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Patterns of reassault in batterer programs.

A comparative multisite evaluation was conducted of four "well-established" batterer programs in geographically distributed cities to assess the pattern of reassault. Eight hundred and forty batterers were recruited and tested at program intake from each site (210 per site). The batterers and their partners were interviewed by phone every 3 months for 15 months after intake with a response rate for the female partners of nearly 70% for the full follow-up. According to initial victims, 31% of the men reassaulted during the follow-up. The reassault rate varies only slightly when adjusting for new partners (32%) or no partner contact (32%), but substantially more when adjusting for reports from the batterers (36%) and batterers plus arrest record (39%). Rates of verbal abuse (70%) and threats (43%) are much higher, but 73% of the women report feeling "very safe." Nearly half of the men who reassaulted did so within 3 months after program intake. "Voluntary" participants were significantly more likely to reassault (44% vs. 29%), as were program dropouts (40% vs. 28%). The "well-established" batterer programs appear to contribute to a short-term cessation of assault in the majority of batterers. However, a small portion of the men are unaffected by or unresponsive to the intervention.

Adult↗

Youth access to tobacco: the effects of age, gender, vending machine locks, and "it's the law" programs.

OBJECTIVES: This study evaluated the influence of age, gender, vending machine lockout devices, and tobacco industry-sponsored voluntary compliance programs ("It's the Law" programs) on underage youths' ability to purchase tobacco. METHODS: Twelve youths made 480 attempts to purchase tobacco in Massachusetts from over-the-counter retailers and vending machines with and without remote control lockout devices. Half the vendors were participating in It's the Law programs. RESULTS: In communities with no requirements for lockout devices, illegal sales were far more likely from vending machines than from over-the-counter sources (odds ratio [OR] = 5.9, 95% confidence interval [CI] = 3.3, 10.3). Locks on vending machines made them equivalent to over-the-counter sources in terms of illegal sales to youths. Vendors participating in It's the Law programs were as likely to make illegal sales as nonparticipants (OR = 0.87, 95% CI = 0.57, 1.35). Girls and youths 16 years of age and older were more successful at purchasing tobacco. CONCLUSIONS: The It's the Law programs are ineffective in preventing illegal sales. While locks made vending machines equivalent to over-the-counter sources in their compliance with the law, they are not a substitute for law enforcement.

Adolescent↗

Involuntary treatment of eating disorders.

OBJECTIVE: Involuntary treatment of any psychiatric disorder has always been controversial, especially for eating disorders. Patients with an eating disorder of life-threatening severity frequently refuse hospitalization. In this study, the authors compared individual characteristics and treatment outcomes of patients admitted to an inpatient program for voluntary or involuntary treatment of their eating disorder. METHOD: This study examined 397 patients admitted to an inpatient treatment program over 7 years. Demographic measures, length of illness, weight history, and treatment response of patients admitted for voluntary treatment and those legally committed for involuntary treatment were compared. RESULTS: The two groups were similar in age, gender ratio, and marital status, but those legally committed for involuntary treatment had a longer illness duration and significantly more previous hospitalizations. At admission, the patients legally committed for involuntary treatment were lower in weight and required a significantly longer hospitalization to attain a healthy discharge weight. However, there was no statistically significant difference between involuntary and voluntary patients in rate of weight restoration (2.6 versus 2.2 lb/week, respectively). The groups did not differ in history of comorbid substance abuse or clinical depression but did differ significantly on all admission IQ measures. Eating disorder severity, as assessed by the Eating Attitudes Test-26, Eating Disorder Inventory, and MMPI-II, was similar for both patient groups. CONCLUSIONS: This study suggests that a substantial minority of patients with severe eating disorders will not seek treatment unless legally committed to an inpatient program. Despite the involuntary initiation of treatment, the short-term response of the legally committed patients was just as good as the response of the patients admitted for voluntary treatment. Further, the majority of those involuntarily treated later affirmed the necessity of their treatment and showed goodwill toward the treatment process. Only a long-term follow-up study will indicate whether these two populations differ in the enduring nature of their treatment response.

Adult↗

HIV surveillance among injecting drug users.

