Further issues in small area variations analysis.

In this article, I examine Wennberg's "practice style" hypothesis and the literature on variations among small areas. According to Wennberg, geographic variations in rates of per capita use for many clinical procedures arise mainly from differences over what constitutes appropriate care. I show, however, that the role of practice style in explaining variations among areas has not been clearly demonstrated. I also argue that the practice style hypothesis can neither be established nor refuted by the methods traditionally used to study small areas and, moreover, that inferences about practice style variations cannot be drawn from differences among areas in their rates of use. I thus conclude that more research at the micro level in the practice patterns of the individual physician is needed before major health care initiatives based on small area methodology are undertaken.     

Job Access and Homicide Patterns in Chicago: An Analysis at Multiple Geographic Levels Based on Scale-Space Theory

Economists and criminologists have long tried to establish linkages between job markets and crime. Most prior research, however, was across large areas (e.g., states, metropolitan areas) or across time. This research focuses on examining the variation of job markets within a city (i.e., Chicago) and whether it is related to the spatial pattern of crime (i.e., homicide). The job market condition is measured by job accessibility, an index computed by a Geographic Information System (GIS) method. Multivariate regressions, controlling for other socioeconomic covariates, are used to analyze the relationship between job access and homicide rates. Considering problems with analysis of rare events such as homicide in small populations, this research constructs various levels of geographic areas from census tracts to generate more stable homicide rates with larger base populations. In particular, a spatial clustering method based on the scale-space theory is used to merge adjacent tracts of similar attributes into new geographic areas. The study shows an inverse relationship between job accessibility and homicide rates across census tracts and the newly-constructed geographic areas in Chicago.     

The treatment ideal and detention reality: Demographic,professional/ occupational and organizational influences on detention worker punitiveness

For some time, corrections researchers have focused on the punitive and rehabilitative orientations of correctional officers. Relatively little research attention, however, has been devoted to understanding the support for these orientations among correctional workers responsible for the care and custody of juvenile delinquents. Based on survey data drawn from a sample of detention care workers (DCWs) in two facilities in a Southeastern state (N=109), this paper examines the extent to which, and why, DCWs adopt a punitive orientation to youth in detention despite policies and training that discourage this view. Findings, that contrast the relative impact of demographic, occupational/professional and organizational environment variables in accounting for variation in punishment/control orientation among DCWs, suggest that demographic indicators (i.e., age, gender) and organizational environment contribute disproportionately to explained variance in punitive orientation once other variables are controlled. Implications for detention policy, staff recruitment and training are discussed.     

IMMIGRATION AND THE RECENT VIOLENT CRIME DROP IN THE UNITED STATES: A POOLED,CROSS‐SECTIONAL TIME‐SERIES ANALYSIS OF METROPOLITAN AREAS*

A good deal of research in recent years has revisited the relationship between immigration and violent crime. Various scholars have suggested that, contrary to the claims of the classic Chicago School, large immigrant populations might be associated with lower rather than higher rates of criminal violence. A limitation of the research in this area is that it has been based largely on cross‐sectional analyses for a restricted range of geographic areas. Using time‐series techniques and annual data for metropolitan areas over the 1994–2004 period, we assess the impact of changes in immigration on changes in violent crime rates. The findings of multivariate analyses indicate that violent crime rates tended to decrease as metropolitan areas experienced gains in their concentration of immigrants. This inverse relationship is especially robust for the offense of robbery. Overall, our results support the hypothesis that the broad reductions in violent crime during recent years are partially attributable to increases in immigration.     

Research on multiple murder: Where are we in the state of the art?

Despite considerable public and academic attention to the phenomenon of serial homicide and mass murder, researchers have generally lamented the lack of progress that has been made, especially in the area of theoretical advances. As has been found in other areas that have embarked on similar developmental paths, taking stock of the historical development of the field in terms of the type and quality of research being conducted is an important step in moving forward. To address this concern, the present study provides a review of the current “state of the art” in multiple homicide research. Although academic articles exploring this phenomenon have steadily increased, the statistical and methodological sophistication of these studies is sorely lacking. Furthermore, researchers investigating this phenomenon rarely publish multiple articles in the area and these are generally spread through many different journals and fields. Suggestions for future research and recommendations to streamline the efforts in this field are provided based on the study results.     

