A cost benefit analysis of an enhanced seat belt enforcement program in South Africa.

OBJECTIVE: To examine whether a program to increase the wearing of seat belts in a South African urban area would be worthwhile in societal terms. DESIGN: A cost benefit analysis of a one year enhanced seat belt enforcement program in eThekwini (Durban) Municipality. METHODS: Data were drawn from two main sources--a 1998 study of the cost of road crashes in South Africa and, given the absence of other data, a meta-analysis of the effectiveness of various types of interventions to reduce road crash casualties in the United States--and were analyzed using cost benefit analysis. RESULTS: A program designed to enforce greater wearing of seat belts, estimated to cost 2 million rand in one year, could be reasonably expected to increase seat belt usage rates by 16 percentage points and reduce fatalities and injuries by 9.5%. This would result in saved social costs of 13.6 million rand in the following year or a net present value of 11.6 million rand. There would also be favorable consequences for municipal finances. CONCLUSIONS: Investment in a program to increase seat belt wearing rates is highly profitable in societal terms.

Psychopathy and developmental instability.

Psychopaths are manipulative, impulsive, and callous individuals with long histories of antisocial behavior. Two models have guided the study of psychopathy. One suggests that psychopathy is a psychopathology, i.e., the outcome of defective or perturbed development. A second suggests that psychopathy is a life-history strategy of social defection and aggression that was reproductively viable in the environment of evolutionary adaptedness (EEA). These two models make different predictions with regard to the presence of signs of perturbations or instability in the development of psychopaths. In Study 1, we obtained data on prenatal, perinatal, and neonatal signs of developmental perturbations from the clinical files of 643 nonpsychopathic and 157 psychopathic male offenders. In Study 2, we measured fluctuating asymmetry (FA, a concurrent sign of past developmental perturbations) in 15 psychopathic male offenders, 25 nonpsychopathic male offenders, and 31 male nonoffenders. Psychopathic offenders scored lower than nonpsychopathic offenders on obstetrical problems and FA; both psychopathic and nonpsychopathic offenders scored higher than nonoffenders on FA. The five offenders from Study 2 meeting the most stringent criteria for psychopathy were similar to nonoffenders with regard to FA and had the lowest asymmetry scores among offenders. These results provide no support for psychopathological models of psychopathy and partial support for life-history strategy models.

The functions of aggression by male teenagers.

A selectionist theory states that violence by males toward male peers originally served specific functions and violence to female peers served others. Differences in self-reported victimization and perpetration in studies of 1.452 high school students were hypothesized. In Study 1, male-to-male aggression was reported to be more prevalent than male-to-female aggression. For male-to-male aggression, perpetrator reports agreed with or exceeded victim reports, and victims were more often strangers than close friends, In contrast, for male-to-female aggression, there were consistently fewer reports from perpetrators than from victims, and victims were less often strangers than girlfriends. Study 2 obtained similar findings for reported frequency, number of victims and perpetrators, and sexual aggression. Study 3 showed that girls' aggression contrasted with that by boys with respect to intra- versus intersex aggression and perpetrator victim agreement.

Dissimulation in phallometric testing of rapists' sexual preferences.

Sexual preferences of 38 rapists were assessed phallometrically with and without a semantic tracking task in a counterbalanced design. Four categories of audiotaped vignettes describing neutral interactions, consenting sex, rape, and nonsexual violence were employed as stimuli. In the semantic tracking task, participants were instructed to press one button when violent events were described in the vignette and another when sexual activities were described. Phallometric assessment with the semantic task better discriminated between rapists and non-sex-offender participants (from an earlier study) than the same assessment without the task. Among four rapists who had previous experience with phallometric testing, there was a very strong correlation between deviance scores and tracking accuracy. Results suggest that the semantic task may improve discriminant validity, particularly among sex offenders who have had previous experience with phallometric assessment.

Birth order and fluctuating asymmetry: a first look.

