Showing papers by "RAND Corporation published in 2006"
TL;DR: This work systematically review evidence on the costs and benefits associated with use of health information technology and to identify gaps in the literature in order to provide organizations, policymakers, clinicians, and consumers an understanding of the effect ofhealth information technology on clinical care.
Abstract: This review found that 4 benchmark institutions have done most of the published research on the effects of the electronic health record on medical care. The research shows that electronic health re...
3,053 citations
TL;DR: In this article, the extent to which student engagement is associated with experimental and traditional measures of academic performance, whether the relationships between engagement and academic performance are conditional, and whether institutions differ in terms of their ability to convert student engagement into academic performance.
Abstract: This study examines (1) the extent to which student engagement is associated with experimental and traditional measures of academic performance, (2) whether the relationships between engagement and academic performance are conditional, and (3) whether institutions differ in terms of their ability to convert student engagement into academic performance. The sample consisted of 1058 students at 14 four-year colleges and universities that completed several instruments during 2002. Many measures of student engagement were linked positively with such desirable learning outcomes as critical thinking and grades, although most of the relationships were weak in strength. The results suggest that the lowest-ability students benefit more from engagement than classmates, first-year students and seniors convert different forms of engagement into academic achievement, and certain institutions more effectively convert student engagement into higher performance on critical thinking tests.
1,586 citations
TL;DR: This article reviewed the recent empirical literature on teacher recruitment and retention published in the United States and examined the characteristics of individuals who enter and remain in the teaching profession, characteristics of schools and districts that successfully recruit and retain teachers, and the types of policies that show evidence of efficacy in recruiting and retaining teachers.
Abstract: This article critically reviews the recent empirical literature on teacher recruitment and retention published in the United States. It examines the characteristics of individuals who enter and remain in the teaching profession, the characteristics of schools and districts that successfully recruit and retain teachers, and the types of policies that show evidence of efficacy in recruiting and retaining teachers. The goal of the article is to provide researchers and policymakers with a review that is comprehensive, evaluative, and up to date. The review of the empirical studies selected for discussion is intended to serve not only as a compendium of available recent research on teacher recruitment and retention but also as a guide to the merit and importance of these studies.
1,244 citations
TL;DR: This study demonstrates robust decision making (RDM), an analytic method that helps design robust strategies through an iterative process that first suggests candidate robust strategies, identifies clusters of future states of the world to which they are vulnerable, and then evaluates the trade-offs in hedging against these vulnerabilities.
Abstract: Robustness is a key criterion for evaluating alternative decisions under conditions of deep uncertainty. However, no systematic, general approach exists for finding robust strategies using the broad range of models and data often available to decision makers. This study demonstrates robust decision making (RDM), an analytic method that helps design robust strategies through an iterative process that first suggests candidate robust strategies, identifies clusters of future states of the world to which they are vulnerable, and then evaluates the trade-offs in hedging against these vulnerabilities. This approach can help decision makers design robust strategies while also systematically generating clusters of key futures interpretable as narrative scenarios. Our study demonstrates the approach by identifying robust, adaptive, near-term pollution-control strategies to help ensure economic growth and environmental quality throughout the 21st century.
728 citations
TL;DR: This paper focuses on the technologies required to meet the global health diagnostics needs presented in the previous papers, highlighting how new diagnostic technologies might have the potential to change medical and public-health scenarios in the developing world.
Abstract: This paper focuses on the technologies required to meet the global health diagnostics needs presented in the previous papers, highlighting how new diagnostic technologies might have the potential to change medical and public-health scenarios in the developing world.
528 citations
TL;DR: The authors studied corporate philanthropy using an original database that includes firm-level data on dollar giving, giving priorities, governance, and managerial involvement in giving programs, and found that firms with higher debt-to-value ratios give less cash to charities and are less likely to establish foundations.
523 citations
TL;DR: In this paper, the authors examined the development of trust and cooperation in computer-mediated and face-to-face teams and found that trust started lower in computer mediated teams but increased to levels comparable to those in face to face teams over time.
