Involvement of Ministries of Health in Health Service Coverage Decisions: Is England an Aberrant Case?

This article examines the involvement of ministries of health in making health service coverage decisions in Denmark, England, France and Germany. The study aims to inform debate in England about the feasibility of reducing perceived ministerial and bureaucratic ‘interference’ in decisions affecting the National Health Service, based on interviews with senior government officials and other health system stakeholders. Ministries of health differ in their involvement in health system governance and coverage decisions (‘the benefits package’), reflecting differences in institutional arrangements. In all four countries, organizations at arm's length or independent from government are either involved in providing technical advice to the ministry of health or have been mandated to take these decisions themselves. However, ministries of health occasionally intervene in the decision‐making process or ignore the advice of these organizations. The Department of Health in England is not an aberrant case, at least in relation to coverage decisions. Indeed, ministries of health in Denmark and France play a larger role in making these decisions. Public pressure, often amplified by the media, is a shared reason for ministerial and ministry involvement in all four countries. This dynamic may thus limit the feasibility of attempts to further separate the NHS from both the Department of Health and wider political pressures.     

Digit ratios (2D:4D) as predictors of risky decision making for both sexes

Many important decisions involve financial risk, and substantial evidence suggests that women tend to be more risk averse than men. We explore a potential biological basis of risk-taking variation within and between the sexes by studying how the ratio between the length of the second and fourth fingers (2D:4D) predicts risk-taking. A smaller 2D:4D ratio has been linked to higher exposure to prenatal testosterone relative to estradiol, with men having lower ratios than women. In financially motivated decision-making tasks, we find that men and women with smaller 2D:4D ratios chose significantly riskier options. We further find that the ratio partially explains the variation in risk-taking between the sexes. Moreover, for men and women at the extremes of the digit-ratio distribution the difference in risk-taking disappears. Thus, the 2D:4D ratio partially explains variation in financial risk-taking behavior within and between sexes and offers evidence of a biological basis for risk-taking behavior.     

Staying strong: gender ideologies among African-American adolescents and the implications for HIV/STI prevention

This paper explores adolescents' definitions of what it means to be a man and a woman, the psycho-social context surrounding the formation of gender ideologies and their relationship to HIV/STI prevention. Semi-structured, in-depth interviews were conducted with fifty African-American adolescents living in Baltimore, Maryland. Female gender ideologies included economic independence, emotional strength and caretaking. Male gender ideologies emphasized financial responsibility, toughness and sexual prowess. Findings suggest that stronger adherence to male gender ideologies related to toughness and sexual prowess is influenced by male participants' perceived inability to fulfill their primary gender role as economic providers and the importance of gaining approval from male peers in the absence of adult male role models. Stronger adherence to female gender ideologies related to emotional strength and caretaking may be linked to a heightened desire for male intimacy and tolerance of male sexual risk behavior. Implications of the gender ideologies documented and their commonalities are discussed in terms of HIV/STI prevention.     

Foreign-born emigration: A new approach and estimates based on matched CPS files

The utility of postcensal population estimates depends on the adequate measurement of four major components of demographic change: fertility, mortality, immigration, and emigration. Of the four components, emigration, especially of the foreign-born, has proved the most difficult to gauge. Without "direct" methods (i.e., methods identifying who emigrates and when), demographers have relied on indirect approaches, such as residual methods. Residual estimates, however are sensitive to inaccuracies in their constituent parts and are particularly ill-suited for measuring the emigration of recent arrivals. Here we introduce a new method for estimating foreign-born emigration that takes advantage of the sample design of the Current Population Survey (CPS): repeated interviews of persons in the same housing units over a period of 16 months. Individuals appearing in a first March Supplement to the CPS but not the next include those who died in the intervening year, those who moved within the country, and those who emigrated. We use statistical methods to estimate the proportion of emigrants among those not present in the follow-up interview. Our method produces emigration estimates that are comparable to those from residual methods in the case of longer-term residents (immigrants who arrived more than 10 years ago), but yields higher--and what appear to be more accurate--estimates for recent arrivals. Although somewhat constrained by sample size, we also generate estimates by age, sex, region of birth, and duration of residence in the United States.     

Evaluating social investment in disability policy

Disability policy in European countries is displaying a shift towards social investment: increasing human capital and access to the labour market. The reasoning that underlies this transition is that disabled persons would benefit from mainstream employment, but are impeded in traditional policy by deficiencies in labour supply and demand. However, the shift towards more activating policies in many countries is accompanied by a decline in social protection. It is unclear whether social investment may effectively promote the employment chances of disabled persons within this context. The present research examines this question through a quantitative, cross-sectional, multilevel analysis on microdata from 22 EU countries. Our findings suggest greater activation to predict lower employment chances, while reducing passive support shows mixed effects. Conversely, measures for facilitation in daily life predict greater employment chances, as do measures for sheltered work. These findings raise questions over the value of social investment for disabled persons—and underline the need to overcome broader barriers in the labour market and in society.     

Demographic differences in response rates for PHQ9 in a university student population

Objective: To examine differences in complete response rates for depression screening questions based on demographic characteristics. Methods: Cross-sectional study examining associations between demographic characteristics and completely responding depression-screening questions. Participants: “Healthy Minds Study” data, collected in a public University in February 2016, where 7,326 students participated. Results: women (AOR: 0.69; 95% CI =0.57–0.83) and gay/lesbian students (AOR: 0.24; 95% CI =0.10–0.60) had better complete response rates. Non-US (AOR: 1.46; 95% CI =1.03–2.07), black (AOR: 3.32; 95% CI =1.92–5.77), and Middle-Eastern students (AOR: 3.73; 95% CI =1.73–8.02) had lower complete response rates. Conclusions: Our study shows sex, gender, citizenship, and race categories have significant differences in complete response rates for the outcome. Our findings have several implications; including recognizing interventions for depression based on responders may not target those that tend to be “partial-responders”. Efforts in survey design, recruiting and completion of surveys should be maximized.     

Maternal Postpartum Depression Increases Vulnerability for Toddler Behavior Problems through Infant Cortisol Reactivity

The current study examined the role of hypothalamic‐pituitary‐adrenal reactivity (a physiological indicator of stress) in early infancy as a mediator of the relationship between maternal postpartum depression and toddler behavior problems. Participants were 137 at‐risk mothers and their children participating in a longitudinal study of intergenerational transmission of risk. Mothers’ depression was measured five times during the infants’ first 18 months. Infant cortisol was collected during a social stressor (the still‐face paradigm) when infants were 6 months old, and mothers reported on toddlers’ internalizing and externalizing symptoms at 18 months. Among this sample of high‐risk mother–infant dyads, early postpartum depression predicted atypical infant cortisol reactivity at 6 months, which mediated the effect of maternal depression on increased toddler behavior problems. Clinical implications are discussed.