Does diet soda cause strokes? Nope!

I am guessing that many families reading the paper at breakfast today had this happen: Somebody said to someone else: “See, I told you drinking diet soda was bad for you!”

And that is because of a study reported widely in the media regarding the relationship between consumption of diet soda and stroke. Strokes are very bad things, often devastating the person to whom they occur, so a finding about anything that might increase our risk for stroke is worthy of notice.

 At Evidence-Based Living, one of the most fun things we do is to track back from the media coverage to the actual research findings. In so doing, we hope to help people figure out the nature of the evidence and whether we should immediately change our behavior. This was an unusually big story, and so we ask: Believe it or not?

First, let me say that media coverage was a little more measured than usual. Some news outlets did use headlines like that from Fox News: Diet Soda Drinkers at Increased Risk for Stroke” which make it sound like a firm finding (and probably led to some of the heated breakfast-table conversations). But many other outlets included the all-important “may” in the headline, and the articles themselves included qualifications about the study. 

So let’s take a look at this finding, using some of the key questions EBL recommends you always employ when you are trying to figure out whether a scientific finding should change the way you live. 

1. What kind of a study was this? Was it a good one?

 This is what scientists call an observational study. It was not a randomized, controlled experiment in which some people were asked to drink diet soda and others were not. It uses a longitudinal study called the Northern Manhattan study (or NOMAS). And yes, it is a very good study of its kind. It looks at stroke risk factors across white, black, and Hispanic populations living in the same community (northern Manhattan). It is a large and representative sample, followed up annually to determine if people suffered a stroke (verified by doctors on the research team). Many publications in top referred scientific journals have been published from the study (some of which are available for free on the website). 

2. Where did the information in the media come from? 

Here, in EBL’s opinion, is the first problem. The results were presented at a scientific conference this week (the American Stroke Association). This is not the same as being published in a referred scientific journal. In addition, we cannot follow an EBL cardinal rule: Go to the original article. The only information that is available on the study is from a press release issued by the association and subsequent interviews with the study’s lead author and other experts. So we need to wait until the results are published before we even think of changing our behavior in response to them. 

3. Are the results definitive?

No, no, and again no. There are some good reasons not to drink diet soda (including possible increased risk of diabetes and osteoporosis), but these findings do not “prove” that diet soda leads to strokes.  

Some reasons why this is a very tentative and preliminary finding include the following: 

  • All the data are self-report, so we are dependent on people remembering their diet soda consumption. 

  • It’s the first study to show this association. EBL readers know that we need multiple studies before we even begin to think about recommending behavior change.

  • It’s not all diet soda drinking: It looks like only people drinking diet soda every day show the association with stroke, suggesting that lower consumption may not increase risk. 

  • The study is not representative of the U. S. population. First of all, you had to be over 39 years old in 1990 to get in the study and the average age of the sample now is in the late 60s, so the results can’t be generalized to younger people. Further, the sample for this study included 63% women, 21 % whites, 24 % blacks and 53 % Hispanics. In the U.S as a whole, 51% of the population are women, 77% are white, 23% black, and 16% Hispanic. So it’s a very different group from what a random sample of Americans would get you.

  • We don’t know the reason for the association. The lead author, Hannah Gardener, is open about this: “It’s reasonable to have doubts, because we don’t have a clear mechanism. This needs to be viewed as a preliminary study,” By “clear mechanism,” she means that even if this relationship exists between diet soda and stroke, we don’t know why. 

There’s more we could say, but our main point is this: It doesn’t take very long for you to “deconstruct” what the actual evidence is behind a news story. With a basic understanding of how studies are done and access to the Web, you can often find out as much as you need to know. In this case, the media have reported the first highly tentative findings of an association between two things. Now other scientists need to test it again and again to see if it holds up, as well as finding out why the association exists.

 I go for sparkling water instead of diet soda because of other problems mentioned earlier with diet beverages.  But regarding stroke risk, the data just aren’t there yet. 