509 citations
TL;DR: A large body of literature spanning numerous cohorts from many countries and with different demographic characteristics does not provide evidence to suggest a significant association between omega-3 fatty acids and cancer incidence.
Abstract: ContextOmega-3 fatty acids are purported to reduce the risk of cancer. Studies have reported mixed results.ObjectiveTo synthesize published and unpublished evidence to determine estimates of the effect of omega-3 fatty acids on cancer risk in prospective cohort studies.Data SourcesArticles published from 1966 to October 2005 identified through MEDLINE, PREMEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and CAB Health; unpublished literature sought through letters to experts in the neutraceutical industry.Study SelectionA total of 38 articles with a description of effects of consumption of omega-3 fatty acids on tumor incidence, prospective cohort study design, human study population; and description of effect of omega-3 among groups with different levels of exposure in the cohort were included. Two reviewers independently reviewed articles using structured abstraction forms; disagreements were resolved by consensus.Data ExtractionTwo reviewers independently abstracted detailed data about the incidence of cancer, the type of cancer, the number and characteristics of the patients, details on the exposure to omega-3 fatty acids, and the elapsed time between the intervention and outcome measurements. Data about the methodological quality of the study were also abstracted.Data SynthesisAcross 20 cohorts from 7 countries for 11 different types of cancer and using up to 6 different ways to categorize omega-3 fatty acid consumption, 65 estimates of the association between omega-3 fatty acid consumption were reported. Among these, only 8 were statistically significant. The high degree of heterogeneity across these studies precluded pooling of data. For breast cancer 1 significant estimate was for increased risk (incidence risk ratio [IRR], 1.47; 95% confidence interval [CI], 1.10-1.98) and 3 were for decreased risk (RR, 0.68-0.72); 7 other estimates did not show a significant association. For colorectal cancer, there was 1 estimate of decreased risk (RR, 0.49; 95% CI, 0.27-0.89) and 17 estimates without association. For lung cancer one of the significant associations was for increased cancer risk (IRR, 3.0; 95% CI, 1.2-7.3), the other was for decreased risk (RR, 0.32; 95% CI, 0.13-0.76), and 4 other estimates were not significant. For prostate cancer, there was 1 estimate of decreased risk (RR, 0.43; 95% CI, 0.22-0.83) and 1 of increased risk (RR, 1.98; 95% CI, 1.34-2.93) for advanced prostate cancer; 15 other estimates did not show a significant association. The study that assessed skin cancer found an increased risk (RR, 1.13; 95% CI, 1.01-1.27). No significant associations between omega-3 fatty acid consumption and cancer incidence were found for aerodigestive cancer, bladder cancer, lymphoma, ovarian cancer, pancreatic cancer, or stomach cancer.ConclusionsA large body of literature spanning numerous cohorts from many countries and with different demographic characteristics does not provide evidence to suggest a significant association between omega-3 fatty acids and cancer incidence. Dietary supplementation with omega-3 fatty acids is unlikely to prevent cancer.
483 citations
TL;DR: The goal of this study was to examine the association between park proximity, park type, and park features and physical activity in adolescent girls, and found that the type, number, and specific parks features were associated with girls' nonschool metabolic equivalent–weighted moderate/vigorous physical activity.
Abstract: OBJECTIVES.Physical activity may be constrained or facilitated by local environments. The availability of neighborhood facilities for physical activity may be particularly relevant for youth, who are unable to drive and whose activity is often limited to the immediate distance they are able to walk or bicycle. Several studies have shown that proximity to recreational facilities and parks is one of the most important predictors of physical activity. Because the United States already has an extensive infrastructure of parks, with 70% of adults indicating that they live within walking distance of a park or playground, parks may be a potential venue for increasing physical activity. This might be particularly important for adolescent girls, whose physical activity levels decline substantially as they go through puberty. The goal of this study was to examine the association between park proximity, park type, and park features and physical activity in adolescent girls. PATIENTS AND METHODS.This was a cross-sectional study using baseline data from the Trial of Activity for Adolescent Girls. It included 1556 grade 6 girls who were randomly selected from 6 middle schools in each of the following 6 field site areas: Washington, DC, and Baltimore, Maryland; Columbia, South Carolina; Minneapolis, Minnesota; New Orleans, Louisiana; Tucson, Arizona; and San Diego, California. Girls wore accelerometers for 6 days to measure metabolic equivalent‐ weighted moderate-to-vigorous physical activity, a measure accounting for the volume and intensity of activity. Metabolic equivalent‐weighted moderate-tovigorous physical activity was calculated for the hours outside of school time using 2 different cutpoints, activity levels 3.0 metabolic equivalents and 4.6 metabolic equivalents, the latter indicating activity at the intensity of a brisk walk or higher. We mapped all of the parks within 1 mile of each girl’s home. Trained staff used a checklist to document the presence of facilities and amenities at each park, including passive amenities, such as drinking fountains, restrooms, and areas with shade, as well as active amenities like basketball courts, multipurpose fields, playgrounds, and tennis courts.
