Search

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]

The inability to attract adequate numbers of psychiatrists has been a concern of community mental health (CMH) planners for some time. This paper considers whether normative or utilitarian (i.e., economic) inducements have more of an impact on their participation. Data are drawn from a survey of 946 New York area psychiatrists. These data suggest the likelihood of incremental growth among community psychiatrists because organizational involvement, high quality residency training, and "younger generation" status all are linked to normative commitments to CMH values. Moreover, since political orientation is the strongest single determinant of these values, commitments also can be deliberately stimulated through normative appeals. Yet, our principal finding is that severe utilitarian disincentives tend to undercut the effects of normative inducements and commitments. The paper concludes by examining the social policy implications for community mental health staffing of the primacy of utilitarian considerations among psychiatrists. [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]

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families. [ABSTRACT FROM AUTHOR]

Nothing the limited understanding of group dynamics among health reseachers using corrective group, this papers proposes that a number of principles already estalished in the field of small groups might be used facilite the processes of comformity and social control in correctve groups. An exploratory experiment designed to test the effects of several group charactiristics was conducted wth smoking cessation group. The experiment, with smoker wishing to quit, included four conditions: one with experimeter attention; a second with attention and simple group environment; a commitment, and goal interdependence. it was hypothesized that pressures toward comformity and control would increase with the addition of each successive characteristics, and that smoking reduction among the conditions would be ordered along this pressure dimension. The results of the experiment support the hypothesis; smoking reduction increased directly for use in corrective groups are discussed. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [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 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]

In this paper we address two related questions: how much do economic recessions affect the aggregate well-being of a population, and by what means? Using data from the 1973-77 Quality of Employment Panel of full-time workers who experienced the 1974-75 recession (N = 830), we answer these questions by using an analytic procedure that allows us to determine the percentage of total aggregate (mean) change in well-being attributable to various changes in sociodemographic statuses, labor market positions, and job characteristics. Results from this procedure showed significant increases in the mean levels of distress and dissatisfaction for this sample and that the largest percentages of change were accounted for by changes in job characteristics: about 20 percent of the total change in distress and 47 percent of the total change for dissatisfaction. In particular, increased job demands and increasingly inadequate pay made substantial contributions, with the latter alone accounting for a quarter of the total change in dissatisfaction. Unemployment experiences also contributed substantial, but smaller, percentages to the change in distress (10 percent). [ABSTRACT FROM AUTHOR]

This paper examines three questions regarding the relationship between marriage and mental health, specifically depression and alcohol problems. First, does marriage lead to improved mental health compared to never marrying? Second, do any mental health benefits of marriage primarily accrue to men? Third, what qualitative aspects of marriage are related to psychological disorder? We explore these questions in a longitudinal sample of young adults sampled at age 21 and again at age 24. We find no indication that marriage reduces depression. Married people do report fewer alcohol problems than the never-married but this could be due to the selection of less problematic drinkers into marriage. We also fail to find that men receive disproportionate mental health benefits from marriage. Finally, we find that marital conflict is associated with problem drinking for men and depression for women. The results indicate the importance of considering stage in the life cycle and gender-sensitive indicators of psychological disorder in studies of marriage and mental health. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given by Professor Bloom in connection with his receipt of the Leo G. Reeder Award for distinguished scholarship in medical sociology. The address was given August 12, 1989 to the Medical Sociology Section of the American Sociological Association during its annual meeting, held in San Francis. co. [ABSTRACT FROM AUTHOR]

Although researched extensively over several decades, the prevalence, costs and reasons for depression among women during the middle years remain a challenge to public health. A vast literature is distilled into two predominant schools of thought, each with profoundly different implications for research and clinical practice. One school (the estrogen-deficiency perspective) holds that depression is associated with or triggered by endocrine changes in women around 50 years of age (menopause). A second school (the social-circumstances perspective) holds that depression is related to social circumstances encountered frequently by women during their fourth and fifth decades. Employing data from a randomly selected cohort of 2,500 premenopausal women sampled in Massachusetts, this paper shows that: * depression is associated with a surgical menopause and may even be a cause rather than a consequence of this surgery for this atypical group of women: * depression is not associated with the natural changes from pre- to immediately postmenopause: and * the most marked increases in depression are associated with multiple causes of worry and multiple roles among currently married women (including paid work, adolescent children, ailing husbands, and aging parents or parents-in-law). Some implications of these findings are discussed in the context of a rapidly aging population. [ABSTRACT FROM AUTHOR]