   

How do I know if a program works? A “CAREful” approach

I was recently giving a talk on intervention research and I was asked: “How do I tell whether the evidence for a particular program is good or not?” I often talk with practitioners in various fields who are struggling with exactly what “evidence-based” means. They will read “evidence” about a program that relies only on whether participants liked it, or they will see an article in the media that recommends a treatment based on a single study. What should you look for when you are deciding: Is the evidence on this program good or not?

I came across a very helpful way of thinking about this issue in the work of educational psychologist Joel R. Levin. He developed the acronym “CAREful research,” which sums up what needs to be done when drawing conclusions from intervention research.

In Levin’s “CAREful” scheme, he identifies four basic components of sound intervention studies.

Comparison – choosing the right comparison group for the test of the intervention. Usually, there needs to be a group that does not receive the program being studied, so one can see if the program works relative to a group that does not receive it. A program description should explain how the comparison was done and why it is appropriate.

Again and again – The intervention program needs to be replicated across multiple studies; one positive finding isn’t enough.

Relationship – There has to be a relationship between the intervention and the outcome. That is, the intervention has to affect the outcome variables. That may seem simple, but it’s important; the program has to have a positive effect on important outcomes, or why should you use it?

Eliminate – The other possible explanations for an effect have to be eliminated, usually through random assignment to experimental and control groups and sound statistical analysis.

 Levin and colleauges sum up the CAREful scheme:

“If an appropriate Comparison reveals Again and again evidence of a direct Relationship between an intervention and a speciried outcome, while Eliminating all other competing explanations for the outcome, then the research yields scientifically confincing evidence of the intervention’s effectiveness.”

To see a good example of an evidence-based approach to intervention that reflects this kind of CAREful research, take a look at the PROSPER program, which takes a similar approach to youth development progams.

So when you are looking at intervention programs, “Be CAREful”: Applying these four criteria for good research can help you decide what works and what doesn’t.

Another evidence-based diet tip: Keep a diary

Are you still working on that New Year’s resolution to lose weight?  If so, there is some newly published evidence that might give you the boost that you need.

A systematic review published last month in the Journal of the American Dietetic Association concluded that there is a “consistent and significant positive relationship between self-monitoring diet, physical activity or weight and successful outcomes related to weight management.”  (You remember how much we love systematic reviews, right?)

The article reviewed 22 studies that looked at self-monitoring during weight loss programs.  Fifteen of the studies focused on keeping a food journal, one looked at keeping an exercise journal, and six tracked subjects who recorded their weight at least once a week. 

Researchers found that both written and electronic journals helped with weight loss.  They also found that that people kept a weekly record of their weight lost more than those who weighed themselves less frequently. 

Despite the conclusive evidence, the review identified limitations in the methods of many of the studies included. In all but two studies, participants were predominantly white and women. And most of them used self-reporting instead of researchers collecting the data themselves.

Still, the evidence is pretty clear:  If you want to lose weight, keep a journal of your diet, weight and exercise.  Just this simple task can make all the difference.

Video feature: Psyche 101 with Professor Stephen Ceci

To follow-up our post on Professor Stephen Ceci’s work on child testimony, we thought it would be useful to share a recent lecture Ceci gave to a Psychology 101 class at Cornell. 

In the lecture, he discusses five factors that can damage or change a child memory: 

  • Suggestive questioning.
  • Giving false expectations or stereotypes.
  • Confirmatory bias, or tendency for people to favor information that confirms their preconceptions.
  • Visually-guided imagery.
  • High levels of stress

“How can children come to believe something that’s wrong?” Ceci asked.

“When young children, ages 3 and 4, are questioned by neutral interviewers, they do very well. They recall events with 90 percent accuracy,” he explains. “However, when children are repeatedly interviewed over the course of weeks and months with misleading suggestions ­ which sometimes occurs in forensic cases ­ many come to remember the false events as true and provide detailed and coherent narratives about these false events.  So compelling did the children’s narratives appear that we suspected that some of the children had come to truly believe they had experienced the fictitious events. Neither parents nor researchers were able to convince 27 percent of the children that the events never happened.”

You can view the entire lecture by clicking here.

Video Feature: How the physical environment affects children

Here at Evidence-Based Living, we’ve written before about the research of Gary Evans, a Cornell professor in the Department of Design and Environmental Analysis who has spent much of his career researching how the physical environment impacts child well-being – especially for children in poverty.

