Accommodating diverse clients' needs in evaluation capacity building: A case study of the Tobacco Control Evaluation Center

In this case study, we detail and analyze how the Tobacco Control Evaluation Center (TCEC), an evaluation technical assistance center that serves approximately 100 local tobacco control organizations in California, endeavors to build capacity among the state-funded local providers it serves by using evaluation capacity building activities with an utilization-focused evaluation framework. We call this a "blended approach" and describe these methods. Satisfaction and demand for TCEC services are documented to provide measurements for evaluation capacity building. Final evaluation report scores from two intervention cycles (2004-2007 and 2007-2010) submitted to the California Health Department, Tobacco Control Division are also assessed and compared. These measures demonstrate an increase in evaluation capacity by local projects under TCEC's purview.     

The quality and use of regulatory analysis in 2008

This article assesses the quality and apparent use of regulatory analysis for economically significant regulations proposed by federal agencies in 2008. A nine-member research team used a six-point (0-5) scale to evaluate regulatory analyses according to criteria drawn from Executive Order 12866 and Office of Management and Budget Circular A-4. Principal findings include: (1) the average quality of regulatory analysis, though not high, is somewhat better than previous regulatory scorecards have shown; (2) quality varies widely; (3) biggest strengths are accessibility and clarity; (4) biggest weaknesses are analysis of the systemic problem and retrospective analysis; (5) budget or "transfer" regulations usually receive low-quality analysis; (6) a minority of the regulations contain evidence that the agency used the analysis in significant decisions; (7) quality of analysis is positively correlated with the apparent use of the analysis in regulatory decisions; and (8) greater diffusion of best practices could significantly improve the overall quality of regulatory analysis.     

Risk management in a developing country context: improving decisions about point-of-use water treatment among the rural poor in Africa

More than 1 billion people, the vast majority of which live in the developing world, lack basic access to clean water for domestic use. For this reason, finding and promoting effective and sustainable solutions for the provision of reliable clean water in developing nations has become a focus of several public health and international development efforts. Even though several means of providing centrally located sources of clean water in developing communities exist, the severity and widespread nature of the water problem has led most development agencies and sanitation experts to strongly advocate the use of point-of-use treatment systems alongside whatever source of water people regularly use. In doing so, however, development practitioners have been careful to point out that any interventions or infrastructure regarding water safety and human health must also adhere to one of the central principles of international development: to facilitate more democratic and participatory models of decision making and governance. To this end, the research reported here focused on the development of a deliberative risk management framework for involving affected stakeholders in decisions about POU water treatment systems. This research, which was grounded in previous studies of structured decision making, took place in two rural villages in the East African nation of Tanzania.     

A hospital protocol to resolve complaints against staff physicians

Complaints of discrimination or harassment in the workplace have become almost commonplace in recent years, increasing in both frequency and variety. In the hospital setting, this trend is manifested in allegations against members of the medical staff by hospital employees as well as by patients or their families. Whether real or fancied, such allegations are reflective of a potentially disruptive undercurrent of organizational tensions. Left unresolved, they can erode the essential partnership between staff physicians and other members of the health care delivery team. Unsatisfactory patient experiences may also damage the reputation of the institution and thereby undermine its viability. With either group of complainants, allegations of malfeasance that are not resolved at the source in a timely manner are far more likely to result in expensive, time-consuming, and potentially damaging litigation.     

Unconventional style reaps rewards for Ruckdeschel. Physician executive's career carries cancer center to the forefront. Interview by Patty Ryan

He didn't like math. Loved biology. So he ditched his plans to become an engineer and ended up pursuing a career in medicine and hospital administration. He led a sleepy cancer center to new heights of cutting-edge research and progressive types of treatment. And he did it all on his own terms--a mix of practicality and instinct that serves up some interesting perspectives for fellow physician executives to consider. Meet John Ruckdeschel, MD.     

The impact of childhood abuse and neglect on adult mental health: a prospective study

This paper examines the impact of three types of victimization in childhood--sexual abuse, physical abuse, and neglect--on lifetime measures of mental health among adults. In contrast to research that relies on retrospective recall of childhood victimization, this work uses a prospective sample gathered from records of documented court cases of childhood abuse and neglect in a midwestern city around 1970. These subjects were interviewed about twenty years later. In addition, this research compares outcomes of the 641 members of the abuse and neglect group with a matched control group of 510 persons who did not have documented cases of abuse or neglect. The results indicate that men who were abused and neglected as children have more dysthymia and antisocial personality disorder as adults than matched controls, but they did not have more alcohol problems. Abused and neglected women report more symptoms of dysthymia, antisocial personality disorder, and alcohol problems than controls. After controlling for stressful life events, however, childhood victimization had little direct impact on any lifetime mental health outcome. This research indicates the importance of adopting an approach that places childhood victimization in the context of other life stressors and of prospective changes over the life course.     

