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

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

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

More than 100 studies have cited M. Harvey Brenner's (1973) claim that fluctuations in the economy increase the onset of mental illness and thus generate increases in mental hospitalization. Published attempts to replicate Brenner, however, have considered only twentieth-century data. One of Brenner's most memorable claims was that a stable inverse relationship between mental illness and the economy could be seen over a 127-year span beginning in the early nineteenth century. Unfortunately, no research since Brenner's has considered nineteenth-century populations. In this paper we analyze the hypothesis that economic change provokes a substantial fraction of first admissions to mental hospitals. We used admissions registers from the three institutions to construct a data base that approximates a psychiatric case register for a nineteenth-century American city from 1881 to 1891. Time-series tests show no support for the "provocation" hypothesis. [ABSTRACT FROM AUTHOR]

This paper attempts to explain the higher psychological distress and psychological vulnerability of women and the unmarried as a function of greater exposure to uncontrollable life events (including network events) and perceived lack of control over life circumstances. Panel data on a sample of 1,106 adult heads of household living in Chicago provide measures of relevant variables. Contrary to expectation, event exposure is inconsistently associated with gender and marital status; instead, exposure depends on the types of roles held by individuals. Although group members at higher risk of disturbance perceive less control over their lives, these perceptions neither singly nor jointly with event exposure, explain gender or marital status differences in psychological distress or in vulnerability to negative events in general. In light of these findings, the utilities of a "common stress" and a "unique stress" approach for explaining status differences in symptoms are contrasted. [ABSTRACT FROM AUTHOR]

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

This paper attempts to show the importance of including variables relating to providers of care in a full explanation of utilization of ambulatory care services. Data were obtained via interviews in a sample survey of Rhode Island households conducted in 1974. The concept of an affiliation with a medical care provider is developed and the number of affiliations is used as a provider or pattern of care variable to include in a multiple regression equation to explain utilization of ambulatory care services. The two key predictors of utilization are the number of affiliations and the number of conditions. Other important variables are total family income and a dummy variable representing whether or not a person has some form of government aid (such as Medicare or Medicaid) in paying for health costs. As the number of affiliations and number of conditions increases, utilization increases. Having a government-sponsored form of aid also increases utilization. A negative relationship is found between income and utilization. Together the variables included in the regression equation explain 40.4 percent of the variance, thus indicating the importance of including variables relating to affiliations and to how people actually obtain care in future attempts to explain utilization. [ABSTRACT FROM AUTHOR]

This paper presents findings on the relationship between race and mental health extracted from a major five year epidemiologic study conducted in the southeastern United States. Mental health scores on five separate psychiatric scales are compared for blacks and whites. These comparisons are made in two ways. First, simple correlations using Tints and analysis of variance are computed; then the variable race is included with age, sex and socioeconomic status in a stepwise multiple regression equation. The results show that blacks had higher mean scores than whites on all the scales: the differences are statistically significant on every measure. When controlled for the oilier sociodemographic factors, however, the variable black is statistically significant in only two of the equations and in one of these the significance level is quite minimal. Being black is a highly significant variable when scores on a phobia scale are analyzed. In every instance, low socioeconomic status is the most powerful predictor of high mental health scores. The authors conclude that there is no definitive evidence that race alone is a primary etiologic factor in accounting for differences in the rates of mental illness between blacks and whites. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

This paper attempts to answer a series of questions regarding the interaction of income and birth weight across generations. First, does the effect of the income of a mother during her pregnancy on her infant's birth weight depend on the family's birth weight history (genetic predisposition)? Second, does the effect of low birth weight status on adult life chances depend on income during early childhood? These questions have implications for the way we envision the biological and social worlds as interacting across generations. To address these issues, this study uses intergenerational data from the Panel Study of Income Dynamics, survey years 1968 through 1992. Results of sibling comparisons (family-fixed-effects models) demonstrate that maternal income has a significant impact on birth weight for those infants who are already at high risk hereditarily (i.e., who have a low birth weight parent). However, it is not clear whether income acts as a developmental buffer for low birth weight infants as their lives progress. These findings suggest the existence of biosocial interactions between hereditary predisposition and socio-economic environment. [ABSTRACT FROM AUTHOR]