This paper is a revision of the address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on September 1, 1986 to the Medical Sociology Section of the American Sociological Association during its annual meetings, held in New York City. [ABSTRACT FROM AUTHOR]

This paper reports data front the Tecumseh Community Health Study relating measures of occupational characteristics and stresses collected in 1967-69 to biomedical and questionnaire assessments of health behavior and morbidity taken at the same time, and to mortality over the succeeding nine-to-twelve-year period. Overall, our findings show only slight evidence of associations between job characteristics or stresses and health behavior and morbidity. Consistent with prior research, however, the few positive associations found among the employed—irrespective of sex—are strongest between job pressures or demands, and health behavior and morbidity. By contrast, job rewards and satisfactions and occupation-education discrepancies show little consistent relation to health behavior and morbidity, while differences by occupation and self-employment are modest. None of the 1967-69 reported job characteristics and stresses, all of which were ascertained in a single data collection, predicts mortality by 1979. However, in a subsample of 288 men first interviewed in 1967-69 and still working and reinterviewed in 1970, those with moderate to high levels of job pressures or tensions at both interview points were three times as likely to die between 1970 and 1979 as men whose level of pressure or tension was low on at least one interview point, even if high at the other. Future research must monitor subjectively experienced stress over time if we are to relate such stress to types of morbidity or mortality that have a long etiology. [ABSTRACT FROM AUTHOR]

Recently interest has shifted from the fact of a relationship between social stressors and health outcomes to factors that may buffer the impact of social stressors. Many forms of the stress-resource-adaptation model are possible. This paper argues that there is not one, but at least two distinct versions of the stress-buffering argument. Statistical models corresponding to each of these versions are developed with an emphasis on the interpretive logic of each model. Three other models described are not consistent with the notion of stress-buffering, but are sometimes thought to be. If more than one form of stress-buffering exists, then it ix possible that some coping resources play a "dual" buffering role. An illustration of how dual stress-buffering works suggests the importance of searching for such resources. Criteria for delimiting and distinguishing cases of stress-buffering from non-cases are discussed in the final section. [ABSTRACT FROM AUTHOR]

This paper assesses the proportion of variance due to interviewer effects in responses to a mental health interview and investigates the extent to which such variations were due to specific interviewer characteristics. The total interviewer effects studied accounted for from 0% to 5% of the variance; positive responses to psychological symptom scales increased with interviewer age and experience and were related to low interviewer symptom levels. It is suggested that interviewers who are older, have interviewing experience, and have lower symptom levels create a relaxed, friendly atmosphere that decreases respondents' reticence to report personal feelings and experiences. Despite the fact that interviewer effects explain relatively little of the variance, analyses within subgroups of the sample indicate that the characteristics of inter-viewers used can have important influences on inferences made from the data. [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]

This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns accounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments. [ABSTRACT FROM AUTHOR]

A selective systematic overview is provided of the literature on the utilization of health and welfare services that appeared in the United States and Europe, mainly within the last two decades. Methodological questions that appear to characterize much of the work to date, are discussed and analytically distinct approaches or research strategies in the study of utilization behavior are presented. The paper traces the emergence of work in this area, questions the wisdom of investigators proceeding along traditional research lines, and highlights a number of promising new possibilities for research. [ABSTRACT FROM AUTHOR]

When biomedical knowledge and technology create the capacity for humans to avoid disease and circumvent early death, sociological factors become more, not less important for population health. The transformation of disease causation from cruel fate, accident, and bad luck to circumstances that are under some degree of human control facilitates a powerful social shaping of disease and death. When humans have control, it is their policies, their knowledge, and their behaviors that shape the consequences of biomedical accomplishments, and thereby extant patterns of disease and death. I propose a "social shaping approach" that can frame our understanding of these processes and allow us to take action to optimize population health. Support for this approach is garnered from evidence of dramatic improvements in population health and in the uneven distribution of those improvements across persons, places, and times. Health improvements suggest that humans have gained control of disease whereas the uneven and very slow spread of such improvements underscores the critical importance of social factors. But the evidence presented represents a stick figure at best, one that needs to be filled in by a well-supported "epidemiological sociology" that uses a wide range of sociological concepts and theories to elucidate the social shaping of disease and death. Absent a robust societal investment in epidemiological sociology, population health will reside below its optimal level and the maldistribution of health-enhancing innovations will continue to create health disparities. [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]

