走向深层发展伦理学——贝克风险社会理论的发展伦理学意蕴

对发展伦理学而言,贝克“风险社会理论”的根本方法论意义,在于启发我们思考这样一个问题:“应该用什么方法、在什么层面上建构发展伦理学”?贝克风险社会理论对明确发展伦理学的研究视域、学理层次、研究平台等具有重要方法论启示。     

PROMOTING LOW-FAT ENTREE CHOICES IN A PUBLIC CAFETERIA

Reductions in dietary fat have been recommended in the prevention of coronary heart disease. Because entrees contribute substantially to total meal fat content, we evaluated a cafeteria-based intervention for increasing the purchase rate of low-fat entrees (M = 6.83 g) relative to nonlowfat entrees (M = 25.59 g). The intervention included a poster listing the benefits of a LF diet and the daily LF entrees (i.e., broiled or baked chicken and fish dishes). During 6 days per phase, food selections (N = 3,264) were monitored by trained observers. The intervention, which cost $80.00, produced significant increases (i.e., from 20% to 35%) in the purchase rate of LF entrees.     

Patterns of adolescent involvement in problem behaviors: Relationship to self-efficacy,social competence,and life events

Using a sample of 556 adolescents from a suburban community, patterns of various adolescent problem behaviors (e.g., delinquent behavior, smoking, use of alcohol or drugs) and their links to self-efficacy, social competence, and life events were examined. Cluster analysis was conducted to identify four subgroups of adolescents who showed distinct patterns of problem behaviors. These clusters were compared on the measures of self-efficacy, social competence, and life events. Overall results suggest there are meaningful links between adolescents’ problem behavior patterns and self-efficacy, the amount and quality of participation in various after school activities, and life events. For example, a subgroup of adolescents who showed uniformly low prevalence of all problem behaviors reported more positive academic self-efficacy, more active participation in sports and nonsports activities, more positive life events, and fewer negative events than adolescents who were involved in multiple problem behaviors. Implications for prevention and future research on adolescent problem behaviors are discussed.     

The technical and democratic approaches to risk situations: Their appeal,limitations, and rhetorical alternative

Because of the increasing number of man-made hazards in contemporary life, as well as the growing number of disastrous industrial accidents, interest in risk communication has burgeoned. Consequently, scholars and practitioners need to understand two of the more common responses to risk situations, the technical and democratic. This paper describes these two responses, identifies types of individuals likely to prefer each, and explains why, historically and sociologically, they are so intuitively compelling for many people. Arguing that both responses to risk situations are ultimately unconducive to rational discourse, the paper identifies problematic assumptions about communication that underlie both. The paper then sketches an alternative model of risk communication that recognizes the distinct features of communication in risk-ridden situations, describes ways in which communicators can identify characteristic tensions and goals in these situations, and specifies how to use research-supported heuristics for diagnosing the principal obstacles to their communicative goals and selecting the best strategies to address these obstacles.     

Pigeons' preference for variable-interval water reinforcement under widely varied water budgets.

Water budget of pigeons was varied to assess the dependence of risk-sensitive preferences upon economic context such as has been reported for energy-budget manipulations with small animals in behavioral ecology research. Fixed- and variable-interval terminal-link water schedules reinforced choice between equal variable-interval initial-link schedules arranged on two pecking keys. While keeping a severely restrictive budget the same across three phases of the experiment, a contrasting distinct ample budget was arranged in each. To mimic typical methods in behavioral ecology studies, in each ample budget a more than three-fold increase in amount of water per reinforcer presentation was instituted simultaneously with significantly increased overall access to water. Total choice response rates plummeted in the ample budgets, and body weights either increased significantly or remained unchanged in different phases as expected by the nature of the different manipulations. Clear preferences for the variable-interval schedule were found throughout the experiment, except for rare instances of key bias. The results agree with similar operant food-reinforcement studies and extend conditions under which risk preference apparently does not depend upon economic context.     

