responses from significant others in their environment which, in turn, will affect their own outcomes.

This article comments on a research paper "Pathways to Medicine Use." In that article the authors employed path analysis to predict the use of prescribed and nonprescribed drugs by a sample of 2,378 adults from the Baltimore SMSA. Three sets of independent variables were included in the analysis: "predisposing" variables such as age, sex, and race; "enabling" variables, have Medicare, have Medicaid, perceived availability of care, drug expense, economic class, and time to MD; "need for care" variables, perceived morbidity, and anxiety. In their discussion of the findings, for example, they argue that women". . . did report more anxiety, and it is mainly through this intervening variable that they use more prescribed medicines." Yet the indirect effect of sex through anxiety is only about .03, with the remaining .04 of what they label indirect effect consisting of non-causal association. Similarly, they conclude that "nonwhites have somewhat lower rates of medicine use than whites, directly and indirectly. through the link of Medicaid to perceived morbidity . . ., suggesting that there were some cultural differences in regard to use of medicines."

In this article we present two sets of empirical analyses that consider the extent to which socioeconomic gradients in self-assessed health and child mortality changed since the beginning of the twentieth century in the United States. This empirical issue has important and wide-ranging research and policy implications. In particular, our results speak to the value of considering the role of broader social, economic, and political inequalities in generating and maintaining socioeconomic disparities in morbidity and mortality. Despite dramatic declines in morbidity and mortality rates in the United States across the twentieth century, we find that socioeconomic-status gradients in morbidity and mortality declined only modestly (if at all) during that period. [ABSTRACT FROM AUTHOR]

Recent examinations of gender differences in physical health suggest that women's disadvantage may be smaller than previously assumed, varying by health status measure and age. Using data from the 1997-2001 National Health Interview Surveys, we examine gender-by-age differences in life-threatening medical conditions, functional limitations, and self-rated health and consider whether potential mediating mechanisms (e.g., socioeconomic status, behavioral factors) operate uniformly across health measures. The results show that the gender gap is smallest for life-threatening medical conditions and that men do increasingly worse with age. For self-rated health, men are more likely to report excellent health at younger ages, but with increasing age this gap closes. Only for functional limitations do we find a consistent pattern of female disadvantage: Women report more functional limitations than men, and the gap increases with age. The ability of explanatory mechanisms to account for these patterns varies by the health measure examined. [ABSTRACT FROM AUTHOR]

The development of social epidemiology and medical sociology over the last half of the 20th century, in which Leo Reeder played a central role, transformed scientific and popular understanding of the nature and causes of physical health and illness. Viewed in the early 1950s as shaped almost entirely by biological processes and medical care, physical health and illness are now understood to be as much or more a function of social, psychological, and behavioral factors. Utilizing a stress and adaptation conceptual framework, social epidemiology has identified a broad range of psychosocial risk factors for health, most notably: (1) social relationships and support; (2) acute or event- based stress; (3) chronic stress in work and life; and (4) psychological dispositions such as anger/hostility, lack of self-efficacy/control, and negative affect/hopelessness/pessimism, with new risk factors continuing to be identified. However, proliferation of risk factors must be balanced by conceptual integration and causal understanding of the relationships among them, their causes, and consequences. One source of such integration and understanding has been the rediscovery of large and persistent socioeconomic and racial-ethnic social inequaldisparities in health. Socioeconomic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial, and well as many environmental and biomedical, risk factors, and these risk factors help to explain the size and persistence of social disparities in health. Improving the socioeconomic position of a broad range of disadvantaged socioeconomic and racial-ethnic strata constitutes a major avenue for reducing exposure to and experience of deleterious risk factors for health, and hence for improving the health of these groups and the overall population. This in turn requires better understanding of the macrosocial forces that influence the socioeconomic position of... [ABSTRACT FROM AUTHOR]

