Promoting adolescent health: worksite-based interventions with parents of adolescents.

A promising public health approach for reducing adolescent risk behavior is to recognize and support the role of parents in promoting healthful behaviors. Although there are various settings where parents can be reached, this article focuses on one particular setting--the parent's place of employment. The article discusses the development and implementation of parenting programs for parents of adolescents. Such programs are new and should be evaluated to determine whether they are effective.

The relationship between ethical ideology and ethical behavior intentions: an exploratory look at physicians' responses to managed care dilemmas.

Within the past few years, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This paper examines the relationship between physicians' behavior intentions with respect to four managed care ethical scenarios and their responses to Forsyth's (1980) Ethics Position Questionnaire (EPQ). This is one of the first papers to compare this scale to behavioral intentions in the workplace. We provide a literature review of the ethical dilemmas that doctors face under a managed care system and conduct a national random sample of general practitioners and surgeons regarding the four managed care ethical dilemmas. The results show that the doctors surveyed are significantly more idealistic than relativistic. In relating the EPQ to the ethical scenarios, however, there was no support for the proposition that ethical ideology was related to the ethical behavioral intentions. This suggests more research is needed to establish the links between ethical positions, attitudes, and behavioral intentions. Finally, there were little differences in EPQ scores by practice or demographic variables, the only significant result being that general surgeons are significantly more idealistic than family practitioners.

Leaving an unethical managed care plan: an exploratory look at doctors' intentions.

To address the problems of unnecessary care and limited resources, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing pressures. This article briefly considers four ethical situations that doctors face under managed care systems. The article surveys a national random sample of general practitioners and surgeons to determine how doctors would respond to these dilemmas and the extent to which exposure to such situations influences them to leave a managed care plan.

Culture, coping, and context: primary and secondary control among Thai and American youth.

Do cultural values and traditions influence the development of coping styles ? To address this question, we compared self-reports of coping by 6-14-year-olds in Thailand and the U.S. One hundred and forty-one children were interviewed about six common stressors: separation from a friend, injection in a doctor's office, adult anger, peer animosity, school failure, and physical injury. Children's self-reported coping methods were coded as overt or covert. Coping goals were coded as reflecting primary control (attempts to influence objective conditions), secondary control (attempts to adjust oneself to objective conditions), or relinquished control. Although findings revealed numerous cross-national similarities, there were also multiple main and interaction effects involving culture, suggesting that sociocultural context may be critical to our understanding of child coping. Consistent with literature on Thai culture, Thai children reported more than twice as much covert coping as American children for stressors involving adult authority figures (i.e. adult anger, injection in doctor's office). Thai children also reported more secondary control goals than Americans when coping with separation, but American children were five times as likely as Thais to adopt secondary control goals for coping with injury. The findings support a model of coping development in which culture and stressor characteristics interact, with societal differences most likely to be found in situations where culture-specific norms become salient.

The ethics of managed care. An initial look at physicians' perspectives.

The need for medical care in the United States had exceeded the financial resources required to pay for that care. To address this problem, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This article reviews the ethical dilemmas physicians face under a managed care system and conducts a national random sample of general practitioners and surgeons regarding four major ethical dilemmas: under treatment of patients due to overt pressures or financial incentives, breaches of patient confidentiality by the physician that are required by the managed care plan, lack of disclosure to the patient of the financial incentives or overt pressures under which the physician functions, and overuse of practice guidelines. The results of this survey suggest that physicians are more likely to compromise patients' confidentiality and not discuss financial arrangements with patients than they are to compromise actual patient care. Those physicians with more than 30 percent of their patient load coming from managed care are more likely to have faced the scenarios presented by the survey. There is, however, no statistically significant difference in the physicians' responses to these scenarios based on the percentage of the physicians' patient load coming from managed care.

A multimethod study of problem behavior among Thai and American children in school: teacher reports versus direct observations.

Previous literature describes Thai children as unusually polite, deferent, and behaviorally restrained. Yet, in a recent study employing teacher reports, Thai children were reported to show many more behavior problems than American children. Such a finding may reflect culture-linked differences in the perspective of Thai versus American teachers. To explore this possibility, we used trained observers to conduct direct observations of Thai and American children's school behavior, and we obtained teacher reports on the same children. Observational results were precisely the opposite of previous and present teacher-report findings: Observers reported twice as much problem behavior and off-task behavior in American children as in their Thai age-mates. This pattern may reflect Thai-U.S. differences in teachers' style, societal values and practices, even child temperament. The finding support the value of direct behavior observation in cross-national research on child problems.

Behavioral and emotional problems among Thai and American adolescents: parent reports for ages 12-16.

We studied adolescents' behavioral and emotional problems in the United States and in Thailand, a Buddhist country in which, reportedly, aggression is discouraged and self-control, emotional restraint, and social inhibition are encouraged. Standardized parent reports on 118 problems revealed 45 Thai-U.S. differences. Thai adolescents were reported to show more overcontrolled problems (e.g., shyness, compulsivity, inhibition of talking, fearfulness, and constipation) than American adolescents (p < .0001). The two groups did not differ reliably in total undercontrolled problems, but Americans showed higher levels of direct, overt, and interpersonally aggressive undercontrol (e.g., fighting and bullying), whereas Thais showed more indirect and subtle undercontrol that was not interpersonally aggressive (e.g., sulking and sullenness). The findings suggest that different cultures may be linked to different styles of adolescent problem behavior.