Perceptions of community, social capital, and how they affect self-reported health: a multilevel analysis.

OBJECTIVES: The link between social capital and self-reported health has been widely explored. On the other hand, we know less about the relationship between social capital, community socioeconomic characteristics, and non-social capital-related individual differences, and about their impact on self-reported health in community settings. METHODS: Cross-sectional study design with a proportional sample of 7965 individuals from 20 US communities were analyzed using multilevel linear regression models, where individuals were nested within communities. The response rates ranged from 13.5% to 25.4%. RESULTS: Findings suggest that perceptions of the community and individual level socioeconomic characteristics were stronger predictors of self-reported health than were social capital or community socioeconomic characteristics. CONCLUSIONS: Policy initiatives aimed at increasing social capital should first assess community member's perceptions of their communities to uncover potential assets to help increase social capital.

Increasing PAs' awareness and understanding of self-help groups. An educational model.

A model for inclusion of information about self-help groups into a PA training program is provided based on the results of a study of 26 PA students enrolled in a patient-counseling class. Interactions with self-help groups yield more positive beliefs and greater intentions to collaborate with self-help groups than training programs that do not address self-help groups. The experiential component is also useful for increasing understanding of appropriate roles for professionals interacting with self-help groups.

Understanding the attitudes and intentions of future professionals toward self-help.

Examined the attitudes, beliefs, and intentions toward self-help groups of 168 graduate students in clinical psychology and social work from five universities using the theory of reasoned action as a model (Fishbein, 1979). Participants held positive attitudes and beliefs regarding self-help and intended to collaborate. Participants who were members of self-help groups had significantly greater intentions to collaborate and had more positive beliefs vs. nonmembers. There were no differences between social work and psychology students. Path analysis showed that students who held positive attitudes and beliefs and perceived that their faculty were positive regarding self-help had intentions to collaborate with self-help groups. Involving self-help groups as partners in professional training was considered empowering and a wise use of the expert resources that groups can provide.

An assessment of the needs of mutual-help groups.

Assessed the needs of mutual-help groups in relation to how self-help clearinghouses can best assist. Most important problems centered on member involvement, attendance and recruitment, lack of public awareness, and finances. Most important needs were for greater public education and more referrals to groups. Significant differences were found across different types of organizational affiliation for the problems of recruitment of members, lack of public awareness, and problem members. The dynamic nature of mutual-help groups may naturally produce many of the turnover, attendance, and involvement problems which in turn generates the ongoing need to recruit new members in part through greater public awareness. Many of the goals and needs of mutual-help groups, coupled with the large number of group members, may lead to significant social and policy change in health and mental health services.

Understanding the decision to take the predictive test for Huntington disease.

The predictive test for Huntington disease (HD) has allowed those at risk to determine gene status prior to symptoms. The purpose of this research was to understand the motivation and the anticipated reactions of those requesting the test. Forty persons at 50% risk for HD and 31 companions participated in a structured personal interview as part of the predictive test protocol. Reasons for taking the test centered on the reduction of anxiety and uncertainty associated with being at risk and enhanced planning and decision making. Participants also believed that taking the test would produce more positive than negative outcomes. With a favorable result, most anticipated a reduction of anxiety, a more normal future, and relief knowing their children would be at a very low risk. Most also cited benefits as more likely than consequences with an unfavorable result. Making the most of life, easier planning, and reduced uncertainty were rated as more likely than any of the adverse impacts, including short-term depression and becoming frightened. Almost all participants (95%) said they would rather learn that they have the HD gene than remain at 50% risk. The uncertainty, anxiety, and chronic stress associated with being at risk appears to underlie the motivation of many seeking the predictive test for HD.

Estimation of fertility and fitness in Huntington disease in New England.