Racial inequity in the provision of healthcare is widely recognized. In this paper I assess the role of social distance from healthcare providers in accounting for whites' higher rating of healthcare providers. Using data from the Detroit Area Study, I test whether having higher socioeconomic status, like most healthcare providers, and racial concordance with healthcare provider account for the gap in satisfaction between whites and African Americans. I find that socioeconomic status and racial concordance variables account for a portion of whites' higher rating of the respect shown by their healthcare provider Racial differences in evaluation of time spent with healthcare provider are accounted for by socioeconomic status, but not racial concordance. As researchers explore the causes of and remedies for the racial disparity in use and evaluation of healthcare, the subtle and indirect effects of race on the patient-healthcare provider relationship must be considered. [ABSTRACT FROM AUTHOR]

This paper is a revision of an address given upon receipt of the Leo G. Reeder Award for Distinguished Scholarship in Medical Sociology. It was presented on August 24, 1991, to the Medical Sociology Section of the American Sociological Association during its annual meetings, held in Cincinnati, Ohio. [ABSTRACT FROM AUTHOR]

The paper focuses on two forces (stressors and resources) in the life stress process as they affect psychological distress. Utilizing three waves of panel data from a representative community sample in upstate New York, six causal models of the life stress process are tested with indicators of two types of stressors (social and physiological) and two types of resources (social and psychological). Both deterring and coping models are tested. Analysis shows that: (1) stressors and resources in the social environment have a direct impact on depressive symptoms, (2) social resources mediate the effects of social stressors on psychological distress, and (3) psychological resources indirectly affect distress by enhancing social resources. The critical role played by the social environment in the life stress process involving psychological distress is substantiated. The implications of these and other findings are discussed. [ABSTRACT FROM AUTHOR]

This paper presents a measurement model of a ten-item scale of maternal anxiety during pregnancy. Using confirmatory factor analysis, its reliability and validity are examined in a hospital sample of mothers (N = 266) surveyed postpartum in Galveston, Texas. According to several indices of overall fit as well as individual parameter estimates, a latent internal structure of three interrelated dimensions is confirmed for the scale items. These first-order constructs are anxiety about being pregnant, childbirth, and hospitalization. This model exhibits a considerably better fit than both a no-factors model and a model in which the dimensions are uncorrelated. Finally, several exogenous constructs expected to be associated with pregnancy anxiety—age, marital status, and worry over health—exert significant effects on dimensions of the model or on a second-order factor. [ABSTRACT FROM AUTHOR]

This paper examines self-perceptions of risk for AIDS and factors that contribute to estimations of risk. On the basis of a telephone survey of 1,540 adults age 18 to 60, we address the question: What heuristic factors predict perception of risk for AIDS? Results show that five heuristic categories determine self-perceptions of risk: sexual practices, moral evaluations of people with AIDS, emotional response to AIDS, protective actions in response to AIDS, and demographic characteristics. Number of sexual partners over the past five years and knowledge of sexual partners' past sexual behavior are associated significantly with increased perceptions of risk. Fear of AIDS and worry about one's health also contribute significantly to self-perception of risk, as does shame associated with having AIDS. Asian-Americans and persons with no particular religious affiliation report greater perceptions of risk. These findings call attention to heuristic factors in considering theories of risk and in designing interventions to change preventive actions associated with high risk for AIDS. [ABSTRACT FROM AUTHOR]

In the late 1950s American pediatricians began to place increased emphasis on psychosocial and behavioral issues in medical training and research. An intraprofessional movement for psychosocial pediatrics led to alterations in the specialty's stated jurisdiction. One explanation for the movement's origins is that demand for treating sick children was eroding; primary-care providers took up the delivery of behavioral services to avoid extinction. This paper shows that routinization of work, not market decline, preceded psychosocial pediatrics. Academicians rather than community practitioners spearheaded boundary expansion. The movement's major consequence appears to be a new division of labor between pediatricians and other health care professionals rather than increased pediatric treatment of children's psychosocial disorders. [ABSTRACT FROM AUTHOR]

This paper reports the first results from a survey of unemployment in Southeastern Michigan. The study includes samples of currently unemployed, previously unemployed and stably employed respondents. Special efforts were made to obtain information about the context surrounding each job loss reported, thus allowing the explicit analysis of selection bias in the estimation of unemployment effects. The analysis documents the substantial influences that unemployment has on self-reported physical health, somatization, anxiety, and depression that cannot be explained by selection bias. [ABSTRACT FROM AUTHOR]