Confirmatory Factor Analysis of the Multi-Attitude Suicide Tendency Scale

This paper reports an examination of the factor structure of Orbach's Multi-Attitude Suicide Tendency Scale (MAST) utilizing confirmatory factor analytic techniques. Participants were 215 undergraduate students ranging in age from 18 to 20 who completed the MAST, the Reynolds Adolescent Depression Scale, the Suicide Ideation Questionnaire, and a self-harmful behavior scale. Support was found for the original factor structure, reliability, and validity of the MAST. A correlated model fit the data significantly better than an uncorrelated model. The results of this study indicate that the MAST is a valid and reliable measure appropriate for use with college-aged individuals for research purposes. Because the correlated model fit the data better than the uncorrelated, we suggest that future studies should attempt to replicate this finding, which would lead to a reexamination of the theory which underlies the MAST.     

Health Risk Behaviors and Their Relationships to Health Care Utilization Among Veterans Receiving Primary Medical Care

This paper reports the findings of a behavioral health risk screening form and examines the interrelationships among behavioral risk factors and health care utilization. Participants were 1,000 veterans who completed a brief self-report questionnaire assessing affective distress and behavioral health risk factors while they waited to see their primary care provider. Participants reported a mean level of affective distress in the mild range on a scale of 0 to 20 (M = 6.4, SD = 4.95), and 22.4% reported moderate or high levels of affective distress. Fifty percent of the sample denied alcohol use; 5% of the men and none of the women reported a pattern of use that met established criteria for at-risk drinking. Twenty-six percent of the sample reported current tobacco use, 45% acknowledged concerns about diet and/or weight, and 54% reported concern about pain. These factors were largely significantly intercorrelated and several were related to indices of health care utilization. It was concluded that veterans receiving health care in primary care settings report significant levels of affective distress and other health risk behaviors and that the presence of these factors is associated with increased use of the health care system. These data encourage increased efforts to identify these factors and to develop behavior change interventions.     

A Simple, Unified Approach to Bayesian Risk Calculations

A simple, unified approach for calculating Bayesian risks is presented and illustrated with examples. Although new genetic tools have reduced the need for these risk calculations, situations still exist in which consultands need to know these kinds of risks (for example, when no direct test is available for a particular deleterious mutation, or when a consultand wants to know his/her risk before deciding whether to undergo a direct test). The Unified Approach presented here is straightforward and ensures calculating the correct risks. It can be applied to a wide variety of genetic counseling situations, including but not limited to: calculating recurrence or carrier risks for dominant and recessive diseases; incorporating false-positive and false-negative rates on genetic tests into risk calculations; and determining the probability that an isolated case in a family represents a new mutation. The method is based on basic principles of probability and likelihood theory but can be used without sophisticated knowledge of this theory. The method relies on two rules, the Rule of All Configurations and the Rule of Fundamental Probabilities, which are explained and illustrated. The Unified Approach does not represent new or original mathematics but should make it easier for users to calculate risks accurately. A warning is included that complex calculations should always be independently verified by another individual.     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Women's Understanding of Their Risk of Developing Breast/Ovarian Cancer Before and After Genetic Counseling

Many studies have reported that individuals frequently over- or underestimate their risk of developing cancer both before and after they attend genetic counseling for breast and/or ovarian cancer. Using a combination of interviews and written questionnaires, we investigated counselees' understanding of their risk of developing cancer before and after genetic counseling. We demonstrate that although 76% of the sample thought that their risk was elevated relative to women in general, only a small proportion (17%) were willing or able to provide a numerical estimate of their risk of developing cancer before they attended the clinic. Following the consultation, 43% indicated that their risk of developing cancer was lower than they had anticipated. Twenty-two percent described their risk in absolute rather than relative terms, i.e., that they would definitely (not) develop cancer in the future. The implications of these findings for further research are discussed.