The current state of medical school education in bioethics, health law, and health economics.

Current challenges in medical practice, research, and administration demand physicians who are familiar with bioethics, health law, and health economics. Curriculum directors at American Association of Medical Colleges-affiliated medical schools were sent confidential surveys requesting the number of required hours of the above subjects and the years in which they were taught, as well as instructor names. The number of relevant publications since 1990 for each named instructor was assessed by a PubMed search. In sum, teaching in all three subjects combined comprises less than two percent of the total hours in the American medical curriculum, and most instructors have not recently published articles in the fields they teach. This suggests that medical schools should reevaluate their curricula and instructors in bioethics, health law, and health economics.     

Municipal Rebate Programs for Environmental Retrofits: An Evaluation of Additionality and Cost‐Effectiveness

When policies incentivize voluntary activities that also take place in the absence of the incentive, it is critical to identify the additionality of the policy—that is, the degree to which the policy results in actions that would not have occurred otherwise. Rebate programs have become a common conservation policy tool for local municipalities seeking to retrofit residential properties with efficient appliances. This research evaluates whether such rebates can be cost‐effective means for water utilities to promote water conservation. A unique database is developed that combines water‐use data over a three‐year period for all households that participated in a utility's high‐efficiency toilet (HET) rebate program, water‐use data for a matched sample of neighbors who did not receive a rebate, and a survey of rebate participants. Difference‐in‐differences models indicate that installation of an HET reduces household water consumption by approximately 7 percent. While installation of an HET appears to be an effective means for achieving household reductions in water consumption, our results also suggest that the rebate program is a much less effective means for achieving household reductions in water consumption. Specifically, the rebate program is found to provide limited additional water savings beyond what would have occurred naturally and is responsible for only 37 percent of the total water reduction attributable to the installation of HETs over the study period. © 2013 by the Association for Public Policy Analysis and Management.     

Continuity in Change: Leftwing Coalitions in Uruguay and Chile

Coalitions have been critical for the reemergence of democracy and stability in Uruguay and Chile. Where do they come from? Why are they successful? To explore the role of history and ideologies in the formation and successes of two leftwing coalitions, Uruguay’s Frente Amplio (Broad Front) (FA) and Chile’s Concertación por la Demcracia (Concertación), the author traveled to South America. In Montevideo and Santiago, she spoke with professors and politicians, government officials and former Presidents. This essay will introduce the Uruguayan and Chilean political party systems, discuss how they have dealt with crimes committed by the dictatorships (1973–1990), and highlight the significance of the two coalitions. It will use the term “left” to designate parties which favor egalitarianism and statism, and claim to speak for the people, especially the underprivileged; the term “right” for those which favor liberty, individual initiative, equality of opportunity, and limited government.     

Book Reviews: Central Asia

Marianne North, a well-to-do and well-connected Victorian lady painter, made a number of expeditions to all parts of the world to paint plants and flowers in their native habitat. Over 800 of her paintings are displayed in a special gallery which she donated to Kew Gardens. The article concentrates on her travels in various parts of Asia, especially Japan, Sarawak, Java, Ceylon and India.     

Poverty and prosperity among migrant settlers in the Amazon rainforest frontier of Ecuador

Household‐level interview data from a probability sample survey conducted in the northeastern Ecuadorian Amazon in 1990 are used to examine the determinants of income and assets among migrant farmers in the agricultural frontier. Multivariate analysis indicates that size of plot owned, proximity to markets, duration of residence, quality of soil, receipt of technical assistance, off‐farm employment and initial wealth positively influence current household income and wealth. More land in cattle pasture is also associated with higher status. Some settlers are prospering relative to others despite variable soil quality, unsustainable land uses, geographic isolation, apparent scarcity of labor, and lack of supportive infrastructure. The article closes with a discussion of implications for policies to assist small farmers, with some consideration of the potential ecological consequences of farmers’ activities.     

Sociocultural Variations in the Body Image Perceptions of Urban Adolescent Females

This study investigated the influences of ethnicity, socioeconomic status, and ethnic peer group composition on awareness and internalization of socially sanctioned standards of appearance using the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ). The researchers surveyed a convenience sample of 208 adolescent females at an ethnically diverse urban high school. Statistical analyses found that ethnicity influenced awareness of socially sanctioned standards of appearance but the effects of ethnicity varied by level of caregiver educational attainment. Ethnicity and caregiver educational attainment together accounted for variance in the internalization of these standards. Moreover, African American girls with ethnically heterogeneous peer groups had significantly higher awareness and internalization scores than those without mixed friends. These findings highlight the importance of multiple ecological factors in assessing risk for disturbed body image and eating disorders. Ethnicity remains an important predictor of disturbed body image but should be treated as a dynamic, rather than a fixed risk factor.     

Qualitative Evaluation of a High School Mental Health Program

Expanded school mental health (ESMH) programs offer a comprehensive range of mental health services (evaluation, therapy, case management) to youth in special and regular education. Research is needed to document that these programs are in fact providing quality care to youth and leading to enhanced outcomes. In this exploratory study, focus groups were conducted with high school students receiving mental health services and students not receiving services, therapists, parents, administrators, and health care staff to gauge the quality and effectiveness of an ESMH program. It was difficult to schedule parents for group sessions; thus, interviews also were conducted with this group. Focus groups and interviews were effective methods for understanding strengths, areas for improvement, and outcomes for our ESMH program. Participants reported that therapy served as a protective factor, enhancing physical and mental health and reducing risk for teenagers. Ideas for improving clinical practice were developed from study results.