Evans, an environmental psychologist, has completed a large body of research that examines the relationship of crowding, noise, housing and neighborhood quality on the lives of children.  His research reveals that these factors can have a lot of impact on a child’s academic achievement, as well as cognitive and social development.

Last year, Human Ecology undergraduate student Kyler Wilkins earned a first place finish in the College of Human Ecology’s 2010 Elsie Van Buren Rice Awards public speaking competition for his presentation of Evans research entitled “The Hard Knock Life: The Environment of Poverty and Children’s Development.”  In it, Wilkins describes how Evans research is being used by policy-makers to improve children’s access to healthy foods in schools and conduct cognitive interventions in to improve the memories of children in poverty. You can see it here:

To learn more about Evans’s work, you can also view a one-hour lecture he delivered to extension professionals by clicking here.

Jumpstart your diet with evidence-based tips

Losing weight is one of the most popular New Year’s resolutions made in the United States, where approximately 68 percent of the population in considered overweight or obese. So it’s no surprise that each January fitness centers are packed with people, diet books fly off the shelves, and weight-loss programs see surges in their memberships.

With all of the options and information out there, it’s hard to figure out the best way to drop pounds and improve your health. And unfortunately many popular diets and weight-loss programs are not based on the facts – which may explain why only 5 percent of people who diet are able to lose weight and keep it off. 

But, the fact is, there are evidence-based methods for losing weight. We put together this collection of diet tips based on academic studies to make sure your diet is based on the facts.

Get moving. A systematic review of 43 studies found that exercise combined with diet changes resulted in a greater weight reduction than diet changes alone.  (For a refresher on the value of systematic reviews, click here.) The review also found that exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.  The take-home message: It’s not enough just to cut out the cookies.  You have to get moving as well.

Try a “low glycemic index” diet.  Glycemic index is a measure of the effects a specific food has on blood sugar levels. Foods that break down more slowly and release glucose (a type of sugar the body uses for energy) more gradually have a low glycemic index. These include fruits and vegetables, meat, eggs, milk, whole grains and nuts. Foods that break down quickly during digestion and release glucose rapidly have a high glycemic index. They include refined sugar, white bread and rices, and most processed starches.

A systematic review of six studies found that overweight people were more likely to lose weight and improve their cholesterol on low glycemic index diets compared to other diets.  In other words, make sure your diet is full of fruits, vegetables, whole grains and protein, and light on processed sugar and starches.

Put away the extra-large bowls, take out the smaller plates.  Several studies have found that people eat more out of larger containers without even realizing it.  One study by Cornell psychologist Brain Wansink found that movie-goers ate 30 to 40 percent more popcorn out of large containers compared to those who were served popcorn in medium-sized containers. Another study by Wansink found that food served in larger bowls at a party led to 56 percent greater food intake compared with food served in smaller-sized serving bowls.  Both studies lead to the conclusion that serving size provides us implicit clues on much is appropriate to eat.

Set up your environment to encourage healthy eating.  Studies show that when you’re busy watching television, reading, or socializing while you eat, you pay less attention to how much food you consume to the point where your body’s natural signals of fullness are ignored. As often as possible, make time to sit down at a table to eat meals and snacks, and avoid multitasking when it comes to food.

Eat breakfast.  The National Weight Control Registry is the largest-ever prospective study of people who have lost weight and successfully kept it off. The registry is currently tracking more than 5,000 people who have lost weight and kept it off. What is one trait many of the participants have in common?  They eat breakfast. A study of nearly 3,000 subjects in the registry found that nearly 80 percent eat breakfast everyday and only four percent never eat breakfast. Even if it’s small, try to consume something in the morning to jumpstart your metabolism.

Wishing you a healthy New Year!

Does reading aloud to young children make a difference?

One of my earliest memories as a child was sitting on a wooden porch swing reading books with my mom.  My mom tells me that she started reading to me from day one, and even read to her belly while she was pregnant. Needless to say, books have always held an important place in our home.

