Spinning on its axes: DSM and the social construction of psychiatric diagnosis.

Through a critical examination of the psychiatric profession's heavy reliance on the Diagnostic and Statistical Manual of Mental Disorders, the authors explore the central role of diagnosis in the theory and practice of psychiatry. The set of beliefs that have guided the psychiatric profession since the creation of DSM-III are viewed as being tied to the new extension of the biopsychiatric medical model. From a sociological perspective, the authors address the issue of psychiatric nosology with reference to practice styles and professional dominance, and consider the impact of DSM's intrinsic social biases both within and outside psychiatry's traditionally drawn boundaries. They conclude that working soley within the confines of a medical framework of diagnosis, with little attention to the wider social and cultural contexts that should surround diagnostic practice, psychiatry will be unable to understand and explain the changing needs of its clientele.

Parenting from a distance: the effects of paternal characteristics on contact between nonresidential fathers and their children.

Changes in marital and fertility behavior have influenced the role of father for many men. We use data from the first two waves of the National Survey of Families and Households to examine various sociodemographic, situational, and attitudinal characteristics that might influence the degree of contact between nonresidential fathers and their minor children. We tap two different dimensions of distance parenting and find that although several variables influence both visiting and talking on the telephone or writing letters, some factors (the presence of multiple children in a household) predict visiting only, while others (child's age and gender) predict only verbal/written contact. Similarly, some of the life-course decisions made by fathers appear to crowd out their involvement with nonresidential children, whereas other decisions reinforce their parenting behavior.

Fathers and absent fathers: sociodemographic similarities in Britain and the United States.

Using data from the British Household Panel Survey and the National Survey of Families and Households in the United States, we present a sociodemographic profile of fathers and compare the determinants of absent fatherhood in each country. Although fatherhood has a younger profile in the United States, especially for blacks, predictors of fathers' residency with their children are remarkably similar in the two countries. In both countries, the strongest predictor of a father's absence is the parent's relationship to each other at the time of the child's birth. Policy implications of this finding are discussed.

The initiation of adolescent sexual and contraceptive behavior during changing times.

This paper examines changes in the initiation of adolescent sexual and contraceptive behavior in the United States between 1978 and 1988. Since a number of contextual changes occurred during this time period including a focusing of public attention on adolescent pregnancy along with the widespread publicity surrounding AIDS, we expected that the response to these events not only would change over time, but would also vary across social groups. Using data from Cycles III and IV of the National Survey of Family Growth, we find that the overall population patterns of earlier initiation of sexual intercourse and increased use of condoms at first intercourse are not found in all segments of the population. In general, the effects of race, religion, mother's education, and age changed during this time period. The long-term trend of younger age at first intercourse was halted for Blacks, and reversed for White, fundamentalist Protestants, but continued for all other Whites. Overall, patterns throughout the decade suggest that pressures from parents, religious groups, and others either lead to a later age at first intercourse, or use of contraception, but not both. A notable exception is that increased maternal education leads to both a later age at first intercourse and a higher likelihood of using contraception at first intercourse.

PIP: Over the period 1978-88, the US public gave increasing attention to adolescent pregnancy and AIDS. In that context, one might expect changes in the initiation of adolescent sexual and contraceptive behaviors. The authors examined such changes. The analysis of data from the third and fourth cycles of the National Survey of Family Growth failed to demonstrate the existence of trends toward the earlier initiation of sexual intercourse and increased use of condoms at first intercourse in all population segments. The effects of race, religion, mother's education, and age changed during the period. The long-term trend of younger age at first intercourse continued for all Whites except those who are fundamentalist Protestants, ended for Blacks, and reversed for White, fundamentalist Protestants. Overall patterns throughout the decade suggest that pressures from parents, religious groups, and others lead to either a later age at first intercourse or use of contraception, but not both. Increased maternal education, however, leads to both a later age at first intercourse and a higher likelihood of using contraception at first intercourse.

Infant and child mortality in rural Egypt.

This research examines determinants of infant and child mortality in rural Egypt, primarily the effects of household economic status and the availability of health services. Certain features of the health service environment affect survival in the neonatal period. In early childhood, survival chances improve markedly as income increases and if the household depends almost exclusively on employment income. In infancy and in early childhood, mortality is strongly associated with region of residence and maternal demographic characteristics, and is weakly associated with parental schooling.

