Search

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

Divergent planning trends in human service fields are described and analyzed. Highlighted are simultaneous emphases on local high impact and state planning, domain issues in comprehensive planning, and the impact of technology and participation. Each trend is posed as an opportunity for attacking a delimited aspect of human service problems—and as a potential danger if it were given undue emphasis. The authors point to longer run dangers of bypassing state delivery systems, problems of domain encroachment and the need for strengthened executive authority in the public sector which can balance the influence of the technocrat-planner with that of greater citizen participation. [ABSTRACT FROM AUTHOR]

The article presents the response of the authors to the paper titled "The Legacy of Stress Research: The Course and the Impact of This Journal" which appeared in the September 1990 issue of the "Journal of Health and Social Behavior." The authors' principal concern has been to craft as effective and complete a statement as possible while remaining judicious stewards of the journal's scare page allocation. They made three brief comments on the general nature of the exchange and proceeded to commentary-specific responses.

A retraction is presented for the article "In Sickness and in Health? Physical Illness as a Risk Factor for Marital Dissolution in Later Life" which was published in a previous issue which states the retraction is due to an error in the coding of the dependent value which yields a divorce-risk estimate different from what was published.

The article responds to comments made by Catherine Schaefer from the Department of Biomedical and Environmental Health Sciences of the University of California on study of the mental and physical health consequences of job stress and social support by J. R. LaRocco, J. S. House and J. R. P. French, Jr that published in the September 1980 issue of the "Journal of Health & Social Behavior." The author appreciates Schaefer's comments regarding the theoretical contributions of the paper to the understanding of the concept of social support, and supports her call for improved conceptualization and empirical study of the processes of social support. The paper was concluded on a similar note and, in fact, speculated on the nature and substance of those processes. The article also welcomes her raising some statistical issues with which researchers have been concerned throughout their work. Researchers, perhaps mistakenly, decided not to raise these issues in their paper due to constraints of time and space, though they addressed some of them in other places. Some of those issues have been addressed in this article.

Although the papers presented at the Seventh World Congress of Sociology session on Planning Medical Manpower are derived from the experience of researchers in ten nations, all of the writers subscribe to the concept of a health service system which is developed in part in several papers. This perspective assumes that a health service system includes all formal and informal activities centered on the provision of health services and of their utilization, by a population; in its connotation for health manpower this perspective includes all health personnel, their recruitment, training and behaviour. Further, a health service system is molded by prevailing social values, historical precedents; contained by disease, educational and fiscal restraints; and is inextricably linked with other systems. This approach provides a conceptual baseline for the testing of hypotheses generated by the various studies a framework within which it is possible to test whether certain behaviours and attitudes are universal in their implications or limited to specific settings. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor commenting of the article "Suicide and Pseudocide: A Reanalysis of Maris' Data," published in theMarch 1972 issue of the "Journal of Health and Social Behavior."

This section introduces several articles on the impact of race and ethnicity on mental health.

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

We investigate how loneliness develops over the marital dissolution process in older age (i.e., transition at or after age 50) while paying close attention to heterogeneities by the dissolution pathway—widowhood and separation—and gender. Using data from over 8,000 Household, Income and Labour Dynamics in Australia survey respondents, we assess the association of interest using fixed effects regressions. Findings indicate that loneliness increased in the year before widowhood or separation among both women and men. Levels spiked in the year of dissolution, particularly for widowhood but less for separation. Widowed men were substantially more affected than widowed women, and gender differences were negligible for separation. Although loneliness levels gradually declined, widowed men remained vulnerable for remarkably long periods. Such chronic loneliness might be linked to other health disadvantages. These findings highlight the importance of long-term and gender-specific approaches to social support and integration after marital dissolution. [ABSTRACT FROM AUTHOR]

Whereas previous research shows that union membership is associated with improved health, static measurements have been used to test dynamic theories linking the two. We construct a novel measure of cumulative unionization, tracking individuals across their entire careers, to examine health consequences in older adulthood. We use data from the Panel Study of Income Dynamics (1970–2019) and predict self-rated health, functional limitations, and chronic health conditions in ages 60 to 79 using cumulative unionization measured during respondents' careers. Results from growth models show that unionized careers are associated with.25 SD to.30 SD improvements in health among older adults across all measures. Analyses of life course mechanisms reveal heterogeneous effects across unionization timing, age in older adulthood, and birth cohort. Moreover, subgroup analyses reveal unionization to partially, but not fully, ameliorate disparities based on privileged social positions. Our findings reveal a substantial and novel mechanism driving older adulthood health disparities. [ABSTRACT FROM AUTHOR]

