Enhancing social diffusion theory as a basis for prevention intervention: A conceptual and strategic framework

Social diffusion theory has recently been recognized as a promising approach for large-scale disease prevention and health promotion efforts. This paper describes how principles and tactics from social cognitive theory, operant psychology, social psychology, social marketing, and the overarching stages of change model can be used to further develop the conceptual and strategic (technological) bases of social diffusion theory. Within an integrative framework, we discuss in detail more effective ways to train peer mediators of behavior change as one example of how social diffusion theory can benefit from this conceptual and strategic reformulation. We then further illustrate the use of peer mediators of change in human immunodeficiency virus (HIV) and cancer prevention intervention studies with both interventions training peer mediators to diffuse information, norms, and risk reduction strategies. Although the results of these studies showed reductions in high-risk behaviors across population segments, more closely following the framework discussed in this article should further increase the behavior change potential of future interventions based on social diffusion theory.     

Waxing and waning in concert: dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 7 years among clinic-referred boys

Six waves of structured diagnostic assessments were conducted of 168 clinic-referred 7- to 12-year-olds, over 7 years. Wave-to-wave changes in the number of conduct disorder (CD) behaviors were paralleled by correlated changes in the numbers of symptoms of oppositional defiant disorder (ODD), attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety. In addition, CD in Wave 1 predicted levels of ODD, ADHD, depression, and anxiety in later waves when initial levels of those symptoms were controlled, but only ODD in Wave 1 predicted CD in later waves when initial CD levels were controlled. These findings indicate a striking degree of dynamic comorbidity between CD and other types of psychopathology and provide an initial empirical framework for needed developmental models of comorbidity.     

Reviews: Books, Art

POLITICS ON THE COUCH: CITIZENSHIP AND THE INTERNAL LIFE. By Andrew Samuels, 235 pp. New York: Karnac (Other Press). $16.00. MARTHA, MARTHA: HOW CHRISTIANS WORRY. By Elaine Leong Eng, M.D. Binghamton, NY: Haworth Press, Inc., 2000. $14.95. SPILT MILK: PERINATAL LOSS AND BREAKDOWN. Edited by Joan Raphael-Leff. 100 pp. London: Institute of Psychoanalysis, 2000. MOTHERHOOD AND SEXUALITY. By Marie Langer, 305 pp. New York: Other Press, 2000. $30.00. BRANCHING STREAMS FLOW IN THE DARKNESS: ZEN TALKS ON THE SANDOKAI. By S. Suzuki. Eds: M. Weitsman and M. Wegner. 193 pp. Berkeley, CA: University of California Press. $22.50. RESTORED HARMONY: AN EVIDENCE BASED APPROACH FOR INTEGRATING TRADITIONAL CHINESE MEDICINE INTO COMPLEMENTARY CANCER CARE. By Stephen Sagar, MD. xviii + 134 pp. Hamilton, Ontario, Canada: Dreaming Dragonfly Communications, 2001. $19.95 (US); $29.95 (Can.), paperback. (ISBN: 0-9689488-0-4). CHIYO-NI, WOMAN HAIKU MASTER. By Patricia Donegan and Yoshie Ishibashi, 184 pp. Boston: Charles E. Tuttle Co., 1998. $16.95. THE METAPHYSICAL CLUB: A STORY OF IDEAS IN AMERICA. By Louis Menand, 442 pp. New York: Farrrar, Straus, and Giroux, 2001. $27.00. BUDDHISM WITHOUT BELIEFS: A CONTEMPORARY GUIDE TO AWAKENING. By Stephen Bachelor, 127 pp. Riverhead Books, 1997. $21.95. Video Art is Dead, Long Live Video Art     

