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How does a drug with a limited safety and efficacy record become an international blockbuster? In June 2006 the FDA approved and recommended a new vaccine directed against 4 types of sexually transmitted human papillomavirus, associated with 70% of cervical cancer cases and 90% of genital wart cases. Branded as a "cervical cancer vaccine" Gardasil has been met with as much fanfare as controversy, and retains blockbuster status in Merck's portfolio. Sold as a cancer risk-reduction method, Gardasil carries its own risks, with startlingly low efficacy and elevated likelihood of serious adverse events (side effects). Through the lens of risk, this dissertation examines Gardasil's popularity in the face of evidence that it is neither as safe nor as effective as advertised. Through three distinct research projects, I identify (a) five sociological factors responsible for Gardasil's success on the heels of Vioxx, one of the biggest drug scandals in history; (b) how amongst healthy vaccinated girls, cervical cancer is experienced as a "risk object," yet when a young woman experiences a serious adverse event that "object of risk" and her "experience of risk" shift toward Gardasil; and (c) that Gardasil is so trusted among young women, that warnings about potential side effects from others made some girls more likely to get vaccinated and have a positive opinion on the vaccine, suggesting that Gardasil benefits from a broader cultural assumption that vaccines are inherently safe and effective. Physicians and pharmaceutical marketing also play an important role. Gardasil is a risk-reduction drug and vaccine purported to treat risk while it simultaneously creates new risk for further health problems in some consumers. This dissertation contributes to sociological literatures on pharmaceuticalization, pharmaceutical pseudoscience, the social construction of risk, research on regulatory agencies, and the sociology of medicine more broadly.

This dissertation analyzes the everyday work experiences of hospice, a type of end-of-life care. The following chapters integrate micro-sociological perspectives with meso- and macro- level explanations of organizational behavior to account for workers' performances of emotional labor, care-related identities, constraints on their daily work, and ultimately hospice workers' strong commitment to their jobs and the hospice philosophy. Using a mixed methodological approach, I argue that hospice workers engage in emotional labor, but that instead of feeling dissonance or alienation, hospice workers develop a positive identity around their work. Their identities and work experiences are still constrained by institutional forces, however. Hospice workers' experiences highlight two tensions in the administration of caring labor: keeping commitment during times of organizational change and balancing the needs of the self with the needs of the care recipient. The main contributions of this work include new understandings of the relationships between identity, emotions, and work; a novel combination of theories that better explain care workers' behaviors and constraints on their action; and, a refined approach to thinking about emotional labor.

The bonding power of the gift has been the subject of much social scientific research. My dissertation adds to this by examining the relationship between gift giving and commitment to a social network or an employing organization. Ideas and concepts from social exchange and identity theories provide the theoretical underpinnings for this investigation. Social exchange theory views human interaction as a series of resource exchanges, and I contend that how people exchange resources may have ramifications for the bonds that develop between them and for their commitment to particular social relations. This study has two parts. In the first half of the dissertation, I ask whether the greater relational solidarity that results from direct reciprocal exchange, as opposed to negotiated exchange, differentially affects whether actors choose to leave their existing exchange networks for new ones and if so, why? Direct reciprocal exchange involves actors directly and independently giving resources to others without knowing whether the recipients of those resources will reciprocate in kind. Negotiated exchange involves actors jointly bargaining over the terms of an agreement. Differences between these two forms of exchange inform my causal argument about why actors are more like to stay in social networks if they participate in direct reciprocal exchange. I test this argument using an experiment. The second half of the dissertation continues this investigation into reciprocal exchange by examining the factors that affect gift giving in the workplace as well as the effects of gift giving on organizational commitment. Here, gift giving is defined broadly to include any act that involves people freely and independently volunteering to provide either tangible or intangible benefits to others without knowing if others will reciprocate. Data from a survey distributed to registered nurses working for a large healthcare organization provides the empirical basis for this investigation.

Recent research and popular discourse offers evidence of a significant number of people in the U.S. and elsewhere in the world that self-identify as both "spiritual" and "not religious." Based on the conventional religious paradigm that has previously been supported by western scholarship, spirituality is a factor of religious involvement and such an identity combination should be rare in societies where people overwhelmingly participate in church activities. However, these new empirical data challenge this supposition. This quandary has renewed an interest among academics in understanding the relationship between spirituality and religion and in identifying mechanisms that have an impact on variance on particular combinations of the two. This dissertation explores the antecedent nature of certain combinations of structural conditions across nation states in association with substantial aggregations of "spiritual but not religious" populations in an effort to offer empirical evidence that can be used to support theoretical arguments about the cross-national variation of this population. Using fuzzy set qualitative comparative methods and data from 32 nation states, this analysis explores the necessity and sufficiency of individual demographic and economic conditions, church and state relations, and popular attitudes about church involvement in politics while examining the consistency of their presence in paths that lead to "spiritual non-religious" identification. The results suggest that in the midst of an atmosphere of attitudes that oppose the involvement of religious organizations in politics that is related to the size of the institutional religious canopy, a nation's structural economic forces may be driving the variance in religious identification that is associated with spiritual identification. However, a full understanding of this relationship can only be gained through combining tests offered in this work with future qualitative cross-national studies tha

Personal injury lawyers aid clients who see themselves as victims of medical, commercial, or other forms of negligence and who seek compensation through the civil justice system. Previous studies have suggested that these lawyers are highly selective, accepting only a small percentage of potential cases with which they are presented. Yet little is known about the actual process of screening. How do lawyers decide which cases to accept and which to decline? Do lawyers agree on the factors that make a good case and those which make a bad case? How might local legal and cultural environments influence the screening process? These questions, and related issues of access, inequality, policy, and justice, are at the core of this dissertation.Using in-depth interviews and an experimental vignette study given to 83 lawyers who specialize in medical malpractice and products liability, I examine the case screening process, paying particular attention to the roles of tort reform and the legal cultures and environments in which lawyers work. Half the lawyers I interviewed practice in states which are considered to be difficult jurisdictions for the practice of personal injury law due to tort reform and conservative political climates (Texas and Colorado), while the other half work in states that have been relatively unaffected by tort reform and are considered to be more "plaintiff friendly" (Pennsylvania and Massachusetts).Lawyers respond not only to legal rules and changes to those rules, but also to their perceptions of how jurors will respond to and evaluate their case. My analyses show that while lawyers in both types of states accept roughly the same percentage of cases, they do so using different approaches and theories of liability. When making distinctions between good and bad cases, lawyers in states without tort reform emphasize the importance of a client's "likeability" and jury appeal, while lawyers in states with tort reform place more importance on characteristic