Financial education: Behavior change is possible

One-third of U.S. adults report that they have no savings. More than a quarter of them admit to not paying their bills on time. And more than half of American households don’t have a budget.

Given these figures, it’s not surprising that more than 40 percent of U.S. adults would give themselves a grade of C, D, or F for their personal finance knowledge.  These figures come from the 2009 Consumer Financial Literacy Survey by HarrisInteractive, which surveyed more than 1,000 U.S. adults last year.

Given this dim view of personal finance in our nation, it’s clear that many households would benefit from programs that provide financial education.  But do these programs actually help families improve their financial situations?

A new study reveals the answer is yes. Two researchers from the University of Wisconsin-Madison pulled together evaluations from 41 financial education and counseling programs in a systematic review. Their article is published in the Fall 2010 issue of the Journal of Consumer Affairs. They used a research process called a qualitative systematic literature review to summarize evaluations that measured financial education and counseling’s impacts on financial knowledge and behavior.

The majority of studies cited in their review conclude financial education and counseling are beneficial and hold the promise of improving financial knowledge and facilitating behavior change. But the study also notes that many of these evaluations share methodological weaknesses including selection bias and measurement issues.  Many of the programs also do not utilize an explicit theory or framework for behavior change, which would lend precision to both program development and the measurement of program impacts, the authors wrote.

They encourage researchers and educators who run these programs to pay more attention to theory-based evaluations and invest in randomized field experiments may be fruitful.

Here at Cornell Cooperative Extension, we offer classes to help families develop a household spending plan, save energy and reduce their energy bills and use credit wisely through a program called EmPower New York. The free workshops are offered in 46 counties and sponsored by the New York State Energy Research and Development Authority (NYSERDA).

EmPower is doing its  part to collect viable data on the programs’ effectiveness.  This year, they’re conducting phone surveys with the Survey Research Institute at Cornell to determine the extent of behavior change for those who’ve participated in the workshop.  They’re expecting results sometime in June.

PROSPER helps prevent substance abuse

Growing numbers of youth are experimenting with alcohol and drugs at younger ages.  Nearly a quarter of teens report having had five or more alcoholic drinks in one day, according to data from the U.S. Center for Disease Control.  More than one-third have used marijuana.

 There are hundreds of programs available across the country to help dissuade teens from going down the path of substance abuse. But what works?

PROSPER Partnerships – which stands for PROmoting School-community-university Partnerships to Enhance Resilience – is a model that links Cooperative Extension, public schools, local communities and university researchers to introduce evidence-based programs that prevent substance abuse among middle school students and their families.

There are already PROSPER networks in Iowa, Pennsylvania and Alabama.  New York is lucky enough to be one of seven additional states in the process of forming a PROSPER Partnership with Cornell serving as the university partner.

That’s an exciting prospect for communities in New York. It means that families will have access to a menu of programs proven to work.

“There are many family and youth programs that are research-based, but that is not the same as having strong evidence behind them that the programs actually work,” explained Kim Kopko, an extension associate at Cornell’s Department of Policy Analysis, who is leading the PROSPER team at Cornell. “The programs on the PROSPER menu are evidence-based.  They are carefully implemented and tested on the ground level. They’re time intensive, and expensive, but they work.”

There are five elements that make the program successful:

  • A state-level partnership based in the land grant university system that is connected to the National PROSPER Network.
  • Strategic community teams lead by a local extension educator, a key school district employee  (typically a guidance counselor), and a variety of representatives from the community.
  • Every community team oversees the implementation of one family and one school program that they choose.
  • Community teams must move through a multi-phased developmental process focusing on long-term sustainability.
  • State partners provide on-going evaluation to ensure the program remains successful.

PROSPER has plenty of evidence to prove that their system yields results. PROSPER Programs typically recruit 17 percent of eligible families in their communities, compared to less than six percent for other community programs. 

Students who participate in the program are better at problem solving, more likely to refuse offers of alcohol and other drugs, less likely to believe that substance use has positive effects and more likely to delay initiation of substance use. And each $1 invested in the program yield about $9.60 of savings.