Little attention has been paid to the ecological effects of unemployment, despite strong theory suggesting that being socially or economically connected to unemployed persons can induce illness. Theory suggests, for example, that the labor market experience of adult males should affect maternal and infant health. We advance this line of inquiry by testing the hypothesis that quarterly increases in unemployment among Norwegian and Swedish males were associated with increased incidence of very low weight births from 1973 through 1995. Results support the hypothesis. We estimate that approximately 188 very low weight births could have been averted in Norway, and about 329 in Sweden, if quarterly increases in male unemployment had been constrained to the median over the 23-year period. Our findings imply that the social cost of unemployment may be underestimated by focusing on unemployment as an individual risk factor. [ABSTRACT FROM AUTHOR]

Disability has long been identified as a predictor of self-assessed health, but some studies suggest the opposite causal direction. The aim of this study is to examine the dynamic relationships between physical disability and assessments of health among Black and White adults while simultaneously considering changing morbidity. Research questions include: Do more negative health assessments lead to greater morbidity and physical disability? Do negative health assessments lead to a cycle of health decline over time? These questions were addressed for Black and White respondents over 15 years using data from three waves of the National Health and Nutrition Examination Survey I: Epidemiologic Follow-Up Study. Results from structural equation modeling reveal that self-assessed health predicts subsequent change in health, suggesting a cycle between health problems and negative health assessments for both White and Black adults. In addition, self-assessed health among African Americans declined at a faster rate than was the case for White adults. [ABSTRACT FROM AUTHOR]

Over the last several decades, epidemiological studies have been enormously successful in identifying risk factors for major diseases. However, most of this research has focused attention on risk factors that are relatively proximal causes of disease such as diet, cholesterol level, exercise and the like. We question the emphasis on such individually-based risk factors and argue that greater attention must be paid to basic social conditions if health reform is to have its maximum effect in the time ahead. There are two reasons for this claim. First we argue that individually-based risk factors must be contextualized, by examining what puts people at risk of risks, if we are to craft effective interventions and improve the nation's health. Second, we argue that social factors such as socioeconomic status and social support are likely "fundamental causes" of disease that, because they embody access to important resources, affect multiple disease outcomes through multiple mechanisms, and consequently maintain an association with disease even when intervening mechanisms change. Without careful attention to these possibilities, we run the risk of imposing individually-based intervention strategies that are ineffective and of missing opportunities to adopt broad-based societal interventions that could produce substantial health benefits for our citizens. [ABSTRACT FROM AUTHOR]

For persons with serious chronic morbidity, disability is a very dynamic process as morbidity advances or retreats, and as interventions succeed or fail. This article studies trajectories of function (cognitive, emotional, social, physical, and global well-being) over a year for 165 persons whose chronic morbidity prompted a hospital stay. Changes in functioning from hospital admission to one year post-discharge are analyzed; functional statuses were measured nine times in that period. Both intra-individual and inter-individual changes are studied by means of a combination of visual and statistical techniques. (1) Individuals: After the hospital stay, functions typically improve in the first month, stabilize for several months, then begin to fluctuate and worsen. Individual trajectories are very changeful over a year, yet there is short-run continuity (from one measurement point to the next). (2) Groups: Persons with fracture of hip show the most striking and protracted improvements over the year, compared to persons with other conditions. Chances of functional recovery are highest for persons with just one chronic condition; those chances decline as comorbidity increases. Having many social contacts is associated with initial high function that is maintained over the year; having few contacts is associated with stable low function. The analyses point to the scientific value of short remeasurement intervals for persons with severe or multiple morbidity. [ABSTRACT FROM AUTHOR]

African Americans generally have more health problems than Whites, as manifested on most indicators of morbidity and mortality. The question pursued in this research is whether the more extensive health problems of minority older adults lead to a more pessimistic outlook on health. Previous research suggests that Black older adults who may be more pessimistic in their health orientations are thereby deterred from expecting health improvements from medical interventions. Using data from the Supplement on Aging to the Health Interview Survey conducted in 1984, a structural model is developed to examine the influence of functional morbidity and race on health promotion efforts and health assessments. Analysis of data from 3,237 respondents indicates that Black older adults report significantly more functional morbidity and more negative health assessments that White older adults. No direct racial differences were observed on health promotion efforts, but total effects show that Black persons are less likely to report promoting their health. When considering the four categories defined by race and sex, older Black women report the highest levels of functional morbidity and the most negative assessments of health. [ABSTRACT FROM AUTHOR]