475 citations
TL;DR: Differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality ofhealth care.
Abstract: Background American adults frequently do not receive recommended health care. The extent to which the quality of health care varies among sociodemographic groups is unknown. Methods We used data from medical records and telephone interviews of a random sample of people living in 12 communities to assess the quality of care received by those who had made at least one visit to a health care provider during the previous two years. We constructed aggregate scores from 439 indicators of the quality of care for 30 chronic and acute conditions and for disease prevention. We estimated the rates at which members of different sociodemographic subgroups received recommended care, with adjustment for the number of chronic and acute conditions, use of health care services, and other sociodemographic characteristics. Results Overall, participants received 54.9 percent of recommended care. Even after adjustment, there was only moderate variation in quality-of-care scores among sociodemographic subgroups. Women had higher overall scores than men (56.6 percent vs.52.3 percent, P<0.001), and participants below the age of 31 years had higher scores than those over the age of 64 years (57.5 percent vs. 52.1 percent, P<0.001). Blacks (57.6 percent) and Hispanics (57.5 percent) had slightly higher scores than whites (54.1 percent, P<0.001 for both comparisons). Those with annual household incomes over $50,000 had higher scores than those with incomes of less than $15,000 (56.6 percent vs. 53.1 percent, P<0.001). Conclusions The differences among sociodemographic subgroups in the observed quality of health care are small in comparison with the gap for each subgroup between observed and desirable quality of health care. Quality-improvement programs that focus solely on reducing disparities among sociodemographic subgroups may miss larger opportunities to improve care.
442 citations
TL;DR: If group-level collective efficacy is indeed important in the regulation of individual-level net energy balance, it suggests that future interventions to control weight by addressing the social environment at the community level may be promising.
TL;DR: The results demonstrate the feasibility, reliability, and validity of the PedsQLTM 4.0 Generic Core Scales as a school population health measure for children and adolescents.
Abstract: Background: The application of health-related quality of life (HRQOL) as a school population health measure may facilitate risk assessment and resource allocation, the tracking of student health at the school and district level, the identification of health disparities among schoolchildren, and the determination of health outcomes from interventions and policy decisions at the school, district, and county level. Objective:To determine the feasibility, reliability, and validity of the 23-item PedsQLTM 4.0 (Pediatric Quality of Life InventoryTM) Generic Core Scales as a school population health measure for children and adolescents. Design: Survey conducted in 304 classes at 18 elementary schools, 4 middle schools, and 3 high schools within a large metropolitan school district. Methods:The PedsQLTM 4.0 Generic Core Scales (Physical, Emotional, Social, School Functioning) were completed by 2437 children ages 8–18 and 4227 parents of children ages 5–18. Results:The PedsQLTM 4.0 evidenced minimal missing responses, achieved excellent reliability for the Total Scale Score (α = 0.89 child, 0.92, parent report), and distinguished between healthy children and children with chronic health conditions. The PedsQLTM 4.0 was related to indicators of socioeconomic status (SES) at the school and district level. The PedsQLTM School Functioning Scale was significantly correlated with standardized achievement scores based on the Stanford 9. Conclusion: The results demonstrate the feasibility, reliability and validity of the PedsQLTM 4.0 Generic Core Scales as a school population health measure. The implications of measuring HRQOL in schoolchildren at the school, district, and county level for identifying and ameliorating health disparities are discussed.