That’s good evidence-based practice at work, and a model that even more states should try to adopt.

Survey says…parent education in NY is working!

Cooperative Extension in New York offers parents and caregiver a variety of programs designed to promote positive parenting and healthy child development.  But are these programs making a difference?

A new analysis by Cornell faculty members suggests they are. Researchers surveyed more than 400 people who participated in parent education classes in nine New York counties. The classes each included at least six hours of instruction.

Before and after the courses, participants were asked ten questions about parenting attitudes, behaviors, and knowledge designed to capture some of what was taught in the class.

Participants showed significant improvements on eight of the ten questions, including:

  • making rules that take their child’s needs into consideration.
  • decreases in how often they yell at their child.
  • decreases in the number of hours their children spend watching television.
  • increased patience with their children.
  • increased time spent reading with their child.
  • increased use of explanations for rules they make.
  • increased feelings of support.
  • increased confidence in having the skills necessary to be a good caregiver.

The results suggest that these parent education courses are having a positive impact on their participants.  You can learn more about the programs at http://www.parenting.cit.cornell.edu.

EFNEP: An evidence-based approach to nutrition education

Across the state of New York, there are thousands of families who worry about their next meal, or whether there will be enough money for a weekly grocery-shopping trip.

For the past 41 years, the Expanded Food Education and Nutrition Program has been using an evidence-based approach to help those families improve their nutrition and use their resources more wisely. Cornell faculty in the Division of Nutritional Sciences provide leadership for the program, and work with Cooperative Extension Educators across the state to conduct research and translate those findings into programming that helps families with children.

The program involves hands-on, experiential learning taught to individuals or small groups by a member of their own community.  Local educators undergo extensive training designed by Cornell Nutrition faculty members.

“Many of our community educators haven’t had formal training before, because the focus in recruiting is to hire local community members who can relate to the course participants,” said Joan Doyle Paddock, senior extension associate in Nutritional Sciences. “We’ve developed and rolled out a 19-session training session that provides them with the latest information on nutrition and the most effective educational methods, both based on scientific research.” 

Evaluation conducted a few years ago found that participants taught individually, rather than in group settings, reported greater improvements in nutrition behaviors.  Based on this, the 19-session training was developed to improve group facilitation skills and the result has been improved outcomes for all types of participants.

“We’re not interested in just teaching people information; we’re looking for them to make behavioral changes in their lives,” she said. “Over the years, we’ve collected a lot of evidence that shows this program really does make a difference.”

Among one of the most important findings is this: EFNEP is yielding results for New York families.  A 2008 study found that every $1 spent on the program reaps $10 in health benefits. Jamie Dollahite, associate professor of nutritional sciences, conducted the study, which looked at the costs and benefits of the program for 5,730 low-income adults who “graduated” from New York’s program.

“Cost-effectiveness was estimated to be as great as for many current health interventions, such as lifestyle changes to prevent diabetes,” Dollahite explained.

Other findings include:

  • The program is most successful when the community educators believe in the value of the program and feel they are making a difference in the lives of EFNEP families.
  • Nutrition education increases food security for low-income families, and there is a dose response relationship between the number of lessons received and increases in food security.
  • Nutrition educators are motivated by perceptions of EFNEP’s value to families, relationships with their coworkers, and having a voice in decisions at work.

What is translational research?

Today, we’re talking with Elaine Wethington, associate professor in the Departments of Human Development and Sociology at Cornell. Wethington is a medical sociologist and an expert in the areas of stress and social support systems. She’s also one of the nation’s leading experts in translational research methods.

Cornell’s College of Human Ecology is pursuing a translational research model to better link social and behavioral science research to extension and outreach, creating a more seamless link between science and service. But the question arises: What is “translational research?”

Evidence-Based Living sat down with Wethington to talk about the growing field of translational research.

To start off, what exactly is translational research?

Many definitions have been given for translational research, but the definition I like best is that it is a systematic effort to convert basic research knowledge into practical applications to enhance human health and well being. 

