Comparing relative effects of education and economic resources on infant mortality in developing countries

Research on the social determinants of health has often considered education and economic resources as separate indicators of socioeconomic status. From a policy perspective, however, it is important to understand the relative strength of the effect of these social factors on health outcomes, particularly in developing countries. It is also important to examine not only the impact of education and economic resources of individuals, but also whether community and country levels of these factors affect health outcomes. This analysis uses multilevel regression models to assess the relative effects of education and economic resources on infant mortality at the family, community, and country level using data from demographic and Health Surveys in 43 low-and lower-middle-income countries. We find strong effects for both per capita gross national income and completed secondary education at the country level, but a greater impact of education within families and communities.     

Bayesian analysis of skew-normal independent linear mixed models with heterogeneity in the random-effects population

We present a new class of models to fit longitudinal data, obtained with a suitable modification of the classical linear mixed-effects model. For each sample unit, the joint distribution of the random effect and the random error is a finite mixture of scale mixtures of multivariate skew-normal distributions. This extension allows us to model the data in a more flexible way, taking into account skewness, multimodality and discrepant observations at the same time. The scale mixtures of skew-normal form an attractive class of asymmetric heavy-tailed distributions that includes the skew-normal, skew-Student-t, skew-slash and the skew-contaminated normal distributions as special cases, being a flexible alternative to the use of the corresponding symmetric distributions in this type of models. A simple efficient MCMC Gibbs-type algorithm for posterior Bayesian inference is employed. In order to illustrate the usefulness of the proposed methodology, two artificial and two real data sets are analyzed.     

Development Guidelines from a Study of Suicide Prevention Mobile Applications (Apps)

Every day, Americans are inundated with advertisements and appeals to purchase the latest mobile technology in the form of smart phones, tablets, and their accompanying applications (apps). Human service organizations (HSOs) across the United States have begun to recognize that apps can provide a valuable resource for individuals and communities by addressing social issues. Additionally, forward-thinking HSOs are aware that apps are a fresh and important way of reaching a rapidly changing, tech-savvy population. But just like the marketplace at large yields a variety of apps that range from useful and engaging to poorly contrived and ineffective, HSOs' foray into app development has achieved mixed results. This report analyzes existing mobile applications available for one specific field of HSO service delivery—suicide prevention—in order to describe what is currently available and to generate beginning guidelines for the development, implementation, and evaluation of new suicide prevention apps for underserved populations. Twenty-seven apps were analyzed and recommendations for HSOs and future research are presented.     

College students’ knowledge about Sickle Cell Disease

ABSTRACT

Sickle Cell Disease (SCD) is a serious health problem affecting millions around the world. Key to prevention is knowledge about the disease and the reproductive implications. This study explored college students’ knowledge about SCD. Participants included 416 college students at a North Texas campus between October and December 2014. A cross-sectional survey design using an 18-question survey was used. Although most participants had heard of SCD, 21% had never heard of the disease. Furthermore, participants lacked knowledge regarding the differences between the disease and carrier status, prevalence, reproductive implications, prevention, and testing. Findings showed that couples had more knowledge about SCD compared to singles and there were no significant differences between those with children and those without indicating a need for education before they start dating. Most participants had not undergone SCD carrier screening and had no interest in screening. The Universal Prevention approach would be a suitable approach and should be utilized in improving knowledge about SCD.     

Cultural integration through shared learning among resettled Bhutanese women

ABSTRACT

The multidimensional needs of recently resettled refugees have been well documented and range from elevated rates of mental illness and health care challenges to difficulties accessing resources due to language and literacy barriers. These factors are largely responsible for the challenges resettled refugees face in acquiring and maintaining stable employment. It is possible that achieving financial stability through steady employment and purposeful money management may alleviate some stressors associated with the resettlement process, though research in this area that is specific to refugees is in its infancy. What is clear, however, is that a traditional approach to mental health treatment (i.e., therapy in a traditional office setting) may lack effectiveness because of the lack of attention to extraneous stressors such as poverty, transportation, and language and literacy challenges that impact resettled refugees. The purpose of this study was to qualitatively assess the impact of a group-based financial education course and social enterprise on the self-reported mental health (i.e., post-traumatic stress symptoms, depression, anxiety, and somatization) of Bhutanese refugee women resettled in the United States. The study also sought to evaluate the acceptability and overall satisfaction with various components of the intervention. This qualitative study was a follow-up to a larger quantitative study that included 65 Bhutanese women who were resettled to the southwestern United States by a large resettlement agency. The results of this study offer insights into the lived experiences of Bhutanese refugees in the United States, particularly related to cultural integration bolstered by group-based education and shared learning opportunities.     