TL;DR: Exposure to grocery store mediates and suppresses the association of residential neighborhoods with BMI and could explain why previous studies may not have found robust associations between residential neighborhood predictors and BMI.
TL;DR: It was shown that African-American and Hispanic women have longer intervals between mammography and are more likely to have advanced-stage tumors at diagnosis and to die of breast cancer than white women, but in women with similar screening histories, these rates were similar regardless of race or ethnicity.
Abstract: African-American women are less likely to receive adequate mammographic screening than white women, which may explain the higher prevalence of advanced breast tumors among African-American women. Tumor characteristics may also contribute to differences in cancer outcomes because African-American women have higher-grade tumors than white women regardless of screening. These results suggest that adherence to recommended mammography screening intervals may reduce breast cancer mortality rates.
TL;DR: Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys and girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully.
Abstract: To examine the link between childhood overweight status and elementary school outcomes. Prospective study design: multivariate regression models examining the association between changes in overweight status and school outcomes between kindergarten entry and end of third grade, after controlling for various child, family and school characteristics. Nationally representative sample of US children who entered kindergarten in 1998, with longitudinal data on body mass index (BMI) and school outcomes at kindergarten entry and end of third grade. Wide range of elementary school outcomes collected in each wave including academic achievement (math and reading standardized test scores); teacher reported internalizing and externalizing behavior problems (BP), social skills (self-control, interpersonal skills) and approaches to learning; school absences; and grade repetition. Measurements of height and weight in each wave were used to compute BMI and indicators of overweight status based on CDC growth charts. A rich set of control variables capturing child, family, and school characteristics. Moving from not-overweight to overweight between kindergarten entry and end of third grade was significantly associated (P<0.05) with reductions in test scores, and teacher ratings of social-behavioral outcomes and approaches to learning among girls. However, this link was mostly absent among boys, with two exceptions – boys who became overweight had significantly fewer externalizing BPs (P<0.05), but more absences from school compared to boys who remained normal weight. Being always-overweight was associated with more internalizing BP among girls but fewer externalizing BPs among boys. Change in overweight status during the first 4 years in school is a significant risk factor for adverse school outcomes among girls but not boys. Girls who become overweight during the early school years and those who start school being overweight and remain that way may need to be monitored carefully.
TL;DR: A conceptual model based on Donabedian's work is developed that examines the relationship of quality of care, both technical and interpersonal, with patients' global evaluations of health care and concludes that patient preferences and placing priority on the personal relationship between physician and patient have been shown to be key strategies of a patient-centered approach.
Abstract: In this cohort study of 236 vulnerable older patients, respondents rated their communication with doctors and the global quality of their health care. Using the patients' medical records, research ...
TL;DR: The burden of ED on the US population is significant and obesity, hypertension, smoking, and diabetes mellitus are significantly associated with ED risk, and mitigation of these risk factors may ameliorate the burden ofED.
Abstract: Background To our knowledge, the burden of disease attributed to erectile dysfunction (ED) has not been adequately quantified across a complete spectrum of age and race using a global disease definition, as recommended by the National Institutes of Health consensus statement. To obtain a better understanding of the national estimates of prevalence and risk factors for ED, we analyzed data from the 2001-2002 National Health and Nutrition Examination Survey. Methods The National Health and Nutrition Examination Survey collects data by household interview. The sample design is a stratified, multistage, probability sample of clusters of persons representing the civilian noninstitutionalized population. Data include medical histories in which specific queries are made regarding urological symptoms (including ED). These items were selected for analysis in 3566 men, 20 years and older. Results In men 20 years and older, ED affected almost 1 in 5 respondents. Hispanic men were more likely to report ED (odds ratio [OR], 1.89), after controlling for other factors. The prevalence of ED increased dramatically with advanced age; 77.5% of men 75 years and older were affected. In addition, there were several modifiable risk factors that were independently associated with ED, including diabetes mellitus (OR, 2.69), obesity (OR, 1.60), current smoking (OR, 1.74), and hypertension (OR, 1.56). Conclusions The burden of ED on the US population is significant. Hispanic men had an elevated risk for ED, a finding that requires confirmation in prospective studies. Obesity, hypertension, smoking, and diabetes mellitus are significantly associated with ED risk. Mitigation of these risk factors may ameliorate the burden of ED.