The Management of Incidental Findings in Neuro-Imaging Research: Framework and Recommendations

This paper addresses the question of how incidental findings (IFs) in clinical research should be managed by researchers, focusing in detail on IFs discovered in neuroimaging research. It begins by engaging the larger research ethics issue of whether researchers have any obligations of clinical care to participants, and assesses the content and merits of one particular framework for answering this question, Richardson and Belsky's ancillary care model. From here the paper develops an organizational structure for integrating the ancillary care model with existing research ethics standards, with the aim of better understanding their respective domains. It makes a distinction between incidental findings that are anticipated by informed consent documents, and those that are unanticipated, arguing that this distinction is critical for evaluating researcher obligations. Finally, it takes on the issue of incidental findings in neuroimaging research, translating the standards discussed into recommendations for both unanticipated and anticipated findings.     

The Prevalence of Mental Health Problems in Men Arrested for Domestic Violence

The problem of male perpetrated intimate partner violence (IPV) is widespread. In an effort to identify risk factors for perpetrating IPV, researchers have examined mental health problems among perpetrators. However, the majority of research in this area has examined personality psychopathology and/or limited their investigation to posttraumatic stress disorder (PTSD) or depression. Thus, the present study examined self-reported Axis I psychopathology among men arrested for domestic violence (N?=?308). Results replicated past research showing high rates of PTSD and depression. In addition, the prevalence of generalized anxiety disorder (GAD), panic disorder, social phobia, and alcohol and drug disorders were very high. All types of mental health problems were positively associated with aggression perpetration. Males meeting probable diagnostic classification reported significantly more frequent aggression than males not meeting diagnostic classification, even after controlling for social desirability. Directions for future research and implications of these findings are discussed.     

Is it Important to Examine Crime Trends at a Local “Micro” Level?: A Longitudinal Analysis of Street to Street Variability in Crime Trajectories

Over the last 40 years, the question of how crime varies across places has gotten greater attention. At the same time, as data and computing power have increased, the definition of a ‘place’ has shifted farther down the geographic cone of resolution. This has led many researchers to consider places as small as single addresses, group of addresses, face blocks or street blocks. Both cross-sectional and longitudinal studies of the spatial distribution of crime have consistently found crime is strongly concentrated at a small group of ‘micro’ places. Recent longitudinal studies have also revealed crime concentration across micro places is relatively stable over time. A major question that has not been answered in prior research is the degree of block to block variability at this local ‘micro’ level for all crime. To answer this question, we examine both temporal and spatial variation in crime across street blocks in the city of Seattle Washington. This is accomplished by applying trajectory analysis to establish groups of places that follow similar crime trajectories over 16 years. Then, using quantitative spatial statistics, we establish whether streets having the same temporal trajectory are collocated spatially or whether there is street to street variation in the temporal patterns of crime. In a surprising number of cases we find that individual street segments have trajectories which are unrelated to their immediately adjacent streets. This finding of heterogeneity suggests it may be particularly important to examine crime trends at very local geographic levels. At a policy level, our research reinforces the importance of initiatives like ‘hot spots policing’ which address specific streets within relatively small areas.     

Are arrest statistics a valid measure of illicit drug use? The relationship between criminal justice and public health indicators of cocaine,heroin, and marijuana use

Several alternative indicators are currently available to researchers, policy makers, and practitioners for gauging levels and patterns of illicit drug use within and across communities. Yet there exists little information that allows reliable comparisons across indicators to determine whether they tell essentially the same story about variation in the prevalence of drug use. In particular, it remains unclear how closely arrest statistics, the leading law enforcement indicator of illicit drug use, correspond to other law enforcement indicators, such as urine tests of jail inmates, or to public health measures, such as emergency departments' and medical examiners' reports. In this paper we assess the relationships between alternative law enforcement and public health indicators of cocaine, heroin, and marijuana use for a sample of large U.S. cities. We find pronounced convergence across measurement systems in cocaine and heroin use, but little convergence for marijuana use. In addition to other research and policy implications, these results increase confidence in the use of arrest data to assess variation across urban areas in cocaine and heroin use.     

CROSS-NATIONAL VARIATION IN HOMICIDES: IS RACE A FACTOR?

J. P. Rushton has done research indicating that predominantly black nations have higher rates of violent crime than predominantly white nations, which have higher rates than predominantly Asian nations. He attributes these differences to constitutional, inheritable factors on which the races vary. This article discusses the numerous problems with Rushton's use of international crime data and analysis, foremost of which are his use of one-way analysis of variance and lack of consideration of other causes of variation. Regression analysis-including dummy race variables and other relevant explanatory variables-indicates no significant association between race and cross-national homicide rates, the best and probably only valid indicator of cross-national variation in violent crime. This is the case whether reanalyzing Rush-ton's data or analyzing properly adjusted, inspected, and selected homicide rates.     

