Statistical Analysis with Missing Data

Coping, defined as action-oriented and intrapsychic efforts to manage the demands created by stressful events, is coming to be recognized both for its significant impact on stress-related mental and physical health outcomes and for its intervention potential. We review coping resources that aid in this process, including individual differences in optimism, mastery, self-esteem, and social support, and examine appraisal and coping processes, especially those marked by approach or avoidance. We address the origins of coping resources and processes in genes, early life experience, and gene-environment interactions, and address neural underpinnings of coping that may shed light on evaluating coping interventions. We conclude by outlining possible intervention strategies for improving coping processes.

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Coping Resources, Coping Processes, and Mental Health

Background: Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. Methods: We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. Results: The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Interpretation: Systematic inquiry into patients’ migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

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Common mental health problems in immigrants and refugees: general approach in primary care

Aims: To assess the impact of alcohol advertising and media exposure on future adolescent alcohol use. Methods: We searched MEDLINE, the Cochrane Library, Sociological Abstracts, and PsycLIT, from 1990 to September 2008, supplemented with searches of Google scholar, hand searches of key journals and reference lists of identified papers and key publications for more recent publications. We selected longitudinal studies that assessed individuals' exposure to commercial communications and media and alcohol drinking behaviour at baseline, and assessed alcohol drinking behaviour at follow-up. Participants were adolescents aged 18 years or younger or below the legal drinking age of the country of origin of the study, whichever was the higher. Results: Thirteen longitudinal studies that followed up a total of over 38,000 young people met inclusion criteria. The studies measured exposure to advertising and promotion in a variety of ways, including estimates of the volume of media and advertising exposure, ownership of branded merchandise, recall and receptivity, and one study on expenditure on advertisements. Follow-up ranged from 8 to 96 months. One study reported outcomes at multiple time-points, 3, 5, and 8 years. Seven studies provided data on initiation of alcohol use amongst non-drinkers, three studies on maintenance and frequency of drinking amongst baseline drinkers, and seven studies on alcohol use of the total sample of non-drinkers and drinkers at baseline. Twelve of the thirteen studies concluded an impact of exposure on subsequent alcohol use, including initiation of drinking and heavier drinking amongst existing drinkers, with a dose response relationship in all studies that reported such exposure and analysis. There was variation in the strength of association, and the degree to which potential confounders were controlled for. The thirteenth study, which tested the impact of outdoor advertising placed near schools failed to detect an impact on alcohol use, but found an impact on intentions to use. Conclusions: Longitudinal studies consistently suggest that exposure to media and commercial communications on alcohol is associated with the likelihood that adolescents will start to drink alcohol, and with increased drinking amongst baseline drinkers. Based on the strength of this association, the consistency of findings across numerous observational studies, temporality of exposure and drinking behaviours observed, dose-response relationships, as well as the theoretical plausibility regarding the impact of media exposure and commercial communications, we conclude that alcohol advertising and promotion increases the likelihood that adolescents will start to use alcohol, and to drink more if they are already using alcohol.

Impact of alcohol advertising and media exposure on adolescent alcohol use: a systematic review of longitudinal studies

This essay describes how a basic scientist was thrust into the epicenter, the political cauldron of our national drug control policy, and how the experience altered her professional trajectory and perspective.

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Office of National Drug Control Policy: a scientist in drug policy in Washington, DC.

Aims To examine the relationship between exposure to different forms of alcohol advertising and subsequent drinking among US adolescents and assess whether exposure to an alcohol and drug prevention program mitigates any such relationship.

Design  Regression models with multiple control variables examined the relationship between exposure to alcohol advertising in grade 8 and grade 9 drinking for two groups of South Dakotan adolescents: (1) seventh-grade non-drinkers (n = 1206) and (2) seventh-grade drinkers (n = 1905). Interactions between the intervention program and the significant advertising predictors were tested.

Setting  Forty-one middle schools in South Dakota, USA.

Participants  A total of 3111 seventh-graders followed through grade 9.

Measurements  Advertising variables were constructed for four types of alcohol advertising—television, in-store displays, magazines and concession stands. Other predictors tested included measures tapping social influences, social bonds, problem behavior, alcohol beliefs, television exposure and demographics.

Findings  For seventh-grade non-drinkers, exposure to in-store beer displays predicted drinking onset by grade 9; for seventh-grade drinkers, exposure to magazines with alcohol advertisements and to beer concession stands at sports or music events predicted frequency of grade 9 drinking. Although exposure to television beer advertising had a significant bivariate relationship with alcohol use for grade 7 non-drinkers, it was not a significant predictor of drinking for either group in multivariate analyses. Participation in the prevention program, ALERT Plus, reduced future drinking for both groups and counteracted the effect of in-store beer displays.