When my son Aaron was born, my husband and I started reading to him right away too.  In the beginning we had some children’s books, but we would also read aloud whatever each of us happened to be reading at the time.  Aaron heard a little Harry Potter and some Bicycling magazine, and even a few academic studies that I had to read for work. Now that he’s two years old, we read at least three or four children’s books together each day. Currently, his favorite stall tactic is, “Mama, how about we read a book?”

A few weeks ago, when a friend passed along a book to me about the benefits of reading to children, I was eager to learn about the tangible benefits. The book, called Reading Magic, makes the case that reading aloud to children helps them develop an interest in books, encourages those first words, inspires them to learn to read themselves, and creates a special bond between child and parent.

While I found the book interesting, it doesn’t offer any systematic, concrete evidence about reading aloud to children. So, of course, I had to do some digging.  It turns out my mom knew what she was doing all those years ago!

Three separate systematic reviews of what educators call dialogic reading – essentially engaging in a conversation with young children as you read to them – found positive effects for language skills, improved literacy and school readiness.

The study that piqued by interest the most was a review of 10 studies published by the Puckett Institute’s Research and Training Center on Early Childhood Development, an organization dedicated to identifying and implementing evidence-based practices that improve the development of at-risk infants, toddlers, and preschoolers.

The study identified several specific benefits for children who regularly participated in dialogic reading, including: positive gains in expressive language development, increases in the length of spoken phrases, and greater expressive vocabulary scores.

All of this raises the question, what the heck makes dialogic reading so special?  Essentially, the adult helps the child become the teller of the story by asking questions and prompting the child to participate. The Reading Rockets project, sponsored by the U.S. Department of Education, provides some practical tips on how to engage in dialogic reading with kids.

If there are any small children in your life, sit down with them for a regular story time. The evidence shows it’s great for kids.

Portable space heaters: Money-savers or energy-wasters?

In Ithaca, it seems that the weather took a sudden dip a few weeks ago.  Temperatures fell below freezing within a few hours, and it doesn’t look like they’ll warm much until spring. That was our cue to turn on the heat for the season.

As much of the northern hemisphere launches into winter, millions of people across the country are firing up their home heating systems – an act that will cost most households hundreds if not thousands of dollars this year. 

With those costs comes the natural inclination to save a little money.  That’s when many – myself included, occasionally – turn to portable electric space heaters. When there’s a chill in the room, it seems so logical to flip a switch to warm a smaller space, instead of cranking up the heating system for the entire house.  But are electric space heaters a good way to reduce your heating costs?  The evidence says no.

Mark Pierce, extension associate at Cornell’s College of Human Ecology, is an expert in energy efficiency issues in residential buildings.  He conducted a detailed analysis of heating costs in a 1,200-square-foot, three-bedroom house to determine if there is a benefit to using portable electric heaters.

Pierce asked the question, which is more expensive: heating the entire house to 70 degrees for three hours, or heating the house to 60 degrees for three hours and using a space heater to raise the temperature of one room to 70 degrees? 

His analysis factored in all sorts of details like the levels of insulation in the floors, walls and ceiling, heat loss through windows and doors, and they type of heating fuel used. He assumed an outside air temperature of 10 degrees.

Using average costs for heating fuels in New York, he found turning down the thermostat from 70 to 60 degrees would reduce heating costs by about 50 to 80 cents, depending on the heating fuel used.  Meanwhile, using a portable heater to heat one room from 60 to 70 degrees over the same time period would cost 52 cents – a meager savings, even when using the most expensive heating fuels.

But why is the cost of heating just one room with a space heater so high?  Because electricity is about twice as expensive as fossil fuels, Pierce explains.

“Electricity is more expensive because it is a secondary form of energy, meaning that a primary form of energy – burning fossil fuels to power a generator for example – must first be consumed to make electricity,” he writes. “By the time electricity gets to your home from a power plant, about 70 percent of the energy consumed to create it has been lost due to generation and distribution system inefficiencies.”

Instead, Pierce recommends other ways to reduce your heating bills, such as adding insulation to your floors, walls and ceilings, installing a more efficient heating system and sealing holes and cracks around doors, windows and electrical outlets.

