Karen Rose Duszynski

family Attitudes Reported in Youth as Potential Predictors of Cancer

&NA; In long‐term prospective study of a cohort of former medical students, men who later developed cancer reported different family attitudes in youth from those of their healthy classmates. The items checked on a Family Attitude Questionnaire by the future cancer group indicated a lack of closeness to parents compared with the items checked by the healthy group. Family attitudes of the future mental illness/suicide group resembled those of the cancer group, while those of the essential hypertension and coronary heart disease groups were like those of the healthy group. These prospective findings appear to fit with those of retrospective studies concerning early family relationships in cancer patients.

Family attitudes in youth as a possible precursor of cancer among physicians: a search for explanatory mechanisms.

A measure of youthful family attitudes, the Closeness to Parents Scale, has continued to be predictive of cancer among physicians in a prospective study of medical students. Nonetheless, questions have remained concerning the meaning and reliability of this measure and whether its predictive value is diminishing over time. Perhaps more important, it is necessary to ascertain whether the relationship is the result of some methodological artifact or whether it is mediated by an association with known risk factors, such as smoking, drinking, and radiation exposure. Each of these issues was examined in turn, using a variety of statistical techniques to refine the scale and to equate cancer and control groups with respect to risk factors as well as possible artifacts. In a group of 913 men, it was found that the scale is primarily a function of good father-son relationships and that its association with later cancer persists even after the influence of possible mediating and artifactual variables is statistically controlled. Several possible explanations for these findings are discussed.

Attitudes toward narcotic addiction.

In an effort to isolate the major dimensions of attitude and expectation regarding narcotic addiction and its treatment and to compare different groups of addict/clients and agency staff on these factors, a comprehensive questionnaire was administered to 900 addict/clients and 237 agency personnel in 25 drug treatment clinics in six states. Results of a factor analysis, which used questionnaire data from all of the 1137 subjects so that direct group comparisons could be made, indicated the presence of 10 major dimensions of attitude and expectation. Results also suggested considerable variation, particularly by status (client us. staff) and ethnic group, on these dimensions. An additional analysis of staff attitudes and expectations revealed correlations with years of education, ex-addict status, and years of work experience. Such findings suggest the need to consider client/staff characteristics and attitudes in the planning of treatment services for narcotic addicts. An abbreviated (53- item) attitude and expectation questionnaire was developed for this purpose.

MMPI-168 profiles of male narcotic addicts by ethnic group and city.

MMPI-168 profiles were obtained on 225 male narcotic addicts who were attending methadone maintenance clinics in Baltimore and New York City during 1983 and 1984. Data were collected on Black and White (Anglo, other than Hispanic) addicts in Baltimore and on Black, Hispanic, and White addicts in New York City. In general, the profiles indicated high levels of psychopathology, with particularly high elevations on the F, D, PD, PT, and Sc scales. Consistent across cities and in agreement with earlier findings, profiles of Whites indicated somewhat more maladjustment than those for Blacks, while the profiles of Hispanics displayed essentially the same levels of disturbance as those for Whites. Comparisons by city revealed greater deviance for New York City subjects, a finding more evident among Whites than among Blacks.

Are words of the Rorschach predictors of disease and death? The case of "whirling".

&NA; The frequency with which the word whirling and similar words (whirlall words) were used in Rorschach tests administered to 1154 medical students 20 to 35 years ago has been counted by computer. Subjects (now for the most part physicians in midlife) were assigned to different groups according to their health status as of December 1982. When the proportion of subjects using whirlall words was compared across health groupings, those in the suicide and other deaths groups had used the largest proportions of such words. Subjects were then divided into dead and living groups, and those in the total dead group showed a threefold greater frequency of whirlall words than did those in the living group, a highly significant difference (p less than 0.001). Also, the mean number of Rorschach responses was significantly higher for the dead group as compared with the living group (p less than 0.05) and for the major cancer group as compared with the healthy group (p less than 0.01).

Relationships between client/counselor congruence and treatment outcome among narcotic addicts

Abstract Questionnaire data on 897 narcotic addict clients admitted to 25 drug treatment clinics in six states were used to test the hypothesis that the greater the degree of congruence (agreement) between clients and counselors on how they view the clients problems and the most effective ways to deal with them, the more successful the treatment outcome. Results indicated that relationships between client-counselor congruence, as measured by three major content domains of the questionnaire, and treatment outcome, assessed by counselor ratings of client progress at 6-month follow-up varied among ethnic/sex groups of addicts. Blacks and Hispanics, and particularly black females, generally showed the greatest association between congruence and outcome, and whites, particularly white males, the least. Although these congruence/outcome relationships were slight, the need for tailoring treatment according to ethnic/sex classification of addicts is suggested. Issues relating to the predictive utility of congruence as a measure of treatment outcome are discussed.

Differences among treatment clinic types in attitudes toward narcotic addiction.

Factor analysis of data from a general survey of attitudes and opinions concerning narcotic addiction and its treatment revealed 10 major dimensions, five of which were likely to have significant implications for drug abuse intervention strategies. For these latter dimensions, differences were determined among clients and staff according to type of treatment clinic (three types involving the provision of methadone maintenance in various combinations with other treatments and one involving the use of abstinence only). The most pronounced differences were between the methadone clinics and those offering abstinence only. Both theclients and staff of abstinence clinics were more skeptical concerning treatment effectiveness, were more negative regarding the use of narcotice drugs, and were more disposed to the use of ex-addict counselors kand group procedures in treatment.

Youthful habits of work and recreation and later cancer among physicians

Scores on seven factors derived from a Habits of Work and Recreation Survey administered to 1,038 white male medical students 17 to 35 years ago were used to compare students who subsequently developed some form of major cancer with those who did not. With the Type I error rate controlled through use of multivariate analysis of variance and age and smoking ruled out as possible confounding variables, the two groups were significantly differentiated, primarily in terms of intellectual interests--cancer cases having fewer. Students at or below the overall mean on the intellectual interests measure were more than three times as likely to develop cancer as were students with scores above the mean. In this population, the results appear interpretable in terms of the stamina concept, in which few intellectual interests may reflect an absence of stamina and spontaneity and/or failure to meet subcultural expectations--factors possibly associated with increased cancer risk.

A multivariate analysis of circulatory data and their relationship to later disease

Measurements on 21 separate variables involving blood pressure and heart rate were obtained under casual, resting, and controlled conditions as part of the baseline evaluation of 1087 white males participating in a prospective investigation of possible precursors of premature disease and death. These measurements were subjected to a components-type factor analysis with orthogonal rotation of component vectors in an effort to construct statistically independent composites of greater predictive power and generality as well as to minimize problems in interpretation introduced by partially redundant variables. Multivariate and univariate techniques were afterwards used to test differences between groups of subjects who developed specific major disorders and those who remained in good health. Comparison of factor scores with original circulatory measures in a series of prospective analyses revealed that the former had the greater predictive power. Although only the hypertension group could be unequivocally differentiated from all others, a number of nominally-significant findings may provide leads for further research.

Dimensions of Family Attitudes among Female Medical Students

Factor analyses of a 65-item Family Attitudes Questionnaire were performed using data from 77 female medical students, and the results compared with those derived from parallel analyses previously carried out on 913 males. The first unrotated principal component appeared to be highly similar in both male and female groups, in that family closeness is the construct apparently measured. Further analyses, however, revealed the first principal component to be a function of good overall family relationships in women, but primarily a function of good father-son relationships in men.