Morbidity measures in the presence of recurrent composite endpoints

The analysis of recurrent event data in clinical trials presents a number of difficulties. The statistician is faced with issues of event dependency, composite endpoints, unbalanced follow‐up times and informative dropout. It is not unusual, therefore, for statisticians charged with responsibility for providing reliable and valid analyses to need to derive new methods specific to the clinical indication under investigation. One method is proposed that appears to have possible advantages over those that are often used in the analysis of recurrent event data in clinical trials. Based on an approach that counts periods of time with events instead of single event counts, the proposed method makes an adjustment for patient time on study and incorporates heterogeneity by estimating an individual per‐patient risk of experiencing a morbid event. Monte Carlo simulations demonstrate that, with use of a real clinical study data, the proposed method consistently outperforms other measures of morbidity. Copyright © 2003 John Wiley & Sons, Ltd.     

Low-Income Children's Participation in a Public Health Insurance Program in Georgia

To expand health care coverage to uninsured, low-income children, the Congress created the State Children's Health Insurance Program (SCHIP) in 1997. Given ample evidence that state Medicaid programs have failed to enroll many eligible children, experts questioned whether SCHIP could successfully enroll low-income children. Using Georgia state SCHIP data, we analyzed enrollment patterns and identified factors contributing to program enrollment. This study found that the children's enrollment is explained by perceived costs and benefits of joining the program as well as the underlying family structure, demographic factors, and health status. We discuss implications of these findings on the participation of low-income families in public sector programs.     

Use of incentives to motivate healthy behaviors among employees

We conducted an extensive literature search of both published and unpublished sources to assess the use and effectiveness of worksite interventions that offer financial and other incentives. Many companies are using financial incentives, either alone or in combination with other interventions, to motivate employees to adopt and maintain healthier lifestyles. These incentives include cash bonuses, paid vacation days, and health insurance rebates. Although more research is needed, the literature suggests that financial incentives, if properly implemented, may successfully promote behavioral change among employees. Eric A. Finkelstein Ph.D., M.H.A. currently conducts economic and health policy research at RTI International, teaches an undergraduate Health Economics course at Duke University, and is a member of RTI-UNC Center of Excellence in Health promotion Economics. He focuses on the economic causes and consequences of health behaviors, with a primary emphasis on behaviors related to obesity. He has published several peer-reviewed papers in this area. A recent publication entitled “National Medical Expenditures Attributable to Overweight and Obesity,” was published in Health Affairs and garnered national media attention, including a front-page story in USA Today, coverage in Time magazine and the Washington Post, and was reported in other radio, television, newspaper, and Internet outlets across the country. That paper is now routinely cited as a driving motivation to reduce obesity rates. Dr. Finkelstein currently leads several projects concerning the causes and consequences of health behaviors for the CDC and other public and private sector agencies, and frequently speaks at conferences concerning the economic impact of obesity and strategies for reducing this burden. Katherine M. Kosa, M.S. conducts economic and food and nutrition policy research at RTI International with a primary focus on consumer behavior research. She recently completed a study to examine the general public's attitude and support for obesity interventions recently introduced at the state and federal level. To inform labeling policy decisions for USDA and FDA, Ms. Kosa conducts focus groups and surveys to understand consumer attitudes, knowledge, and practices.     

An Experimental Analysis of Children's Dislike of Aggressors and Victims

We experimentally examined social contextual factors that might moderate children's dislike for aggressors and for victims of aggression, by varying both the aggressor's behavior (aggressive toward multiple children versus aggressive only toward one child) and the victim's behavior (passive versus assertive). Children (117 male and female fourth to sixth graders) listened to one of four scenarios describing the experiences of boys at a summer camp and rated how much they liked the aggressor, the victim, and the other children in the scenario; children also reported how much they thought the aggressor, victim, and others liked each other. Overall, and consistent with previous research, children disliked aggressors the most, followed by victims and then by the other children in the scenarios. Importantly, children's liking was influenced by the social context in which the aggression occurred, particularly in regards to how the victim responded. Aggressors (general or focused) were liked more if their victim was assertive rather than nonassertive. Furthermore, children liked nonassertive victims less than assertive victims, particularly a nonassertive victim in response to a general aggressor. Inferred liking among the group members also was dependent on the social context of the provocation. This research highlights the need to consider aggression as more than a set of behaviors. Aggression is a social event embedded within a social context and interpersonal relationships must be considered.     