Conclusions  Several forms of alcohol advertising predict adolescent drinking; which sources dominate depends on the child's prior experience with alcohol. Alcohol prevention programs and policies should help children counter alcohol advertising from multiple sources and limit exposure to these sources.

Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment

Objective
To evaluate the need for survey mode adjustments to hospital care evaluations by discharged inpatients and develop the appropriate adjustments.

Effects of Survey Mode, Patient Mix, and Nonresponse on CAHPS® Hospital Survey Scores

http://www.abpbrasil.org.br/departamentos/coordenadores/coordenador/noticias/arquivos/artigo_adolescentes.pdf

Early adolescent exposure to alcohol advertising and its relationship to underage drinking.

The CAHPS® hospital project is an effort jointly sponsored by the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research and Quality to collect data that objectively measure patients' perceptions of hospital care and services The CAHPS consortium has developed a standardized survey instrument for collecting information from recently discharged adult patients about care they received in medical, surgical, or obstetric sections of acute care hospitals In this paper, we describe unit and item nonresponse patterns in the pilot version of the CAHPS Hospital Survey, which was conducted in Arizona, Maryland, and New York A subset of items on the pilot survey will be used in national implementation (see Goldstein et al 2005)

Surveys generally do not yield complete responses from every individual sampled from the population In certain situations, nonresponse can bias the survey findings if appropriate adjustments are not made There are two basic types of survey nonresponse Unit nonresponse is the failure of a member of the sample to respond to the survey as a whole Item nonresponse is the failure of a unit respondent to answer one or more survey items that the respondent is eligible to answer In this analysis, we examine and model patterns of both unit and item nonresponse to the pilot CAHPS Hospital Survey to assess the potential impacts of nonresponse bias and the corresponding adjustments (Throughout this paper, nonresponse and nonresponse bias refer to unit nonresponse unless otherwise specified)

There are other sources of bias that have the potential to affect analyses of the CAHPS hospital data In particular, the mix of services and patient characteristics often varies significantly among hospitals Thus, comparisons of CAHPS Hospital Survey data across hospitals or across different groups of patients may be biased unless case-mix adjustments are made to take such differences into account It is important that nonresponse analyses of the CAHPS Hospital Survey data be made in conjunction with case-mix analyses, as one type adjustment may affect biases targeted by the other

Thus, once eligible discharges have been selected from each hospital, there are at least two links from this targeted group of patients to the data ultimately obtained, each of which can threaten equitable comparisons among hospitals Case-mix adjustments attempt to account for response bias among respondents—ie, the systematic lack of correspondence between actual health care experiences and reports thereof among respondents (see O'Malley et al 2005) Nonresponse analyses, the subject of the present manuscript, attempt to account for nonresponse bias resulting from differences between respondents and the full set of those targeted by the survey Together, case-mix adjustment and nonresponse analyses enable survey estimates to more accurately reflect consumer experience of hospital performance and to provide more informative comparisons with consumers, hospitals, and other stakeholders engaging in quality improvement efforts

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Patterns of unit and item nonresponse in the CAHPS Hospital Survey.

The authors examined the relationship among trauma, coping, depression, and mental health service seeking in a probability sample of sheltered homeless and low-income housed women. Results highlight the diversity of trauma. In a longitudinal analysis, women who lived in shelters or experienced major violence had a twofold increase in their risk of depression over the 6-month follow-up. In a cross-sectional analysis, childhood sexual abuse, living in a shelter, physical violence, childhood physical abuse, and death or injury of a friend or relative predicted avoidant coping and symptoms of depression. Active coping and depression predicted mental health service seeking among traumatized women. Modifying coping strategies may ameliorate some of the negative impact of trauma and potentially enhance mental health service use among at-risk women.

https://www.rand.org/content/dam/rand/pubs/reprints/2008/RAND_RP1329.pdf

Katrin Hambarsoomians

Papers

Does alcohol advertising promote adolescent drinking? Results from a longitudinal assessment

Effects of Survey Mode, Patient Mix, and Nonresponse on CAHPS® Hospital Survey Scores

Early adolescent exposure to alcohol advertising and its relationship to underage drinking.

Patterns of unit and item nonresponse in the CAHPS Hospital Survey.

Trauma, depression, coping, and mental health service seeking among impoverished women.