A prospective study of pathways to hospital readmission in Canadian forensic psychiatric patients

Individuals admitted to secure care often experience lengthy hospitalizations and are likely to be admitted on more than one occasion. In the context of growing demand and costs associated with secure care, the current study investigates the frequency and reasons for readmission among 87 forensic patients recently discharged into the community. We identify risk factors that are associated with the likelihood of readmission and describe areas of overlap and discordance with the existing literature in civil and forensic samples. Using a prospective design that included patient follow-up interviews and records review, we found that 28% of patients were readmitted on one or more occasions over a 12-month period. Psychiatric decompensation, substance use, and treatment non-adherence were the central reasons prompting readmission. Patients with one or more readmissions were found to have spent significantly more time in the forensic mental health system as compared to patients not readmitted. They were more likely to have a substance use disorder and were estimated to be at higher risk for violence. Results replicate the finding of low rates of serious violence and reoffending among discharged forensic patients, and substantiate the centrality of substance use as a growing and clinically important treatment issue.     

Depressive symptoms among working women in rural North Carolina: a comparison of women in poultry processing and other low-wage jobs

We report on the prevalence of self-reported depressive symptoms and associated factors among women employed in a poultry processing plant and a community comparison group of other employed women in northeastern North Carolina in the southern United States. The rural area is poor and sparsely populated with an African American majority. The largest employer of women in the area is a poultry processing plant. The goals of the analyses were 1) to evaluate whether women employed in poultry processing had a higher prevalence of depressive symptoms than other working women from the same geographic area, and 2) to evaluate factors which might be associated with depression among all of these working women, including specific characteristics of their work environment. Recruitment of participants (n=590) and data collection were by community-based staff who were also African American women. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Work organization factors were measured with the Job Content Questionnaire (JCQ). Log-binomial regression was used to calculate crude and adjusted prevalence ratios. The prevalence of depressive symptoms, based on a CES-D measure of sixteen or more, was 47.8% among the poultry workers and 19.7% among the other working women (prevalence ratio=2.3). After adjusting for socioeconomic variables, health-related quality of life and coping style, the prevalence of depressive symptoms remained 80% higher among the poultry workers. The prevalence of symptoms was also higher among those who perceived low social support at work, hazardous work conditions, job insecurity, and high levels of isometric load. These factors were all more common among the women employed in the poultry plant. The concentration of this low-wage industry in economically depressed rural areas illuminates how class exploitation and racial discrimination may influence disparities in health among working women.     

A Cross-National Analysis of the Mediating Effect of Economic Deprivation on Crime

This study develops and tests a model of economic deprivation and crime using data from 52 nations for the years 1995–1999. The model, centering on the role of absolute and relative economic deprivation in mediating crime, predicts that social change causes variation in economic deprivation, which, in turn, leads to variation in crime rates. The results show that the relative deprivation variable, income inequality, mediates a large portion of the effects of two social change variables, population growth and urbanization, on homicide, while one of the absolute deprivation variables, GDP, transmits a great part of the effects of social change variables on theft. Both social change variables were found to have a weak direct connection to homicide and theft rates. Implications for policy and future research are discussed.     

White-collar offenders and the jail experience: a comparative analysis

The incarceration experiences of white-collar offenders have received relatively little attention among criminological researchers, and the research that has been conducted has focused on offenders’ experiences in prisons rather than jails. The purpose of this study was to fill this gap by examining approximately 6500 inmates incarcerated in local jails, comparing those classified as white-collar offenders to violent and other non-violent offenders. The differences between offender types based on demographics, psychological adjustment (i.e., mental health issues since arrival to jail), and behavioral adjustment (i.e., institutional misconduct) are examined to see whether white-collar inmates have more difficulty than others adjusting to the jail environment (consistent with the special sensitivity hypothesis). Findings suggest that white-collar jail inmates do not appear to experience symptoms indicative of poor psychological or behavioral adjustment to the jail environment. Implications for policy and future research are discussed.     

LAND USE AND VIOLENT CRIME*

Although research has shown specific land uses to be related to crime, systematic investigation of land uses and violent crime has been less common. This study systematically examines links between land uses and violent crime and assesses whether such links are conditioned by socioeconomic disadvantage. We employ geocoded Uniform Crime Report (UCR) data from the Indianapolis police department and information on 30 categories of land use and demographic information from the 2000 U.S. Census. We use land use variables to predict violent crime counts in 1,000 × 1,000‐feet grid cells using negative binomial regression models. Results indicate that, net of other variables, specific land uses predict variation in counts for individual violent crimes and aggregate rates. Some nonresidential land uses are associated with higher violent crime counts, whereas others are associated with lower counts. Specific land uses also condition the effects of socioeconomic disadvantage on violent crime. The implications for routine activity/opportunity and social disorganization/collective efficacy theories of crime are discussed.     