We investigated the hypothesis that maternal immunoreactivity to male-specific features of the foetus can increase developmental instability. We predicted that the participants' number of older brothers would be positively related to the fluctuating asymmetry of ten bilateral morphological traits. The participants were 40 adult male psychiatric patients and 31 adult male hospital employees. Consistent with the hypothesis, the participants' number of older brothers--but not number of older sisters, younger brothers or younger sisters--was positively associated with fluctuating asymmetry. The patients had significantly larger fluctuating asymmetry scores and tended to have more older brothers than the employees, but the positive relationship between the number of older brothers and fluctuating asymmetry was observed in both groups.

Risk appraisal and management of violent behavior.

OBJECTIVE: To help clinicians enhance the safety of the public, hospital staff, and patients and improve patient management, this article briefly reviews recent empirical work on appraisal of the risk of violence and the management of violent individuals. METHODS: Research on the prediction, management, and treatment of violent persons published in the last decade was reviewed. RESULTS: Risk appraisal research indicates that violence is predictable in some populations. The factors most highly and consistently related to risk are historical, including age, sex, past antisocial and violent conduct, psychopathy, aggressive childhood behavior, and substance abuse. Major mental disorder and psychiatric disturbance are poor predictors of violence. Actuarial methods are more accurate in predicting risk than unaided clinical judgment, which is a poor index. The Violence Risk Appraisal Guide has been shown to be a reliable and accurate actuarial instrument. Well-controlled studies have shown the effectiveness of behavior therapy and of behavioral staff training programs to reduce violence by persons in institutions, chronic psychiatric patients, and other populations. Otherwise, little is known about what psychotherapeutic or pharmacological treatments reduce violent recidivism by which clients under what circumstances. Recent work on the neurophysiology of aggression holds exciting promise but does not yet provide a scientific basis for prescriptive treatment. CONCLUSIONS: The most exciting and promising avenues for research on the management of violence lie in the joining of two scientific paths to understanding violence--biology and psychology.

Cross-validation and extension of the violence risk appraisal guide for child molesters and rapists.

A cross-validation of the Violence Risk Appraisal Guide was performed on a sample of 159 child molesters and rapists followed for an average of 10 years at risk. The performance of the instrument was also examined on a 10-yr followup of 288 sex offenders that included both those in the original construction sample for the VRAG and the validation sample. The instrument performed as well as it had in construction for predicting violent recidivism in both the cross-validation and extended followup samples, and moderately well in the prediction of sexual recidivism. Survival analyses showed that child molesters exhibited higher risk of sexual recidivism than rapists or offenders against both children and adults, whereas the opposite was true for violent recidivism. As predicted, psychopathy and phallometrically determined sexual deviance exhibited a multiplicative interaction effect on sexual recidivism. Proportional hazards event history analyses supported the use of the VRAG for the prediction of violent recidivism among sex offenders.

Viewing time as a measure of sexual interest among child molesters and normal heterosexual men.

Although phallometric assessment is the best scientific method for measuring male sexual interest, it is intrusive and highly technical. We examined viewing time as an unobtrusive and technically simple measure of sexual preference and compared the discrimination obtained by viewing time measures with that obtained by phallometric measures. Slides of nude males and females of various ages were shown to child molesters and normal men while their viewing times were recorded. Subjects then rated the sexual attractiveness of the stimulus persons. Phallometric assessments using the same stimulus categories were also given to some of the Ss. Deviance scores calculated from the viewing time data significantly discriminated between the child molesters and the normals, although the discrimination achieved was less than that obtained using phallometric measures. Sexual attractiveness ratings did not differentiate the two groups. Among the normal men, viewing time and sexual attractiveness ratings were highly correlated; but the correlation was much lower for child molesters. Viewing time shows considerable promise as an unobtrusive measure of male sexual interest.

Violent recidivism: assessing predictive validity.