This paper presents a cohort analysis of the use of health services by elderly Americans. Standard cohort tables are constructed using data on approximately 50,000 individuals from the 1972, 1976, and 1980 Health Interview Surveys. Six 4-year age cohorts are tracked: the youngest, 56-59 years old in 1972: the oldest, 84-87 years old in 1980. Significant age and period effects on physician and hospital contact have been detected; for example the aging effect reflects an increase in the percentage of individuals who either saw a physician on an outpatient basis or were hospitalized in the previous year. Analysis of the volume of physician visits reveals an inverse J-curve relationship with age, with the pivotal point occurring at or about age 80. Consideration of nine alternative explanations of the J-curve phenomenon shows that three are plausible on either conceptual or empirical grounds. Two of these explanations suggest the substitution of either (1) hospital-based services for ambulatory-based services or (2) social supports (especially in the form of older children as care givers) for physicians' services: the third explanation focuses on the involuntary severance of patient-practitioner relationships. resulting from the retirement or death of longstanding family physicians. Finally, competing policy implications of these explanations are discussed. [ABSTRACT FROM AUTHOR]

Over the past decade, a body of research has developed which purports to show that the well-established relationship between race and psychological distress is duc entirely to social class. In our paper we demonstrate that this view is incorrect: Most prior research has assumed that the effects of race and social class are additive; our analysis shows that they are actually interactive. The form of interaction is such that thc true effect of race is suppressed and tire true effect of social class is magnified in a model that fails to take the interaction into consideration. An analysis of eight different epidemiologic surveys documents this result and shows that race differences in psychological distress are particularly pronounced among people with low incomes. On the basis of this result we call for renewed interest in the effect of race on mental health. [ABSTRACT FROM AUTHOR]

Although the dramatic rise in national expenditures for medical services the past quarter century is due to a number of factors, this paper investigates the hypothesis that an increase in the supply of physicians is one major factor. Longitudinal analysis of trends for the United States from 1940 to 1981, and the cross-sectional analysis of eight industrialized countries and nine census regions in the United States, support the hypothesis. Since the increase in physicians is largely due to deliberate policy decisions in the past, the increase in costs, which policymakers are now trying to contain is in large part the result of actions that policymakers themselves have made. The increase in the supply of physicians (the "physician surplus") will put upward pressures on the national expenditures for medical care in the years ahead. [ABSTRACT FROM AUTHOR]

This paper considers the meaning of minority group status for the Hispanic population of the United States regarding access to medical care. A review of the relevant literature raises a number of questions concerning determinants of medical care utilization for Hispanics. They are explored using data from a national survey of health care utilization that oversampled the Hispanic population of the southwestern United States. Some indicators suggest that limited access to medical care for Hispanics in this region is associated with low levels of income, education, and health insurance coverage. Some implications of the findings for future research on Hispanics' access to medical care are presented. [ABSTRACT FROM AUTHOR]

This paper examines the effects of the recently completed New Jersey-Pennsylvania Negative Income Tax Experiment on health and health care utilization. Both economic and sociological theory suggest that the negative tax benefits may, in the short run, increase the proportions reporting themselves in ill health and utilizing care, and, in the long run, reduce these figures. However, the empirical literature suggests the effects may be modest, vary by family members. and be swamped by other variables. Data are presented for two or three points itt time (depending on the family member) over the three year duration of the experiments and no effects of any kind are observed. The results give credence to suggestions that health and health care utilization may be more a function of life style or preferences than income. While neither economic nor sociological theory asserts the effects of income are simple, these data suggest its theoretical role is still not well understood. [ABSTRACT FROM AUTHOR]

This paper develops and tests a model of the health services delivery system based on an examination of the interrelationships among patient and provider variables (treated as exogenous) and access, utilization, continuity, quality, and satisfaction with medical care services (treated as endogenous). The model is tested using data collected from 106 hypertension patients enrolled in the Seattle Prepaid Health Care Project during the period February 1, 1971, through June 30, 1973. Several findings of both sociological and public policy interest emerged. Perceived access to care was among the most important predictors of patient satisfaction: patients from larger families were less satisfied with their care and experienced poorer outcomes of care; patients receiving care from independent fee-for-service practitioners experienced better outcomes than patients receiving care from prepaid group practice providers, even though the latter met a higher percentage of indicated criteria for care; and there was no relationship between perceived access to care and annualized visits. Several important interaction effects involving the nature of the provider system were predicted and supported by the data. The findings are viewed as a first step in the development of a "middle-range" theory of health services delivery systems. [ABSTRACT FROM AUTHOR]