Sleep duration changes across the life course and differs by education in the United States. However, little research has examined whether educational differences in sleep duration change over age—or whether sleep duration trajectories over age differ by education. This study uses a life course approach to analyze American Time Use Survey data (N = 60,908), examining how educational differences in weekday sleep duration change from middle to older adulthood (ages 40–79). For men only, differences in total sleep time between individuals with less than a high school degree and those with more education converge in older adulthood. Results suggest that this leveling is explained by decreasing educational stratification in work hours as men enter older adulthood. Findings highlight the importance of employment for shaping gendered socioeconomic differences in sleep and demonstrate differences by education in how sleep duration changes over age, with possible implications for health disparities. [ABSTRACT FROM AUTHOR]

Doctors (and sociologists) have a long history of struggling to understand why patients seek medical help yet resist treatment recommendations. Explanations for resistance have pointed to macrostructural changes, such as the rise of the engaged patient or decline of physician authority. Rather than assuming that concepts such as resistance, authority, or engagement are exogenous phenomena transmitted via conversational conduits, we examine how they are dynamically co-constituted interactionally. Using conversation analysis to analyze a videotaped interaction of an oncology patient resisting the treatment recommendation even though she might die without treatment, we show how sustained resistance manifests in and through her doctor's actions. This paradox, in which the doctor can both recommend life-prolonging care and condition resistance to it, has broad relevance beyond cancer treatment; it also can help us to understand other doctor–patient decisional conflicts, for instance, medication nonadherence, delaying emergent care, and vaccine refusal. [ABSTRACT FROM AUTHOR]

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

This paper examines the effects of hospital characteristics and radical organizational change on the relative representation of health care professions in hospitals over the period of the 1980s. Health care organizations, and hospitals in particular, represent organizations where multiple professional groups make competing claims of expertise that often conflict. The question our research seeks to answer is whether different constellations of organizational characteristics and organizational changes affect the outcome of these professional conflicts. Using the annual census of hospitals compiled by the American Hospital Association, we examine the effects of several characteristics of community hospitals on the relative representation of specific professional groups. We find that hospital mergers favor physicians at the expense of administrators, and multihospital system affiliation favors technical core occupations at the expense of administrators. Measures of organizational growth and decline increase the relative representation of physicians and administrators compared to nurses, and increase the probability that hospitals will employ physicians' assistants and nurse practitioners. Our results are evaluated in light of recent developments in the sociology of medicine and research on the relative standing of occupations in other industries. [ABSTRACT FROM AUTHOR]

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

The introduction to this special issue of the Journal expands the scope of research on "the sociology of medical education" to include studies of the institutions in which physicians are trained as well as studies of the socialization of the physician throughout the life cycle. Research since the 1960s is reviewed briefly and the papers in this issue are discussed. Studies of the macropolitics and micropolitics of academic medicine are called for as well as comparative analyses of the settings in which physicians are trained and research on the relative effects on physicians' attitudes and behavior of different sets of experiences, professional and nonprofessional, over the course of their life cycle-all in the context of massive changes in the organization of health care. [ABSTRACT FROM AUTHOR]

This paper proposes a symbolic interactionist basis for the identification of insanity. In contrast to the labeling model and the psychiatric model, the symbolic interactionist view holds that the defining feature of psychosis is the observer's inability to take the role of the actor or to make successful attributions. Psychotic behavior is thus not simply an objective feature of an individual but an interactional phenomenon whose fundamental characteristic is role-taking. It is shown that the same thought, mood, or behavior may be either sane or insane depending on role-taking success or failure. The only exception to this generalization is when the observer attributes the failure to take the role of the other to his or her own limitations. The paper then discusses several challenges to the symbolic interactionist approach. Finally, the labeling theory and symbolic interactionist approaches are compared. Although both focus on the societal reaction to insanity, it is shown that they differ in a number of fundamental ways. It is argued that symbolic interactionism provides a more correct understanding of the social definition of insanity. [ABSTRACT FROM AUTHOR]

