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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]

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]

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]

This study employs multichannel sequence analysis of data from the Survey of Health, Ageing, and Retirement in Europe to explore variations in the association between work–family life trajectories and women's mental health across European cohorts born between 1924 and 1965 within different policy contexts. It finds that trajectories characterized by prolonged employment and delayed familial commitments are generally associated with increased depressive symptoms. Notably, the strength of this association varies significantly across cohorts and is notably moderated by defamilization policies. These policies, which aim to reduce dependency on family for managing social risks, buffer mental health challenges in traditional family roles but are less effective for women in trajectories with delayed family formation. This investigation highlights the nuanced ways in which historical and cultural contexts alongside policy environments shape mental health outcomes at various life stages, offering valuable insights into our understanding of health disparities across the life course, with an emphasis on exposure to changing institutions. [ABSTRACT FROM AUTHOR]

In low-income countries, intergenerational processes can culminate in the replication of extreme forms of health disadvantage between mothers and adult daughters, including experiencing a young child's death. The preventable nature of most child deaths raises questions of whether social resources can protect women from enduring this adversity like their mothers. This study examined whether education—widely touted as a vehicle for social mobility in resource-poor countries—disrupts the intergenerational cycle of maternal bereavement. We estimated multilevel discrete-time survival models of women's hazard of child loss using Demographic and Health Survey Program data (N = 195,744 women in 345 subnational regions in 32 African countries). Women's educational attainment minimizes the salience of their mothers' bereavement history for their own probability of child loss; however, mothers' background becomes irrelevant only among women with ≥10 years of schooling. Education's neutralizing influence is most prominent in the highest mortality-burdened communities. [ABSTRACT FROM AUTHOR]

The increased politicization of sexual and reproductive health has created barriers to medically necessary care. In absence of formal health care, social ties become critical sources of information and resources, yet the disclosure of stigmatized health needs carries significant risk. How do people navigate the risks and benefits of disclosure when seeking care for stigmatized needs? Drawing on original survey data (N = 153) and in-depth interviews (N = 55) with women who attempted a self-managed abortion, I first describe the distinct roles of weak and strong ties in women's health-seeking experiences. I then demonstrate how both partial disclosure and nondisclosure are critical tools for obtaining information, resources, and emotional support during periods of health-seeking. Findings advance understanding of disclosure as a continuum that can be strategically wielded by people with stigmatized needs to confront and evade stigma and surveillance from their networks, the state, and the formal health care system. [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]

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 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]

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]

Medical sociologists have much to gain by bringing in global health. In this article, I make the case for expanding our field by furthering sociological perspectives on global health. I reflect on my career, the influence of scholar-activist mentors, and my contributions to the development of scholarship about medicalization, narrative, and global health in medical sociology. First, I focus on medicalization, its relationship to biomedicalization and pharmaceuticalization, and critiques of the medicalization of global health. Second, I analyze the narrative turn in studies of illness experiences and the inclusion of visual materials as an integral part of narrative studies of illness. Third, I explore global health and show examples of bodies of knowledge that medical sociologists are building. Although I present each as a distinct area, my discussion illustrates how the three areas are intertwined and how my contributions to each traverse and build connections among them. [ABSTRACT FROM AUTHOR]

Restrictive immigration policies harm the mental health of undocumented immigrants and their U.S. citizen family members. As a sociopolitical stressor, threat to family due to immigration policy can heighten anxiety, yet it is unclear whether political engagement helps immigrant-origin students to cope. We used a cross-sectional survey of college students from immigrant families (N = 2,511) to investigate whether anxiety symptomatology was associated with perceived threat to family and if political engagement moderated this relationship. We stratified analyses by self/parental immigration statuses—undocumented students, U.S. citizens with undocumented parents, and U.S. citizens with lawfully present parents—to examine family members' legal vulnerability. Family threat was significantly associated with anxiety; higher levels of political engagement reduced the strength of this relationship. However, this moderation effect was significant only for U.S. citizens with lawfully present parents. These findings emphasize the importance of the family immigration context in shaping individuals' mental health outcomes. [ABSTRACT FROM AUTHOR]

