A study explored how young adults experience control and exercise personal agency (self-determination) as they pass through periods of transition in education and training, work, unemployment, and in their personal lives. Data were gathered through structured questionnaires administered to at least 100 young adults from universities and companies, and among unemployed young people in each of these three contexts in two localities in Germany and one in England that were experiencing economic transformation. In addition, 21 group interviews were carried out involving 136 participants from these groups. First findings from the study showed that choice and uncertainty can be important dimensions in young adults' biographies in the current moment. Their experiences and actions are not exclusively determined by socializing and structural influences, but also involve elements of subjectivity, choice, and agency. The research is expected to contribute to understanding of the process involved in becoming independent and personally effective in different settings. It is also expected to add to the debate about the most effective ways to support transitions in early adult life. (Contains 19 references.) (KC) Reproductions supplied by EDRS are the best that can be made from the original document. REVISED VERSION APRIL 24TH 2000 'Taking Control of their Lives? `: first findings from a comparative study ofpersonal agency and social structures in young adult transitions in England and the new Germany Karen Evans', Peter Rudd2, Martina Behrens3, Jens Kaluza 4, Claire Woolley 5 Paper presented at the American Educational Research Association Conference New Orleans, April 24th 28th, 2000 Correspondence: Professor Karen Evans School of Educational Studies, University of Surrey Guildford, Surrey, GU2 5XH United Kingdom e-mail: k.evans@surrey.ac.uk ' University of Surrey, England 2 National Foundation for Educational Research, England 3 University of Surrey Research Fellow (Hanover Project) 4 University of Surrey Research Fellow (Leipzig Project) 5 University of Surrey Research Fellow (Derby Project)

Background: The debate continues regarding the best management for women with low-grade abnormal cervical cytology attending colposcopy. We compared psychosocial outcomes of alternative management policies in these women. Methods: In all, 989 women, aged 20–59 years, with low-grade abnormal cytology, were randomised to immediate large loop excision (LLETZ) or two to four targeted punch biopsies taken immediately with recall for LLETZ if these showed cervical intra-epithelial neoplasia 2/3. At 6 weeks after the last procedure, women completed the hospital anxiety and depression scale (HADS) and the impact of event scale (IES). At 12, 18, 24 and 30 months post recruitment, women completed the HADS and process outcome specific measure (POSM). Prevalence of significant depression (⩾8), significant anxiety (⩾11) and distress (⩾9) and median POSM scores were compared between arms. Multivariate odds ratios (ORs) for immediate LLETZ vs biopsy and recall were computed. Results: Over the entire follow-up, there was no significant difference between arms in cumulative prevalence or risk of significant depression (OR=0.78, 95% CI 0.52–1.17) or significant anxiety (OR=0.83, 95% CI 0.57–1.19). At 6 weeks post procedure, distress did not differ significantly between arms. At later time points, 8–11% had significant depression and 14–16% had significant anxiety but with no differences between arms. The POSM scores did not differ between the arms. Conclusions: There is no difference in long- or short-term psychosocial outcomes of immediate LLETZ and punch biopsies with selective recall.

Objective To estimate the cost effectiveness of alternative methods of managing low grade cervical cytological abnormalities detected at routine screening.Design Cost analysis within multicentre individually randomised controlled trial.Setting Grampian, Tayside, and Nottingham.Participants 4201 women with low grade abnormalities.Interventions Cytological surveillance or referral to colposcopy for biopsy and recall if necessary or referral to colposcopy with immediate treatment based on colposcopic appearance.Main outcome measures Data on resource use collected from participants throughout the duration of the trial (36 months), enabling the estimation of both the direct (health care) and indirect (time and travel) costs of management. Quality of life assessed at recruitment and at 12, 18, 24, and 30 months, using the EQ-5D instrument. Economic outcomes expressed as costs per case of cervical intraepithelial neoplasia (grade II or worse) detected, by trial arm, as confirmed at exit, and cost utility ratios (cost per quality adjusted life year (QALY) gained) for the three pairwise comparisons of trial arms.Results The mean three year discounted costs of surveillance, immediate treatment, and biopsy and recall were 150.20 pound ((sic)177, $249), 240.30 pound ((sic)283, $415), and 241.10 pound ((sic)284, $4000), respectively, viewed from the health service perspective. From the social perspective, mean discounted costs were 204.40 pound ((sic)241, $339), 339.90 pound ((sic)440, $563), and 327.50 pound ((sic)386, $543), respectively. Estimated at the means, the incremental cost effectiveness ratios indicated that immediate treatment was dominated by the other two management methods, although it did offer the lowest cost per case of cervical intraepithelial neoplasia detected and treated. The pronounced skews in the distributions indicated that probabilistic uncertainty analysis would offer more meaningful estimates of cost effectiveness. The observed differences in the cost effectiveness ratios between trial arms were not significant.Conclusion Judged within the time frame of the TOMBOLA evaluation, there is no compelling economic reason to favour any one follow-up method over either of the others.