Contract, Charity, and Honorable Entitlement: Social Citizenship and the 1967 Abortion Act in Northern Ireland after the Good Friday Agreement

This article investigates the extent to which women’spolitical, civil, and social citizenship rights in the post–Good Friday Agreement (1998)period in Northern Ireland can be expanded. It argues that theGood Friday Agreement, as a framework document, offers someopportunity for the expansion of women’s political andcivil citizenship rights. Legislative attempts to extend the1967 Abortion Act (United Kingdom) to Northern Ireland and recentefforts to have the existing law governing abortion in NorthernIreland clarified through the judiciary are examined to demonstratethe continued denial of women’s social citizenship rights.Various routes to address Northern Irish women’s accessto abortion services are assessed, and it is argued that extendingthe 1967 Abortion Act to Northern Ireland, a long-standing demandof pro-choice women’s groups, will insufficiently facilitatewomen’s access to social citizenship rights. Consistentwith recent directions in social policy scholarship, this articleargues that a recognition of agency as an outcome of individualand collective social action is necessary to access abortionand women’s social citizenship rights in the post–GoodFriday Agreement period in Northern Ireland.     

Employment and the Risk of Domestic Abuse Among Low‐Income Women

This paper uses data from 2 randomized evaluations of welfare‐to‐work programs—the Minnesota Family Investment Program and the National Evaluation of Welfare‐to‐Work Strategies—to estimate the effect of employment on domestic abuse among low‐income single mothers. Unique to our analysis is the application of a 2‐stage least squares method, in which random assignment enables us to control for omitted characteristics that might otherwise confound the association between employment and domestic abuse. We find that increased maternal employment decreases subsequent reports of domestic abuse in both studies. In the Minnesota Family Investment Program—a program with an enhanced income disregard that allowed welfare mothers to keep a portion of their welfare income as earnings rose—an increase in household incomes appears to have contributed to reductions in reports of domestic abuse.     

The Timing of Entry Into Fatherhood in Young, At-Risk Men

Timing of first fatherhood was examined in a sample of 206 at-risk, predominantly White men, followed prospectively for 17 years. An event history analysis was used to test a model wherein antisocial behavior, the contextual and familial factors that may contribute to the development of antisocial behavior, and common correlates of such behavior, including academic failure, substance use, and early initiation of sexual behaviors, lead both directly and indirectly to an early transition to fatherhood. Having a mother who was younger at first birth, low family SES, poor academic skills, failure to use condoms, and being in a cohabitating or marital relationship predicted entry into fatherhood. Implications of the findings for prevention of and intervention with early fathering are discussed.     

Border Lines: Indigenous Peoples in Genocide Studies*

L'histoire des peuples autochtones ne figure pas parmi les sujets qui sont traités dans la recherche comparée en génocide. Les auteures examinent l'approche conceptuelle qui a conduit à cette lacune en s'attardant à la terminologie employée et à la distinction qu'impose la typologie du génocide entre génocide idéologique et génocide provoqué par l'expansion d'un groupe aux dépens d'un autre, et en soulignant l'importance qui est rattachée dans cette même typologie à la logique qui motive les régimes coupables de génocide. On examine également la relation qui existe entre génocide des peuples autochtones et ceux des autres peuples, ceci en relation avec trois critères d'analyse, soit la réaction des persécutés, le processus de guérison et la quête de justice. À la suite de cet examen, on démontre qu'une approche plus globale dans l'étude comparée du génocide, approche qui reconnaîtrait l'enver-gure des génocides des peuples autochtones, serait à l'avantage des chercheurs. Enfin, les auteures font remarquer que l'approche foncièrement européenne dans la recherche en génocide a pour effet de circonscrire le débat. The experiences of indigenous peoples have been left outside the framework of comparative genocide research. We first discuss conceptual reasons for this omission, focussing on the role of genocide definitions, ideological vs. developmental distinctions in genocide typologies, and the emphasis in genocide typologies on the motivations of perpetrators. We then illustrate the relation between indigenous genocides and other genocides by examining three important foci of genocide studies: responses, healing and justice. From these comparisons and contrasts, we conclude that a broader comparative approach that acknowledges the importance of indigenous genocides would contribute significantly to genocide studies. Finally, we note that adherence to European world views in genocide studies limits the potential for constructive analysis.