One of the continuing paradoxes facing social epidemiologists concerns sex differences in morbidity and mortality. Although women live longer than men, they apparently get sick more. We hypothesize that women's higher morbidity levels result from less paid work and lower wages combined with more hours spent in household labor, child care, and helping others, and fewer hours of leisure and sleep. Men and women hold different social roles; men hold most of the highly rewarding roles. We operationalize social roles as time commitments to various role-related activities. This approach provides interval-level measures such as time spent in caring for children instead of simple dichotomies such as parent/ nonparent. We find that when gender differences in social roles are controlled, being male is associated with poorer health than being female. We conclude that if gender roles were more equal, women would experience better health than men, more consistent with their greater longevity. [ABSTRACT FROM AUTHOR]

A nationally representative sample of 6- through 12-year-old children and their parents is used to examine the development of illness orientations. A comprehensive model linking family structure and socio-environmental factors, health service utilization, parents' child-rearing practices, children's basic health, and one specific type of illness orientation (accepting "correct" beliefs about illness and doctors) is developed. Findings suggest that the most important direct influence on children's illness orientations is the child's self-esteem. The most prominent background factors relating directly and indirectly to the child's self-esteem are the parents' intellectual ability and, for younger children, living in a one-parent family. No evidence is found for hypothesized differences between 6- and 7-year-olds and 11- and 12-year-olds. [ABSTRACT FROM AUTHOR]

Studies suggest that health care providers' evaluation of patients is related to aspects of the presenting problem, i.e., its seriousness, curability, and rarity; the extent to which the problem was self-caused; and to aspects of the patients, i.e., their age, social distance from providers and cooperativeness. Analysis of 220 emergency room staff members' perceptions of 14 hypothetical patients showed that with the exception of rarity of problem and social distance, the tested factors were significantly related to ratings of rewardingness of patient encounters. Results indicated that predictors of reward derived from substance-abusing and non- substance-abusing patients were different. While seriousness of illness was the primary predictor with non-substance-abusers, perceived cooperativeness was primary with substance-abusers. Predictors of rewarding patient encounters also differed according to staff level. Implications 'of these differences for emergency treatment of substance-abusers is discussed. [ABSTRACT FROM AUTHOR]

This study documents the wide-ranging significance for health of the person's sense of control, i.e., the sense of mastery vs. fate-orientation. Health behavior is examined in three domains: (1) preventive care; (2) health knowledge and perspectives; and (3) physical status, e.g., acute and chronic illness. A representative metropolitan sample was interviewed at the beginning (1976) and at the close (1977) of a year-long investigation that included telephone call-backs at six-week intervals to trace health-related incidents. A sense of low control is shown to be significantly associated with (1) less self-initiated preventive care; (2) less optimism concerning the efficacy of early treatment; (3)poorer self-rated health; and (4) more illness episodes, more bed confinement, and greater dependence upon the physician. These relationships are also shown to be discriminating, e.g., meaningfully different for men and women, and hence are unlikely to be instrument-generated effects. The results are interpreted in the light of the recent congruence in psychology and sociology on the importance of the sense of control. [ABSTRACT FROM AUTHOR]

Longitudinal surve&ydot; data describing 6,190 subjects are analyzed using log-linear methods to determine which, if any, of three hypothesized links between short-term community economic change and illness or injury is correct. Assumptions of these three possible links are, respectively: (1) Economic contraction increases the incidence of undesirable job and financial events that, in turn, increase the incidence of illness and injury; (2) Economic change per se increases the incidence of undesirable job and financial events and, therefore, of illness and injury; and (3) Economic change per se increases the incidence of all job and financial events and, therefore, of illness and injury. The data support the first hypothesized connection, but the process is observed only in middle SES respondents. [ABSTRACT FROM AUTHOR]

