What Explains the Rural-Urban Gap in Infant Mortality: Household or Community Characteristics?

The rural-urban gap in infant mortality rates is explained by using a new decomposition method that permits identification of the contribution of unobserved heterogeneity at the household and the community level. Using Demographic and Health Survey data for six Francophone countries in Central and West sub-Saharan Africa, we find that differences in the distributions of factors that determine mortality-not differences in their effects-explain almost the entire gap. Higher infant mortality rates in rural areas mainly derive from the rural disadvantage in household characteristics, both observed and unobserved, which explain two-thirds of the gap. Among the observed characteristics, environmental factors-a safe source of drinking water, electricity, and quality of housing materials-are the most important contributors. Community characteristics explain less than onequarter of the gap, with about two-thirds of this coming from community unobserved heterogeneity and one-third from the existence of a health facility within the community. The effect of disadvantageous environmental conditions-such as limited electricity and water supply-derives both from a lack of community-level infrastructure and from the inability of some households to exploit it when available. Policy needs to operate at both the community and household levels to correct such deficiencies.     

Sample size calculations for clinical studies allowing for uncertainty about the variance

One of the most important steps in the design of a pharmaceutical clinical trial is the estimation of the sample size. For a superiority trial the sample size formula (to achieve a stated power) would be based on a given clinically meaningful difference and a value for the population variance. The formula is typically used as though this population variance is known whereas in reality it is unknown and is replaced by an estimate with its associated uncertainty. The variance estimate would be derived from an earlier similarly designed study (or an overall estimate from several previous studies) and its precision would depend on its degrees of freedom. This paper provides a solution for the calculation of sample sizes that allows for the imprecision in the estimate of the sample variance and shows how traditional formulae give sample sizes that are too small since they do not allow for this uncertainty with the deficiency being more acute with fewer degrees of freedom. It is recommended that the methodology described in this paper should be used when the sample variance has less than 200 degrees of freedom.     

Variations in Child Care by Grandparents During the First Three Years

Routine child care by grandparents was examined for 1,229 children who were participants in the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care. Four groups were identified: extended full‐time care, extended part‐time care, sporadic care, and no routine care during the first three years. The odds of sporadic child care by grandparents were higher when mothers were relatively young and worked nonstandard hours. The odds of extended full‐time grandparent care versus extended part‐time grandparent care were higher for mothers of color and mothers with more extensive full‐time employment. All types of grandparent care were more likely when a grandparent lived in the household. These findings suggest that grandparent care is heterogeneous and may occur in response to different family circumstances.     

Barriers to accessing HIV and sexual health services among gay men in Tasmania,Australia

We examined barriers to accessing HIV and sexual health services among gay and bisexual men (GBM) in Tasmania, Australia, using in-depth interviews. Most participants were satisfied with the care they had received at public sexual health services. Barriers included the limited number of services, concerns about anonymity and privacy in small communities, difficulties accessing services via a general practitioner, and perceived stigma and discrimination. Improving the accessibility and availability of HIV and sexual health services in Tasmania is crucial to promote the engagement of GBM, which could be achieved via combined efforts of government services and community organizations.     

Public Policy and Diffusion of Innovation

Marketers have traditionally studied diffusionof innovation with a primary focus on theindividual consumer as a unit of analysis, themajor types of findings being characteristicsof adopter categories and opinion leadership. We propose that this perspective is notadequate from a macromarketing perspective, inwhich the goals are to set public policy forsocietal good or to create an environment whichenables the diffusion of an innovation in a waythat no single marketer could do alone. Insetting public policy which can enable (orinhibit) diffusion of innovation for societalgood, a system composed of a mass socialinfrastructure, a competitive infrastructure,and a technical infrastructure should beconsidered.     

Single-Person Adoption: For and Against

SUMMARY. With the support of the Department of Health, Bristol University is carrying out a small-scale research study of single-person adoption. In advance of the findings, the author surveys existing arguments for and against the approval of single people as adoptive parents. The debate raises some larger questions—not simply about adoption and necessary safeguards, but about the nature of the approval process itself.     

Dependence in the 2001 one-number census project

Summary.  The one-number census approach was developed by the Office for National Statistics to adjust the counts from the 2001 census of England and Wales for underenumeration. The method is underpinned by an assumption of independence between the count of the population that was given by the 2001 census and the count that was given by the Census Coverage Survey. Some dependence was, however, detected, and the paper describes the strategy that was used to measure dependence and to adjust the 2001 census population estimates.