PIP: Maternity history and household economic data were analyzed for 2783 ever married women from rural areas collected during the February-June 1980 Egyptian Fertility Survey (part of the World Fertility Survey) to examine economic and health service determinants of infant and child mortality. The neonatal, early infant, and early child mortality rates were 78,63, and 128 respectively. Children who lived in Upper Egypt were more likely to die than those in Lower Egypt. Neither household sanitation, maternal risk factors, socioeconomic factors, nor medical facilities or personnel accounted for this difference. It was thought that differences in culture were responsible for the discrepancy. The major determinants of child survival during the 1st month included maternal risk status (maternal age, parity, and months passed since prior birth) and region (p.01). In addition, neonatal mortality was highest in villages with only a traditional birth attendant (daya) and those with no combination health unit (p.05). Combination units provided health services as well as social, educational, and rural economic services. During the early infancy period (1-7 months), just region and maternal risk status considerably influenced child survival (p.01). By the time children reached the early childhood stage (8-59 months), the effect of region tapered off, but maternal risk status remained a significant determinant (p.01). It was only during this period that higher household income, especially if it were mostly employment income, significantly improved child survival (p.05). Children from households making up to top 1/3 of income distribution were 35% less likely to die than those from the remaining households. Maternal and paternal education did not greatly affect child survival. It is concluded that economic position and economic well being considerably influenced child survival.

Factors in the resolution of adolescent premarital pregnancies.

This article examines the effect of family background factors on first premarital pregnancy resolution for adolescents in the United States. Teenage fertility constitutes a sizable percentage of total fertility, and each outcome has a potentially different type of family structure associated with it. Not only are there marked racial/ethnic differences in the ways such pregnancies are resolved, but the effects of family structure, age at first conception, family size, and working mother also differ between blacks, whites, and Hispanics. Parental education is a highly significant predictor for all groups: the higher the level of education, the less likely the pregnancy will be carried to term.

Household income and child survival in Egypt.

This article uses household-level economic and fertility survey data to examine the relationship between household income and child survival in Egypt. Income has little effect on infant mortality but is inversely related to mortality in early childhood. The relationship persists with other associated socioeconomic variables controlled. The mechanisms underlying the income effects are not evident from this analysis: income differentials in sources of household drinking water, type of toilet facilities, and maternal demographic characteristics do not explain the net impact of income on child mortality. The absence of effects on child survival of the size of the place of residence and the relatively weak effects of maternal schooling are also notable.

Birth weight and the effects of birth spacing and breastfeeding on infant mortality.

Analyses previously reported, based on data from the World Fertility Survey (WFS), are replicated here with data from the Malaysian Family Life Survey. Comparison of results, when data limitations inherent in the World Fertility Surveys are reproduced or relaxed, suggests that these limitations cause little distortion, and thus bolsters confidence in the validity of results based on WFS data in which these limitations are inescapable. Generalizations based on the present investigation and on the body of previous work that it tends to validate are presented. Most significantly, these include the greater importance of both breastfeeding and birth spacing under generally unfavorable conditions, the variability of durations to which some benefit of continued breastfeeding persists, and the observation that the great majority of birth-spacing effects operate through some mechanism other than the association of breastfeeding with birth interval lengths.

PIP: Analyses previously reported, based on data from the World Fertility Survey (WFS) are replicated with data from the Malaysian Family Life Survey, based on a stratified probability sample for 1,262 ever-married women 50 years of age in Peninsular Malaysia. Comparison of the results, when data limitations inherent in the WFS are reproduced or relaxed, suggests that these limitations cause little distortion, and thus bolsters confidence in the validity of results based on WFS data in which these limitations are inescapable. Generalizations based on the present investigation and on the body of previous work that it tends to validate are presented. The greater importance of both breastfeeding and birth spacing under generally unfavorable conditions becomes clear. The relationship between breastfeeding and survival for all births, as well as for the last 2 births, emphasized in this model, has a logit coefficint significant at the .01 level for the 1st month of life as well as the period from birth to 1 year. The durations to which some benefit of continued breastfeeding persists, are variable. In countries where the situation generally is more favorable to child survival, as indicated by rates of infant mortality, breastfeeding's positive effects on child survival are less significant. Breastfeeding promotion and continuation should be the goal especially for programs operating among very poor groups. The great majority of birth spacing effects operate through some mechanism other than the association of breastfeeding with birth interval lengths, as indicated by the fact that significant survival advantages are often associated with birth spacing after controlling for breastfeeding.