Translational research was designed for the medical world.  It emerged in response to concern over the long time lag between scientific discoveries and changes in treatments, practices, and health policies that incorporate the new discoveries.

What is applied research, and how does it differ?

Translational research is broader than the traditional term “applied research.”  Applied research is any research that may possibly be useful for enhancing health or well-being. It does not necessarily have to have any effort connected with it to take the research to a practical level. 

For example, an applied research study might analyze longitudinal data that tracks participants’ health and social relationships.  The researchers would report their findings in an academic journal.

But in translational research, the same study would include some “action steps.”  The researchers would partner with a community and ask for ideas about how their findings might apply there.  Together, they would come up with an intervention plan that would also include scientific evaluation of its effectiveness. 

Why are social science researchers slower to adopt these models compared to the medical community?

I think the answer to this question is that researchers have followed where the money has been allocated. The opportunities for social and behavioral scientists have not been established as rapidly.

More recently, three major government institutions have been funding projects that emphasize public health outreach using translational research – the Centers for Disease Control, the National Institutes of Health and the National Institute on Aging.  All three have been establishing translational research centers across the country, primarily focused on underserved communities and health disparities.

Thus, social scientists are only now being encouraged to take part.  More recently economic stimulus funds dispersed the National Institute of Health funded a number of translational research projects headed by social scientists, including three funded at Cornell.  I predict that soon there will be social scientists engaged in translational research across the country, not just at funded centers.

What are the benefits of moving toward translational research?

For researchers, there is benefit to being affiliated with a center that provides seed funding for projects, methodological assistance, advice on developing proposals and experience in getting community input into research projects.

For universities, translational research centers provide a tactical advantage for attracting more funding.  Translational research centers also provide a way for universities to meet public service goals in their strategic plans.

For communities, translational research provides opportunities to make a difference in their own communities.  As part of one of the Cornell centers, we engaged public service agency directors in events where they could contribute to our research agenda.  With a stake in the research, communities feel that they are making a valued and important contribution.  We heard over and over from the community members that this was a real source of pride and accomplishment for them.

How can extension programs participate?

One way local extension programs can participate in translational research is to take part in community stakeholder groups that meet with researchers who are designing intervention and prevention research programs.  Typically, a wide variety of stakeholders need to be engaged.  County Cooperative Extension offices have many collaborative relationships in their counties and can work with researchers to make contacts.

Typically, local extension professionals do not have time to engage in research themselves.  Yet they have valuable experience that can be shared.  This makes Cooperative Extension an ideal contributor for implementing programs.

Video feature: Science education outreach

Researchers and scientists across the country are making new discoveries every day, but continually must find the best ways to share that knowledge with the public.  The Cornell Center for Materials Research sets outstanding example of the best way to accomplish this.

The center’s mission is to advance, explore and exploit the science and engineering of advanced materials. It is part of a  national network of centers for Materials Research encompasses 29 centers funded by the National Science Foundation.

Nev Singhota is the director of the center’s Educational Programs Office, which reaches out to thousands of students, hundreds of parents and teachers, and many undergraduates from across the country. Many Cornell faculty, post-doctoral fellows, graduate and undergraduate students contribute to the center’s outreach efforts by visiting schools, hosting family and teacher workshops and coordinating an “Ask the Scientist” column in the local newspaper.

Singhota describes her role a facilitating interactions between Cornell scientists and all sorts of people in the community. “We create this web,” she said. “We’re like the spider who is trying to connect everyone together .” 

Interested in hearing more about Cornell Center for Materials Research’s outreach efforts?  Check out this conversation with Singhota:

Cornell NutritionWorks: Addressing obesity at the community level

Approximately one-third of all adults in the United States are obese and nearly 17 percent of youth are obese.  This national epidemic leads to an increased risk of diabetes, high cholesterol, high blood pressure, sleep disorders, joint problems, as well as social and psychological problems for millions of Americans.  