The 2010 special issue of Journal of Health and Social Behavior, titled "Fifty Years of Medical Sociology," defined the contours of the medical sociological perspective. We use this as a backdrop to outline and assess the continued integration of genetics into medical sociology research. We contend that the explosion of genetic and epigenetic data in population health data sources has made the medical sociological perspective increasingly relevant to researchers outside of sociology, including public health, epidemiology, and quantitative genetics. We describe vast, underappreciated, and mostly unsolved challenges that limit the scientifically appropriate interest in incorporating genetics into existing paradigms. It is our hope that medical sociologists continue this integration but redouble efforts to maintain the core insights in social science research, such as the importance of environmental and structural (i.e., nonbiological) factors in determining health processes and outcomes and the use of rich, integrated, and rigorous empirical analyses. [ABSTRACT FROM AUTHOR]

Mental health costs of economic change are measured in a cross-level analysis that combines aggregate economic conditions (unemployment rate or absolute change in employment levels) with individual self-reports of undesirable job and financial events, psychosomatic symptoms, and help-seeking for emotional problems. The data were collected in Los Angeles County during 1978-80 in 12 quarterly surveys. Data for 4,144 Anglo respondents are analyzed in seven-way contingency tables to test two competing classes of explanations of the reported association between economic change and the use of mental health facilities. One class assumes that economic contraction affects utilization by increasing the incidence of disorder. The other class assumes that economic change affects utilization without increasing the incidence of disorder, but by influencing the decision to seek help for chronic or anticipated disorder. The results support versions of both classes of explanations. The support, however, is qualified by several factors that suggest that the widely-cited association between the economy and mental health is more complex than usually portrayed. [ABSTRACT FROM AUTHOR]

The present study examines the relationship between stress and the utilization of health services. Utilizing a prospective diary method with a random sample of 96 female users of a neighborhood health center, bivariate analysis indicate that the presence of stress on a given day is associated with an approximate doubling of the probability of a health care contact on that day. When controls are introduced into these analyses for a variety of background characteristics of these families, the daily stress/utilization relationship persists, independently of reported symptoms. In addition, a measure of stressful life events reported prior to the diary period also predicts utilization independently of both the daily stresses and reported symptoms; the stressful life-events variable in fact is one of the best single predictors of utilization. The diary data are also aggregated to approximate a retrospective research design, and substantial evidence of aggregation bias is found. [ABSTRACT FROM AUTHOR]

The editor, in this article, presents his views on various issues related to health and social behavior. The editor argues that according to figures provided by the previous two editors of the "Journal of Health and Social Behavior," (JHSB) this journal has had and continues to have an impact just under the "American Sociological Review" and the "American Journal of Sociology. " In fact, JHSB's impact factor has been almost double that of "Social Forces" for a number of years. The editor promises to continue the outstanding work of prior JHSB editors in selecting and publishing high quality, theory-driven, empirical papers across a wide range of topics in health and illness, the sociology of medicine, and the organization of medical care. JHSB is the journal. In the editor's view , a good editor, with the help of the editorial board and a bevy of careful reviewers, publishes the very best papers that are submitted for consideration and trusts that these reflect the cutting edge of the field.

A policy brief is provided on psychological distress and social isolation prior to and throughout the COVID-19 pandemic in Canada, including the impact of social isolation on diminishing the mental health of older people. It recommends that public health policies related to social distancing coincide with mental health services to address social isolation and distress in the elderly.