This paper examines three related questions: First, can psychiatrists' judgments be successfully predicted by multiple regression techniques? Second, assuming that they can, are such ratings a valid measure of mental health for the same sample at a later point in time? Third, what is the relation between mental health ratings made in 1954 and such subsequently reported behavioral outcomes as nervous break-down, mental hospitalization, or seeking professional help for emotional problems? The evidence presented warrants two conclusions. (1) The computer-derived mental health ratings are an adequate substitute for the original ratings. The regression equation accounts for 69 percent of the variance in those ratings; and the computer-derived ratings behave in the same way as the psychiatrists' ratings in relation to other variables. (2) However, neither the psychiatrists' ratings nor the computer-derived ratings are very accurate in predicting subsequent self-reported behavior indicative of mental impairment. [ABSTRACT FROM AUTHOR]

This paper addresses the problem of the effects of a total institution (Goffman, 1961) environment on the use of medical services. The empirical focus is on a midwestern United Slates penitentiary for men. Three components of the problem are identified: the difference between the incidence of physician visits as compared with a "free" population, variations in the use of medical services among different groups of inmates, and discussion of possible reasons for differences found. For the first two component's, evidence is presented; for reasons that are discussed, however, explanation of differences found remains speculative. [ABSTRACT FROM AUTHOR]

This paper reports preliminary findings from research concerning the utilization of physicians' services. Data were obtained via interviews in a sample of Los Angeles County households in 1973. The results reported herein pertain only to the adult respondents. The relationships between adjusted family income and physician visits were found to vary with the scales and methods used. The indigent report a significantly greater number of physician visits than the nonindigent. Correlation and regression and regression analyses, however, show adjusted income to be unrelated to physician visits. One-way analysis of variance showed significant variation in physician visits by age, sex, and public insurance coverage (Medicaid or Medicare). Regression analysis showed days disables, public insurance coverage, and sex to be key predictors of physician visits. Path analysis was used to test a model of utilization derived from our interpretation of arguments proposed by Monteiro (1973). Adjusted income was found to have no significant effect on visits-either directly, or indirectly via days disabled and public insurance coverage. Disability and public insurance coverage were found to be positively related to visits, the latter even with disability controlled. Age was found to be positively related to visits via its effect on disability and public insurance coverage. [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]

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

From interorganization and sector theory, we hypothesize that the flow of personnel into and out of organizations is patterned according to prestige hierarchies. The prestige of personnel inputs will be associated positively with the prestige of the organizations into which they enter, and the prestige of these organizations' personnel outputs will be associated positively with the prestige of the characteristics of the social environment entered. The model is tested using longitudinal data on foreign- and U.S.-educated physicians and the characteristics of their U.S. training hospitals. Generally congruent with the theory, the findings and their implications for health policy and organization theory are explored. [ABSTRACT FROM AUTHOR]

Using data drawn from interviews and observations with 18 families whose children were diagnosed with life-threatening, often rare diseases, I examine how families accessed and negotiated medical care at a top 10–ranked university research hospital. Access to highly specialized and technologically advanced care was essential in these critical cases. Combining analysis of these high-stakes cases with recent work highlighting the interactional dynamics of care delivery, I show how families followed different paths to elite care and used different illness management strategies throughout the treatment process depending on their ability to mobilize what Janet Shim terms cultural health capital. These diverging illness management strategies reproduced inequality even at the top of the U.S. healthcare system by allowing some families to secure microadvantages throughout the illness experience. These findings suggest a complex interplay between structures of care delivery and families’ illness management strategies and point to the need for broader conceptualizations of healthcare advantages. [ABSTRACT FROM PUBLISHER]

A lack of health insurance has long been associated with negative effects on individual and family health due to access barriers. However, we know little about how a lack of health insurance affects wider communities beyond health care. Based on in-depth interviews in two Los Angeles communities, we report how a lack of health insurance affects the functioning of religious institutions and schools from kindergarten to 12th grade. We find a negative spillover effect at the individual and institutional levels for schools experiencing greater absenteeism due to health insurance problems of pupils. However, we find that religious organizations are little affected by a lack of health insurance of adherents. Instead, churches offer health programs as a means to engage their communities. Besides documenting a negative and a positive spillover effect, we offer a conceptual framework for the qualitative study of health spillover effects and examine the policy implications of our findings. [ABSTRACT FROM PUBLISHER]