While there is an urgent need to address obesity with a focus on prevention, it can be difficult – even for a professional – to sort through all of the information about diet and health in the media, on the Internet, and even at grocery stores.

Enter Cornell NutritionWorks, an online professional development program for nutrition, health, and youth professionals such as registered dietitians, extension nutrition and 4-H educators, public health nutritionists, health education specialists, and school food service directors.   

Cornell NutritionWorks uses distance-learning technology to provide cutting edge nutrition information, interaction with Cornell experts, discussion forums for practitioners and continuing education credit for nutrition professionals. The program is lead by Cornell Senior Extension Associate Christina Stark, who’s spent nearly 30 years interpreting and communicating research-based information on food and nutrition issues to extension educators, other professionals, consumers and the media.

“To prevent childhood obesity, professionals need to look beyond focusing just on individual behavior change,” Stark says “We need to work collaboratively with community partners to change local environments so they support healthy eating and active living. For many professionals, this is a new way of thinking and working. Cornell NutritionWorks provides training in using this new evidence-based approach.”

Current offerings on the website include:

  • Preventing Childhood Obesity: An Ecological Approach, an in-depth six-week online course, offered three times a year, that helps participants use an ecological approach to identify local factors that contribute to childhood obesity and develop an action plan for their communities.  The next session will be offered fall 2010. There is a fee for this course.
  • Has the Food Revolution Reached Washington?, a cyber-presentation by Marion Nestle, professor of nutrition, food studies and public health at New York University and a visiting professor at Cornell. The talk examines how the U.S. food system contributes to our obesity epidemic, describes current food industry trends that affect consumers’ ability to choose healthy foods, and outlines the evidence for a food revolution in the United States.
  • The Built Environment, Food, and Physical Activity, a cyber- presentation by Ann Forsyth, professor in Cornell’s Department of City and Regional Planning, that discusses ways to think about the built environment, food, and physical activity measures to improve community health.

To get the latest, research-based information on nutrition and health, Cornell NutritionWorks is the place to go.  All of the content, with the exception of the in-depth course, is available to members at no charge. And membership is free.

Educating parents: The parts of a successful program

Before having children, many parents-to-be – me included – assume that taking care of a child will come naturally every step of the way. They think, “Of course I’ll know what to do when my toddler has a temper tantrum in the middle of the grocery store, or when my kid hits someone at the playground.” Until it actually happens.

The good news is parent education programs abound. Cooperative extension offices, medical facilities, government agencies and non-profit organizations across the country offer a wide-range of workshops and courses to help parents who need additional information and even practice at parenting. We recently heard from Jennifer Birckmayer, a true pioneer of parenting education in New York State, who asked Evidence-based Living about the evidence base for such programs. She wondered, does the research show they really work?

The answer is yes. Two recent analyses by the Center for Disease Control and researchers at the University of Kansas demonstrate parent education programs are effective, and that specific program components work better than others to help parents learn new skills and reduce children’s negative behaviors.

The research shows that parent training programs yield better results for parents and children when they:

  • teach parents emotional communication skills, like actively listening to their children and identifying children’s emotions.
  • teach parents the correct use of time out including removing all forms of attention and using a designated location when possible.
  • teach parents to respond consistently when disciplining their child.
  • teach parents positive interaction skills, like playing with their children and praising good behavior.
  • require parents to practice with their child during the training sessions so the facilitator can provide the parent with immediate feedback.

There are also some aspects of parent education programs that are clearly less effective in teaching parents new skills and modifying children’s behavior, according to the research.  They are:

  • teaching parents how to problem solve about child behaviors
  • teaching parents how to promote children’s academic and cognitive skills
  • including ancillary services, such as  job skills training or anger management, as part of the parenting program

According to the analyses, a major component of improving children’s behavior boils down to providing

parents with the skills they need to improve their relationships with their children. This reflects a major conclusion of child development research: Children who have positive relationships with their parents are much less likely to misbehave.

For more information about parent education programs, check out Parent Training Programs: Insight for Practitioners and “A Meta-analytic Review of Components Associated with Parent Training Program Effectiveness” in the Journal of Abnormal Child Psychology.

