New evidence on calcium and Vitamin D

Television news programs, newspapers and the Internet are all full of recommendations of how to lead a healthier life. They recommend specific foods, vitamins and all sorts of dietary supplements. But it’s important to look toward research-based facts to understand what your body really needs.

It turns out the federal Institute of Medicine (IOM) is recommending that you up the dose of two nutrients in particular – calcium and Vitamin D.

Cornell nutritionist Patsy Brannon recently served on an IOM panel that issued new recommendations for calcium and vitamin D consumption.  The report triples the recommended vitamin D intake for most healthy people from 200 to 600 international units (IUs) per day. It also caps the suggested vitamin D intake at 4,000 IUs per day, citing links between elevated vitamin D blood levels and adverse effects, including kidney and tissue damage.

The panel making the recommendation was composed of 14 physicians and nutritionists from the United States and Canada, who reviewed more than 1,000 studies and reports and consulted many scientists and stakeholders.

The updated recommendations will influence food policy on many levels, including U.S. Department of Agriculture standards for school meals, nutrition information on food packages and the content of rations eaten by soldiers in the field.

Even with the sharp increase in daily intake levels, the panel found that few people in the United States or Canada lack adequate vitamin D, in part because sunlight provides enough of the nutrient to overcome dietary deficiencies.

“Contrary to the highly publicized epidemic of vitamin D deficiency in America and Canada, the average American and Canadian is meeting his or her needs for vitamin D,” Brannon told the Cornell Chronicle for a story.

The findings also counter recent studies suggesting that insufficient vitamin D levels may be linked to a host of chronic conditions, including cancer, diabetes, autoimmune disorders, and heart and cardiovascular disease.

“The evidence available is inconsistent, with some studies demonstrating this association while others show no association, and still others show evidence of adverse effects with high blood levels of vitamin D,” Brannon said. “Thus, it is not possible to conclude whether there is an association of low vitamin D with chronic disease or not.”

For a complete listing of recommended intakes by age group and gender, click here.

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As an aside, the Cochrane Collaboration has conducted several systematic reviews on Vitamin D supplements for specific medical conditions.  They’ve found that:

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.

Democracy and higher education: A discussion with Cornell prof Scott Peters

Cornell education professor Scott Peters has dedicated his career to the intersection between academia and community life. His new book, Democracy and Higher Education: Traditions and Stories of Civic Engagement, examines how higher education contributes to a democratic society. Evidence-based Living sat down with Scott to learn about his vision of Cooperative Extension.

What first inspired you to research the topic of the public role for higher education?

“I spent 10 years working for a community-university non-profit that was located on the campus of the University of Illinois.  The experiences I had and people I worked with awakened an interest in exploring the history of American higher education’s public mission and purposes.  I was especially interested in understanding the origins and meaning of the “land-grant mission.”  I often heard people use this phrase like it had some deep profound meaning.  But I couldn’t find anyone who could explain exactly what it meant.  So I would trace the origins of my interest to those experiences.”

Do you feel that academics have a duty to contribute to democracy and civic life more-so than other professionals?

“I don’t think academics have a duty that is greater than other professions.   Professionals in every field and sector of society who want to be what William Sullivan calls “civic professionals” face the same challenge.  They have to learn how, as Sullivan puts it, to deploy their technical expertise and judgment “not only skillfully but also for public-regarding ends and in a public-regarding way.”  There’s no one “correct” way to do this.  But there is a debate about what it can and should look like.  I take that debate up in my new book.”

Do you think there are shortfalls in the current higher education system as a whole – that universities, in general, could do a better job of engaging in public life?

“We can and should do much better, yes.  But my work has been more focused on illuminating, interpreting, and analyzing the many positive roles and contributions academic professionals and institutions are taking up and making despite the challenges and shortfalls.  We give very little attention to faculty members’ civic engagement work.  And we devote very little time and space for serious conversation about it.  By ‘serious,’ I mean research-based, with robust theoretical and historical groundings.”

Do you have a vision of what the world would look like if engaged professors did a better job of reaching out to help communities?

“I have a vision of what it would look like if we invested more time and attention to understanding and learning from stories of the civic work that professors (and students and staff) are already doing.  If we did, there would be a much richer understanding of the public and academic significance of this type of work.  We’d see it as a multidimensional activity that has both academic and civic value.  But we’d also see it as something that can and needs to be improved. “

Is there anything else people should know about your work?