You can read more evidence-based tips about reducing your home heating bills by clicking here.  Wishing you a warm and cozy winter!

Science in the courtroom: A Cornell professor uncovers the facts behind child testimony

I received a postcard in the mail last week notifying me I was called for jury duty.  The prospect seemed an inconvenience. (Where would I find care for my two-year-old son while serving?). But it was also exciting!

I’ve always been interested in the law, and the idea of serving on a jury conjured up a feeling of civic responsibility that felt good.  It was a job I wanted to take seriously, and I immediately began wondering if there was any research I should consider before embarking on this important task.

Unfortunately, there were no trials in my town this week, so I didn’t even have to report to the court. But the notice did bring to mind the work of Cornell Professor Stephen Ceci, an expert in developmental psychology who has conducted ground-breaking research on the testimony of children.

Ceci’s work bridges the gap between research and real-life in a very tangible way: findings from his studies have influenced the way thousands of law enforcement officers, social workers, lawyers, and judges deal with the testimony of children. This is research that makes a tangible difference in the lives of people who often find themselves in difficult situations.

 (An interesting side note: Ceci refuses to be an expert witness for either prosecutors or defenders – a decision that has lent him credibility among judges throughout North America, who often cite his work in their decisions.)

A main topic of Ceci’s work is how children respond when they are questions about sexual abuse. The conventional wisdom says that children delay reporting abuse for years and will initially deny any abuse occurred when asked directly. But after repeated questioning, they gradually begin to tell little bits and pieces about how they were abused. Next, they recant altogether. Only later, when they are in what is perceived to be a psychologically safe situation, do they give a full and elaborate disclosure.

In analyses of dozens of published studies, Ceci and his colleagues separated out the methodologically-sound studies on children’s disclosure from poorly conducted ones. They found in high-quality studies, children did report abuse in full detail when explicitly asked. They also found that when a child is questioned repeatedly, he is likely to relent and say what he thinks the interviewer wants to hear to get out of an uncomfortable situation.

“It’s important for judges to know what science shows, because this set of invalid beliefs animates the whole investigatory process,” Ceci explained. “It motivates investigators and interviewers to pursue reluctant children, who may be reluctant because nothing actually happened.”

In the case U.S. v. Desmond Rouse, the United States Court of Appeals for the Eighth Circuit (the court directly beneath the U.S. Supreme Court) established new law on vetting child testimony based almost exclusively on the work of Ceci and his colleagues.

For anyone who works with children involved in the court system, Ceci’s work provides a whole new way to think about their testimony.

Medicine by the numbers: Cornell professor on how we make health care decisions

These days, a routine trip to the doctor’s office can easily morph into a complicated calculation of risks and benefits. With the advent of pharmaceutical advertising and the plethora of medical information on the Internet, patients have more choices and responsibility to make decisions than ever before.

Enter Cornell professor Valerie Reyna, a faculty member in human development and expert in judgment and decision-making.

Her ground-breaking research has shown that medical information is difficult to understand for people of all education levels. In laboratory studies and analyses of real-world data, Reyna has found that adults tends to make all decisions – including medical decisions – based on the overall meaning or gist of situation, instead of using statistics and details. So there is a disconnect between the way medical information is presented and the way people make decisions. 

For example, the risk of dying on the table during carotid endarterectomy (a vascular surgery procedure that removes plaque from the lining of your carotid artery) is 2 percent. In one of Reyna’s studies, some patients undergoing the surgery estimated their chance of dying as 10 percent, while others estimated as little 0 percent or no risk at all. Even though zero is numerically closer to two than ten is, someone who estimates 10 percent has made a more informed choice because that person grasps the important bottom-line: the surgery involves some risk.

But Reyna has found that gists are only as good as a person’s level of knowledge or understanding. For instance, the gist that “condoms block the exchange of bodily fluids” leads people to overestimate condoms’ effectiveness against sexually transmitted diseases, because it does not take into account infections that are transmitted by skin-to-skin contact, such as human papilloma virus. In this case, the bottom line is that some infections are transmitted skin to skin, not via exchange of fluids.

