Causal inference with generalized structural mean models

Summary.  We estimate cause–effect relationships in empirical research where exposures are not completely controlled, as in observational studies or with patient non-compliance and self-selected treatment switches in randomized clinical trials. Additive and multiplicative structural mean models have proved useful for this but suffer from the classical limitations of linear and log-linear models when accommodating binary data. We propose the generalized structural mean model to overcome these limitations. This is a semiparametric two-stage model which extends the structural mean model to handle non-linear average exposure effects. The first-stage structural model describes the causal effect of received exposure by contrasting the means of observed and potential exposure-free outcomes in exposed subsets of the population. For identification of the structural parameters, a second stage 'nuisance' model is introduced. This takes the form of a classical association model for expected outcomes given observed exposure. Under the model, we derive estimating equations which yield consistent, asymptotically normal and efficient estimators of the structural effects. We examine their robustness to model misspecification and construct robust estimators in the absence of any exposure effect. The double-logistic structural mean model is developed in more detail to estimate the effect of observed exposure on the success of treatment in a randomized controlled blood pressure reduction trial with self-selected non-compliance.     

How Welfare Policies Affect Adolescents' School Outcomes: A Synthesis of Evidence From Experimental Studies

Using data from 8 random assignment studies and employing meta‐analytic techniques, this article provides systematic evidence that welfare and work policies targeted at low‐income parents have small adverse effects on some school outcomes among adolescents ages 12 to 18 years at follow‐up. These adverse effects were observed mostly for school performance outcomes and occurred in programs that required mothers to work or participate in employment‐related activities and those that encouraged mothers to work voluntarily. The most pronounced negative effects on school outcomes occurred for the group of adolescents who had a younger sibling, possibly because of the increased home and sibling care responsibilities they assumed as their mothers increased their employment.     

Boundary Spaces

While shows like The X-Files and 24 have merged conspiracy theories with popular science (fictions), some video games have been pushing the narrative even further. Electronic Art's Majestic game was released in July 2001 and quickly generated media buzz with its unusual multi-modal gameplay. Mixing phone calls, faxes, instant messaging, real and "fake' websites, and email, the game provides a fascinating case of an attempt at new directions for gaming communities. Through story, mode of playing, and use of technology, Majestic highlights the uncertain status of knowledge, community and self in a digital age; at the same time, it allows examination of alternative ways of understanding games' role and purpose in the larger culture. Drawing on intricate storylines involving government conspiracies, techno-bio warfare, murder and global terror, players were asked to solve mysteries in the hopes of preventing a devastating future of domination. Because the game drew in both actual and Majestic-owned/-designed websites, it constantly pushed those playing the game right to borders where simulation collides with " factuality'. Given the wide variety of "legitimate' conspiracy theory, alien encounters and alternative science web pages, users often could not distinguish when they were leaving the game's pages and venturing into " real' World Wide Web sites. Its further use of AOL's instant messenger system, in which gamers spoke not only to bots but to other players, pushed users to evaluate constantly both the status of those they were talking to and the information being provided. Additionally, the game required players to occupy unfamiliar subject positions, ones where agency was attenuated, and which subsequently generated a multi-layered sense of unease among players. This mix of authentic and staged information in conjunction with technologically mediated roles highlights what are often seen as phenomenon endemic to the Internet itself; that is, the destabilization of categories of knowing, relating, and being.     

Foster parenting: A developmental model

This paper proposes a developmental framework for foster parents and outlines four distinct growth stages. Such a framework can be of value to program administrators who are required to assess foster parent development during the crucial matching process. To draw a distinction between each developmental stage, specific instrumental tasks and indicators are outlined.     

Psychological Control and Autonomy Granting: Opposite Ends of a Continuum or Distinct Constructs?

This article explores the relationship between parental psychological control and parental autonomy granting, and the relations between these constructs and indicators of adolescent psychosocial functioning, in a sample of 9,564 adolescents from grades 9 to 12. Participants completed a comprehensive parenting questionnaire as well as several measures of psychosocial adjustment. Confirmatory factor analyses of the parenting items revealed discrete factors for psychological control and autonomy granting, suggesting that these are distinct parenting constructs rather than opposite ends of a parental control continuum. Moreover, structural equation modeling showed that these factors were weakly correlated and differentially related to adolescent internalizing symptoms. Findings have implications for future conceptualization and measurement of psychological control and autonomy granting, and for research examining their effects on adolescent development.     

Measuring Substance Abuse Treatment Need Among Adults in Florida: A Social Indicators Approach

Determining the size and demographiccharacteristics of substance abuse populationsis extremely important for implementing publicpolicies aimed at the control of substanceabuse. Such information not only assists in theallocation of limited treatment resources bythe state, but also in the monitoring ofsubstance abuse trends over time and in theevaluation of innovative policy initiatives. Inthis study, we develop three composite measuresof treatment need. We then use these measuresto estimate treatment need for alcohol abuseand for controlled substance abuse within eachof Florida's 67 counties. This study providesan important empirical component of communityplanning, quantifying and, to a limited degree,specifying the level of need for the substanceabuse treatment of community residents. Anadditional benefit is the development of a costeffective and unobtrusive methodology fordetermining empirically when levels of need arechanging so that treatment levels can beadjusted accordingly. With proper use,policymakers can readily employ the methodologydeveloped in this study in Florida andelsewhere to make better-informed decisions inthe allocation of finite substance abusetreatment resources.     

Improving the contributions of technology assessment to the health care system of the U.S.A.

Summary Based on 14 case studies of highly effective therapies and the reasons they succeeded less frequently than they could, we propose a variety of steps to improve the health care system of the U.S.A. Whatever proposal emerges from current national debates until innovations are shown to be safe and effective, they should not be supported; when slightly better technologies are much more expensive than other good ones we need to consider appropriate choices carefully; simplified billing and bookkeping would reduce our costs; when a technology is rapidly introduced cautionnary measures may be needed; tracking immunization and repairing their omissions requires a new system; educational programs such as seen effective in hypertension should be applied in other areas such as vaccination; in organ transplantation the nation should consider “presumed consent”; our payment system sometimes creates perverse incentives and therefore needs review; and the preferences of the public in allocation of health resources need to be discovered once the public is informed about the issues. Research supported by Andrew W. Mellon Foundation.