Research shows that restrictive immigration policies and practices are associated with poor health, but far less is known about the relationship between inclusive immigration policies and health. Using data from the United States natality files, we estimate associations between state laws granting undocumented immigrants access to driver's licenses and perinatal outcomes among 4,047,067 singleton births to Mexican and Central American immigrant birthing people (2008–2021). Fitting multivariable log binomial and linear models, we find that the implementation of a license law is associated with improvements in low birthweight and mean birthweight. Replicating these analyses among U.S.-born non-Hispanic White birthing people, we find no association between the implementation of a license law and birthweight. These findings support the hypothesis that states' extension of legal rights to immigrants improves the health of the next generation. [ABSTRACT FROM AUTHOR]

Changes in family structure (e.g., parental separation or stepfamily formation) are associated with a deterioration in children's well-being. Most researchers have focused on the impact of such changes on children's educational and psychosocial outcomes, whereas the effects on children's biological processes have been studied less often. We analyze the effects of changes in family structure on children's stress levels using data from the German Health Interview and Examination Survey for Children and Adolescents study (2003–2006 and 2014–2017). Our outcome variable is the biomarker c-reactive protein (CRP), which correlates with psychological distress and is collected from blood samples. Calculating first-difference estimators, we analyze whether children have higher CRP levels after changing to (1) single-parent families (n = 117) or (2) stepfamilies (n = 80). Our findings suggest that changing to a single-parent family significantly increases children's stress, whereas changing to a stepfamily does not. These observations are important because increased stress in childhood can negatively affect well-being later in life. [ABSTRACT FROM AUTHOR]

We investigate recent trends in U.S. suicide mortality using a "structural determinants of health" framework. We access restricted-use multiple cause of death files to track suicide rates among U.S. Black, White, American Indian/Alaska Native, and Latino/a men and women between 1990 and 2017. We examine suicide deaths separately by poisonings and nonpoisonings to illustrate that (1) women's suicide rates from poisonings track strongly with increases in prescription drug availability and (2) nonpoisoning suicide rates among all adult Americans track strongly with worsening economic conditions coinciding with the financial crash and Great Recession. These findings suggest that institutional failures elevated U.S. suicide risk between 1990 and 2017 by increasing access to more lethal means of self-harm and by increasing both exposure and vulnerability to economic downturns. Together, these results support calls to scale up to focus on the structural determinants of U.S. suicide. [ABSTRACT FROM AUTHOR]

On average, incarcerated people have higher rates of poor health, mental illness, and histories of adverse childhood experiences (ACEs) than the general population. This mixed-methods analysis examines the relationship between ACEs and poor adult health among a sample of formerly incarcerated people. The quantitative analysis (N = 122) shows childhood adversity is associated with various health conditions in adulthood, although the strength of this relationship varies by the kinds of ACEs respondents encountered. The qualitative analysis of life history timelines (N = 42) reveals two pathways relating ACEs to poor health and legal system involvement: (1) violence and victimization and (2) drug use as a coping mechanism. Unaddressed mental health challenges in the aftermath of adversity emerged as an important precursor to both pathways. Prisons lack a meaningful consideration of these early life events and the social structures that result in the high rates of vulnerable people in its care. [ABSTRACT FROM AUTHOR]

In the United States, natural disasters have increased in frequency and intensity, causing significant damage to communities, infrastructure, and human life. Migrant workers form part of a growing occupational group that rebuilds in the aftermath of natural disasters like hurricanes and tornadoes. The work these migrant workers perform is essential but also unstable, exploitative, and dangerous, which stresses their health and well-being. This study focuses on the health and well-being of migrant roofers, a precarious occupational group who restores communities and helps the U.S. population adjust to a climate-changed world. Using surveys (N = 359) and in-depth interviews (n = 58) from a convenience sample of migrant roofers, we examine how precarity in terms of employment, housing, and legal status affect the sleep outcomes of these workers, who derive their income from an industry where instability is the norm, live in substandard and irregular housing, and lack workplace protections given their legal status. [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]

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]

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]