Request for planning ideas. Agency for Health Care Policy and Research, HHS. Notice

The Agency for Health Care Policy and Research (AHCPR) invites recommendations for future initiatives in areas identified as priorities in the Agency's current strategic plan. This plan describes the framework that the Agency will use to guide the development of budget proposals for Fiscal Years 2000, 2001, and 2002 as well as decisions on resource allocations for research, translation (including tool development), dissemination, and evaluation activities that will facilitate the implementation of research findings at all levels of the health care system.     

Ethics of Population-Based Research

This paper considers the morally relevant ways in which population-based research is a distinct type of human subjects research that have unique moral considerations relevant for public health practitioners and researchers. By defining population-based research, the authors distinguish it from public health practice and then consider, in more detail, the ways in which population-based research differs from clinical human subjects research. Based upon the distinctions between these types of research and practice, they identify five important issues that arise in the design and conduct of certain kinds of population-based research. The authors hope that public health practitioners find these distinctions useful in determining when their work may actually be population-based research and that public health researchers use them to identify the areas where ethical issues in their research may arise.     

The detection of deception with the reality monitoring approach: a review of the empirical evidence

One of the verbal approaches to the detection of deceit is based on research on human memory that tries to identify the characteristics that differentiate between internal and external memories (reality monitoring). This approach has attempted to extrapolate the contributions of reality monitoring (RM) research to the deception area. In this paper, we have attempted to review all available studies conducted in several countries in order to yield some general conclusions concerning the discriminative power of this approach. Regarding individual criteria, the empirical results are not very encouraging: few criteria discriminate significantly across studies, and there are several variables that moderate their effect. Some of the contradictory findings may have emerged because of differences in the operationalizations and procedures used across individual studies. However, more promising results have been reported in recent studies, and the approach as a whole appears to discriminate above chance level, reaching accuracy rates that are similar to those of criteria-based content analysis (CBCA). Some suggestions for future research are made.     

The Independent Medicare Advisory Committee: death panel or smart governing?

This comment explores whether health care reform legislation establishes an administrative body effectively charged with the rationing of health care resources; insofar as it establishes a presidentially appointed Independent Medicare Advisory Committee (IMAC). IMAC would be charged with "making two annual reports dictating updated rates for Medicare providers including physicians, hospitals, skilled nursing facilities, home health, and durable medical equipment." IMAC's recommendations would be implemented nationally, subject to a Congressional vote. Congress would be granted a thirty-day window to achieve a simple majority for or against the IMAC recommendations. Part I is an introduction. Part II of this article covers the history of American health care. It lays out the federal government's evolving role in the arena of public health and health care, starting in the mid-nineteenth century and continues up to the present day. Part III examines the existing process by which Medicare spending is controlled. This part focuses on the administrative procedures that control Medicare reimbursements. Part IV examines IMAC. This part discusses IMAC's statutory provisions and the administrative transparency laws IMAC would be bound to follow. The close of this part, draws on three analogies as a gauge for how IMAC will operate: Senator Tom Daschle's Federal Health Board (FHB) proposal; the administrative oversight of the Federal Reserve; and the United Kingdom's National Institute for Health and Clinical Excellence (NICE). Part V creates a snapshot of the U.S. health care system as it operates today. This part emphasizes cost, quality, and accessibility of health care, with comparisons to international and state-run health care systems. Throughout this article there are a number of words, phrases, and agencies that have been given acronyms. For convenience, an index of these acronyms is provided in an appendix following the article.     

An analysis of self-reported suicide attempts and ideation in a national sample of incarcerated individuals convicted of sexual crimes

ABSTRACT

Suicide is the leading cause of preventable death in US jails and prisons, with rates three to nine times higher than those of the general population. Although suicide in correctional settings has been recognised as a serious problem, the research on suicide among incarcerated individuals remains limited. Individuals who have committed sexual offenses may be at an elevated risk for suicide. Specifically, they have been found to report high rates of hopelessness and depressive mood, and approximately 14% of individuals convicted of sexual offenses have reported a suicide attempt at some point in their lives. Most of these data are based upon official reports and may represent an underreporting of the true prevalence of the problem. The current study provides an analysis of the prevalence and factors associated with self-reported suicidal thoughts and behaviours in a large national sample of individuals convicted of a sexually based crime. Overall, 17.9% of the offenders reported an attempted suicide in their lifetime, 15.1% reported experiencing suicidal ideation but never made an attempt. Risk factors for suicide attempts and ideation for this population are reported. The findings are discussed in the context of suicide prevention and intervention efforts among those who have committed sex offenses.