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This open access book is a practical introduction to multilevel modelling or multilevel analysis (MLA) – a statistical technique being increasingly used in public health and health services research. The authors begin with a compelling argument for the importance of researchers in these fields having an understanding of MLA to be able to judge not only the growing body of research that uses it, but also to recognise the limitations of research that did not use it. The volume also guides the analysis of real-life data sets by introducing and discussing the use of the multilevel modelling software MLwiN, the statistical package that is used with the example data sets. Importantly, the book also makes the training material accessible for download – not only the datasets analysed within the book, but also a freeware version of MLwiN to allow readers to work with these datasets. The book's practical review of MLA comprises: Theoretical, conceptual, and methodological background Statistical background The modelling process and presentation of research Tutorials with example datasets Multilevel Modelling for Public Health and Health Services Research: Health in Context is a practical and timely resource for public health and health services researchers, statisticians interested in the relationships between contexts and behaviour, graduate students across these disciplines, and anyone interested in utilising multilevel modelling or multilevel analysis. "Leyland and Groenewegen's wealth of teaching experience makes this book and its accompanying tutorials especially useful for a practical introduction to multilevel analysis." ̶ Juan Merlo, Professor of Social Epidemiology, Lund University "Comprehensive and insightful. A must for anyone interested in the applications of multilevel modelling to population health". ̶ S. (Subu) V. Subramanian, Professor of Population Health and Geography, Harvard University ; For researchers and students with a basic mastery of ordinary least squares and logistic regression Discusses multilevel analysis in context of public health, health services research, and epidemiology Includes an online component where users can download the datasets analyzed in the book, and also a freeware version of the multilevel modelling software MLwiN ​​​​​​​Can be used as part of a course on multilevel modelling, or as a self-training text

Background: Greenland struggles with a high prevalence of smoking, alcohol and drug abuse. In response to the increasing need for preventive initiatives, the first public health program Inuuneritta was introduced in 2007. Internationally, frameworks focus primarily on the implementation of a single, well-described intervention or program. However, with the increasing need and emergence of more holistic, integrated approaches, a need for research investigating the process of policy implementation from launch to action arises. This paper aims to augment the empirical evidence on the implementation of integrated health promotion programs within a governmental setting using the case of Inuuneritta II. In this study, the constraining and enabling determinants of the implementation processes within and across levels and sectors were examined. Methods: Qualitative methods with a transdisciplinary approach were applied. Data collection consisted of six phases with different qualitative methods applied to gain a comprehensive overview and understanding of Inuuneritta II's implementation process. These methods included: observations and focus group discussions at the community health worker (CHW) conference, telephone interviews, document analysis, and a workshop on results dissemination. Results: Enabling determinants influencing the implementation process of Inuuneritta II positively were high motivation among adopters, local prevention committees supporting community health workers, and the initiation of the central prevention committee. In contrast, constraining determinants were ambiguous program aims, high turnovers, siloed budgets and work environments, and an inconsistent and neglected central prevention committee. Conclusion: Inuuneritta II provided a substantial framework for an integrated health policy approach. However, having a holistic and comprehensive program enabling an integrated approach is not sufficient. Inuuneritta II's integrated approach does not harmonise with the government's inflexible organisational structure resulting in insufficient implementation.

Background: European legislation prohibits direct-to-consumer advertising of prescription medicines, but allows drug manufacturers to provide information to the public on health and diseases. Our aim was to measure the frequency of disease awareness campaigns in Latvian media and assess their compliance with international and European standards. Methods: Materials on health/disease and treatments were collected between April and September 2015 from 12 newspapers and magazines and six online portals. Disease awareness campaigns were assessed using a previously developed instrument based on the WHO Ethical Criteria for Medicinal Drug promotion and European standards (EU law and pharmaceutical industry self-regulatory guidelines). Collected materials were used to examine the information provided on medical conditions and their diagnosis and treatment. The inter-rater reliability was calculated. Results: We collected 263 materials from print (n = 149) and online media (n = 114); 94 were news items and 169 were disease-awareness advertisements. Cancer, cardiovascular problems, allergies and respiratory diseases were common topics. Of the 157 campaigns assessed, non-compliance was identified in 149 cases (inter-rater reliability 90%), mainly due to misleading or incomplete information, lack of balance and the absence of a listed author/sponsor. Six disease awareness campaigns directly mentioned a pharmaceutical product by brand name and other four included the logo or name of a manufacturer, referred to a condition and indirectly mentioned a treatment, all in contravention with European law. Conclusions: The compliance of disease awareness campaigns in Latvian media with international and European standards is low. This raises concerns about the nature of information being conveyed. Through lack of balance, missing sponsorship information, and misleading or incomplete information, these campaigns could contribute to inaccurate self-diagnosis and generate demand among those who might not need medical treatment.