Health care in the United States is highly regulated, yet compliance with regulations is variable. For example, compliance with two rules for securing electronic health information in the 1996 Health Insurance Portability and Accountability Act took longer than expected and was highly uneven across U.S. hospitals. We analyzed 3,321 medium and large hospitals using data from the 2003 Health Information and Management Systems Society Analytics Database. We find that organizational strategies and institutional environments influence hospital compliance, and further that institutional logics moderate the effect of some strategies, indicating the interplay of regulation, institutions, and organizations that contribute to the extensive variation that characterizes the U.S. health care system. Understanding whether and how health care organizations like hospitals respond to new regulation has important implications both for creating desired health care reform and for medical sociologists interested in the changing organizational structure of health care. [ABSTRACT FROM PUBLISHER]

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]

This research argues that immigrants’ political, social, and economic incorporation experiences, which are embedded in individual life course trajectories and heavily influenced by governmental policies, play an important role in producing diverse health outcomes among older U.S. foreign-born persons. Using data from the 2008–2010 American Community Survey and 1998–2010 Integrated Health Interview Series, we demonstrate how naturalization, a key indicator of social and political inclusion, is related to functional health in midlife and older age. Consistent with the theoretical framework, we find that among those foreign-born who immigrated as children and young adults, naturalized citizens show better health at older ages compared with noncitizens, although this relationship is partly mediated by education. But among those older foreign-born who immigrated at middle and older ages, naturalized citizens report worse health compared with noncitizens. Moreover, this negative health selection into naturalization becomes stronger for those naturalizing after the 1996 Welfare Reform Act. [ABSTRACT FROM PUBLISHER]

Modern patients walk a tightrope between respecting medical authority and acting as knowledgeable advocates regarding health issues, with the agency and responsibilities that come with this. This article uses conversation analysis to explore this balance in relation to patient disclosures of medical misdeeds in video-recorded primary care medical visits (e.g., taking another’s prescription medication or failing to adhere to a healthy lifestyle or prescription regimen). We focus on patient-initiated disclosures. We show that disclosures are used (1) where patients are seeking physician assessment of their behavior, (2) where patients are proposing the etiology of a health problem, and (3) where patients are lobbying for a particular treatment outcome. We argue that disclosures of medical misdeeds are an important but understudied domain of conduct in which patients show awareness of their own agency over, and responsibility for, their healthcare and respect for the physician’s medical authority. [ABSTRACT FROM PUBLISHER]

Despite the proliferation of studies documenting the relationship between physical limitation and depressive symptoms in the United States, we currently do not know (1) whether physical impairment is associated with other dimensions of emotional well-being and (2) if these associations differ for men and women as well as married and nonmarried adults. We use panel data from two national samples to examine gender and marital status variations in the impact of physical limitation on four indicators of mental health. We find that physical limitation is associated with increases in depressive symptoms and negative feelings as well as decreases in positive emotions. Although the patterns are complex, we also find gender and marital status differences in these associations. Our results provide additional support for Aneshensel’s (1992; Aneshensel, Rutter, and Lachenbruch 1991) argument about the highly contingent nature of stress reactivity and contribute to theory about both gender and marital status differences in the impact of stress on mental health. [ABSTRACT FROM PUBLISHER]

Over the past half century the gap in mortality across education levels has grown in the United States, and since the mid-1980s, the growth has been especially pronounced among white women. The reasons for the growth among white women are unclear. We investigated three explanations—social-psychological factors, economic circumstances, and health behaviors—for the widening education gap in mortality from 1997 to 2006 among white women aged 45 to 84 years using data from the National Health Interview Survey Linked Mortality File (N = 46,744; 4,053 deaths). Little support was found for social-psychological factors, but economic circumstances and health behaviors jointly explained the growing education gap in mortality to statistical nonsignificance. Employment and smoking were the most important individual components. Increasing high school graduation rates, reducing smoking prevalence, and designing work-family policies that help women find and maintain desirable employment may reduce mortality inequalities among women. [ABSTRACT FROM PUBLISHER]

