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This study examined the roles of self-focused attention and post-event processing in social performance anxiety and social interaction anxiety. College students (N = 101) completed measures of social performance anxiety, social interaction anxiety, self-focused attention, post-event processing, and beliefs related to social anxiety. Interoceptive self-focused attention and post-event processing predicted social performance anxiety after controlling for social interaction anxiety. The associations with social interaction anxiety were not significant after controlling for social performance anxiety. Associations of behavioral self-focused attention with social performance anxiety and social interaction anxiety were not significant after controlling for interoceptive self-focused attention. No evidence of an interaction between self-focused attention and post-event processing in the prediction of social anxiety was found. This study found no evidence that the associations of interoceptive self-focused attention and post-event processing with social performance anxiety were statistically mediated by high standards, conditional beliefs about self, and unconditional beliefs about self. These results and their theoretical implications are discussed.

Social anxiety disorder (SAD) is often treated as a discrete diagnostic entity that represents a naturally occurring class, though empirical evidence largely supports a dimensional conceptualization of social fears. Further, the inclusion of a "performance only" specifier in the DSM-5 implies that individuals who experience intense social anxiety exclusively in performance situations are distinct from those with broader social fears. The purpose of the present research was to examine the latent structure of SAD and the DSM-5 "performance only" specifier in a large nonclinical sample (n = 2019). Three taxometric procedures (MAXCOV, MAMBAC, and L-Mode) were applied to indicators derived from two commonly used measures of social anxiety. Results yielded convergent evidence indicating that social anxiety exhibits a dimensional latent structure. Further, social performance anxiety demonstrates continuous relationships with milder social fears, suggesting that the "performance only" specifier may not represent a discrete entity. The implications of these findings for the assessment, diagnosis, classification, and treatment of social anxiety are discussed.

Extant stimulus-specific fear measures are limited to a small number of stimuli and contain significantly different content. This article describes 2 studies that develop a more flexible fear measure—the Circumscribed Fear Measure (CFM)—and examine its psychometric properties. In Study 1, participants (N = 771) completed an initial item pool while considering their most feared stimulus. Results of factor analyses were used to propose a 25-item, 5-factor measure that would span the domain of specific phobia reactions, applicable to different stimuli. In Study 2, participants (N = 959) completed the 25-item CFM, extant phobia measures, and a measure of disability. The CFM exhibited a 5-scale structure that had an equivalent structure across different stimuli. It showed good factorial validity, reliability, and generally good convergent and discriminant validity. Criterion validity was commensurate with that of extant phobia measures. The use of the measure as an index of an individual's greatest fear is also discussed. The CFM shows promise and could have substantial research and clinical utility.

Objective: To determine the influence of previous infectious illnesses and health care coverage on the utilization of health care services for young children. Study Population: Children aged 6 weeks to 5 years who received health care at a large pediatric practice in Norfolk and Chesapeake, VA enrolled between 3/96 and 11/97 into an ongoing 3-year surveillance study. Methods: At enrollment, parents completed an oral survey concerning their knowledge, attitudes, and practices regarding infectious illnesses and health care utilization. Parents were questioned regarding previous experience and anticipated utilizations. Results: The 517 children were 52% male and 81% white. The mean age was 22 ± 1 mo. Parents reported that children had a median of 1 visit (range 0-25) to the physician for upper respiratory symptoms in 6 mos prior to the survey. In order to visit the physician, 49% of parents would miss work. Children previously diagnosed with otitis media (OM) were more likely to visit the physician for ear pain (326/329) than children without a previous OM (173/181)(OR=5.03; 95% CI, 1.2-29.7). All 44 children previously diagnosed with Group A Streptococcus (GAS) pharyngitis were more likely to visit the physician for sore throat than children without a previous GAS pharyngitis (370/433)(p=.007). Children previously diagnosed with “cold” (211/363) were less likely to visit the physician for future cold symptoms than children without a previous diagnosis of “cold” (103/152) (OR=0.66; 95% CI, 0.43-1.00). Previous diagnoses of bronchitis and pneumonia did not influence anticipated health care utilization for cough. The level of parental education did not influence anticipated health care utilization for upper respiratory symptoms. In this study, 495/517 (96%) families reported third party health care coverage. Families covered by HMO, Medicaid, and CHAMPUS tended to visit a physician more often for rhinorrhea and cold symptoms (p=.08) than PPO, private insurance, and self-pay families. Conclusions: Previous diagnoses of OM and GAS pharyngitis were the most important predictors of parental behavior for increased health care utilization in this survey. Previous experience with “cold” resulted in fewer visits to the physician. These findings will guide efforts to educate parents for appropriate health care utilization in a private practice setting.