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

By comparing national survey data collected in 1957 and 1976, this paper assesses the stability of relationships between social class and the use of professional help for personal problems, examining the influence of education and income on: (a) problem definition, (b) the decision to seek help, and (c) the choice of a particular help source. In spite of a general increase in "readiness for self-referral" from 1957 to 1976 for the population as a whole, social class differences in defining a problem as relevant for professional help and in adopting a self-help position with regard to potential problems (both reported in 1957) generally persist in 1976. Among those who have identified a personal problem as relevant for help, however, social class differences in the actual use of help, apparent in 1957, have largely disappeared. Despite a marked increase in the use of mental health professionals in all socioeconomic strata, education and income differences in the use of psychiatrists and psychologists found in 1957 also generally persist in 1976, although the gap between high- and low-income groups appears to be narrowing. Although perceived psychological distress is found to play a major role in seeking help, differences in professional help-seeking by socioeconomic status are largely independent of reported symptom levels. These patterns of persistence and change are interpreted as reflecting differential changes in the influence of motivational versus facilitating factors, respectively. [ABSTRACT FROM AUTHOR]

Empirical evidence does not support the claim that task delegation to nonphysicians is greater in large medical organizations than in small office practices. Can the behavior of physicians in these organizations he explained through reference to professional attitudes? This paper reports a study which examined simultaneously two sets of variables as predictors of physicians' delegation behavior: (1) paramedical resources available in the organization, and (2) physicians' professional attitudes. A comparison of multiple regression analyses of delegation behavior in traditional work settings and in modern, formally organized settings is presented. In modern settings, in contrast to traditional settings, physicians' delegation behavior was found to be only weakly related to paramedical resources, and it was unrelated to professional attitudes. [ABSTRACT FROM AUTHOR]

This paper examines the association between psychological distress and persons' perceptions of their physical well-being. Associations between psychological distress and ratings of health status within four diverse data sets are examined, controlling for physical health status as well as for sociodemographic variables. The results indicate that, despite variation in the characteristics of the populations under study, the mode of data collection employed, and the specific questions used to measure psychological distress, distress remains a statistically significant correlate of perceived health status. [ABSTRACT FROM AUTHOR]

This paper examines stability and change in reported subjective stress during one year among 263 wives whose husbands suffered a first myocardial infarction. Patterns of subjective stress scores remained relatively stable over the study year. Level of severity of illness in the husband had some relationship to stress score at particular points in time, although clear-cut findings did not emerge. Some variations in subjective stress levels were also found between women of different educational and ethnic backgrounds. Reported subjective stress is reviewed as part of a more general stress experience, reflected in emotional volatility and marital unhappiness, rather than as a correlate of such variables as illness burdens in the household, employment of wife, age, and socioeconomic status. [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 focuses on the question of what characteristic of life events is responsible for their link to psychological disorder, is it the readjustment (i.e., change) inherent in such events or is it their undesirable or threatening character? New data on this issue are presented in the context of previous findings from three studies. The combined evidence favors undesirability as the characteristic of life events that should be measured to most accurately assess their stressfulness. This basic conclusion holds up for a variety of different dependent measures, different methods of defining the desirability of events, and varying ways of weighting events. [ABSTRACT FROM AUTHOR]

This paper has two primary purposes. The first involves the empirical assessment of a general framework for theory and research in health service utilization studies, developed as a modification of Aday and Andersen's (1974) causal structure of access to medical care. My analysis of this framework uses multiple regression techniques on data from a regional cross-sectional survey of 487 households conducted in 1972. The data demonstrate support for the general framework. The second purpose centers around the extant findings that health maintenance organization (HMO) subscribers are less satisfied with their health care than are the conventionally insured. Using the general framework to see what health service utilization characteristics were likely to predispose one to join an HMO, I found that would-be joiners are more likely to be high users of preventive services. Because the main purpose of the HMO is to increase the use of preventive services, and assuming a reasonable rate of diminishing returns of such care, then a "ceiling effect" takes place in which the would-be joiner cannot increase use of preventive care very much, and hence is plausibly and expectably less satisfied with the HMO. [ABSTRACT FROM AUTHOR]