Although women typically report using health services more frequently than do men, the reason for this difference is unclear. According to the "fixed role hypothesis," women report greater use of health services because, in the aggregate, they have fewer work and time constraints on their behavior, thus making it easier for them to reschedule activities in order to visit a doctor. Examining data from the 1976-1977 Los Angeles Health Survey, the proportion of chronic problems resulting in a self-reported doctor contact was initially 11 percent higher for women (N = 988; p < .001). As predicted by the fixed role hypothesis, controlling for differences in fixed roles (particularly employment status) reduced this differential to a nonsignificant 5 percent. No sex differences were found in reports of using health services for acute illness (N = 628). These findings suggest that the fixed role hypothesis may be most appropriate for explaining sex differences in behavioral responses to chronic symptoms. [ABSTRACT FROM AUTHOR]

This research investigates, in a field survey of over 11,000 persons in four communities, the implications of multidimensionality in Langner's 22-item index for valid comparisons of sex, education, and age group differences in psychological disorder. Using internal consistency validity analysis, we find one major dimension to the index, and two other dimensions that contribute very little to the index's reliable variance. Through factor analysis, we partition the scale's items into three components: one indicative of psychophysiological symptoms of stress, the second of psychological symptomatology of stress, and the third of physical illness. Results from analyses of mean score differences on index components among age, sex, and education groups, from an unmeasured-variable path analysis that includes a "true score" reflecting the major dimension of the scale, and from examination of the covariance of index components lead us to the conclusion that multidimensionality in the Langner index has only minor effects on status-group differences in index scores. [ABSTRACT FROM AUTHOR]

Traditionally, the sociological concept of the relationship between practitioner and patient has been the sick role, in which the physician as practitioner is in charge, and the patient is obligated to cooperate with the physician's prescribed regimen. More recently, this power relationship has been redefined by some from a consumerist perspective, in which physician and patient bargain over the terms of the relationship. Although each brings different resources to the encounter, neither participant is automatically in charge. Data from a sample of 466 members of the public and 86 physicians are used to assess the extent of reported public attitudes and behaviors that challenge the physician's traditional power, as well as physicians' reported response to such attitudes and events, as evidence of the public's propensity to a consumerist relationship and physicians' willingness to accept it. Among both the public and physicians, substantial minorities express beliefs and report actions congruent with this consumerist perspective. However, different demographic and health belief variables emerge in the two groups as explanatory factors. Doctor-patient power relationships are seen to depend on characteristics of the actors as well as on the illness situation. [ABSTRACT FROM AUTHOR]

Central to the theoretic orientation of the present panel analysis is the Meadian assumption that the attitudes and behavior of individuals are influenced by those with whom they interact on a continuing basis. By implication, the truth or falsity of that statement is particularly important for the victims of serious chronic illnesses whose ordinary patterns of interaction are disrupted and whose social involvements must be modified. In investigating the specific disease condition of renal failure with its associated treatment procedure, hemodialysis, this research examines whether a relationship exists between social environment-including the attitudes of family, friends, and others contractually yet importantly related-and the chronically ill person's modification of social functioning. Analysis of data collected through structured interviews at two times (T1 and T2) separated by a three-year interval finds statistically significant associations between patients' perceived expectations of family and friends and the patients' social functioning, both initially and at the time of reinterview. Although the amount of interactional behavior appears to increase over time, the quality of such interaction clearly decreases. Alienation also increases significantly over time. Partial correlational analysis of the relationships between major variables, control- ling for the effect of education, suggests that although the perceived expectations of primary- group members are clearly associated with social functioning at T1 and T2, the expectations of secondary-group members cannot be so described in either instance. Clinical implications of these findings for the health care professional working with the chronic dialysis patient are discussed. [ABSTRACT FROM AUTHOR]

In this article the author presents his comments regarding the critique by Allan Horwitz on his article "Models, Muddles and Mental Illness Labeling." The author emphasizes that in the area of physical illness social scientists readily accept that treatment is affected both by the scientific understanding of the physical disorder and by various social contingencies that may have a profound effect on the way treatment is implemented. Furthermore, social scientists perceive that the medical profession is very aware that social factors affect the treatment of physical disorders and that the medical profession devotes considerable attention to understanding the role of social factors in treatment and how the effects of some of these social factors may be minimized. Thus social scientists are very aware of the interaction of "social" and "medical" factors in the treatment of physical disorders, and that this in no way detracts from the validity of the medical perspective. However, when one shifts to mental illness he finds that social scientists who are critical of the psychiatric perspective take the discovery that social factors or other contingencies affect the practice of psychiatry as ipso facto evidence of the invalidity of the psychiatric perspective.

