Social factors, treatment, and survival in early-stage non-small cell lung cancer.

OBJECTIVES: This study assessed the importance of socioeconomic status, race, and likelihood of receiving surgery in explaining mortality among patients with stage-I non-small cell lung cancer. METHODS: Analyses focused on Black and White individuals 75 years of age and younger (n = 5189) diagnosed between 1980 and 1982 with stage-I non-small cell lung cancer in Detroit, San Francisco, and Seattle. The main outcome measure was months of survival after diagnosis. RESULTS: Patients in the highest income decile were 45% more likely to receive surgical treatment and 102% more likely to attain 5-year survival than those in the lowest decile. Whites were 20% more likely to undergo surgery than Blacks and 31% more likely to survive 5 years. Multivariate procedures controlling for age and sex confirmed these observations. CONCLUSIONS: Socioeconomic status and race appear to independently influence likelihood of survival. Failure to receive surgery explains much excess mortality.

Explaining reduced cancer survival among the disadvantaged.

The fact that socially disadvantaged cancer patients face a greater risk of mortality than the advantaged is well recognized but poorly understood. Existing research and a newly completed 10-year survival study suggest that complex interrelations among biological factors, medical interventions, and specific dimensions of social differentiation determine survival differences. Patterns of interrelations among determinants of survival appear compatible with an "economic" model in some forms of cancer and a "cognitive-behavioral" model in others. Findings presented here suggest that improved access to health care will reduce mortality risk among the disadvantaged in at least some malignancies, but will not alone make their survival chances equal to those of the advantaged.

Detecting survival effects of socioeconomic status: problems in the use of aggregate measures.

Direct measures of SES are seldom included in medical records or large databases on disease incidence or survival, forcing researchers to infer the SES characteristics of individuals from aggregate data (e.g. census tract-level income, education, etc.). This paper assesses the degree of error that results from such inference and the impact this error may have on reported relationships between SES and survival. The authors obtained both individual and census tract-level data on 536 persons diagnosed with cancer between 1980 and 1982 and monitored their survival through 1992. Pearson correlations between individual-level and census tract-level SES variables ranged between 0.2 and 0.4. Statistically significant relationships between SES and survival were observed in the models based on individual-level but not census tract-level SES data. The authors computed the degree to which inference of individual-level from census tract-level SES reduces estimates of risk ratios across SES. It appears likely that much larger numbers of observations than have been used in published studies will be needed to better understand the relationship of SES to survival and other disease outcomes.

Historical trends in status attainment.

Inquiry into the question of historical trends in status attainment will, in this article, involve the comparison of different age groups and different age groups across time. Mindful of limitations in interpreting differences between age groups as historical trends, this study provides such an analysis. Data for this study are from the NORC General Social Survey (July 1988, University of Chicago) and cover the time period from 1973 to 1988. The data offers an opportunity to both examine certain features of historical change as well as to ascertain its stability.

The effects of alternative support strategies on family caregiving.

Family units (N = 541) of impaired elderly persons and caregivers were randomly assigned to a control group or one of five treatment groups eligible for a variety of respite or educational services. After 12 months of service eligibility, caregivers of elderly persons remaining in the community reported lower levels of subjective burden. Services appeared to delay nursing home placement among families with adult child caregivers, but encouraged placement by spouse caregivers.

Antecedents and consequences of remarriage in later life.

Using the Retirement History Study (RHS), respondents were identified who entered the study widowed or divorced, and then remarried. Respondents were also identified who entered the study as married, became widowed or divorced, and then remarried. In the latter case, because of limitations of the RHS, only males were observed. With some matching relevant to the types of analyses carried out, comparison groups were selected, providing an opportunity to examine both antecedents and consequences of remarriage.

Work disability among cancer patients.

To identify factors affecting the ability of persons with recent cancer diagnoses to remain in the labor force and retain premorbid levels of work performance, the investigators analyzed data on 247 individuals with lung, pancreatic, prostatic, or cervical cancer. Subjects were selected from a population-based tumor registry. According to Pearson correlations, ordinary least squares multiple regression, and logistic analysis, physical factors related to disease were the strongest predictors of work disability, defined as either leaving the labor force or functioning less fully at work than before becoming ill. The strongest predictors of work disability were physical dysfunction measured by the Sickness Impact Profile (SIP) and disease stage. Social background factors such as age, sex, income, and education were not statistically significant predictors. Two job characteristics, (1) physical demands of work and (2) discretion over hours worked and how much work would be done, predicted work disability, the latter appearing to help prevent this condition. Strictly disease-related factors appear more important here in predicting work disability than in studies of other diseases. Still, it appears that increasing flexibility of working hours and the pace of work could help some individuals with cancer histories remain in the labor force. Unwillingness of employers to facilitate such accommodation where technically feasible may constitute a form of discrimination against the cancer patient.

Population growth--a challenge to psychologists.

PIP: This article briefly reviews research conducted in the U.S. on fertility behavior and the characteristics associated with it. The Indianapolis Study (1941), the Family Growth in America Study (1957, 1969), the Growth of American Family Studies (1955, 1960), and the National Fertility Study (1965) are cited. Working wives are associated with lower fertility while Catholics are more often associated with slightly higher fertility. More study is needed to determine the interactions between the number of children desired and intended before and after families are completed, and between the relationship between knowledge and practice of family planning. Motivations for childbearing are discussed in relation to role definitions especially for women. Research into the value systems that are the bases for motivation is proposed.^ieng

THE CHILD BEHAVIOR CHARACTERISTICS (CBC) FORM: REVISED AGE-SPECIFIC FORMS.

The rationale and problems in the development of age-specific CBC forms are described. The relevance of concepts to specific ages and the amount of contact required for rating are precursors t o development of rating forms. Clusters of items that have relevance for the earliest ages were derived from a sequence of studies. The consistency of these clusters in older ages, and the relationship of these to clusters applicable only to the older ages is noted. Reliability and between-cluster correlations are presented.

THE WORK COMPONENTS STUDY (WCS): A REVISED SET OF MEASURES FOR WORK MOTIVATION.

The present study, through reanalysis of earlier data and the analysis of data from a new sample, reports on the refinement of the Work Components Study (WCS). An earlier study yielded six scores but the present one suggests that one of them should be broken into two, yielding seven scores. It is shown that the internal consistency of these scores is satisfactory and that the scores are relatively independent of each other. Finally, the utility of the scores is evaluated by showing their relationships with measures of personality, ability, and aspirations.

Behavioral And Personality Expectations Associated With Status Positions.

Two parallel studies explore whether status-positions may be character- ized by certain general behaviors and personality traits. Fifty-two status- positions, including selected ethnic, occupational, age, sex, and familial categories, were ranked and rated on twenty-eight personality and behavioral characteristics by substantial samples of college students. Analysis of these data indicated that some behavioral characteristics and personality traits are consistently attributed to particular status-positions independently of method (rating or ranking), with little or no effects attributable to the five orders of presentation used. Factor analysis of the status-positions yielded five factors for both the ratings and the rankings, four of which were interpretable and scored: Likeability, Defiance, Responsibility, and Emotionality. The factor structure found was related to previous research on characteristics of persons. Profiles of the status-positions using mean scores based on these four factors plus assertiveness were presented.