Do you have a question for Evidence-Based Living?  E-mail it to Karl Pillemer at kap6@cornell.edu. 

Sheri Hall

Evidence-based cheese!

It’s summer-time in the Finger Lakes – a great time of year to sample regional wines along one of the three local wine trails.  On your tour this year, you can pair that wine with some delicious, local cheese.

Cornell Cooperative Extension has teamed up with regional cheese-makers to create the Finger Lakes Cheese Trail – a driving tour of local creameries where you can learn about the craft of cheese-making and sample local varieties including sheep’s milk cheese, goudas, goat cheese, cheddars, jacks, Colby and even cheese curds.

They’re absolutely delicious!  But are they good for our diets?

The evidence says yes. In fact, cheese provides a myriad of health benefits. A single serving of cheese provides about 300 mg of calcium – nearly one-third of the daily recommended amount.  And a study published in the American Journal of Clinical Nutrition demonstrated that getting calcium from cheese rather than supplements leads to improvements in bone density. Cheese packs in other key nutrients, too, including like protein, magnesium, folate, B1, B2, B6, B12, and vitamins A, D, and E.

Unfortunately, there’s a downside to cheese. Many cheeses are also high in cholesterol, sodium and saturated fat, which can contribute to obesity, high blood pressure, heart disease and cancer. But that doesn’t mean you should eliminate cheese from your diet.

Nutritionists at Yale-New Haven Hospital have published some guidelines on incorporating cheese in a healthy diet. Among their recommendations are:

  • If you like to eat hard cheeses , look for “fat free,” “reduced fat” or “low fat” versions.
  • When looking for soft cheeses, low fat , part-skim or light products are available.
  • If you do use full-fat cheese in a recipe, cut the amount in half to reduce your fat and sodium intake.

So, go ahead. Melt some cheddar on that burger, sprinkle a bit of gorgonzola in your salad or visit a Finger Lakes creamery. As long as you indulge in moderation, you’ll reap all of the health benefits from cheese.

Sheri Hall

Is it okay to tinker? Evidence-based programs and “fidelity”

There is a lot to be said in favor of using evidence-based programs. They have been rigorously tested, and for that reason we can be pretty sure they will have the effects we want them to have. But often an agency or community educator will find an evidence-based program, try it out, and then want to tweak it in one way or the other. It may seem like it doesn’t quite fit your audience, or you might feel like replacing one component with something else, or skipping part of the program.

If you do that, is the program still “evidence-based?” How much can you change a program without making it less effective? The term scientists use is “fidelity” – that is, the faithfulness with which a practitioner implements a program. If you are engaging in fidelity to the program, you are implementing it pretty much as it is written, without changing its core components.

What some people do, however, is adaptation – making changes in the program to make it fit your clientele or the organization you work in. This isn’t necessarily a bad thing, and it might be necessary to fit a program into a given time frame, to accommodate people of different cultures or with different languages, or even just to have more “ownership” of the curriculum. However, if the program is changed too much, it can reduce the strength of the program. (The University of Wisconsin Extension has a helpful fact sheet that differentiates between “acceptable” and “risky” adaptation of programs.)

A recent talk given at Cornell addresses these issues in a very interesting and informative way. The wonderful Cornell Human Development Multimedia Website offers a video of Lori Rollen presenting on “Making Informed Adaptations to Evidence-based Sex and HIV Education Programs.”

(While you are there, take a look at the dozens of other videos with speakers discussing their research. It is an amazing site. I take the occasional lunch at my desk and use this site to catch up on what’s new in the world of research on human development.)

Lori helps you think out when adaptation of a program is a good idea and when it isn’t. She uses a clear “green light, yellow light, red light” system to show when it’s okay to adapt, when you should be cautious, and when it’s best to leave the program just as it is. And the programs she reviews on sex and HIV education are interesting in and of themselves.

Have you had any experience in adapting programs? We’re interested to hear from you.

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