Objective: To determine the frequency of health care utilization for infectious illnesses in a pediatric practice and factors that affect utilization. Study Population: Children aged 6 weeks to 5 years who received health care at a large pediatric practice in Norfolk and Chesapeake, VA enrolled between 3/96 and 10/97 into an ongoing 3-year surveillance study. Methods: Attempts were made to enroll all age-eligible children in the practice. Demographic and medical history data were collected at enrollment and updated monthly. Office visit records were reviewed 2 weeks prior to enrollment for all children and when children were sick. Associations between parental education level and type of health care coverage on frequency of visits for illness were analyzed using Poisson regression analysis. Results: This analysis includes 506 (9%) of age-eligible children in the practice followed for 6618 child months (range 1-21 mos/child). 414 (82%) children had 1861 illness visits (mean 3.4/child-year) that resulted in 2526 diagnoses including 1615 (64%) that involved the upper respiratory tract. Otitis media (OM) was the most frequent primary diagnosis (21%) followed by uncomplicated upper respiratory infections (URI) (15%), sinusitis (4%), and Group A Streptococcus (GAS) pharyngitis (1%). 23% of diagnoses were combinations of the above. The mean number of visits for OM (1.0/child-year) was greater than for the other diagnoses (URI.6/child-year, sinusitis.1/child-year, GAS pharyngitis.06/child-year). 73% of parents had more than a high school education. 98% of families were covered by third party health insurance including: 82% by employer-administered health insurance(private insurance, HMO, PPO), Medicaid 9%, and CHAMPUS 7%. Children of parents with more than a high school education had more sick visits than parents with a high school education or less (Rate ratio=1.18, p=.002). Families with no insurance visited the physician the least often (Rate ratio=0.43, p=.008), followed by CHAMPUS (Rate ratio=.80, p=.03), private insurance, HMO, and PPO (reference group), and Medicaid (Rate ratio=1.13, p=.12). When level of education and type of health care coverage were adjusted, each influenced health care utilization (p

A previous retrospective follow-up mortality study of white men employed at an oil refinery found an excess of leukemia deaths, especially of acute myeloid leukemia (AML). A case-control study was done to determine if the excess could be related to any particular jobs or departments at the refinery or to benzene exposures. The study includes 14 cases with leukemia (eight cases with AML) and 50 matched controls. No particular job or department was identified as the likely source of the excess leukemia deaths. Furthermore, the cases apparently had not been exposed to more benzene than had the controls. Thus, the reason for the excess leukemia at this refinery was not identified. The limitations of the study are discussed.

A retrospective follow-up mortality study of white male employees of an oil refinery located in southern illinois revealed a statistically significant excess number of deaths due to leukemia compared with the experience of U.S. white males (standardized mortality ratio [SMR] = 213; 95% confidence interval [Cl], 117 to 358). The excess was due mainly to acute myeloid leukemia (AML) (SMR = 394; 95% Cl, 172 to 788). From 1973 to 1982, fourteen leukemia deaths were identified; eight of the cancers were of the AML cell type. The work histories of the decedents were examined for the potential for benzene exposure. Although specificity of the work histories was limited, the investigation has shown that the subjects did not work in jobs identified as having the highest benzene exposures. At this time, the excess leukemia remains unexplained.