The effects of social support and stressors (stressful life events) on illness (psychiatric symptoms) are examined in a model with data from a representative sample of the Chinese-American adult population in Washington, D.C. The analysis shows that, as expected, stressors are positively related to the incidence of psychiatric symptoms, and social support is negatively related to psychiatric symptoms. Further, the contribution of social support to predicting symptoms is greater in magnitude than that of stressful life events. When marital status and occupational prestige are incorporated into the model, the significant (negative) contribution of social support to symptoms is not reduced. Implications for the theoretical development of a sociomedical theory of illness are discussed. [ABSTRACT FROM AUTHOR]

Two models of the relationship between life change and illness behavior are tested in a prospective study of surgical patients in six disease-operation categories. The sensitization model hypothesizes that higher levels of life change experienced prior to surgery will be related positively to the number of problems perceived by patients with their postoperative recovery. The physiological reaction model predicts that life change will be positively related to the patients' actual morbidity postoperatively. Inconsistent results were found for each model. Small effects in the direction predicted by the sensitization model were found with gastric surgery, abdominal hysterectomy and vaginal hysterectomy categories. The physiological reaction model received weak support from two categories: abdominal and vaginal hysterectomy. The remaining four categories failed to show support for the physiological reaction model. Overall, the findings are interpreted as failing to show clear support for either model. Various explanations for these negative results are discussed. [ABSTRACT FROM AUTHOR]

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

Data from the national Health Interview Survey for 1957-72 show that females have higher age-standardized rates of acute conditions, chronic conditions, and disability due to acute conditions, compared to males. More males, however, suffer limitations of activity or mobility due to chronic conditions. Females' excess morbidity for acute conditions persists when reproduction-related events are excluded. From 1957-72, females' disadvantage for acute conditions continues unchanged. But for chronic conditions, males are "catching up" to females in overall prevalence, and their conditions are becoming more severe relative to females'. These trends are compatible with trends in sex mortality differences over the same period. Four types of explanation are advanced to account for females' excess morbidity: interview behavior, illness behavior, acquired health risks, and inherited health risks. Empirical evidence suggests the first two factors inflate female rates compared to males; the last two do the opposite. It is hypothesized that excess female morbidity is due primarily to social and psychological factors, and a procedure to test this is stated. [ABSTRACT FROM AUTHOR]

Building on previous work, which suggested that illness symptoms might stabilize into more permanent responses (Scheff 1966; Szasz, 1961; Dohrenwend and Dohrenwend, 1969), it is argued that there should be a reciprocal relationship between self-reported illness and social class. Data from a national panel study were used to test the hypothesis. Alternative explanations for the finding of a reciprocal relationship were discussed and additional data were presented to document more finely the effect of movement into the sick rote on subsequent wage income. [ABSTRACT FROM AUTHOR]

hundred and fifty patients responded to a semantic differential instrument 1 + years after open-heart surgery. Patients perceived sick persons as less independent, less active, and not as good as people in general. The semantic distance between the concepts "most persons who are sick" and "myself after heart surgery" constituted the measure of the patient's tendency to relinquish the sick role. Explanation for variation in this tendency was sough in 19 physical, social, and personality variables believed to affect recovery. Upon regression analysis, five variables--depression, preoperative tendency to reject the sick role, duration of illness prior to surgery, age, and sex--emerged as significant predictors of tendency to relinquish the sick role following surgery. [ABSTRACT FROM AUTHOR]

This research attempts to explain the sudden onset of a series of severe, physical symptoms found in a group of female workers. An attempt to explain the symptoms in classical biomedical terms proved fruitless. Explanations for the behavior indicate that persons who were the most dissatisfied with their work situation tended to present the most severe symptomatology and that these persons reported having friends who also experienced more severe symptoms. The research suggests the use of sociological theory to facilitate explanations of physical illness and provides a replication of the work of Kerckhoff and Back, The June Bug. [ABSTRACT FROM AUTHOR]