TL;DR: In this paper, the authors used exogenous variation in birth dates and kindergarten entrance age policies to generate instrumental variable estimates of the effect of delaying kindergarten entrance on children's academic achievement, finding that entering kindergarten a year older significantly boosts test scores at kindergarten entry.
TL;DR: In this article, English proficiency may be important in explaining disparities in health and health care access among older adults, and English proficiency is used as a predictor of health disparities in older adults.
Abstract: BACKGROUND: English proficiency may be important in explaining disparities in health and health care access among older adults.
TL;DR: In this article, the authors determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures.
Abstract: Purpose In 1999, the National Cancer Policy Board called attention to the quality of cancer care in the United States and recommended establishing a quality monitoring system with the capability of regularly reporting on the quality of care for patients with cancer. Methods Using data from a patient survey 4 years after diagnosis and review of medical records, we determined the percentage of stage I to III breast cancer and stage II to III colorectal cancer survivors in five metropolitan statistical areas (MSAs) across the United States who received recommended care specified by a comprehensive set of explicit quality measures. Results Two thousand three hundred sixty-six (63%) of 3,775 eligible patients responded to the survey, and 85% consented to have their medical records reviewed. Our final analytic sample (n 1,765) included 47% of the eligible patients. Patients with breast and colorectal cancer received 86% of recommended care (95% CI, 86% to 87%) and 78% of recommended care (95% CI, 77% to 79%), respectively. Adherence to quality measures was less than 85% for 18 of the 36 breast cancer measures, and significant variation across MSAs was observed for seven quality measures. The percent adherence was less than 85% for 14 of the 25 colorectal cancer measures, and one quality measure demonstrated statistically significant variation across the MSAs. Conclusion Initial management of patients with breast and colorectal cancer in the United States seemed consistent with evidence-based practice; however, substantial variation in adherence to some quality measures point to significant opportunities for improvement. J Clin Oncol 24:626-634.
TL;DR: The IMPACT intervention is a high-value investment for older adults with diabetes; it is associated with high clinical benefits at no greater cost than usual care.
Abstract: OBJECTIVE—To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression. RESEARCH DESIGN AND METHODS—This article describes a preplanned subgroup analysis of patients with diabetes from the Improving Mood-Promoting Access to Collaborative (IMPACT) randomized controlled trial. The setting for the study included 18 primary care clinics from eight health care organizations in five states. A total of 418 of 1,801 patients randomized to the IMPACT intervention (n = 204) versus usual care (n = 214) had coexisting diabetes. A depression care manager offered education, behavioral activation, and a choice of problem-solving treatment or support of antidepressant management by the primary care physician. The main outcomes were incremental cost-effectiveness and net benefit of the program compared with usual care. RESULTS—Relative to usual care, intervention patients experienced 115 (95% CI 72–159) more depression-free days over 24 months. Total outpatient costs were $25 (95% CI −1,638 to 1,689) higher during this same period. The incremental cost per depression-free day was 25 cents (−$14 to $15) and the incremental cost per quality-adjusted life year ranged from $198 (144–316) to $397 (287–641). An incremental net benefit of $1,129 (692–1,572) was found. CONCLUSIONS—The IMPACT intervention is a high-value investment for older adults with diabetes; it is associated with high clinical benefits at no greater cost than usual care.
TL;DR: Recommendations are presented for achieving high-quality care for common mental disorders at the interface of general medicine and mental health and for overcoming barriers and facilitating use of evidence-based quality improvement models.