Holocaust survivors in a primary care setting: fifty years later

Past studies have not assessed the prevalence of emotional disturbances in Holocaust survivors seeking medical treatment in a family practice environment. The present study examined the prevalence of lifetime (the presence of symptomatology at any time) and current posttraumatic stress disorder (PTSD) symptoms, general anxiety, and depression in Holocaust survivors seeking medical treatment in a primary care setting. 20 of the 27 Holocaust survivors in our sample received a current diagnosis of PTSD and reported significant symptoms of depression and general anxiety. Although 74% of the survivors were currently diagnosed with PTSD, participants in this study had reported an overall decline in reexperiencing, hyperarousal, and overall PTSD symptoms but exhibited increased avoidance and numbing symptoms throughout the lifespan. These preliminary results suggest that removing avoidance as a defense mechanism during the course of psychotherapy may leave these survivors without an adequate way for coping with their trauma, subsequently increasing their vulnerability to psychopathology. Implications for psychological interventions are provided.     

Natural mentors and adolescent resiliency: a study with urban youth

Natural mentors may play an important role in the lives of adolescents. We interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported having a natural mentor. Those with natural mentors were less likely to smoke marijuana or be involved in nonviolent delinquency, and had more positive attitudes toward school. Natural mentors had no apparent effect on anxiety or depression. Using the resiliency theory framework, natural mentors were found to have compensatory but not protective effects on problem behaviors, and both compensatory and protective effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are explored for problem behaviors and school attitudes. The potential importance of natural mentors is supported, and implications for future research are considered.     

Lateral asymmetry in phonological processing: relating behavioral measures to neuroimaged structures

Recent neuroimaging studies have revealed neuroanatomical centers of activation that appear to be linked specifically to phonological processes. Furthermore, there is evidence that these centers of activation are more likely to be bilaterally represented in women than in men. However, behavioral evidence of such hemispheric asymmetries or of related sex differences is somewhat inconsistent. Two experiments were carried out to determine whether behavioral correlates of the neuroimaging findings could be demonstrated. The first experiment employed a rhyme-matching task used in a recent neuroimaging study, in which two nonsense words were projected successively to the left or right sides of the visual field. The results indicated that the left hemisphere was superior for this task. An analysis of gender effects, however, revealed that the asymmetry was restricted to men. The second experiment employed a lateralized pseudohomophone detection task that was designed to determine whether the results of the first experiment could be confirmed in the context of a phonological task with a simpler structure. This experiment broadly supported the findings of the first experiment. The results support the specialization of the left hemisphere for phonological processing, and the existence of gender differences with respect to these processes.     

Assault victimization and suicidal ideation or behavior within a national sample of U.S. adults

Data from a nationally representative sample of 5,238 U.S. adults were used to examine the extent to which physical assault victimization was associated with suicidal ideation or behavior (SIB). The results from multivariable logistic regression analyses indicate that physical assault victimization was positively associated with SIB after adjusting for sociodemographic characteristics and alcohol use (OR = 3.6; 95% CI = 2.4-5.5). Those who were injured during the most recent physical assault (OR = 2.7; 95% CI = 1.2-6.0) and those who were assaulted by a relative (OR = 3.4; 95% CI= 1.0-11.0) or intimate partner (OR = 7.7; 95% CI = 2.7-22.5) were significantly more like to report SIB than victims who were not injured or were assaulted by a stranger. Also, those who were victimized but not injured (OR = 5.6; 95% CI = 3.8-8.2) and those who were victimized by a stranger (OR = 2.9; 95% CI = 1.4-6.0) were more likely to report SIB than non-victims. These results highlight the need for legal, medical, mental health, and social service providers to address the co-occurrence of violent victimization and suicidal ideation, particularly, but not exclusively, victimization by family members and intimates.     

Pharmacogenetics: ethical issues and policy options

Pharmacogenetics offers the prospect of an era of safer and more effective drugs, as well as more individualized use of drug therapies. Before the benefits of pharmacogenetics can be realized, the ethical issues that arise in research and clinical application of pharmacogenetic technologies must be addressed. The ethical issues raised by pharmacogenetics can be addressed under six headings: (1) regulatory oversight, (2) confidentiality and privacy, (3) informed consent, (4) availability of drugs, (5) access, and (6) clinicians' changing responsibilities in the era of pharmacogenetic medicine. We analyze each of these categories of ethical issues and provide policy approaches for addressing them.