Substantial integration of quantitative and qualitative data and findings in mixed methods studies is seldom seen, although maximizing the potential of the approach depends on this. An absence of exemplars has been identified as among a number of factors that currently impede integration in studies carried out by researchers using the approach. This article offers an example of how maximum integration of data sets can be achieved. The sociological study discussed used a combination of methods - questionnaire survey, group interviews, and individual interviews - to obtain a fuller view of young people's perspectives on their lives. Aspects of the project's research design and analyses that were instrumental to achieving a genuinely integrated mixed methods approach are identified.

Objective: To establish whether women with low‐grade abnormalities detected during screening for cervical cancer prefer to be managed by cytological surveillance or by immediate colposcopy. Methods: TOMBOLA (Trial of Management of Borderline and Other Low‐grade Abnormal smears) is a randomized controlled trial comparing alternative management strategies following the screen‐detection of low‐grade cytological abnormalities. At exit, a sample of TOMBOLA women completed a questionnaire eliciting opinions on their management, contingent valuations (CV) of the management methods and preferences. Within‐trial quality of life (EQ‐5D) data collected for a sample of TOMBOLA women throughout their follow‐up enabled the comparison of self‐reported health at various time points, by management method. Results: Once management had been initiated, self‐reported health in the colposcopy arm rose relative to that in the surveillance arm, although the effect was short‐term only. For the majority of women, the satisfaction ratings and the CV indicated approval of the management method to which they had been randomized. Of the minority manifesting a preference for the method which they had not experienced, relatively more would have preferred colposcopy than would have preferred surveillance. Conclusions: The findings must be interpreted in the light of sample bias with respect to preferences, whereby enthusiasm for colposcopy was probably over‐represented amongst trial participants. The study suggests that neither of the management methods is preferred unequivocally; rather, individual women have individual preferences, although many would be indifferent between methods.

Objectives: The aim of this study was to estimate the time and travel costs generated by women when attending for Papanicolaou (Pap) smear tests or colposcopy appointments in the United Kingdom, both absolutely and relative to the health service cost of the national cervical cancer screening programs.Methods: Data were obtained from questionnaires completed by two samples of women participating in a three-center trial of management of low-grade abnormalities detected by screening (n = 1,106 for Pap smears and n = 1,203 for colposcopy appointments). Women were 20 to 59 years of age and resident in Grampian or Tayside, Scotland, or Nottingham, England. Questionnaire data were supplemented with sociodemographic information previously collected at the time of recruitment to the trial.Results: The mean total time and travel costs per attendance at a smear test and at a colposcopy appointment were estimated to be £9.2 and £27.4, respectively, averaged across the three trial areas (valued at 2002 prices). Statistically significant intercenter disparities in time and travel costs were identified, particularly with respect to colposcopy appointments. For these, time and travel costs in Nottingham were substantially less than those in Grampian and Tayside (£22.9, £30.2, and £32.1, respectively). Time and travel costs amount to 26 and 33 percent, approximately, over and above the direct health service costs of the English and Scottish screening programs, respectively.Conclusions: The time and travel costs associated with participation in the UK cervical cancer screening programs are substantial and are not spatially uniform across the country.