Injecting drug users (IDUs) should be considered a 'partially hidden population' at high risk for HIV infection. In almost all locations it should be possible to locate and conduct research with IDUs, but it will probably never be possible to enumerate or draw random samples from an IDU population. Surveillance research studies with IDUs should include risk behaviors, as surveillance of HIV infection only will not be sufficiently time sensitive, and be used to develop and refine HIV prevention programming for the population. Contacts with IDUs can be developed at multiple settings, including voluntary treatment programs, law enforcement settings, and through 'street outreach.' Each type of setting has different advantages, disadvantages and ethical concerns. HIV testing as part of surveillance also raises additional important ethical concerns. The primary risk behaviors that should be included in surveillance studies are 'sharing' of drug injection equipment, the potential for rapid partner change among risk partners, and sexual risk behavior. Additional important objectives for surveillance research include: (1) the size of the local IDU population, (2) patterns of drug use, (3) availability injection equipment, (4) participation in prevention activities, and (5) access to and use of anti-retroviral treatments. HIV incidence is an ultimate objective for surveillance research, but there are no currently available cost-efficient methods for studying HIV incidence, so estimation from indirect measurements is usually required.

HIV Infections↗

Review of the teaching of medical ethics in London medical schools.

The study examined the influence of the Pond Report on the teaching of medical ethics in the London medical schools. A questionnaire was given to both medical students and college officers. All medical colleges reported that ethics was included in the curriculum. However, from students' replies, it seems that attendance of optional courses is low and that not all current final year medical students have had any formal teaching in medical ethics. Stronger guidelines are necessary to ensure appropriate ethical training in London medical schools.

Curriculum↗

Insurance for the insurers. The use of genetic tests.

Genetic testing raises concerns that individuals will be denied health insurance (and thus, effectively, access to health care), or that employers will screen to eliminate potentially costly workers. Although we as a society do not yet concur on the degree to which private businesses have a responsibility to promote social justice, several different policy alternatives might allow us to weigh the interests of insurers, as businesses, against the interests of citizens in a responsible manner.

Eligibility Determination↗

Screening for HIV.

Explore the source record for details and available documents.

AIDS Serodiagnosis↗

AIDS: social, legal, and ethical issues of the "third epidemic".

The "first" and "second" epidemics of AIDS are considered to be the spread of HIV infection and subsequent development of AIDS cases; what has been termed the "third epidemic" is the widespread economic, social, and cultural reaction to the disease, raising crucial social, humanitarian, and legal issues. This article deals with four questions arising from these issues: (1) What is the best public health approach to people with HIV/AIDS, and what rights should they have? (2) Who should be subjected to mandatory testing? (3) Who has a right to know or be warned if someone has HIV/AIDS? and (4) How can society be protected against people who irresponsibly or deliberately set out to infect others? It is concluded that, as recommended by the World Health Organization, policies which balance concern for public health with respect for individual rights are both the most humane and the most effective ways to control the spread of AIDS.

AIDS Serodiagnosis↗

The future of public health law.

Developments in medicine and constitutional law dictate modification of public health legislation in the United States. Traditionally overlooked by legislators, present public health laws provide inadequate decision-making criteria and inappropriate procedures for dealing with issues. Revised legislation should provide health care officials and agencies with the tools to balance individual rights against public health necessities. This Article makes four recommendations for legislative reform: (1) remove artificial legislative distinction between venereal and other communicable diseases; (2) provide criteria defining "public health necessity" to limit discretionary exercise of police power by health officials; (3) provide strong confidentiality protections in the collection and storage of public health information; (4) empower public health officials to select from a graded series of less restrictive alternatives in dealing with public health problems.

Civil Rights↗

Ethical issues in testing for differential sensitivity to occupational hazards.

This study examines the ethical aspects of designing preventive health strategies in the workplace that rely on biochemical indexes of worker susceptibility. It analyzes the benefits and risks of this type of occupational testing, and stresses the desirability of guidelines for the use of hypersusceptibility testing in preemployment screening. The primary value of using such programs to identify previously unsuspected hazards in working environments is underscored. The report proposes elements for effective guidelines that can permit the orderly development of hypersusceptibility tests. Further study is needed to validate these technologies; to review the legal elements of consent and disclosure requirements; to assure continuation of equal employment opportunity; to provide legally enforceable protections of workers as research subjects; and to identify the extent, if any, of possible social and psychological harms imposed by such testing.

Beneficence↗