Parents,Peers, and Places: Young Urban Adolescents’ Microsystems and Substance Use Involvement

Limited research is available that explains complex contextual and interactive effects of microsystems such as family relationships, peer networks, and place-based influences have on urban adolescent substance use. We contend that research into these complex processes is improved by integrating psychological, social, and geographic data to better understand urban adolescent substance use involvement. Accordingly, we tested a longitudinal, 3-way moderation model to determine if the direct effect of teen–parent relationships on substance use involvement is moderated by peer network characteristics, which in turn is moderated by the risk and protective attributes within urban adolescents’ activity spaces, among a sample of 248 adolescents. Results revealed that peer networks moderate the effects of relations with parents on substance use involvement for those adolescents with higher levels of risk attributes within their activity space, but not for those who spend time in locations with less risk. Thus, the teen–parent relationship interacts with peer network characteristics, for those urban adolescents whose activity space is constituted within high-risk environments. We conclude that peer networks have important interactive effects with family relationships that influence substance use, and that this is particularly salient for young adolescents who are exposed to risky environments. This finding underscores the importance of continued study into the interrelations among microsystems of urban adolescents, and provides further support that substance use is a social practice that is constituted within the unique geography of young adolescents’ lives.     

Who shall be Allowed to Give? Living Organ Donors and the Concept of Autonomy

Free and informed consent is generally acknowledged as the legal andethical basis for living organ donation, but assessments of livingdonors are not always an easy matter. Sometimes it is necessary toinvolve psychosomatics or ethics consultation to evaluate a prospectivedonor to make certain that the requirements for a voluntary andautonomous decision are met. The paper focuses on the conceptualquestions underlying this evaluation process. In order to illustrate howdifferent views of autonomy influence the decision if a donor's offer isethically acceptable, three cases are presented – from Germany, theUnited States, and India. Each case features a person with questionabledecision-making capacity who offered to donate a kidney for a siblingwith severe renal insufficiency. Although the normative framework issimilar in the three countries, different or sometimes even contraryarguments for and against accepting the offer were brought forward. Thesubsequent analysis offers two explanations for the differences inargumentation and outcome in spite of the shared reference to autonomyas the guiding principle: (1) Decisions on the acceptability of a livingdonor cannot simply be deducted from the principle of autonomy but needto integrate contextual information; (2) understandings of the wayautonomy should be contextualized have an important influence on theevaluation of individual cases. Conclusion: Analyzing the conceptualassumptions about autonomy and its relationship to contextual factorscan help in working towards more transparent and better justifieddecisions in the assessment of living organ donors.     

Community violence exposure,coping, and problematic alcohol and drug use among urban,female caregivers: A prospective study

Victimization is associated with substance use in women, but less is known about linkages between witnessing community violence and substance use, even though more women witness versus directly experience violence. Further, factors that contribute to or protect against women’s problematic substance use are less well understood. Urban female caregivers (N = 318; >92% African American/black) living in low-income communities were interviewed annually for three waves regarding exposure to community violence, coping behaviors, substance use, and protective factors. Path analyses revealed that lifetime witnessing of violence, but not victimization, assessed at baseline, was associated with changes in avoidant coping, but not active coping, one year later; avoidant coping, in turn, was related to changes in and higher levels of problematic drug use the following year. Victimization was directly related to problematic drug use, but not to alcohol use. Regression analyses indicated that high levels of religious commitment and social support at baseline were prospectively associated with lower levels of avoidant coping. Because caregivers are important role models for their children, it is important to attend to the factors that contribute to their substance use and abuse.     

Prevalence of Cognitively Intact Individuals Residing in Extended Care Nursing Facilities

There appears to be a relative absence of studies that have examined the prevalence of cognitively intact individuals who reside in extended care facilities. Prevalence data were collected on 296 persons who resided in 3 extended care nursing facilities in Central Virginia. Cognitive intactness was evaluated via the Minimum Data Set Cognitive Performance Scale (CPS) and an author-generated survey (i.e., Cognitively Intact Survey [CI Survey]) of select nursing staff members at each facility. The Mini-Mental State Examination (MMSE) was utilized to examine the accuracy of the two measures in identifying cognitive intactness. Findings indicated that prevalence rates of cognitively intact residents varied as a function of the measures utilized to assess intactness. Specifically, a significantly greater proportion of the total sample of residents was judged to be cognitively intact via the CI Survey (34.12%) as compared to the CPS (26.01%). The level of interjudge agreement between the two measures was found to be moderately high (K = 0.68). When the MMSE was employed to verify individuals' levels of intactness, the percentages of residents predicted to actually be cognitively intact were somewhat lower for each measure. Specifically, based on the data obtained via the CI Survey, 22.75% of the total sample were predicted to actually be cognitively intact, whereas 17.85% of the sample were predicted to be intact based on the CPS results. Findings are discussed in light of factors that may have contributed to the differential prevalence rates of cognitively intact individuals obtained across the measures utilized in this study. Concerns regarding the utilization of the MMSE as a criterion measure of cognitive intactness in persons residing in extended care nursing facilities are provided, along with data on the living environments/roommate statuses of those residents judged to be intact via the CI Survey. Implications for the design of future extended care nursing units, as well as future research, are also included.     

Applying evidence to support ethical decisions: Is the placebo really powerless?

Using placebos in day-to-day practice is an ethical problem. This paper summarises the available epidemiological evidence to support this difficult decision. Based on these data we propose to differentiate between placebo and “knowledge framing”. While the use of placebo should be confined to experimental settings in clinical trials, knowledge framing — which is only conceptually different from placebo — is a desired, expected and necessary component of any doctor-patient encounter. Examples from daily practice demonstrate both, the need to investigate the effects of knowledge framing and its impact on ethical, medical, economical and legal decisions. An earlier version of this paper was presented at an international conference, “Placebo: Its Action and Place in Health Research Today,” held in Warsaw, Poland on 12–13 April, 2003.     

One line decreases the visibility of a simultaneous identical distant second line

A top line decreased the visibility of a simultaneous, identical, distant bottom line. This context-produced decrease in visibility (DV) occurred when the bottom line was masked by flanking lines and hence was less visible than the top line. It continued when the top line was three times as far from the bottom line. It disappeared without the mask. There was a hint of an opposing context-produced increase in visibility (IV) when the lines were close together. The DV is not accounted for by numerous extant phenomena and theories. It means that the top line decreased the similarity in visibility between it and the bottom line, a contrast effect for visibility, rather than for a typical attribute. Contrast does not occur between two attributes that are perceptually equal. Therefore, the reason why two distant equally visible objects fail to result in a DV may be that their equal visibility precludes the occurrence of contrast. This DV-as-contrast theory is consistent with evidence that two groups (phenomenal wholes) are associated with both contrast and DVs, and thus also with evidence that one group is associated with both assimilation and IVs.