Reyna wants to help bridge this disconnect and make sure patients have the kind of information they need to make solid, informed choices. She has created a web page that explains how her basic research can help patients and their physicians map our health care choices.

She also offers some tips:

  • Health providers should explain options qualitatively. Instead of relying solely on numbers, it’s helpful to explain probabilities verbally, stressing the bottom-line meaning of information.
  • Display information visually. Simple bar graphs and pie charts help patients extract important information without getting hung up on memorizing the details.
  • Tailor the format to trigger the appropriate gist. Frame messages and choose the most suitable visual formats to convey the bottom line.

How children remember their worlds…and why

We all have early childhood memories – of a favorite relative, a special toy or an event that made a big impression.  They are fixtures we will carry throughout our lives. But how those early experiences become sealed into our minds? 

Research by Human Ecology faculty member Qi Wang helps explain this phenomenon. Wang, an associate professor of human development, runs the Social Cognition Development Laboratory, where she studies how people develop autobiographical memory and their sense of self.

We know from prior research that the process of sharing memories begins early in life. As soon as children become capable of using language, they begin to discuss past events with caregivers. But initially, they make very few spontaneous references to past events. Instead, their recollections are directed by caregivers’ questions about the past. It is not until children are 3 to 5 years old that they can engage in more detailed conversations about the past. Even then, they rely on adults to direct the conversation.

Wang’s research has delved into how parents’ conversations shape children’s memories. She has found children from different cultural backgrounds recall events differently based on their parents’ conversational style.

For example, American mothers tend to elaborate more on children’s own narratives, asking questions that focus on the child and providing additional details about past events. This values children’s participation and emphasizes the importance of individual experience. Hence, American preschool and grade school children provide more elaborate and detailed memory accounts that refer to their own roles and preferences.

By comparison, Chinese and Korean mothers are less likely to elaborate when talking about past events with their children. Instead, they are more likely to ask factual questions and refer to other people. This approach emphasizes interpersonal relations, moral rules and behavioral expectations. As a result, Asian children talk more about other people than themselves when remembering something, and they are more likely to remember daily routines.

These early memories are important because they shape children’s sense of self and the way they recollect events over their entire lives. (Wang has found these cultural differences appear to extend to adulthood.)

A few take-home messages for parents are caregivers are:

  • Consider your goals before starting a discussion with your child. What aspects of the event do you think is important for your child to remember?
  • Consider the type of events you wish to discuss with your child and their implications. Selecting social events would allow you to reflect on your child in relation with others, social norms, and behavioral expectations. Choosing a personal event would allow you to focus on your child’s experiences, thoughts, and feelings relating to the event.
  • Ask a lot of “wh” questions (e.g., who, what, where, when, why). Provide answers when the child does not remember. Avoid repeating questions, or “looking” for a right answer. Try not to create a test-like atmosphere.

You can find Wang’s work summarized in a paper created by Human Ecology’s Department of Human Development.

When every drop counts: The facts on public health during a drought

Throughout the history of the Earth, droughts spanning seasons or even years have taken their toll on plant and animal life.  In more recent U.S. history, a series of major droughts every 20 to 30 years have devastated farms, sparked wildfires and led to adverse health effects.

Although the literature contains well-researched articles on the aspects and implications of drought itself, there have been few fact-based inquiries into how drought affects public health in the United States. Until recently.

Last month, the Centers for Disease Control and Prevention National Center for Environmental Health published a guide to assist public health officials to prepare for and cope with drought in their communities. The document includes information about how drought affects public health, recommends steps to help mitigate the health effects of drought and identifies future needs for research and other drought-related activities.

Among the CDC’s recommendations is to identify the populations that are most affected by a particular adverse condition. For instance, immune-compromised people drinking contaminated well water are most at risk of contracting infectious diseases. Once the affected populations have been identified, public health departments should actively collect and analyze quantitative and qualitative data to help determine the extent of the public health threat and the best steps to mitigate it.

The publication also suggests additional research in numerous areas including identifying the health effects of reusing water, using surveillance data to determine which chronic disease are more frequently reported during a drought, and identifying pathogens that can be used as drought indicators.

Intrigued?  You can find the entire publication by clicking here.

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