Until very recently, there has been little evidence of the ability of either clinicians or actuarial instruments to predict violent behavior. Moreover, a confusing variety of measures have been proposed for the evaluation of the accuracy of predictions. This report demonstrates that receiver operating characteristics (ROCs) have advantages over other measures inasmuch as they are simultaneously independent of the base rate for violence in the populations studied and of the particular cutoff score chosen to classify cases as likely to be violent. In an illustration of the value of this approach, the base rates of violence were altered with the use of data from 3.5-, 6-, and 10-year follow-ups of 799 previously violent men. Base rates for the 10-year follow-up were also altered by changing the definition of violent recidivism and by examining a high-risk subgroup. The report also shows how ROC methods can be used to compare the performance of different instruments for the prediction of violence. The report illustrates how ROCs facilitate decisions about whether, at a particular base rate, the use of a prediction instrument is warranted. Finally, some of the limitations of ROCs are outlined, and some cautionary remarks are made with regard to their use.

Salient victim suffering and the sexual responses of child molesters.

In phallometric testing, audiovisual stimuli in which the audio component depicted a child victim's suffering described from the child's point of view were compared with similar scenarios described from the adult male offender's point of view and to portrayals of consenting adult heterosexual activity. Fifteen male participants who had sexually assaulted girls and 15 nonoffenders were also administered questionnaire measures of empathy and opinions regarding sex with children. Consistent with predictions, maximal discrimination between groups was obtained using deviance indices based on stimuli that emphasized victim trauma. Also consistent with predictions, the questionnaire measures were related to sexual deviance. Recommendations are made regarding stimuli for phallometric testing. The results point to the relevance of changing deviant preferences and enhancing empathy for the victim in the treatment of child molesters.

Psychopathy as a taxon: evidence that psychopaths are a discrete class.

Taxometric analyses were applied to the construct of psychopathy (as measured by the Psychopathy Checklist) and to several variables reflecting antisocial childhood, adult criminality, and criminal recidivism. Subjects were 653 serious offenders assessed or treated in a maximum-security institution. Results supported the existence of a taxon underlying psychopathy. Childhood problem behaviors provided convergent evidence for the existence of the taxon. Adult criminal history variables were continuously distributed and were insufficient in themselves to detect the taxon.

Sexual recidivism among child molesters released from a maximum security psychiatric institution.

The recidivism of 136 extrafamilial child molesters who had received phallometric assessment in a maximum security psychiatric institution from 1972 to 1983 was determined over an average 6.3-year follow-up. Fifty had participated in behavioral treatment to alter inappropriate sexual age preferences. Thirty-one percent of the subjects were convicted of a new sex offense, 43% committed a violent or sexual offense, and 58% were arrested for some offense or returned to the institution. Subjects convicted of a new sex offense had previously committed more sex offenses, had been admitted to correctional institutions more frequently, were more likely to have been diagnosed as personality disordered, were more likely to have never married, and had shown more inappropriate sexual preferences in initial phallometric assessment than those who had not. Behavioral treatment did not affect recidivism.

An empirical approach to classification and treatment planning for psychiatric inpatients.

Treatment efforts for psychiatric patients traditionally are organized according to diagnosis, length of stay, age, and level of management difficulty. The current study, prompted by an attempt to reorganize services for 178 patients at a regional psychiatric hospital, examined the incidence of 72 problems exhibited either in the community prior to admission or within the institution. Factor and cluster analyses were used to identify clinically important subgroups of patients. Implications of the results for institutional organization also are discussed.

The relationship between neuroleptic drug dose and the performance of psychiatric patients in a maximum security token economy program.

This study examined the relationship between neuroleptic medication dose and performance in a token economy program on two maximum security psychiatric wards. Patients receiving higher than average doses exhibited poorer than average program performance but there was a small but statistically significant positive relationship between neuroleptic drug dose (measured in CPZ units/kg) and program performance. However, this positive relationship existed only for the first few weeks of patients' hospital stays, and there was a delay (approximately 2 weeks) between the administration of the drug and the maximal positive effect on program performance. Only a very small minority of medication changes were ever followed by improvements in program performance. The results are discussed in terms of what is a rational strategy for the provision of psychiatric medication and other forms of treatment in institutional settings.