Abstract: This paper is based on a report commissioned by the Subcommittee on Mental Health Interface With General Medicine of the Presidents New Freedom Commission on Mental Health. Although mental and medical conditions are highly interconnected, medical and mental health care systems are separated in many ways that inhibit effective care. Treatable mental or medical illnesses are often not detected or diagnosed properly, and effective services are often not provided. Improved mental health care at the interface of general medicine and mental health requires educated consumers and providers; effective detection, diagnosis, and monitoring of common mental disorders; valid performance criteria for care at the interface of general medicine and mental health; care management protocols that match treatment intensity to clinical outcomes; effective specialty mental health support for general medical providers; and financing mechanisms for evidence-based models of care. Successful models exist for improving the collaboration between medical and mental health providers. Recommendations are presented for achieving high-quality care for common mental disorders at the interface of general medicine and mental health and for overcoming barriers and facilitating use of evidence-based quality improvement models.
TL;DR: In this paper, the authors assessed the impact of peer influence on both initiation and escalation of cigarette, alcohol, and marijuana use among sixth, seventh, and eighth graders in the US.
TL;DR: Geocoding and surname analysis show promise for estimating racial/ethnic health plan composition of enrollees when direct data on major racial and ethnic groups are lacking and can be used to assess disparities in care, pending availability of self-reported race/ethnicity data.
Abstract: Objective. To review two indirect methods, geocoding and surname analysis, for estimating race/ethnicity as a means for health plans to assess disparities in care. Study Design. Review of published articles and unpublished data on the use of geocoding and surname analyses. Principal Findings. Few published studies have evaluated use of geocoding to estimate racial and ethnic characteristics of a patient population or to assess disparities in health care. Three of four studies showed similar estimates of the proportion of blacks and one showed nearly identical estimates of racial disparities, regardless of whether indirect or more direct measures (e.g., death certificate or CMS data) were used. However, accuracy depended on racial segregation levels in the population and region assessed and geocoding was unreliable for identifying Hispanics and Asians/Pacific Islanders. Similarly, several studies suggest surname analyses produces reasonable estimates of whether an enrollee is Hispanic or Asian/Pacific Islander and can identify disparities in care. However, accuracy depends on the concentrations of Asians or Hispanics in areas assessed. It is less accurate for women and more acculturated and higher SES persons due intermarriage, name changes, and adoption. Surname analysis is not accurate for identifying African Americans. Recent unpublished analyses suggest plans can successfully use a combined geocoding/surname analyses approach to identify disparities in care in most regions. Refinements based on Bayesian methods may make geocoding/surname analyses appropriate for use in areas where the accuracy is currently poor, but validation of these preliminary results is needed. Conclusions. Geocoding and surname analysis show promise for estimating racial/ ethnic health plan composition of enrollees when direct data on major racial and ethnic groups are lacking. These data can be used to assess disparities in care, pending availability of self-reported race/ethnicity data.
TL;DR: In this article, the authors investigated the interaction between terror attacks and electoral outcomes in Israel and analyzed a dynamic model of reputation that captures the salient characteristics of terrorist attacks and election outcomes.
Abstract: This article investigates the interaction between terror attacks and electoral outcomes in Israel. The authors analyze a dynamic model of reputation that captures the salient characteristics of thi...
TL;DR: In this paper, the authors estimated the impact of hypothetical new diagnostic tests for tuberculosis (TB) in patients with persistent cough in developing countries and found that a variety of new tests could help better identify TB cases and target treatment, thereby reducing the burden of disease.
Abstract: We estimated the impact of hypothetical new diagnostic tests for tuberculosis (TB) in patients with persistent cough in developing countries. We found that a variety of new tests could help better identify TB cases and target treatment, thereby reducing the burden of disease.
TL;DR: Listening to music with degrading sexual lyrics is related to advances in a range of sexual activities among adolescents, whereas this does not seem to be true of other sexual lyrics.
