The Hassles Scale (HS; Kanner, A.D., et al., J. Behav. Med. 4: 1-39, 1981) has aroused considerable debate. Its authors and some others report that it provides a superior way of operationalizing psychosocial stress and that it predicts health outcomes as well as or better than measures of major life events. Critics contend that the HS is confounded by an inability to separate the external, objective sources of stress from the internal, subjective reactions to it and that it measures, rather than predicts, psychological distress. In this article we argue that a careful distinction between the two major HS summary scores, Hassle Number and Hassle Intensity, will largely disentangle the confound. Results based on data collected from a sample of alcohol and substance abusers (N = 630) suggest that the number of external stressors and the strength of internal reactions to them can be separately assessed using the HS. Results indicate that these two components are independently as well as jointly associated with psychological distress.

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At year's end, students' perceptions toward the learning environment, as reported on the MSLES, differed significantly according to the medical school campus where they trained. Further studies are needed to identify specific factors, such as grading policies, administrative support, and existence of learning communities, which may influence perceptions of the learning environment at various schools. Identifying such variables would assist schools in developing a positive learning environment.