Numerous studies report gene-environment interactions, suggesting that specific alleles have different effects on social outcomes depending on environment. In all these studies, however, environmental conditions are potentially endogenous to unmeasured genetic characteristics. That is, it could be that the observed interaction effects actually reflect underlying genetic tendencies that lead individuals into certain environments. What is critical to move this literature forward is random environmental variation that we know is not correlated with innate characteristics of subjects. We exploit a natural experiment that randomizes a particular stressor—birth weight discordance within twin pairs—to address this challenge and ask: Do random differences in early environment (prenatal nutrition) moderate genetic effects on depression, delinquency, or GPA? Using Add Health data, the only consistently significant allele–birth weight interaction we reveal works in the opposite direction of Caspi et al.’s classic finding regarding the interaction of maltreatment with genetic variation in the serotonin transporter promoter. Less robust interactions found for DRD2 and MAOA are consistent with this pattern that reverses prior findings. These results do not necessarily overturn existing research but support our methodological point that gene-environment research must address endogeneity. [ABSTRACT FROM PUBLISHER]

Extensive research documents the relevance of families and socioeconomic resources to health. This article extends that research to sexual minorities, using 12 years of the National Health Interview Survey (N = 460,459) to examine self-evaluations of health among male and female adults living in same-sex and different-sex relationships. Adjusting for socioeconomic status eliminates differences between same- and different-sex cohabitors so that they have similarly higher odds of poor health relative to married persons. Results by gender reveal that the cohabitation disadvantage for health is more pronounced for different-sex cohabiting women than for men, but little difference exists between same-sex cohabiting men and women. Finally, the presence of children in the home is more protective for women’s than men’s health, but those protections are specific to married women. In all, the results elucidate the importance of relationship type, gender, and the presence of children when evaluating health. [ABSTRACT FROM PUBLISHER]

A legacy of research finds that marriage is associated with good health. Yet same-sex cohabitors cannot marry in most states in the United States and therefore may not receive the health benefits associated with marriage. We use pooled data from the 1997 to 2009 National Health Interview Surveys to compare the self-rated health of same-sex cohabiting men (n = 1,659) and same-sex cohabiting women (n = 1,634) with that of their different-sex married, different-sex cohabiting, and unpartnered divorced, widowed, and never-married counterparts. Results from logistic regression models show that same-sex cohabitors report poorer health than their different-sex married counterparts at the same levels of socioeconomic status. Additionally, same-sex cohabitors report better health than their different-sex cohabiting and single counterparts, but these differences are fully explained by socioeconomic status. Without their socioeconomic advantages, same-sex cohabitors would report similar health to nonmarried groups. Analyses further reveal important racial-ethnic and gender variations. [ABSTRACT FROM PUBLISHER]

This article bridges the literatures on the economic consequences of divorce for women with that on marital transitions and health by focusing on women’s health insurance. Using a monthly calendar of marital status and health insurance coverage from 1,442 women in the Survey of Income and Program Participation, we examine how women’s health insurance changes after divorce. Our estimates suggest that roughly 115,000 American women lose private health insurance annually in the months following divorce and that roughly 65,000 of these women become uninsured. The loss of insurance coverage we observe is not just a short-term disruption. Women’s rates of insurance coverage remain depressed for more than two years after divorce. Insurance loss may compound the economic losses women experience after divorce and contribute to as well as compound previously documented health declines following divorce. [ABSTRACT FROM PUBLISHER]

Large, pervasive, and persistent racial inequalities exist in the onset, courses, and outcomes of illness. A comprehensive understanding of the patterning of racial disparities indicates that racism in both its institutional and individual forms remains an important determinant. There is an urgent need to build the science base that would identify how to trigger the conditions that would facilitate needed societal change and to identify the optimal interventions that would confront and dismantle the societal conditions that create and sustain health inequalities. [ABSTRACT FROM AUTHOR]

This study examined two types of potential sources of racial-ethnic disparities in medical care: implicit biases and time pressure. Eighty-one family physicians and general internists responded to a case vignette describing a patient with chest pain. Time pressure was manipulated experimentally. Under high time pressure, but not under low time pressure, implicit biases regarding blacks and Hispanics led to a less serious diagnosis. In addition, implicit biases regarding blacks led to a lower likelihood of a referral to specialist when physicians were under high time pressure. The results suggest that when physicians face stress, their implicit biases may shape medical decisions in ways that disadvantage minority patients. [ABSTRACT FROM PUBLISHER]