The racial crossover in family complexity in the United States

This article examines the evolution of the black extended family by documenting a black-white crossover in the proportions of unmarried adults living in complex households after the middle of the twentieth century. We demonstrate significant racial differences in the trends in complex house-hold residence over the life course, characterized by far greater declines in complex living among whites, particularly at younger ages. In this context, the higher level of family extension that recent research has found typifies black families is both a relatively new phenomenon and one that is not just limited to single-parent families; it characterizes all ages, those with and without children, and men as well as women.     

Cohort effects in the educational attainment of second generation immigrants in Germany: An analysis of census data

Even though second generation immigrants make up ever increasing population shares in industrialized countries we know little about their social integration and wellbeing. This study focuses on the educational attainment of German born children of immigrants. Their schooling success still lags behind that of natives. This paper investigates school attendance and completed degrees of second generation immigrants and finds that even after controlling for characteristics the educational gap remains large and significant. The available evidence suggests that this group as a whole does not assimilate to native educational standards and instead increasingly falls behind.This research was completed while the author was guest at the Institute for the Study of Labor (IZA) in Bonn, Germany. I am grateful for IZAs hospitality and particularly for the help of Thomas K. Bauer. I thank the anonymous referees and the editors for very helpful comments. Responsible editors: David Card and Christoph M. Schmidt.     

Estimating and comparing adverse event probabilities in the presence of varying follow-up times and competing events

Safety analyses of adverse events (AEs) are important in assessing benefit–risk of therapies but are often rather simplistic compared to efficacy analyses. AE probabilities are typically estimated by incidence proportions, sometimes incidence densities or Kaplan–Meier estimation are proposed. These analyses either do not account for censoring, rely on a too restrictive parametric model, or ignore competing events. With the non-parametric Aalen-Johansen estimator as the “gold standard”, that is, reference estimator, potential sources of bias are investigated in an example from oncology and in simulations, for both one-sample and two-sample scenarios. The Aalen-Johansen estimator serves as a reference, because it is the proper non-parametric generalization of the Kaplan–Meier estimator to multiple outcomes. Because of potential large variances at the end of follow-up, comparisons also consider further quantiles of the observed times. To date, consequences for safety comparisons have hardly been investigated, the impact of using different estimators for group comparisons being unclear. For example, the ratio of two both underestimating or overestimating estimators may not be comparable to the ratio of the reference, and our investigation also considers the ratio of AE probabilities. We find that ignoring competing events is more of a problem than falsely assuming constant hazards by the use of the incidence density and that the choice of the AE probability estimator is crucial for group comparisons.     

Growing Pains of a New Health Care Field: Genetic Counselling in Australia and the United States

The growing pains of genetic counselling in Australia and the United States are compared. Genetic counselling is discussed in terms of occupational struggles for status by the non-medical professionals and the effect this has on the balance between counselling and medical goals in this new health care field. The influence of medical team members vis-a-vis non-medical personnel is viewed as being stronger in Australia than in the United States.     

Well‐being among adolescent boys

Most studies on mental health in the adult population have found a significant relationship between mental health and social class. No study has thoroughly examined this relationship in the adolescent population. This article, based on the Bachman, O'Malley, and Johnston “Youth in Transition” data set, tests the social class/mental state relationship among adolescents. Three separate measures—well‐being, psychiatric symptoms, and depression—are used to indicate mental state. Social class is based on a composite measure of socioeconomic level that exists within the “Youth in Transition” data set. Surprisingly, no relationship was found. These results persisted even when more traditional measures of social class based on parents’ education and the Duncan ranking of the fathers’ occupations were substituted for socioeconomic level. An alternative explanation supporting social stress is discussed in light of Thornberry's developmental hypothesis.