This study leverages multiple measures of gender from a US national online survey (N = 1,508) to better assess how gender is related to self-rated health. In contrast to research linking feminine behaviors with good health and masculine behaviors with poor health, we find that masculinity is associated with better self-rated health for cisgender men, whereas femininity is associated with better self-rated health for cisgender women. The patterns are similar whether we consider self-identification or how people feel others perceive their gender, though reflected appraisals are most strongly associated with health for cisgender women. We also find that people who report they are seen as gender nonconforming report worse health, but only when this perception does not match their gender identification. Our results demonstrate that multiple measures of gender allow researchers to disentangle how health is not only shaped by gender enactments but also shapes perceptions of gender and gender difference. [ABSTRACT FROM AUTHOR]

Using longitudinal survey data from the Socio-Economic Panel Study ( N = 3,003 respondents with 22,165 individual-year observations) and exploiting temporal and regional variation in state-level unemployment rates in West Germany, we explore differences in trajectories of individuals' self-rated health over a period of up to 23 years after leaving education under different regional labor market conditions. We find evidence for immediate positive effects of contextual unemployment when leaving education on individuals' health. We find no evidence for generally accelerated or decelerated health deterioration when leaving education in high-unemployment contexts. We find, however, that individual unemployment experience when leaving education is associated with worse health and with more accelerated health deterioration in high-unemployment contexts. The cumulative experience of unemployment after leaving education does not mediate the influence of early labor market experiences for long-term health outcomes. In addition, our analyses indicate no gender differences in these results. [ABSTRACT FROM AUTHOR]

Using longitudinal data from the Toledo Adolescent Relationships Study, we examine the relationship between intimate partner violence (IPV) and depressive symptoms during adolescence and young adulthood (N = 1,273) while controlling for time-stable and time-varying correlates. Results show temporal changes in depressive symptoms, such that increases in depressive symptoms correspond to IPV exposure. While prior work has theorized that certain populations may be at increased psychological vulnerability from IPV, results indicate that both perpetration and victimization are associated with increases in depressive symptoms for both men and women, and irrespective of whether IPV exposure occurred in adolescence or young adulthood. Cumulative exposure to IPV does not appear to increase depressive symptoms beyond the effect observed for the most recent IPV exposure, but physical maltreatment by a parent does appear to diminish the association between IPV perpetration and depressive symptoms for a small subset of the sample. [ABSTRACT FROM PUBLISHER]

Using the 2004 Behavioral Risk Factor Surveillance System, we explore the relationship between racial awareness, perceived discrimination, and self-rated health among black (n = 5,902) and white (n = 28,451) adults. We find that adjusting for group differences in racial awareness and discrimination, in addition to socioeconomic status, explains the black-white gap in self-rated health. However, logistic regression models also find evidence for differential vulnerability among black and whites adults, based on socioeconomic status. While both groups are equally harmed by emotional and/or physical reactions to race-based treatment, the negative consequences of discriminatory experiences for black adults are exacerbated by their poorer socioeconomic standing. In contrast, the association between racial awareness and self-rated health is more sensitive to socioeconomic standing among whites. Poorer health is more likely to occur among whites when they reflect at least daily on their own racial status—but only when it happens in tandem with mid-range educational achievement, or among homemakers. [ABSTRACT FROM PUBLISHER]

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate. [ABSTRACT FROM PUBLISHER]

Using twin pairs from the National Survey of Midlife Development in the United States, we estimate that 35 percent of the variance in regular smoking is due to additive genetic influences. When we disaggregate the sample by birth cohort we witness strong genetic influences on smoking for those born in the 1920s, 1930s, and 1950s, but negligible influences for those born in the 1940s and 1960s. We show that the timing of the first Surgeon General’s Report coincides with an increase in the genetic influences on regular smoking, but subsequent legislation prohibiting smoking in public places has significantly reduced these influences. These results are in line with existing gene-environment interaction theory, and we argue that variation in genetic influences across cohorts makes it difficult and potentially misleading to estimate genetic effects on health behaviors from data obtained from a single point in time. [ABSTRACT FROM PUBLISHER]