The advent of presymptomatic and prenatal testing in Huntington disease (HD) may change the reproductive behavior of persons at risk for HD. In order to assess future change, an analysis of fertility and reproductive fitness was carried out on 999 affected and 2,253 unaffected offspring from 235 New England families. Ascertainment biases observed for persons born before 1910 and after 1929 reduced the sample to 250 HD cases and 201 unaffected sib controls born between 1910 and 1929. No increase in reproductive rate was found in HD-affected men compared to male control sibs. A small increase in fertility averaging 0.5 child was seen in HD-affected females compared to unaffected females, but this difference was not significant. The increase in mean number of children for HD females is accounted for in part by a small number of affected women who had very large families. No evidence was found to suggest that any increase in reproductive rate for affected persons was related to offspring being born after HD onset. The fitness of both HD-affected and unaffected females was not significantly different from that of the general population of Massachusetts.

Intentions to use predictive testing by those at risk for Huntington's disease: implications for prevention.

Huntington's disease (HD) is a late onset, genetic disorder that is incurable and undetectable until the onset of symptoms. A marker for the gene that causes HD was recently discovered which will lead to a predictive test. The purpose of this research was to assess the knowledge, attitudes, beliefs, and behavioral intentions concerning the impending predictive test by those at risk for HD. Results indicated that a majority of participants favored using the test presymptomatically and would encourage their adult children to use it as well. Fewer participants favored using the predictive test prenatally or on minors. Characteristics that best differentiated those who intend and do not intend to use predictive testing were identified and discussed. Suggestions for interventions were presented with an emphasis on outreach and prevention programs designed to prepare HD families for the difficult decisions the predictive test will precipitate and the subsequent impact of those decisions.

Predictive testing for Huntington's disease with use of a linked DNA marker.

The probability of carrying the gene for Huntington's disease can in many cases be estimated in the children of affected persons by identifying a specific DNA marker that is genetically linked to the gene. We studied 47 persons at 50 percent risk of inheriting Huntington's disease who requested a presymptomatic or prenatal genetic-linkage test between September 1986 and January 1988. The participants were given pre-test counseling and psychological and neurologic evaluations. Nineteen persons later voluntarily withdrew from the protocol, including one who would have been excluded anyway, and one person was from a family that was too small to allow testing. Three D4S10 restriction-fragment-length polymorphisms produced by the HindIII, EcoRI, and Bg/I enzymes were used for all tests, and the probability that a subject was a Huntington's disease carrier was calculated. The accuracy of the test was compromised by a 4 percent recombination frequency between D4S10 and the Huntington's disease gene. Fifteen presymptomatic tests and one prenatal test were completed. Four yielded positive results, seven yielded negative results, and five were uninformative; seven persons are awaiting test results. All participants with positive tests experienced intermittent depression, but none required hospitalization, and no suicide threats were reported. Five participants received a diagnosis of Huntington's disease on the basis of the neurologic assessment. We conclude that some persons in the early stages of Huntington's disease may seek presymptomatic testing rather than neurologic evaluations.

Intended use of predictive testing by those at risk for Huntington disease.

Huntington disease (HD) is a late-onset genetic disorder that is incurable and undetectable until the onset of symptoms. A marker for the gene that causes HD was recently discovered that will lead to a predictive test. The purpose of this research was to assess the attitudes, beliefs, and behavioral intentions concerning the impending predictive test by those at risk for HD. Results from a sample of 56 at-risk individuals indicated that a majority (65%) favored using the presymptomatic test and would encourage their adult children to use it as well. Fewer but still a substantial percentage of respondents would use the prenatal test (42%) and would test at-risk minors (35%). Surprisingly, knowledge about predictive testing was quite low and a majority of those least knowledgeable about predictive testing intended to use the test. These findings emphasized the need for outreach and prevention efforts to prepare the at risk and specialized programs of genetic counseling and follow up to accompany predictive testing.

An analysis of topic areas and topic trends in the Community Mental Health Journal from 1965 through 1977.

A content analysis of all (N = 604) published articles in the Community Mental Health Journal from 1965 through 1977 was performed (a) to provide a cross-sectional view of the community mental health field, and (b) to identify topic trends over time. Sixty-one content categories were used to classify topic areas. Results revealed major and growing emphases on organizing for the delivery and measuring of the effects of mental health service systems. Topics found to be increasing in relative frequency over time included training, measurement and research methodology, and intervention; those decreasing included planning and needs assessment, therapy, and suicide. Topic areas were compared with key characteristics of the field. Topic trends were interpreted in terms of open systems theory.