Anticipated Ethics and Regulatory Challenges in PCORnet: The National Patient-Centered Clinical Research Network

PCORnet, the National Patient-Centered Clinical Research Network, seeks to establish a robust national health data network for patient-centered comparative effectiveness research. This article reports the results of a PCORnet survey designed to identify the ethics and regulatory challenges anticipated in network implementation. A 12-item online survey was developed by leadership of the PCORnet Ethics and Regulatory Task Force; responses were collected from the 29 PCORnet networks. The most pressing ethics issues identified related to informed consent, patient engagement, privacy and confidentiality, and data sharing. High priority regulatory issues included IRB coordination, privacy and confidentiality, informed consent, and data sharing. Over 150 IRBs and five different approaches to managing multisite IRB review were identified within PCORnet. Further empirical and scholarly work, as well as practical and policy guidance, is essential if important initiatives that rely on comparative effectiveness research are to move forward.     

Therapeutic Responses to Domestic Violence in Australia: A History of Controversies

This paper reviews controversies about domestic violence occurring in heterosexual relationships discussed in the Australian context by practitioners and academics and published in the Australian & New Zealand Journal of Family Therapy over the past three decades. Controversies arose in relation to the provision of therapeutic interventions for domestic violence, primarily in individual and couple counselling and group programs. After a literature review, the following controversial issues are identified: (1) the role of patriarchy: Is a patriarchal culture the main cause of domestic violence? (2) Systemic family therapy and gendered violence: Does systemic family therapy hide men's responsibility for domestic violence? (3) Therapeutic and educational interventions for domestic violence: Does therapy turn a ‘crime’ into a ‘psychological problem’? (4) Men as victims: Do both men and women perpetrate domestic violence in equal measure? (5) It takes two to tango: What part do women play in eliciting men's violence?     

Generating synthetic data to produce public-use microdata for small geographic areas based on complex sample survey data with application to the National Health Interview Survey

Small area statistics obtained from sample survey data provide a critical source of information used to study health, economic, and sociological trends. However, most large-scale sample surveys are not designed for the purpose of producing small area statistics. Moreover, data disseminators are prevented from releasing public-use microdata for small geographic areas for disclosure reasons; thus, limiting the utility of the data they collect. This research evaluates a synthetic data method, intended for data disseminators, for releasing public-use microdata for small geographic areas based on complex sample survey data. The method replaces all observed survey values with synthetic (or imputed) values generated from a hierarchical Bayesian model that explicitly accounts for complex sample design features, including stratification, clustering, and sampling weights. The method is applied to restricted microdata from the National Health Interview Survey and synthetic data are generated for both sampled and non-sampled small areas. The analytic validity of the resulting small area inferences is assessed by direct comparison with the actual data, a simulation study, and a cross-validation study.     

ACCOUNTING FOR COMPLEMENTARY SKILL SETS: EVALUATING INDIVIDUAL MARGINAL VALUE TO A TEAM IN THE NATIONAL BASKETBALL ASSOCIATION

Identifying an individual worker's contribution to firm production can be difficult in a team setting where spillovers in labor productivity exist among team members. This paper studies a model of labor productivity where workers have heterogeneous abilities, and can differently affect the productivity of their fellow teammates. Applying the model to the setting of the National Basketball Association (NBA), I can identify the marginal value that a basketball player brings to a particular team lineup, both through his own individual contributions and his complementary contribution to teammates' productivity. Estimates from the model imply that teammates have a significant impact on individual player productivity, and that taking into account spillovers across teammates is important to assessing both overall team productivity and an individual player's contribution to team productivity. I then evaluate whether player complementarities are valued in the NBA labor market in terms of higher salaries, and find that they are undervalued, and that players are instead paid mainly for their individual offensive production. This creates an asymmetry between player incentives and the team objective. To assess the size of this inefficiency, the top trading cycle algorithm of Shapley and Scarf (1974) is used to identify a Pareto optimal matching between players and teams, that accounts for the complementarities between heterogeneous players' skill sets. (JEL J30, L25, L83, M51)     

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges’ g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges’ g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.     

Older Adults’ Experiences of Sexual Difficulties: Qualitative Findings From the English Longitudinal Study on Ageing (ELSA)

There is a growing body of evidence demonstrating that sexual activity is important to the quality of life of older adults, and that it can be influenced by physical, psychological, and social factors. However, older adults’ experiences of sexual difficulties remain relatively unexplored. This article draws on qualitative data collected as part of the English Longitudinal Study of Ageing (ELSA). Participants answered a Sexual Relationships and Activities Questionnaire (SRA-Q), which included an open comment box for further details, 1,084 (1/7) of which were completed. These data were analyzed using Template Analysis, and findings on the experiences of sexual difficulties are presented in this article. Sexual difficulties were contextualized within the couple relationship and could be detrimental to the relationship, particularly if the partner would not seek professional help. Participants reported that sexual difficulties could also have a negative impact on psychological well-being, described mainly as frustration, depression, and sadness. For some participants the supportive nature of their relationship buffered these impacts. Few had sought professional help; those who had reported helpful and unhelpful experiences. These findings add to the limited evidence base and have implications for health care in the context of global aging and a growing recognition of older adults’ sexual rights.     

Grillin’ with My Grandchild©: multigenerational programming for grandfathers and grandchildren

This article describes the Grillin’ with My Grandchild^© multigenerational relationship education program which is designed to encourage the enhancement and maintenance of a meaningful grandfather-grandchild relationship. During this multi-session program, grandfather and grandchild participants engage in several activities which include creating an electronic memory book as well as grilling and eating food together. They learn through facilitated discussion and by sharing personal experiences what it means to be a grandfather and a grandchild. Facilitated discussion about nutritional grilling practices and safe food grilling are implemented at each session. Grandfather-grandchild dyads interact with other familial dyads in their group and experience a sense of community and familiarity. Future research into the relational and psychological benefits of the program are suggested.