Since devolution, the four countries of the United Kingdom have pursued strikingly different National Health Service (NHS) reforms. While England created a supply-side market more radical than the previous internal market system, Wales moved to a softer version of the purchaser/provider split emphasizing localism. This article deploys institutional theory to analyze the forces shaping change, and describes the hybrid forms of economic organization emerging, including the economic regulation model implemented in England. The schism that has resulted in separate NHS subsystems warrants a different analysis from the more familiar phenomenon of infield divergence. We argue that schism was triggered by political-regulatory influences rather than economic or other social institutional forces, and predict that other decentralized public health care systems may follow a similar path. While political-regulatory, normative, and cognitive institutional influences push in the same direction in Wales, the misalignment of political-regulatory and normative elements in England looks set to result in a period of organizational turbulence. [ABSTRACT FROM AUTHOR]

The increasing size of the Latino immigrant population in the United States underscores the need for a more complete understanding of the role that social context plays in influencing the health of immigrants and their children. This analysis explores the possibility that residential location influences the health-risk behaviors of Latino youth in Los Angeles County, California. The data come from the Los Angeles Family and Neighborhood Survey. We apply multivariate, multilevel Rasch models to two scales of adolescent health-risk behaviors (substance use and delinquency). The findings suggest that residence in Census tracts characterized by above-county-average levels of Latinos and above-county-average levels of poverty is associated with increased odds of health-risk behaviors for Latino adolescents, particularly for those born in the United States. The findings lend support to the contention, put forth in the segmented assimilation literature, that disadvantaged urban contexts increase the risk that U.S.-born children of immigrants will experience downward assimilation. [ABSTRACT FROM AUTHOR]

Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption. [ABSTRACT FROM AUTHOR]

Calls have been issued for understanding the "contexts" or "environment" shaping the causes and consequences of health and health care. Existing efforts raise concerns about how a panorama of influences can be considered simultaneously. Sociology's view of contexts as social network structures that shape and are shaped in social interaction offers one key to resolving this dilemma. Because social networks have become central in the social, natural, and physical sciences, this perspective provides a common platform for bringing in sociology's rich theoretical and methodological insights. Yet, to do this well, three conditions must shape our response. First, all levels relevant to health and health care must be considered, separated out, and linked by network mechanisms. The genetic-biological level, perhaps the most foreign level to sociologists, represents the greatest need and best prospect for advancing a sociologically based solution. Second, room must be made to tailor models to populations, whether defined socially or medically. Third, sociologists must find a voice within "big science " to address problems from social construction to social causation that contribute to basic social processes as well as health. I trace developments in the Network-Episode Model as one theoretical starting point. [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]

We hypothesize that divorce immediately increases psychological distress and has long-term negative consequences for the physical health of divorced people. In addition, we hypothesize that divorce indirectly causes long-term increases in distress through stressful midlife events. The hypotheses are tested using data from 416 rural Iowa women who were interviewed repeatedly in the early 1990s when they were mothers of adolescent children; the women were interviewed again in 2001. The data support the hypotheses. In the years immediately after their divorce (1991-1994), divorced women reported significantly higher levels ofpsychological distress than married women but no differences in physical illness. A decade later (in 2001), the divorced women reported significantly higher levels of illness, even after controlling for age, remarriage, education, income, and prior health. Compared to their married counterparts, divorced women reported higher levels of stressful life events between 1994 and 2000, which led to higher levels of depressive symptoms in 2001. [ABSTRACT FROM AUTHOR]

This article examines black Americans' preference for black health care providers. Using data from a national survey, we assess how blacks 'perceptions of discrimination are related to preference for same-race health care providers. Overall, the belief that discrimination is frequent in different-race doctor-patient dyads is associated with greater preference for a same-race provider However; the belief that discrimination occurs regardless of a doctor's race reduces preference for a same-race provider Finally, general perceptions of discrimination are distinct from concerns about personally being treated unfairly, and low personal concern about unfair treatment reduces preference for a same-race provider among those who believe that interpersonal discrimination occurs frequently. These results suggest a complex picture of how perceptions of discrimination influence preferred race of health care provider among blacks in the United States. [ABSTRACT FROM AUTHOR]