The literature on effects of stressful life events reveals two conceptions of stressfulness: undesirability and life change. Relations between stressful life events and psychological distress, severe psychological disorders, and organic illnesses have been demonstrated using a variety of specific measures derived from these two conceptions. Comparisons of measures of undesirability and of life change indicate that they are partially confounded. While all are related to Langner's psychological symptom inventory, a measure of life change is most highly correlated. These results, which are consistent with physiological findings, suggest that stressfulness is better conceived as life change than as undesirability of life events. [ABSTRACT FROM AUTHOR]

This article suggests the utility of distinguishing the primary from the secondary symptomresponse decisions made by students and members of other prepaid medical groups. A model relating factors that affect the secondary symptom-response decision in the illness behavior of students has been developed and subjected to an empirical test. While some of the deviations observed in the data may not be accounted for by the model, the data provide support for the general predictions flowing from it. Attempts have been made to account for the observed deviations, and future tests of the more refilled implications of the proposed theoretical model have been suggested. [ABSTRACT FROM AUTHOR]

It was hypothesized that among subjects who perceive themselves to be in poor health those with fewer or less urgent symptoms, whose life situation makes it more difficult to seek care, and who lack faith in the medical care system would be most likely to fail to seek medical attention. The hypothesis was tested with a population of applicants for social security disability benefits. The hypothesis was only partially confirmed. Two life situational factors of income and welfare contact, and three measures of system orientation were found to be related to the seeking of medical care but urgency and number of symptoms were not. Subjects with low income, recent welfare contact, and negative system orientations were most likely to fail to seek medical attention. Moreover, negative system orientations proved to be associated with low income and welfare experience suggesting that negative orientations may be created by situational factors and serve as rationalizations for failure to seek care when situational factors make it difficult to do so. [ABSTRACT FROM AUTHOR]

Case interviews are used to explore variations in illness behavior and Parsons' sick role formulation. A decision-making model, focusing on the influence of status and role definers (significant others), produced findings relative to the nature of being "well", assignment of a "sick status", and illness behavior. While Parsons' formulation describes modal categories when each component is taken alone, his total configuration describes only a minority of responses. Seven sick role configurations are identified. In addition to interpersonal influence, the nature of "well roles" and the nature and severity of the illness are important variables for the study of illness behavior. [ABSTRACT FROM AUTHOR]

In this article the author replies to the comments made by some authors on his article named "Sex roles and societal reactions to mental illness: The labeling of "deviant deviance," which was published in the March 1982 issue of the "Journal of Health & Social Behavior." The author is of the views that since her research on "deviant" deviance focused on one treatment setting and one point in the labeling process, it is useful to have tests on other settings and other points. She says that the main problem is that they, the criticizers, do not control for other crucial influences on selection into treatment and thus the results cannot be attributed to social control or labeling processes. From the literature on help-seeking, one can say that there are two general influences on or causes of treatment selection. A major influence involves a range of helpseeking factors, such as the definition of a problem and its seriousness, the perception of a problem as relevant for professional help, information about treatment sources, the availability of and access to treatment alternatives, etc.

Sociologists recently presented an insightful review of the literature relating stressful life events and social support to illness. They proposed a theoretical model to account for the joint effect of stress and social support on alterations in health and tested the model using a survey of psychiatric symptoms in a population of Chinese-Americans. Their data confirm the anticipated findings of a positive association between life events and illness and a negative association between social support and illness, but no interactive effects between the two social variables were conclusively demonstrated. Although exploring thoroughly the statistical evidence for such an interaction, their report fails to note two intriguing and potentially important trends in the overall pattern of their data such as for individuals with either high or low levels of social support, there was a small decline in symptom scores between low and medium life change. Between medium and high life change, there was a marked increase in symptom scores, but only for the group with low social support. While these observations in themselves constitute only a suggestively interesting pattern, reexamination of previous work in two quite different studies reveals a similar pattern, raising questions of serious theoretical interest.