公共卫生支出、健康结果与卫生投入政策——基于189个国家和地区的面板门槛分析（1995—2011年）

利用189个国家和地区1995—2011年的数据实证检验公共卫生支出规模对一个国家的健康结果（婴儿死亡率和出生时的平均期望寿命）的影响，结果表明，公共卫生支出占GDP的比重对婴儿死亡率和出生时的平均期望寿命的影响具有门槛效应，门槛值分别位于1.9%和6.62%。分段回归结果显示，公共卫生支出占GDP的比重低于1.9%时，公共卫生投入对出生时的平均期望寿命没有显著影响，对婴儿死亡率的影响较弱；超过1.9%后，公共卫生投入的规模效应开始体现，对健康结果指标的影响均显著增强；超过6.62%后，公共卫生投入对婴儿死亡率的影响不再显著，对出生时平均期望寿命的弹性系数不再变化，单位边际贡献不再增加。中国当前政府卫生投入规模仍然较低，需要继续增大公共资金投入、降低个人卫生支出比重。     

Men,masculinities, and gender-based violence: The broadening scope of recent research

Men's relationships to gender-based violence (GBV) have long been an area of sociological inquiry, but until recently men have primarily been framed as perpetrators of violence against women. More recently, research on men and GBV has broadened to include studying men as victims/survivors, as investigators and law enforcement officers, as passive or active bystanders, and as allies in working to address this social problem. We review this research in an effort to bridge these divergent bodies of work; we identify methodological trends and gaps in existing research, make recommendations for improved theoretical and methodological robustness, and suggest that research perspectives on men and GBV have shifted over time as wider understandings of gender and masculinities become more hopeful and more inclusive. While we see optimism and promise in new directions of GBV research, we urge ongoing research to retain the wisdoms and critical perspectives that marked the beginnings of GBV inquiry.     

铜陵公务员体育锻炼现状及健康状况的研究

本文通过对铜陵市279名在编公务员的问卷调查和跟踪访谈,对公务员的体育锻炼动机、影响体育锻炼的影响因素、体育锻炼场所、项目、形式及健康体检等结果做系统性的分析,寻找出公务员这一人群体育锻炼与身体健康存在的问题,并提出可行性的建议,为改善公务员的身心健康提供一定的科学依据。     

A Psychometric Review of Measures Assessing Discrimination Against Sexual Minorities

ABSTRACT

Discrimination against sexual minorities is widespread and has deleterious consequences on victims’ psychological and physical wellbeing. However, a review of the psychometric properties of instruments measuring lesbian, gay, and bisexual (LGB) discrimination has not been conducted. The results of this review, which involved evaluating 162 articles, reveal that most have suboptimal psychometric properties. Specifically, myriad scales possess questionable content validity as (1) items are not created in collaboration with sexual minorities; (2) measures possess a small number of items and, thus, may not sufficiently represent the domain of interest; and (3) scales are “adapted” from measures designed to examine race- and gender-based discrimination. Additional limitations include (1) summed scores are computed, often in the absence of scale score reliability metrics; (2) summed scores operate from the questionable assumption that diverse forms of discrimination are necessarily interrelated; (3) the dimensionality of instruments presumed to consist of subscales is seldom tested; (4) tests of criterion-related validity are routinely omitted; and (5) formal tests of measures’ construct validity are seldom provided, necessitating that one infer validity based on the results obtained. The absence of “gold standard” measures, the attendant difficulty in formulating a coherent picture of this body of research, and suggestions for psychometric improvements are noted.     

Sexual Orientation Change Efforts and the Search for Authenticity

This article is based on structured interviews of a sample of 15 former participants in sexual orientation change efforts (SOCE), who currently identify as gay or lesbian. The primary research question for this study was, “What was the experience of self-identified gay men and lesbians who went through some type of SOCE and eventually asserted themselves as gay or lesbian?” The research concludes that participants sometimes identified as heterosexual during SOCE, but never changed their underlying homosexual orientation, and that suppression, disconnection, and a sense of inauthenticity were significant phenomena of this process.     

Ideologies & Narratives in Relation to ‘Fat’ Children as Bullies, ‘Easy Targets’ and Victims

In this study, we explore narratives in relation to ‘fatness’, drawing on focus group interviews with parents, early years practitioners, teachers and young people. The study is located in a larger study on bullying and resilience, with no specific focus on obesity or ‘fatness’. Analysis of the interview data highlighted a recurrent focus on ‘fatness’ within the participants’ narratives, by labelling and stigmatising the ‘fat kid’ and ‘bigger children’. We conclude that obesity and fatness, as abnormalities, are now included in commonsense talk in relation to ‘easy targets’, victims and bullies.     

Planning an integrated agriculture and health program and designing its evaluation: Experience from Western Kenya

Multi-sectoral programs that involve stakeholders in agriculture, nutrition and health care are essential for responding to nutrition problems such as vitamin A deficiency among pregnant and lactating women and their infants in many poor areas of lower income countries. Yet planning such multi-sectoral programs and designing appropriate evaluations, to respond to different disciplinary cultures of evidence, remain a challenge. We describe the context, program development process, and evaluation design of the Mama SASHA project (Sweetpotato Action for Security and Health in Africa) which promoted production and consumption of a bio-fortified, orange-fleshed sweetpotato (OFSP). In planning the program we drew upon information from needs assessments, stakeholder consultations, and a first round of the implementation evaluation of a pilot project. The multi-disciplinary team worked with partner organizations to develop a program theory of change and an impact pathway which identified aspects of the program that would be monitored and established evaluation methods. Responding to the growing demand for greater rigour in impact evaluations, we carried out quasi-experimental allocation by health facility catchment area, repeat village surveys for assessment of change in intervention and control areas, and longitudinal tracking of individual mother-child pairs. Mid-course corrections in program implementation were informed by program monitoring, regular feedback from implementers and partners’ meetings. To assess economic efficiency and provide evidence for scaling we collected data on resources used and project expenses. Managing the multi-sectoral program and the mixed methods evaluation involved bargaining and trade-offs that were deemed essential to respond to the array of stakeholders, program funders and disciplines involved.     

Housing hardship and energy insecurity among native-born and immigrant low-income families with children in the United States

The costs for rent and utilities account for the largest share of living expenses, yet these two critical dimensions of material hardship have seldom been examined concurrently in population-based studies. This paper employs multivariate statistical analysis using American Community Survey data to demonstrate the relative risk ratio of low-income renter-occupied households with children experiencing ‘rent burden', ‘energy insecurity', or a ‘double burden’ as opposed to no burden. Findings suggest that low-income households are more likely to experience these economic hardships in general but that specific groups are disproportionately burdened in different ways. For instance, whereas immigrants are more likely to experience rental burden, they are less likely to experience energy insecurity and are also spared from the double burden. In contrast, native-born African Americans are more likely than all other groups to experience the double burden. These results may be driven by the housing stock available to certain groups due to racial residential segregation, decisions regarding the quality of housing low-income householders are able to afford, as well as home-country values, such as modest living and energy conservation practices, among immigrant families. This paper also points to important policy gaps in safety net benefits related to housing and energy targeting low-income households.