Foreign-born health integration during the transition to adulthood: The case of weight

Nativity differences in youths’ health in the United States are striking—the children of foreign-born parents often have healthier outcomes than those of native-born parents. However, very little is known about how immigrant-native differences evolve within the same individuals over time, or about life cycle aspects of the health-related integration of youth with migration backgrounds. Using data from the National Longitudinal Study of Adolescent Health, I examine nativity differences in trajectories of weight gain during adolescence and early adulthood, as well as the degree to which temporal patterns are stratified by race/ethnicity and socioeconomic status. I examine whether nativity differences converge, diverge or remain stable over time, and whether patterns are socially stratified within and across nativity groups. I find that first-generation adolescents begin at a lower weight than their third generation peers and gain weight at a significantly slower pace, resulting in meaningful differences by early adulthood. More complex examination of the relationship between nativity and weight gain reveals additional differences by ethnicity: the foreign-born advantage over time does not extend as strongly to Hispanic adolescents. The findings demonstrate how the health-related integration of foreign-born youth is tied to race/ethnicity and socioeconomic circumstances, and suggest the need to examine the ways in which social circumstances and health change together.     

Home birth and the National Australian Maternity Services Review: too hot to handle?

Background

In February 2009 the Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.

Method

Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.

Findings

450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the ‘Benefits’ and ‘Barriers’ in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.

Conclusion

Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as ‘too hot to handle’ and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a ‘sensitive and controversial issue.’     

Is There a Place for Virtual Poverty Funds in Pro‐Poor Public Spending Reform? Lessons from Uganda's PAF

Various developing countries with weak public expenditure management systems are establishing virtual poverty funds (VPFs), drawing on the experience of Uganda's Poverty Action Fund. As a mechanism for tagging and tracking the performance of specific poverty‐reducing expenditures in the budget, a VPF can be useful. However, this article argues that such devices should be treated from the outset as transitional, and as part of wider processes of strengthening public expenditure management; otherwise, they can seriously distort public expenditure allocations and management systems, potentially undermining growth. Emphasis needs to be placed on identifying the right balance of expenditures in the entire budget; improving the effectiveness and efficiency of existing allocations; and developing better public‐sector policies for promoting pro‐poor private sector growth.     

Developmental Characteristics of African American and Caribbean Black Adolescents' Attributions Regarding Discrimination

The present study examined discrimination attributions in the psychological well‐being of Black adolescents. Findings are based on a representative sample of 810 African American and 360 Caribbean Black youth, aged 13–17, who participated in the National Survey of American Life. Youth completed measures of perceived discrimination, discrimination attributions, depressive symptoms, self‐esteem, and life satisfaction. Approximately half the youth attributed discrimination to race/ethnicity (43%), followed by age (17%), physical appearance (16.5%), and gender (7.5%), and there were no ethnic, gender, or age differences regarding discrimination attributions. Key findings suggest that the association between perceived discrimination and psychological well‐being did not vary according to discrimination attribution, which implies that discrimination is harmful for Black youth regardless of the attribution.     

Child protection: a new approach in South Australia

This paper argues the case for an integrated approach to child protection services, embracing children's safety, risk and needs and incorporating formal assessment instruments. It then provides a brief overview of the new child protection system in South Australia. The steady rise in child abuse/neglect reports raises questions about how best to provide child protection services. Analysis of South Australian data suggests that much of the rise can be attributed to an increase in reports of neglect and emotional abuse and an increase in re‐notifications. This in turn raises questions about the traditional investigative approach. In 1995 Messages from Research advocated that agencies re‐focus on children's needs and concentrate less on investigations into safety and risk. The critical question is how to distinguish families requiring investigation from those needing support. The latest research suggests that such decision‐making in child protection is generally inconsistent and unreliable. This paper argues that statutory agencies should use formal assessment tools to determine the level and nature of their interventions. These arguments have been critical in the development of the new child protection model in SA, which relies on a centralized intake, differential response to reports and the structured decision‐making system. Initial evaluation of the new model indicates improvements in consistency of initial screening and responses to children in danger. Copyright © 1999 John Wiley & Sons, Ltd.     

Blinded sample size recalculation for clinical trials with normal data and baseline adjusted analysis

Baseline adjusted analyses are commonly encountered in practice, and regulatory guidelines endorse this practice. Sample size calculations for this kind of analyses require knowledge of the magnitude of nuisance parameters that are usually not given when the results of clinical trials are reported in the literature. It is therefore quite natural to start with a preliminary calculated sample size based on the sparse information available in the planning phase and to re‐estimate the value of the nuisance parameters (and with it the sample size) when a portion of the planned number of patients have completed the study. We investigate the characteristics of this internal pilot study design when an analysis of covariance with normally distributed outcome and one random covariate is applied. For this purpose we first assess the accuracy of four approximate sample size formulae within the fixed sample size design. Then the performance of the recalculation procedure with respect to its actual Type I error rate and power characteristics is examined. The results of simulation studies show that this approach has favorable properties with respect to the Type I error rate and power. Together with its simplicity, these features should make it attractive for practical application. Copyright © 2009 John Wiley & Sons, Ltd.