Abstract: Background Early sexual activity is a significant problem in the United States. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancy and sexually transmitted diseases are more common among those who begin sexual activity earlier. Popular music may contribute to early sex. Music is an integral part of teens' lives. The average youth listens to music 1.5 to 2.5 hours per day. Sexual themes are common in much of this music and range from romantic and playful to degrading and hostile. Although a previous longitudinal study has linked music video consumption and sexual risk behavior, no previous study has tested longitudinal associations between the content of music lyrics and subsequent changes in sexual experience, such as intercourse initiation, nor has any study explored whether exposure to different kinds of portrayals of sex has different effects. Design and participants We conducted a national longitudinal telephone survey of 1461 adolescents. Participants were interviewed at baseline (T1), when they were 12 to 17 years old, and again 1 and 3 years later (T2 and T3). At all of the interviews, participants reported their sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. A total of 1242 participants reported on their sexual behavior at all 3 time points; a subsample of 938 were identified as virgins before music exposure for certain analyses. Participants also indicated how frequently they listened to each of more than a dozen musical artists representing a variety of musical genres. Data on listening habits were combined with results of an analysis of the sexual content of each artist's songs to create measures of exposure to 2 kinds of sexual content: degrading and nondegrading. Outcome measures We measured initiation of intercourse and advancement in noncoital sexual activity level over a 2-year period. Results Multivariate regression analyses indicated that youth who listened to more degrading sexual content at T2 were more likely to subsequently initiate intercourse and to progress to more advanced levels of noncoital sexual activity, even after controlling for 18 respondent characteristics that might otherwise explain these relationships. In contrast, exposure to nondegrading sexual content was unrelated to changes in participants' sexual behavior. Conclusion Listening to music with degrading sexual lyrics is related to advances in a range of sexual activities among adolescents, whereas this does not seem to be true of other sexual lyrics. This result is consistent with sexual-script theory and suggests that cultural messages about expected sexual behavior among males and females may underlie the effect. Reducing the amount of degrading sexual content in popular music or reducing young people's exposure to music with this type of content could help delay the onset of sexual behavior.
TL;DR: When coupled with management of care, implementation of parity in insurance benefits for behavioral health care can improve insurance protection without increasing total costs.
Abstract: Background To improve insurance coverage of mental health and substance-abuse services, the Federal Employees Health Benefits (FEHB) Program offered mental health and substance-abuse benefits on a par with general medical benefits beginning in January 2001. The plans were encouraged to manage care. Methods We compared seven FEHB plans from 1999 through 2002 with a matched set of health plans that did not have benefits on a par with mental health and substance-abuse benefits (parity of mental health and substance-abuse benefits). Using a difference-in-differences analysis, we compared the claims patterns of matched pairs of FEHB and control plans by examining the rate of use, total spending, and out-of-pocket spending among users of mental health and substance-abuse services. Results The difference-in-differences analysis indicated that the observed increase in the rate of use of mental health and substance-abuse services after the implementation of the parity policy was due almost entirely to a general tr...
TL;DR: The results from this exercise argue in favour of using the multivariate probit rather than the two-step or linear probability model estimators, especially when there is more than one treatment, when the average probability of the dependent variable is close to 0 or 1, or when the data generating process is not normal.
Abstract: Outcomes research often requires estimating the impact of a binary treatment on a binary outcome in a non-randomized setting, such as the effect of taking a drug on mortality. The data often come from self-selected samples, leading to a spurious correlation between the treatment and outcome when standard binary dependent variable techniques, like logit or probit, are used. Intuition suggests that a two-step procedure (analogous to two-stage least squares) might be sufficient to deal with this problem if variables are available that are correlated with the treatment choice but not the outcome. This paper demonstrates the limitations of such a two-step procedure. We show that such estimators will not generally be consistent. We conduct a Monte Carlo exercise to compare the performance of the two-step probit estimator, the two-stage least squares linear probability model estimator, and the multivariate probit. The results from this exercise argue in favour of using the multivariate probit rather than the two-step or linear probability model estimators, especially when there is more than one treatment, when the average probability of the dependent variable is close to 0 or 1, or when the data generating process is not normal. We demonstrate how these different methods perform in an empirical example examining the effect of private and public insurance coverage on the mortality of HIV+ patients.
TL;DR: In this article, the authors describe the development and implementation of the multilevel sample design for the Los Angeles Family and Neighborhood Survey, a study of children, adults, families, and neighborhoods in Los Angeles County.