Pragmatic decisions in the evaluation of consumer satisfaction with mental health treatment

This article examines pragmatic choices which must be made in conducting consumer satisfaction assessment of mental health treatment. It is argued that choices involving sample, format, and procedure for examining satisfaction may influence the results of such research, and must be considered when creating or evaluating these efforts. These choices are examined in detail.     

Frustrated fertility: a population paradox

This Bulletin examines the causes of subfecundity -- the diminished ability to reproduce -- and its effect today and in the past on the fertility, or actual reproductive performance, of individuals and, hence, populations. By definition, all real populations are subfecund since all experience some degree of involuntary biological factors affecting coitus, conception, or the ability to carry a conceptus to live birth which reduces their fecundity below the estimated biological population maximum of 15 children per woman. Affecting both men and women, these factors fall into 5 categories: genetic factors such as blood group incompatibilities and inherited sickle cell anemia or diabetes; psychopathology, including psychic stress and behavioral disorders (e.g., drug and alcohol abuse); infectious diseases such as gonorrhea, malaria, tuberculosis, and postabortion infection; malnutrrition, including the chronic undernutrition of the 3rd World and the overnutrition of developed societies; and hazards posed by increasing amounts of radiation and toxic chemicals in the environment. Reducing subfecundity requires improved living conditions, avoidance of or protection from known hazards, and adoption of medical advances which now can help 40 to 60% of subfecund couples. But even in the U.S. fertility would certainly rise among the 15% of couples now estimated to be involuntarily childless and the 10% who have fewer children than they want, and among disadvantaged groups, and teenagers.     

Was there compression of disability for older Americans from 1992 to 2003?

Medical advances and the growth of the elderly population have focused interest on trends in the health of the elderly. Three theories have been advanced to describe these trends: compression of morbidity, expansion of morbidity, and dynamic equilibrium. We applied multistate life table methods to the Medicare Current Beneficiary Survey to estimate active and disabled life expectancy from 1992 to 2003, defining disability as having difficulty with instrumental activities of daily living or activities of daily living. We found increases in active life expectancy past age 65 and decreases in life expectancy with severe disability. These trends are consistent with elements of both the theory of compression of morbidity and the theory of dynamic equilibrium.     

Using age and spatial flow structures in the indirect estimation of migration streams

This article outlines a formal model-based approach for inferring interregional age-specific migration streams in settings where such data are incomplete, inadequate, or unavailable. The estimation approach relies heavily on log-linear models, using them to impose some of the regularities exhibited by past age and spatial structures or to combine and borrow information drawn from other sources. The approach is illustrated using data from the 1990 and 2000 U.S. and Mexico censuses.     

Race,military service,and marital timing: Evidence from the NLSY-79

I use data from the 1979 National Longitudinal Study of Youth to examine the relationship between military service and marital timing for white men and black men during the 1980s. I use information about active-duty and reserve-duty service as well as veteran status to implement strong controls for selectivity. I find that active-duty military service increases the probability of first marriage for both whites and blacks. In part, this relationship is due to positive selectivity into the military and, for whites, to greater income and economic stability. Above and beyond the effects of selectivity, income, and economic stability, the effect of active-duty military service is particularly strong for black men.     

Older women's fears of violence: the need for interventions that enable active ageing

Women's fear of violence can impact negatively on their active participation in life. An ageing survey conducted with 2,620 Australian respondents aged 50 to 90 years examined aspects of work, learning, social, spiritual and emotional status, health, vision, home, life events, demographics, and asked an open-ended question about what being actively engaged in life meant. Ordinal regression was carried out on two dependent variables: wanting and needing to learn to discourage violence. Analyses found that as women's age increased, those on lower incomes were more likely than others to say they needed to learn how to discourage violence against them. This paper investigates the variables associated with the findings-transport, finances, news media, home safety, and reduced social interactions. Results highlight the importance of understanding women's fear in the context of personal and social issues, and the need to provide learning opportunities to improve safety and social engagement.     

The demographic impact of Partition in the Punjab in 1947

We use data from the 1931, 1941, and 1951 censuses of India and the 1951 census of Pakistan to examine the demographic consequences of Partition in the Punjab in 1947. Had growth rates for the period 1931-41 for the Punjab as a whole continued to 1951, the population of the Punjab would have been 2.9 million larger than that recorded in 1951. Population losses from migration and mortality above age 20 were approximately 2.7 million greater between 1941 and 1951 than would have been predicted by loss rates between 1931 and 1941. We estimate a net Partition-related population movement out of the combined Punjab of about 400,000. We conclude from several lines of analysis that Partition-related population losses in the Punjab, either from deaths or unrecorded migration, were in the range 2.3-3.2 million. Partition was also marked by a dramatic religious homogenization at the district level.     

Retrospective information on health status and its application for population health measures

Healthy life expectancies are almost always calculated by using health data from cross-sectional surveys. This type of calculation is done partly because data from longitudinal surveys are not always available, and when they are available, they are collected at intervals that are longer than one year. In such cases, collecting health information retrospectively for the years skipped by the survey is useful. The main purpose of this paper is to show how retrospective health information can be used to estimate life expectancies in different health states. Healthy life expectancies are estimated with and without using data on retrospective health information, and the corresponding estimates are compared. The two sets of estimates are similar. We conclude that retrospectively assessed health information based on a one-year recall period can be used to estimate years of life in various health states and that estimates based on such information will closely approximate estimates based on concurrent health information.