“I’ve been spending a lot of time investigating the ways the public work of the academy helps to strengthen democracy.  That’s helped me to see that things like extension, outreach, and engagement aren’t just “service” activities.  They aren’t just about helping communities and solving problems.  And they’re certainly not just about transferring information and technologies. At their best they are also avenues for pursuing and improving our teaching and our research.  They’re avenues for making better colleges and universities. This isn’t a theoretical hope.  It’s being demonstrated every day by civically-engaged faculty, staff, and students at Cornell and elsewhere, and has been for well over a hundred years.  One of the most important things I’ve been learning in my research is that engagement work absolutely depends on the development of strong public relationships between the academy and its various external publics.  My work is all about helping people to think deeper and better about what it takes to build and sustain these relationships in ways that strengthen democratic processes, principles, and ideals.”

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.

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.

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.

The science behind jet lag

As our family prepares for our annual trip to England, I find myself searching for the best ways to cope with jet lag.

My husband and I have taken regular trips to visit his parents in England for years, but we never worried too much about jet lag because we never had times when we needed to be awake.  We would just sleep when we felt like it until our bodies slowly made the adjustment.

Then, our son was born. The first time we all visited England, we decided to stay on Eastern Standard Time.  And as first-time parents of a newborn, we were (probably overly) concerned about his eating and sleeping schedule. My in-laws obliged us, staying up until midnight to play with the baby and letting us sleep late in the mornings.

This year is a bit different. As our son approaches two years old, he and our in-laws are more interested in fun outings like the zoo, the beach and the local amusement park.  This means that we will all need to adapt to our new time zone in fairly quick order.

So I set out this week to find some coping mechanisms that will really work.  There’s a lot of advice out there – ideas about caffeine, fluid intake and exercise schedules. Researchers have even discovered the causes of jet lag at the molecular level and are using those findings to develop medicine to help people overcome the condition. 

I was able to find two systematic reviews of jet lag treatments – one by the Cochrane Collaboration and one by England’s Guardian newspaper. Both cover a supplement called melatonin, a hormone responsible for regulating your body’s internal clock. It is the only treatment for jet lag that has been studied in clinical trials.

It eight out of ten studies, the melatonin was found to be effective in reducing the symptoms of jet lag. It has also been studied for treatment of sleep disorders in children, but there are lingering questions about its safety, especially in toddlers.

 Since we’re not treating a medical condition in my son, I would prefer not to give him a supplement. Even a small risk of side effects outweighs any potential benefit of lessened jet lag. For this trip, we’ll stick to the general wisdom for coping (which haven’t undergone any scientific testing):

  • Getting as much sunlight as possible in the mornings.
  • Eat at normal mealtimes in our new time zone.
  • Getting plenty of exercise in the mornings and early afternoons.

Wish us luck, and at least a few nights of peaceful sleep while we’re traveling!

–          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.

Evidence-based programming: What does it actually mean?

Anyone who loves detective novels (like I do) winds up being fascinated by evidence. I remember discovering the Sherlock Holmes stories as a teenager, reading how the great detective systematically used evidence to solve perplexing crimes. Holmes followed the scientific method, gathering together a large amount of evidence, deducing several possible explanations, and then finding the one that best fits the facts of the case. As everyone knows, often the “evidence-based” solution was very different from what common sense told theo other people involved in the case.

In our efforts to solve human problems, we also search for evidence, but the solutions rarely turn up in such neat packages. Whether it’s a solution to teen pregnancy, drug abuse, family violence, poor school performance, wasteful use of energy, or a host of other problems – we wish we had a Sherlock Holmes around to definitively tell us which solution really works.

Over the past decade, efforts have grown to systematically take the evidence into consideration when developing programs to help people overcome life’s challenges. But what does “evidence-based” really mean?

Take a look at these three options: Which one fits the criteria for an evidence-based program?

1. A person carefully reviews the literature on a social problem. Based on high-quality research, she designs a program that follows the recommendations and ideas of researchers.

2. A person creates a program to address a problem. He conducts an evaluation of the program in which participants rate their experiences in the program and their satisfaction with it, both of which are highly positive.

3. An agency creates a program to help its clients. Agency staff run the program and collect pretest and post-test data on participants and a small control group. The group who did the program had better outcomes than the control group.

