INSTITUTIONAL LAYERING IN GOVERNING HEALTHCARE QUALITY

Since the 1980s, regulated markets and New Public Management have been introduced in the public sector across the world. How they have affected existing governance mechanisms such as self‐regulation and state regulation has remained largely unexplored, however. This article examines the origins and consequences of institutional layering in governing healthcare quality. Dutch health care, where a market‐based system has been introduced, is used as a case study. The results show that this market‐based system did not replace but modified existing institutional arrangements. As a result, hospitals have to deal with the fragmentation of quality demands. Using the concept of institutional layering, this study shows how different arrangements interact. As a consequence, the introduction of a certain policy reform will work out differently in different countries and policy sectors. Our ‘archaeological’ study in this layering can be seen as an example of how such incremental change can be studied in detail.     

The Challenges to Cooperation Posed by the Nexus of Terrorism and Organized Crime: Comparing the Situations Between the Andean and the Sahel Regions

The recent conflict in the Sahel area is another case where the nexus of terrorism and organized crime causes challenges to the international community. Comparing the situation with that of the Andean region brings forth the challenges faced when dealing with this type of conflict: the states’ weak presence in the remote regions, the insurgents’ ability to offer income and “security” to the people, immediate threat to international investments, unresolved political/regional issues, the marriage of convenience of insurgents/terrorists and organized crime, internal divisions of the insurgent groups and also ideologies surviving or suffering after the elimination of their leaders.     

Is Russia a militocracy? Conceptual issues and extant findings regarding elite militarization

The dominant paradigm for understanding contemporary Russia holds that Vladimir Putin's tenure in office has been accompanied by a massive influx of former KGB and military personnel – so-called “siloviki” – into positions of power and authority throughout the polity and economy. Claims of extensive elite militarization, however, are largely based on the analyses of only one research program and, moreover, the validity of the estimates produced by that research program is open to question on numerous grounds. In this article, we review existing research on elite militarization in Russia; discuss a series of conceptual and empirical issues that need to be resolved if valid and meaningful estimation of military–security representation is to be achieved; introduce new findings; and evaluate the totality of existing evidence regarding whether the Russian state under Putin deserves to be labeled a militocracy. We find that the most straightforward reading of existing data indicates that the percentage of siloviki in the political elite during Putin's first two terms as president was approximately half of that which has been widely reported in both scholarship and the media, and also declined during the Medvedev presidency. In addition, our analysis of a broader cross section of the elite estimates military–security representation during the Putin presidency to have been lower still. Overall, existing data paint a less alarming picture of the depths to which siloviki have penetrated the corridors of power since 2000 than has been commonly portrayed and thereby cast doubt on Russia's status as an “FSB state.” On the other hand, past trends also provide some basis for expecting that the numbers of siloviki will once again rise during Putin's current presidential term.     

Adolescent Co-occurring Disorders Treatment: Clinicians' Attitudes,Values, and Knowledge

This study examined community-based clinicians’ (N = 294) attitudes, background/experiences, values, and knowledge relating to issues of co-occurring disorders, which occur at a high rate among adolescents involved in the juvenile justice system. Study results reveal that clinicians self-rate their clinical values and attitudes at or above the expected level of competency, but they concede that their skill and knowledge levels are not adequate. Comparison measures reveal that employment setting conditions, geographic region, hours worked per week, and strongly held convictions about the importance of integrated mental health and substance use disorders service delivery distinguish clinicians’ co-occurring disorders knowledge levels. Implications are offered.     

“Making It”: Understanding Adolescent Resilience in Two Informal Settlements (Slums) in Nairobi,Kenya

Many adolescents living in contexts characterized by adversity achieve positive outcomes. We adopt a protection–risk conceptual framework to examine resilience (academic achievement, civic participation, and avoidance of risk behaviors) among 1,722 never-married 12–19 year olds living in two Kenyan urban slums. We find stronger associations between explanatory factors and resilience among older (15–19 years) than younger (12–14 years) adolescents. Models for prosocial behavior and models for antisocial behavior emerge as key predictors of resilience. Further accumulation of evidence on risk and protective factors is needed to inform interventions to promote positive outcomes among youth situated in an ecology of adversity.     

Family Cohesion and Romantic and Sexual Initiation: A Three Wave Longitudinal Study

Although the relation between family relationships and the timing of sexual debut has been the focus of many studies, research on mediating factors is scarce. This study examines whether low levels of family cohesion result in an earlier onset of romantic and sexual experiences, and whether the link between family cohesion and an early sexual debut is mediated by early romantic initiation. A longitudinal sample of 314 adolescent girls and 222 boys, aged 12–17 at Wave 1, completed questionnaires at three measurement points with three year intervals. The results showed that sexual debut followed romantic initiation for 77% of the participants. For early adolescent females (aged 12–14), high levels of family cohesion resulted in a later sexual debut and this association was fully mediated by a delay of romantic initiation. Among boys and older girls, timing of romantic initiation did not mediate the link between family cohesion and timing of sexual initiation. Early adolescent girls who have negative relationships with their parents turn to romantic relationships for intimacy and support, which subsequently provide the opportunity for an early sexual debut. Low levels of family cohesion thus primarily precipitate romantic initiation and sexual initiation appears to be secondary to this process among girls in this age group.     

Peer Selection and Socialization in Adolescent Depression: The Role of School Transitions

Previous studies have indicated homophily in depressive symptoms among adolescent friends, resulting from both peer selection and socialization processes. However, developmental differences and the role of school transitions in these processes have not been elucidated. A sample of 367 (51% female) adolescents was followed from 6th to 11th grade to investigate prospective relationships between adolescents’ and their friends’ depressive symptoms in middle school and in high school. Results revealed that students selected friends with similar levels of depressive symptoms after each school transition. Additionally, friends appeared to socialize adolescents to become more similar in depressive affect in late middle school years. These findings suggest normative selection effects after school transitions, followed by socialization effects in middle school, but not high school.     

Father- and Mother-Adolescent Decision-Making in Mexican-Origin Families

Understanding the prevalence and correlates of decisional autonomy within specific cultural contexts is necessary to fully comprehend how family processes are embedded within culture. The goals of this study were to describe mothers’ and fathers’ decision-making with adolescents (M = 12.51 years, SD = 0.58; 51% female), including parent-unilateral, joint, and youth-unilateral decision-making, and to examine the socio-cultural and family characteristics associated with these different types of decision-making in 246 Mexican-origin families. Mothers reported more joint and youth-unilateral decision-making and less parent-unilateral decision-making than did fathers. Fathers reported more youth-unilateral decision-making with sons than with daughters. Further, for mothers, more traditional gender role attitudes and higher levels of mother-adolescent conflict were associated with more parent-unilateral and less joint decision-making. In contrast, for fathers, lower levels of respect values were associated with more youth-unilateral decision-making with sons, and higher levels of parent-adolescent warmth were associated with more youth-unilateral decision-making with daughters. The importance of understanding the different correlates of mothers’ and fathers’ decision-making with sons versus daughters is discussed.