Statistics for weighing benefits and harms in a proposed genetic substudy of a randomized cancer prevention trial

Summary.  When evaluating potential interventions for cancer prevention, it is necessary to compare benefits and harms. With new study designs, new statistical approaches may be needed to facilitate this comparison. A case in point arose in a proposed genetic substudy of a randomized trial of tamoxifen versus placebo in asymptomatic women who were at high risk for breast cancer. Although the randomized trial showed that tamoxifen substantially reduced the risk of breast cancer, the harms from tamoxifen were serious and some were life threaten-ing. In hopes of finding a subset of women with inherited risk genes who derive greater bene-fits from tamoxifen, we proposed a nested case–control study to test some trial subjects for various genes and new statistical methods to extrapolate benefits and harms to the general population. An important design question is whether or not the study should target common low penetrance genes. Our calculations show that useful results are only likely with rare high penetrance genes.     

Mastery,Homeownership, and Adult Roles During the Transition to Adulthood

We investigate the relationship between homeownership and personal sense of mastery in the transition to adulthood and examine whether three important adult transitions (employment, marriage/cohabitation, and parenthood) moderate the impact of homeownership on mastery. Utilizing the National Longitudinal Survey of Youth—Young Adult Sample (N = 1,609), we estimate change models to assess the direct effects of homeownership on mastery as well as whether this impact is modified by the transition to adult roles. Homeownership increases the sense of mastery among young adults. Homeowners who are unemployed paradoxically receive a boost to mastery not experienced by those who are employed, and homeowners who are parents experience increased mastery, compared to those who do not have children. Owning a home has a positive influence on young adults' sense of mastery during a period when their mastery is in flux and they are accumulating new roles.     

The Value of Information in Decision‐Analytic Modeling for Malaria Vector Control in East Africa

Decision analysis tools and mathematical modeling are increasingly emphasized in malaria control programs worldwide to improve resource allocation and address ongoing challenges with sustainability. However, such tools require substantial scientific evidence, which is costly to acquire. The value of information (VOI) has been proposed as a metric for gauging the value of reduced model uncertainty. We apply this concept to an evidenced‐based Malaria Decision Analysis Support Tool (MDAST) designed for application in East Africa. In developing MDAST, substantial gaps in the scientific evidence base were identified regarding insecticide resistance in malaria vector control and the effectiveness of alternative mosquito control approaches, including larviciding. We identify four entomological parameters in the model (two for insecticide resistance and two for larviciding) that involve high levels of uncertainty and to which outputs in MDAST are sensitive. We estimate and compare a VOI for combinations of these parameters in evaluating three policy alternatives relative to a status quo policy. We find having perfect information on the uncertain parameters could improve program net benefits by up to 5–21%, with the highest VOI associated with jointly eliminating uncertainty about reproductive speed of malaria‐transmitting mosquitoes and initial efficacy of larviciding at reducing the emergence of new adult mosquitoes. Future research on parameter uncertainty in decision analysis of malaria control policy should investigate the VOI with respect to other aspects of malaria transmission (such as antimalarial resistance), the costs of reducing uncertainty in these parameters, and the extent to which imperfect information about these parameters can improve payoffs.     

Conceptualizing Childbearing Ambivalence: A Social and Dynamic Perspective

Childbearing ambivalence is often conceptualized as a state of conflicting desires about having a child that is characteristic of particular individuals or life stages. This study proposes that childbearing ambivalence is dynamic and situational, resulting from the multiple sociocultural frames surrounding childbearing. Using eight waves of prospective data from a population‐based sample of young adults in Malawi, results show that 41% of women and 48% of men are ambivalent about childbearing at some point in the 2.5‐year study. There is limited evidence that ambivalence is related to individual sociodemographic or psychosocial characteristics aside from gender; rather, ambivalence is tied to life course markers such as school enrollment and age. In addition, life course transitions and changes in relationships, health, and economic factors are associated with the onset of ambivalence, supporting the theory that ambivalence is a dynamic state that men and women frequently pass through as their lives and circumstances change.     

Multidimensional Resilience: Predictive and Construct Validity of the Individual,Family, and Community Resilience Profile

Few measures parallel the robust depth offered in the existing multidimensional and ecologically informed theories of resilience. This study sought to evaluate the test–retest reliability, construct, and predictive validity of the individual, family, and community resilience resource profile (IFCR-R). The IFCR-R measures a family’s access to resilience resources and protective factors across multiple ecological levels. Confirmatory factor analysis was used with a sample of n?=?810 low-income families. And 159 families completed multiple time point measures for test–retest reliability and predictive validity evaluation. Results of this study support the proposed multidimensional ecological structure of the IFCR-R and found that the IFCR-R offers an acceptable test–retest reliability and predictive validity for outcomes of mental and physical health.     

Using relative utility curves to evaluate risk prediction

Summary.  Because many medical decisions are based on risk prediction models that are constructed from medical history and results of tests, the evaluation of these prediction models is important. This paper makes five contributions to this evaluation: the relative utility curve which gauges the potential for better prediction in terms of utilities, without the need for a reference level for one utility, while providing a sensitivity analysis for misspecification of utilities, the relevant region, which is the set of values of prediction performance that are consistent with the recommended treatment status in the absence of prediction, the test threshold, which is the minimum number of tests that would be traded for a true positive prediction in order for the expected utility to be non-negative, the evaluation of two-stage predictions that reduce test costs and connections between various measures of performance of prediction. An application involving the risk of cardiovascular disease is discussed.     

Adolescents Conceived through Donor Insemination in Mother‐Headed Families: A Qualitative Study of Motivations and Experiences of Contacting and Meeting Same‐donor Offspring

This study interviewed adolescents conceived using sperm donation to examine their experiences of contacting and meeting ‘same‐donor offspring’ (i.e. donor‐conceived offspring raised in different families who share the same donor), their motivations for this contact, and how they make meaning of these relationships. This in‐depth qualitative study involved semi‐structured interviews with 23 young people aged 12–19 years (mean = 14 years). Interviewees were motivated by curiosity about their biological relations and by wanting to extend their family. Contact with same‐donor offspring was described as being either normal/neutral or as a unique experience that was integrated into their identity. This study highlights the importance of contact between same donor offspring, particularly during adolescence, a developmental stage associated with identity formation. The findings have important policy implications as they suggest that donor‐conceived individuals may benefit from contact with others conceived using the same donor prior to the age of 18 years.     

The Incompatibility of Materialism and the Desire for Children: Psychological Insights into the Fertility Discrepancy Among Modern Countries

We examined factors related to attitudes toward marriage and the importance of having children in both the US and Singapore. Path analysis indicated that life dissatisfaction leads to materialism, and both of these factors lead to favorable attitudes toward marriage, which leads to greater desire for children. Further analysis indicated this model was effective in explaining the difference in desire for children between Singaporeans and Americans, whereby Singaporeans have lower life satisfaction, higher materialism, and lower attitudes toward marriage and children. Materialistic standards of success were also related to the emphasis women placed on potential marriage partners’ earning capacity. As Singaporean women had higher materialistic standards, they also placed higher emphasis on potential mates’ earning capacity. Results suggest a consideration of psychological variables such as life satisfaction, materialism, and mate preferences may lead to a better understanding of larger-scale socioeconomic issues, including low fertility rates among developed East Asian countries.