This revised and expanded third edition text utilizes a public health framework and the latest epidemiological, treatment, and service systems research to promote a comprehensive understanding of the organization, financing, and delivery of mental health and substance abuse services in the United States. Written by national experts in the field, this timely work will provide policymakers, administrators, clinicians, and public health and behavioral health graduate students with the knowledge base needed to manage and transform mental health service systems, both nationally and locally. The boo

Health services research is a multidisciplinary field that examines ways to organize, manage, finance, and deliver high-quality care. This specialty within substance abuse research developed from policy analyses and needs assessments that shaped federal policy and promoted system development in the 1970s. After the authorization of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the National Institute on Drug Abuse (NIDA), patient information systems supported studies of treatment processes and outcomes. Health services research grew substantially in the 1990s when NIAAA and NIDA moved into the National Institutes of Health and legislation allocated 15% of their research portfolio to services research. The next decade will emphasize research on quality of care, adoption and use of evidence-based practices (including medication), financing reforms and integration of substance abuse treatment with primary care and mental health services.

Contents -- Preface -- Chapter 1 -- Public Health Service Agencies: Overview and Funding (FY2015-FY2017)* -- Summary -- Introduction to the PHS Agencies -- Sources of PHS Agency Funding -- Secretary's Transfer Authority -- PHS Evaluation Set-Aside -- Mandatory Funding, User Fees, and Collections -- Mandatory Appropriations -- User Fees -- Collections -- Recent Trends in PHS Agency Funding -- Impact of Budget Caps and Sequestration -- Mandatory Spending -- Discretionary Spending -- FY2013 Sequestration -- FY2014-FY2017 Discretionary Spending Caps -- Mandatory Funding Proposals for FY2017

Background: Recently, euthanasia and assisted suicide (EAS) in patients with psychiatric disorders, dementia, or an accumulation of health problems has taken a prominent place in the public debate. However, limited is known about this practice. The purpose of this study was threefold: to estimate the frequency of requesting and receiving EAS among people with (also) a psychiatric disorder, dementia, or an accumulation of health problems; to explore reasons for physicians to grant or refuse a request; and to describe differences in characteristics, including the presence of psychiatric disorders, dementia, and accumulation of health problems, between patients who did and did not request EAS and between patients whose request was or was not granted. Methods: A nationwide cross-sectional survey study was performed. A stratified sample of death certificates of patients who died between 1 August and 1 December 2015 was drawn from the central death registry of Statistics Netherlands. Questionnaires were sent to the certifying physician (n = 9351, response 78%). Only deceased patients aged ≥ 17 years and who died a non-sudden death were included in the analyses (n = 5361). Results: The frequency of euthanasia requests among deceased people who died non-suddenly and with (also) a psychiatric disorder (11.4%), dementia (2.1%), or an accumulation of health problems (8.0%) varied. Factors positively associated with requesting euthanasia were age (< 80 years), ethnicity (Dutch/Western), cause of death (cancer), attending physician (general practitioner), and involvement of a pain specialist or psychiatrist. Cause of death (neurological disorders, another cause) and attending physician (general practitioner) were also positively associated with receiving euthanasia. Psychiatric disorders, dementia, and/or an accumulation of health problems were negatively associated with both requesting and receiving euthanasia. Conclusions: EAS in deceased patients with psychiatric disorders, dementia, and/or an accumulation of health problems is relatively rare. Partly, this can be explained by the belief that the due care criteria cannot be met. Another explanation is that patients with these conditions are less likely to request EAS.