Do Perceptions of Ballot Secrecy Influence Turnout? Results from a Field Experiment

Although the secret ballot has been secured as a legal matter in the United States, formal secrecy protections are not equivalent to convincing citizens that they may vote privately and without fear of reprisal. We present survey evidence that those who have not previously voted are particularly likely to voice doubts about the secrecy of the voting process. We then report results from a field experiment where we mailed information about protections of ballot secrecy to registered voters prior to the 2010 general election. Consistent with our survey data, we find that these letters increased turnout for registered citizens without records of previous turnout, but they did not appear to influence the behavior of citizens who had previously voted. The increase in turnout of more than three percentage points (20%) for those without previous records of voting is notably larger than the effect of a standard get‐out‐the‐vote mailing for this group. Overall, these results suggest that although the secret ballot is a long‐standing institution in the United States, beliefs about this institution may not match the legal reality.     

Crime,Irregular Warfare,and Institutional Failure in Latin America: Guatemala as a Case Study

This article examines the current crisis in Guatemala as a case study in the phenomenon of “criminal insurgency” in Latin America. Since the close of Guatemala's civil war in 1996, crime—especially violent crime—has increased dramatically, to the point that drug traffickers, organized crime syndicates, and youth gangs are effectively waging a form of irregular warfare against the state. The police, the judiciary, and entire local and departmental governments are rife with criminal infiltrators; murder statistics have surpassed civil-war levels in recent years; criminal operatives assassinate government officials and troublesome members of the political class; and chunks of territory are now effectively under the control of criminal groups. All this has led to growing civic disillusion and eroded the authority and legitimacy of the government. Rampant crime is causing a crisis of the democratic state.     

Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: methodological, ethical and legal concerns

In 2007, WHO/UNAIDS recommended male circumcision as an HIV-preventive measure based on three sub-Saharan African randomised clinical trials (RCTs) into female-to-male sexual transmission. A related RCT investigated male-to-female transmission. However, the trials were compromised by inadequate equipoise; selection bias; inadequate blinding; problematic randomisation; trials stopped early with exaggerated treatment effects; and not investigating non-sexual transmission. Several questions remain unanswered. Why were the trials carried out in countries where more intact men were HIV-positive than in those where more circumcised men were HIV-positive? Why were men sampled from specific ethnic subgroups? Why were so many participants lost to follow-up? Why did men in the male circumcision groups receive additional counselling on safe sex practices? While the absolute reduction in HIV transmission associated with male circumcision across the three female-to-male trials was only about 1.3%, relative reduction was reported as 60%, but, after correction for lead-time bias, averaged 49%. In the Kenyan trial, male circumcision appears to have been associated with four new incident infections. In the Ugandan male-to-female trial, there appears to have been a 61% relative increase in HIV infection among female partners of HIV-positive circumcised men. Since male circumcision diverts resources from known preventive measures and increases risk-taking behaviours, any long-term benefit in reducing HIV transmission remains uncertain.     

Barriers to the operation of mental health legislation in Australian emergency departments: a qualitative analysis

This study aimed to describe the perceived barriers faced by emergency clinicians in utilising mental health legislation in Australian hospital emergency departments. A semi-structured interview methodology was used to assess what barriers emergency department doctors and nurses perceive in the operation of mental health legislation. Key findings from the interview data were drawn in accordance with the most commonly represented themes. A total of 36 interviews were conducted with 20 members of the Australasian College for Emergency Medicine and 16 members of the College for Emergency Nursing Australasia representing the various Australian jurisdictions. Most concerning to clinicians were the effects of access block and overcrowding on the appropriate use of mental health legislation, and the substandard medical care that mental health patients received as a result of long periods in the emergency department. Many respondents were concerned about the lack of applicability of mental health legislation to the emergency department environment, variation in legislation between States and Territories causing problems for clinicians working interstate, and a lack of knowledge and training in mental health legislation. Many felt that clarification of legislative issues around duty of care and intoxicated or violent patients was required. The authors conclude that access block has detrimental effects on emergency mental health care as it does in other areas of emergency medicine. Consideration should be given to uniform national mental health legislation to better serve the needs of people with mental health emergencies.