Receipt of an abnormal cervical smear result often generates fear and confusion and can have a negative impact on a woman's well-being. Most previous studies have focussed on high-grade abnormal smears. This study describes the psychological and psychosocial effects, on women, of having received a low-grade abnormal smear result. Over 3500 women recruited to TOMBOLA (Trial Of Management of Borderline and Other Low-grade Abnormal smears) participated in this study. Anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS) at recruitment. Socio-demographic and lifestyle factors, locus of control and factors associated with the psychosocial impact of the abnormal smear result were also assessed. Women reported anxiety levels consistent with those found in previous studies of women with high-grade smear results. Women at highest risk of anxiety were younger, had children, were current smokers, or had the highest levels of physical activity. Interventions that focus particularly on women's understanding of smear results and pre-cancer, and/or directly address their fears about cancer, treatment and fertility might provide the greatest opportunity to reduce the adverse psychosocial impact of receiving a low-grade abnormal cervical smear result.

A study explored how young adults experience control and exercise personal agency (self-determination) as they pass through periods of transition in education and training, work, unemployment, and in their personal lives. Data were gathered through structured questionnaires administered to at least 100 young adults from universities and companies, and among unemployed young people in each of these three contexts in two localities in Germany and one in England that were experiencing economic transformation. In addition, 21 group interviews were carried out involving 136 participants from these groups. First findings from the study showed that choice and uncertainty can be important dimensions in young adults' biographies in the current moment. Their experiences and actions are not exclusively determined by socializing and structural influences, but also involve elements of subjectivity, choice, and agency. The research is expected to contribute to understanding of the process involved in becoming independent and personally effective in different settings. It is also expected to add to the debate about the most effective ways to support transitions in early adult life. (Contains 19 references.) (KC) Reproductions supplied by EDRS are the best that can be made from the original document. REVISED VERSION APRIL 24TH 2000 'Taking Control of their Lives? `: first findings from a comparative study ofpersonal agency and social structures in young adult transitions in England and the new Germany Karen Evans', Peter Rudd2, Martina Behrens3, Jens Kaluza 4, Claire Woolley 5 Paper presented at the American Educational Research Association Conference New Orleans, April 24th 28th, 2000 Correspondence: Professor Karen Evans School of Educational Studies, University of Surrey Guildford, Surrey, GU2 5XH United Kingdom e-mail: k.evans@surrey.ac.uk ' University of Surrey, England 2 National Foundation for Educational Research, England 3 University of Surrey Research Fellow (Hanover Project) 4 University of Surrey Research Fellow (Leipzig Project) 5 University of Surrey Research Fellow (Derby Project)

FOR nearly two years the mind and muscle of America have been dedicated to war, but the dominant note rising above the clash of combat has been unselfishness. The desire to serve has been the usual, not the exceptional, attitude. Our participation in the war represents an altruism rarely manifested by nations; however, this devotion to the well-being of others is not expended alone on far away objects but continues to be demonstrated in every phase of our social and industrial life. Out of this experience has arisen a finer sentiment of human relationship, a realization of the interests that are common to all mankind, and a sense of responsibility to each of those who make up the nation. Men of business engrossed in their particular objects seldom find occasion to voice the idealism which they express in their work. In a true sense, the idealist is practical in that his vision permits him to make use of realities sooner than the man who pursues material advantage so closely that he dare not raise his eyes from the ground to catch a glimpse of a newer and better world. At no other time have we so much needed this spirit or desire to look out upon the distant horizon. The crisp sentence uttered some months ago with respect to making the world safe for democracy has caught the popular ear and conquered the imagination of all men, and is the symbol of that force which will make for an advancing civilization. Consciously or unconsciously the world has revalued its commodities. At the same time it has revalued the human asset. In this process of appraisal our attention has been attracted more by material than by spiritual considerations. All right-thinking men would be pleased to see these new values permanently replace the old standards. It is well-nigh certain, however, that material valuations cannot be stabilized until the social valuations have been tangibly expressed in the policy of those who are called upon to direct the larger affairs of the country. 91