If you answered “None of the above,” you are correct. Number 3 is closest, but still doesn’t quite make it. Although many people don’t realize it, the term “evidence-based program” has a very clear and specific meaning.

To be called “evidence-based,” the following things must happen:

1. The program is evaluated using an experimental design. In such a design, people are assigned randomly into the treatment group (these folks get the program) or a control group (these folks don’t). When the program is done, both groups are compared. This design helps us be more certain that the results came from the program, and not some other factor (e.g., certain types of people decided to do the program, thus biasing the results). Sometimes this true experimental design isn’t possible, and a “quasi-experimental” design is used (more on that in a later post). Importantly, the program results should be replicated in more than one study.

2. The evaluation studies are submitted to peer review by other scientists, and often are published in peer-reviewed journals. After multiple evaluations, the program is often submitted to a federal agency or another scientific organization that endorses the program as evidence-based.

3. The program is presented in a manual so that it can be implemented locally, as close as possible to the way the program was designed. This kind of “treatment fidelity” is very important to achieve the demonstrated results of the program.

As you might already be thinking, a lot of issues come up when you consider implementing an evidence-based program. On the one hand, they have one enormous advantage: The odds are that they will work. That is, you can be reasonably confident that if implemented correctly, the program will achieve the results it says it will. A big problem, on the other hand, is that a program must meet local needs, and an evidence-based program may not be available on the topic you are interested in.

We’ll come back to these issues in later posts. In the meantime, I recommend this good summary prepared by extension staff at the University of Wisconsin. In addition, I’d suggest viewing this presentation by Jutta Dutterweich from Cornell’s Family Life Development Center, on “Planning for Evidence-Based Programs. And check out our web links for some sites that register and describe evidence-based programs.

Building extension’s public value: We can be more convincing

Those of us who work in the Cooperative Extension system tend to love it. Over the past weeks, I’ve been involved in an interview project with older people who have been involved in extension most of their lives, either as volunteers or as paid employees. Their devotion to extension’s mission shines through every interview. From the inside, the value of what we do seems self-evident.

Then we come up against the harsh reality: Extension is heavily dependent on public funding. Many other constituencies, and in particular elected officials and the general public, need to see the value of what we do. How can we convince those who hold the purse-strings that the work of extension has public value, worth spending government funds on?

I recently came across the work of Laura Kalambokidis, a faculty member in the Department of Applied Economics at the University of Minnesota. One of the pleasures of writing a blog is that you start reading other people’s, and Laura’s brings a fascinating perspective to extension.

In an article in the Journal of Extension, Laura raises the issue of identifying the public value of extension. She lays out the problem facing us succinctly:

The current economic climate has placed significant pressure on the budgets of state and county governments. In turn, those governments have compelled state Cooperative Extension Services to defend their continued receipt of state and county funding. Even when policymakers are persuaded of the efficacy of an Extension program, they have questioned whether the program should be supported with scarce public dollars rather than through user charges.

To address this issue, Laura translates economic theory and research from public sector economics to practical issues of extension. What policymakers need to be convinced of is that extension work has public value – that is, why should the public pay for our services rather than being purchased on the private market? The challenge is to show that extension activities are a public good, one that benefits society as a whole (in addition to benefitting specific program participants). In her words: “Extension staff must also be able to explain why citizens and policymakers who are not direct program participants should value the program.”

In the extension programs I’ve created, I confess that I haven’t done this. When I justify my programs, I point to the good outcomes and satisfaction for program participants. But I don’t really look at the public good – how they have benefits  for the larger community, beyond my participants. For example, I’ve created extension programs to train nursing home staff. But someone could ask: “That’s well and good, but why shouldn’t those programs be paid for by nursing homes as a private good? What’s the public value for what you do?”

Laura’s work suggests that the most effective case can be made for public value when there is market failure – we provide something that isn’t effectively offered privately – and when there are issues of fairness and justice not addressed by private markets. Her article gives a detailed process for identifying public value.

To give one example, extension folks typically believe that they address market failure by providing information. But Laura suggests we consider this carefully, asking questions like:

  • Is there a demonstrable information gap?
  • Can you show that other entities are providing wrong or incomplete information to consumers?
  • Does your information direct consumers (and producers) toward activities that have external benefits?
  • Are you providing information to a population that does not have access to private information sources?

Laura has developed a workshop program where she helps extension associations determine public value of their programs and how to present them as such. More information is available on her web site, which includes a blog.

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