This paper has two purposes. First, it provides a theoretical perspective for understanding the interrelationships among increasing equality of rights and greater equality of distribution and utilization of resources. It argues that increasing complexity, efficaciousness, and costs of technology lead to greater centralization in the delivery of services, which in turn leads to more equality of rights and to greater equality in the distribution and utilization of resources. Second, it confronts the question of whether the expanding equality of rights and the more equal distribution and utilization of resources over several generations bring about equality of results. Focusing on the structure of the British medical delivery system during the period between 1891 and 1971, the study concludes that increasing equality of access, of distribution of resources, and of utilization of services has not brought about more equality in levels of health across social classes. Since the British National Health Service has the most egalitarian service of any highly industrial society, the conclusions of the paper suggest that societies which wish to equalize levels of health across social classes might be more concerned with equalizing income and educational attainment. [ABSTRACT FROM AUTHOR]

It is important to examine the possibility that relationships between commonly studied status indicators and psychological distress indicators are due, in part or wholly, to differences in the impacts of comparable stressor events and situations on people in different status categories. This paper describes and illustrates a strategy for doing this and argues that the systematic existence of impact differentials helps explain the commonly observed relationships between certain social statuses and psychological distress. [ABSTRACT FROM AUTHOR]

This paper addresses current contentions that medical sociology is handicapped as both a scholarly and a policy science by its subordinate relationship to the more powerful field of medicine. An analysis of all research articles published in the JOURNAL OF HEALTH AND SOCIAL BEHAVIOR which focus upon patients reveals the following: (1) the presence, in the majority, of implicit and explicit medical value assumptions influencing all stages of the research process, from the definition of problems and variables through the application of findings to health policy; (2) a tendency for cases of "medical bias" to be associated with collaborative research in which the sociologist is wholly or partly dependent upon medical sponsorship and definition of the research situation. Consequences of this situation for the human subjects of research as well as for the field are discussed. A conclusion is that both our subjects' interests and the theoretic and political integrity of the field are best served by maximizing professional autonomy vis-à-vis medicine. A proposal for studying the structure of working arrangements concludes the paper. [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]

The primary objective of this paper is to review the past twenty years of research activity stimulated by Parsons' original formulation of the sick role concept. The paper also includes an assessment of the present status of this conceptual model and some implications for future research. This review suggests that many questions still remain unanswered. Consequently, an attempt is made to develop a paradigm intended to facilitate the integration of existing research evidence pertaining to sources of variance in the sick role and to provide a guide to a more comprehensive, systematic approach to the study of the sick role. [ABSTRACT FROM AUTHOR]

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

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

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

Republicans and conservatives report better self-rated health and well-being compared to Democrats and liberals, yet they are more likely to reside in geographic areas with heavy COVID-19 morbidity and mortality. This harmed health on "both sides" of political divides, occurring in a time of rapid sociopolitical upheaval, warrants the revisiting of psychosocial mechanisms linked to political health differences. Drawing on national Gallup data (early 2021), we find that predicted differences in health or well-being vary substantially by ideology, party, voting behavior, and policy beliefs, with model fit depending on how politics are measured. Differences in self-rated health, psychological distress, happiness, trouble sleeping, and delayed health care tend to reveal worse outcomes for Democrats or liberals. Such differences often are reduced to insignificance by some combination of mastery, meritocratic beliefs, perceived social support, and COVID-19–related exposures and attitudes. Policy beliefs predict health differences most robustly across outcomes and mechanism adjustments. [ABSTRACT FROM AUTHOR]

In early 2020, when COVID-19 began to spread in the United States, many Twitter users called it the "Chinese virus," blaming racial outgroups for the pandemic. I collected tweets containing the "Chinese virus" derivatives posted from March to August 2020 by users within the United States and created a data set with 141,290 tweets published by 50,695 users. I calculated the ratio of users who supported the racist naming of COVID-19 per county and merged Twitter data with the county-level census. Multilevel regression models show that counties with higher COVID-19 mortality or infection rates have more support for the racist naming. Second, the mortality and infection rates effects are stronger in counties with faster minority growth. Moreover, it is mainly in poor counties that minority growth enlarges the effects of infection and mortality rates. These findings relate to the theories on disease-induced xenophobia and the debate between conflict and contact theories. [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]

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

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

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

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

An introduction is presented that discusses topics including the journal's use of social media networks, thanks given to peer reviews for the journal, and the need for a variety of submissions to the journal.