Parenting services for families affected by substance abuse

This article describes the development, implementation, and replication of a group-based parenting program for families affected by substance abuse. The Nurturing Program for Families in Substance Abuse Treatment and Recovery improves parenting, as measured on objective scales; enhances parents' satisfaction and competence, as measured by participant reports; and is based on principles demonstrated to be effective in reducing risk of both child abuse and neglect and substance abuse for both parents and children.     

Pension prospects of minority ethnic groups: inequalities by gender and ethnicity

Minority ethnic groups have low income in later life from private pensions, partly due to shorter employment records in Britain since migration. Yet disadvantage and discrimination in the labour market, as well as differences in cultural norms concerning women's employment, may lead to persistence of ethnic variation in private pension acquisition. Little is known about the pension arrangements made by men and women in minority ethnic groups during the working life. This paper examines the extent of ethnic disadvantage in private pension scheme arrangements and analyses variation according to gender and specific ethnic group, using three years of the British Family Resources Survey, which provides information on over 97,000 adults aged 20-59, including over 5,700 from ethnic minorities. Both men and women in minority ethnic groups were less likely to have private pension coverage than their white counterparts but the extent of the difference was most marked for Pakistanis and Bangladeshis. Ethnicity interacted with gender, so that Blacks showed the least gender inequality in private pension arrangements, reflecting the relatively similar full-time employment rates of Black men and women. A minority ethnic disadvantage in private pension coverage, for both men and women, remained after taking account of age, marital and parental status, years of education, employment variables, class and income. The research suggests that minority ethnic groups - especially women - will be disproportionately dependent on means-tested benefits in later life, due to the combined effects of low private pension coverage and the policy of shifting pension provision towards the private sector.     

Beyond enmeshment: evidence for the independence of intrusiveness and closeness-caregiving in married couples

In a 1996 article on family theory, we (Green & Werner) proposed that family enmeshment should not be equated with high cohesion and that the construct of enmeshment fails to discriminate between two distinct relationship processes: Closeness-caregiving and intrusiveness. In this study, our model of these two independent dimensions of family connectedness was tested by assessing spouses from 264 couples, using the California Inventory for Family Assessment (CIFA). The CIFA scales showed acceptable reliability. Significant interspouse validity correlations also were obtained. As predicted by our theory, factor analyses distinguished dimensions of intrusiveness (blurring of boundaries) from dimensions of closeness-caregiving (such as warmth and nurturance). On all but two factors, behaviors of only one spouse (but not of both) had interpretable loadings. That is, in most areas, the two spouses' behaviors did not load together to form meaningful factors. The latter finding suggests that family systems theory--with its central notion of reciprocally contingent behaviors between family members--may be useful in understanding only a few dimensions of spouses' behavior (such as reciprocal aggression) whereas personality-in-context theories may be better for understanding most other dimensions (such as warmth and nurturance).     

Effects of alcoholic beverage, instigation, and inhibition on expectancies of aggressive behavior

To investigate the role of alcohol expectancy, situational factors, and personality variables in predicting postdrinking aggression, two questionnaire studies were conducted. Subjects were randomly assigned to imagine themselves and their responses in a scenario situation, which was a combination of different beverages (soda vs. alcohol), instigation, and inhibition conditions. Both studies found significant 3-way interactions of personality aggression proneness (Buss-Durkee Hostility Inventory Assault scale) by beverage condition and by situational cue condition on subjects' reported likelihood of engaging in aggressive behavior. Expected aggression was strongly associated with greater aggression proneness in the nonalcoholic condition when there was a situational cue (low inhibition in Study 1, high instigation in Study 2) invoking aggression, but not when the situational cue was absent. This relationship between aggression proneness and expected aggression, however, was attenuated in the alcoholic drink conditions in both studies. In general, it was found that the effect of alcohol on expected aggression was minor relative to the large and significant effects of aggression proneness, instigation, and inhibition.