Unlike other major adult social roles in the United States, parenthood does not appear to confer a mental health advantage for individuals. However, while research has examined parental status differences in emotional well-being, relatively little is known about variations in emotional distress among parents. In this article, we clarify the relationship between parenthood and current symptoms of depression using data from the National Survey of Families and Households. The analyses provide support for our first hypothesis: Parenthood is not associated with enhanced mental health since there is no type of parent who reports less depression than nonparents. We also find support for our second hypothesis: Certain types of parenthood are associated with more depression than others. Additionally, although we find marital status differences in symptoms among parents, there are no gender differences in the association between parenthood and depression. We discuss the implications of our findings for ongoing theoretical debates about the advantages of social role involvement for mental health as well as the meaning of contemporary parenthood in the United States. [ABSTRACT FROM AUTHOR]

This article proposes a theory of physician-hospital integration The theory is developed by building on three streams of scholarship: "new" institutionalism, "old" institutionalism, and the theory of economic markets. The theory uses several key concepts from these theoretical frameworks, including the notions of environmental demands for legitimacy, market demands for efficiency, and agency. To enhance the predictive power of the theory, two new concepts are introduced: directionality of influence between institutional and market forces at the macro-societal level, and degree of separation of institutional and market domains at the local level-which add important predictive power to the theory. Using these concepts, a number of hypotheses are proposed regarding the ideal types of physician-hospital arrangements that are likely to emerge under different combinations of directionality of influence and institutional and market domain separation. Moreover the theory generates hypotheses regarding organizational dynamics associated with physician-hospital integration, including the conditions associated with high and low prevalence of physician-hospital integration, the extent to which the integrated organization is physiciancentric or hospital-centric, and whether physician-hospital integration is likely to be based on loose contractual arrangements or tight, ownership-based arrangements. [ABSTRACT FROM AUTHOR]

The managed care backlash is analyzed as a collective behavioral response led by attacks from threatened professional, provider, and special interest communities. Central to the backlash was the middle class `s repudiation of explicit rationing at the point of service adopted by Health Maintenance Organizations (HMOs) and other managed care plans. Americans are accustomed to choice and autonomy in their health care utilization and reacted negatively to restrictions. Assisted by negative anecdotes in the media and allegations of the denial of needed services, opponents built a negative picture of managed care often inconsistent with the empirical evidence. They succeeded in arousing public anxiety that appropriate health care might not be available when people most needed it. The private centralization of large health plans made them an easy target for the media, politicians, and provider groups in opposition. These attacks and regulatory initiatives succeeded in diluting strong utilization management controls contributing to current difficulties of containing large health cost increases. [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]

Despite the lack of confidence in government agencies to operate a nationalized health-care system in the United States, government agencies have significantly influenced the distribution and financing of health-care services in the market. Using the State of Florida as a case study, we examine the conditions under which a state health-care agency can consistently influence health-care market arrangements. We examined records from Florida's legislative sessions between 1965 and 1993 focusing on 27 legislative initiatives to involve the state's healthcare agencies in the health-care services market. Using Boolean qualitative comparative analysis (QCA), we examined the conditions that facilitated or inhibited legislative policy initiatives for state action in Florida's health-care services market. The cohesiveness of state administrative agency and legislative leadership is of primary importance. Fragmented interests among health-care providers and fiscally legitimate policy positions, whether those of state agencies or health-care providers, are important enabling factors for state action. [ABSTRACT FROM AUTHOR]

Persons believed to be mentally ill and imminently violent are often subjected to coerced treatment. Among the justifications for this practice is the argument that (removing such people from the community is analogous to quarantine. We test the quarantine theory using daily data from San Francisco. Results suggest that the incidence of coerced treatment of males is inversely related to assaults and batteries by males one day later. The finding implies that persons who are involuntarily committed are at elevated risk of violent behavior. The implications of the findings for the prevention of assaultive behavior are briefly described. [ABSTRACT FROM AUTHOR]

This study examines the effect of religion on subjective health in a sample of Black and White elderly adults living in a southern community of the United States. The analyses lead to several conclusions. First, the findings indicate that future analyses examining the link between religion and subjective health should incorporate measures of functional health. Second, the differences found between Blacks and Whites warrant separation by race in future studies of religion and health. Third, the effects of religion on subjective health seem to be greatest for those suffering from physical health problems. This last finding emphasizes the comfort role of religion suggested by other researchers. [ABSTRACT FROM AUTHOR]