The article is a commentary on the portrayal of the impact of the "Journal of Health and Social Behavior" (JHSB) by Robert J. Johnson and Frederic D. Wolinsky relative to other sociology and social sciences journals in the period of 1977 to 1987. It is agreed that the journal is in high standing and regard within the social science community. The major lessons cited by Johnson and Wolinsky are different from the thesis. It is confirmed that their analysis elucidates the dangers of relying much on impression and too little on factual investigation. Their data show little change in the proportion of stress articles over the 1990s period. The evidence presented does not sustain the general perception regarding the impact status of three other sociological journals relative to JHSB. The argument that the course of the impact of JHSB due to its identification with stress research is questioned based on the data presented. The data given is not organized efficiently to test the hypothesis.

Drawing from an institutional-theory perspective on innovations in organizations, this paper examines the use of human immunodeficiency virus (HIV) prevention practices by the nation's outpatient substance abuse treatment units during a critical period from 1988 to 1995. An institutional perspective argues that organizations adopt new practices not only for technical reasons, but also because external actors actively promote or model the use of particular practices. We examine the extent to which treatment units use several practices to prevent HIV infection among their clients and among drug-users not in treatment. Results from random-effects regression analyses of national survey data show that treatment units significantly increased their use of HIV prevention practices from 1988 to 1995. Further, the results show that treatment units' use of prevention practices was related to clients' risk for HIV infection, unit resources available to support these practices, and organizational support for the practices. Implications are discussed for an institutional view of organizational innovation as well as for research on HIV prevention. [ABSTRACT FROM AUTHOR]

Does voluntary association reduce psychological distress and can these effects be distinguished from the more commonly recognized benefits of social support? This paper attempts to answer this question by reporting the results of an investigation, guided by the stress process model, into the effects of voluntary group membership on psychological distress. I conducted this research through a secondary analysis of a community sample of 850 persons residing in southwestern Ontario in 1984. I find that voluntary group membership results in a reduction in depressive symptoms for men and women ranging in age from 22-89. In addition, voluntary group members suffer lower levels of depressive symptoms in the presence of increasing stress burdens than do those who are not group members, indicating stress buffering effects. Controlling for individual psychosocial resources including mastery, self-esteem, and social support does not reduce these effects, thus leading to the conclusion that voluntary association membership itself makes a unique contribution to distress reduction. [ABSTRACT FROM AUTHOR]

Considerable evidence supports the premise that higher levels of education lead to enhanced health, including protective health behaviors. This paper focuses on how education affects one health behavior known to lead to enhanced health: the cessation of smoking. In particular, the authors examine the extent to which education influences the decision by middle-aged adults to quit smoking following a heart attack, a potentially life-threatening health event. We first hypothesize that middle-aged adults with more formal education will stop smoking more readily than people with less formal education following the experience of a heart attack. Second, we ask what other factors might underlie and explain that hypothesized effect. Using longitudinal data, the authors track changes in individual smoking behaviors after a heart attack among preretirement-age Americans. We control for documented correlates of smoking and heart attack plus other factors associated with education, heart attack, and smoking that may also influence whether a person quits smoking. In addition to confirming evidence on the education-health association as well as the documented connection between heart attack and smoking cessation, this study provides a surprising twist on those links: Our results show that the move to quit smoking following the experience of a heart attack among middle-aged adults is significantly and dramatically moderated by their level of educational attainment. [ABSTRACT FROM AUTHOR]

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

This paper examines the social origins of the rise in adult mortality in Russia and selected Eastern European countries. Three explanations for this trend are considered: (1) Soviet health policy, (2) social stress, and (3) health lifestyles. The socialist states were generally characterized by a persistently poor mortality performance as part of a long-term process of deterioration, with particularly negative outcomes for the life expectancy of middle-aged, male manual workers. Soviet-style health policy was ineffective in dealing with the crisis, and stress per se does not seem to be the primary cause of the rise in mortality. Although more research is needed, the suggestion is made that poor health lifestyles--reflected especially in heavy alcohol consumption, and also in smoking, lack of exercise, and high-fat diets--are the major social determinant of the upturn in deaths. [ABSTRACT FROM AUTHOR]

Most studies of the health consequences of unemployment ignore the economic context within which job loss occurs. Using data from a subset (N = 1,252) of a national probability sample, this paper compares the effects of current and previous unemployment on depression and subjective physical health status across levels of educational attainment and local job availability. Results show that current unemployment effects among the previously unemployed are strongest in low unemployment areas, particularly among individuals with a college-level education. These findings are interpreted in terms of the two categories of unemployment-related stress most frequently identified in the literature: financial strain, which is thought to be more salient for people in lower socioeconomic statuses, and damage to sense of self, which may primarily characterize higher status victims of job loss. [ABSTRACT FROM AUTHOR]

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

This paper replicates and extends an earlier attempt to use data from the General Social Survey (GSS) to track the distribution of AIDS across demographic subgroups. (The GSS asks respondents whether they know a person with AIDS [PWA].) The gender, racial, age, and regional composition of the set of PWAs reported by GSS respondents is compared with that of the official AIDS cases reported to the Centers for Disease Control (CDC). In an attempt to assess the accuracy of the GSS estimates, a similar analysis is performed in which GSS respondents are asked whether they know a homicide victim. Data from four consecutive GSS samples (1988, 1989, 1990, and 1991) are used, permitting a more detailed exploration of potential biases and problems with the network technique. In addition, time series data from the National Health Interview Survey on the percentage of people who know at least one PWA are used to validate the GSS data. Our earlier findings, that the GSS identifies proportionately more White and midwestern cases than are reported to the CDC, are corroborated by the additional data. Possible explanations for these discrepancies are given, and suggestions are made for improving the utility of the approach. [ABSTRACT FROM AUTHOR]

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

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

Although past research indicates that women's higher levels of psychological distress can be accounted for by their greater exposure and vulnerability to role-related stress, the social psychological factors contributing to female vulnerability have not been fully identified. This paper applies identity theory to the phenomenon of gender differences in distress among parents. From an identity perspective, I propose that salience of the parental identity in women's self-conceptions contributes to their vulnerability to parental role strains. Using 1988 survey data from a stratified random sample of married and divorced Indianapolis residents (N=448), I find that gender differences in distress are explained by differences in exposure to parental role strains. Further analyses reveal, however, that salience of the parental identity contributes to both men's and women's vulnerability to parental role strains. These findings underscore the utility of identity theory for explaining psychological distress among women and men. [ABSTRACT FROM AUTHOR]

This paper contrasts economic and professional models of physician admitting behavior. Economic models emphasize physician convenience and income maximization, while professional models emphasize physician autonomy and independence. The paper examines the relative power of these models to explain two types of admitting decisions made by physicians: which hospitals to begin admitting patients to, and how many patients to admit to a hospital. Analyses of physician admitting patterns over a three-year period suggest that economic considerations outweigh professional considerations in both decisions. Results are interpreted in light of recent changes in the profession of medicine and physician-hospital relationships. [ABSTRACT FROM AUTHOR]

This paper explores alternative explanations for the recent sharp decline in cocaine use among high school seniors, using questionnaire data from annual nationwide surveys conducted from 1976 through 1988. Results show important parallels with earlier analyses of the longer-term decline in marijuana use. Although lifestyle factors (e.g., religious commitment, truancy, evenings out for fun and recreation) show strong links with use of marijuana and cocaine, these factors have not developed trends in ways that can account for the declines in use of either drug. Reported availability of either drug has not been reduced. Instead, increases in perceived risks and disapproval appear to have contributed substantially to the recent declines in use of marijuana and cocaine. The findings provide strong support for the use of realistic information about risks and consequences as an important ingredient in efforts to prevent drug use. Coupled with the findings on availability, the results emphasize the importance of efforts to reduce demand (as opposed to supply). [ABSTRACT FROM AUTHOR]