The evidence on child abuse

No one needs an academic study to understand that child abuse and neglect has horrible effects on children and families.  The toll on young people and their caregivers – emotionally, socially and developmentally – is tremendous. But the problem also takes a broader toll on our health care system and society as a whole.

A new study from the U.S. Centers for Disease Control quantifies the toll on society in financial terms. The study examined nearly 600,000 confirmed child maltreatment cases over the course of a year. Approximately 1,740 of the cases resulted in the death of a child. It found the financial costs associated with these cases to be $124 billion, which includes the costs of medical care, special education, the criminal justice system and lost productivity.

Researchers totaled the lifetime cost for each victim of child maltreatment who lived at $210,012 – a figure the matches the cost of other health conditions such as stroke, which has lifetime cost per person estimated at $159,846, or type 2 diabetes, which is estimated between $181,000 and $253,000.

Much of the data for the study came from a project at Cornell called the National Data Archive on Child Abuse and Neglect (NDACAN), housed in the Bronfenbrenner Center for Translational Research (BCTR). The project makes high-quality datasets available to researchers, including data from individual studies and  annual federal data collection efforts, such as state child abuse and neglect and foster care statistics.

“This study very likely underestimates the actual burden as we learn more about the impact of early childhood adversity on brain development and health and well-being  across the life span,” said John Eckenrode, director of NDACAN, professor of human development and director of the BCTR.

“Fortunately, there are now evidence-based programs that may prevent child maltreatment and the associated costs to society,” he said. Among them is the Nurse Family Partnership, a program founded at the College of Human Ecology that aims to improve the lives of disadvantaged mothers and their children.

The take home message: Child abuse and neglect is a big problem. The better we can understand its intricacies and impacts, the better we’ll be able to prevent it in the future.

A new tool to help you lose weight

MyPlateHappy New Year!

Are you making any diet and exercise resolutions this year?  I sure am.

Just in time to help us along, the federal government has launched a new online tracking system.  The system is based on the part of a new, evidence-based initiative to improve the diets of Americans that we’ve written about before here on EBL.

It includes tools to calculate the nutritional information of more than 8,000 foods, tally daily calorie consumption and track physical activity.  You can set weight loss goals, create reports and receive individualized tips about how to improve.

Admittedly, this kind of tool isn’t for everyone.  I know people who crave data – my husband is like this -who love generate graphs and reports showing exactly how many calories they’re consuming and expending. Others find this kind of tracking monotonous and discouraging.

No matter which camp you fall into, the evidence does show that it’s beneficial to track your food consumption – something the new tool will certainly help with. In fact, a systematic review published last year 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.

So if you’re aiming to drop a few pounds in 2012, check out the government’s new tool.  It might be just what you need to jump start your New Year’s resolution.

The evidence on pain: A new blog

Millions of older adults throughout our country live with chronic pain – a disabling and costly disorder. Two years ago, Cornell helped establish an evidence-based center in New York City called the Translational Research Institute for Pain in Later Life, or TRIPLL, to help older adults prevent and manage their pain.

TRIPLL is a collaboration between six institutions: Weill Cornell Medical College, Cornell-Ithaca, Columbia University’s Mailman School of Public Health, Hospital for Special Surgery, Memorial Sloan Kettering Cancer Center and Visiting Nurse Service of New York and Council of Senior Centers & Service of NYC, Inc.

The center aims to build evidence-based practices for pain prevention and treatment, and then disseminate that information to older adults in New York City.

Now the center has launched a blog — http://tripll.org/blog/ — to share research-based information to help those dealing with chronic pain. The blog covers the latest pain research, and also share stories of people living and coping with chronic pain.

“Poorly treated pain has profound consequences for older adults,” said TRIPLL director M. Cary Reid, a geriatrician at Weill Cornell Medical Center.  He  estimates that as many as 40 percent of seniors living independently in the U.S. suffer from chronic pain.

“Unfortunately, older adults and their doctors often dismiss chronic pain as part of aging, causing it to be neglected,” he said. “We want to raise this overlooked issue and improve how we treat pain in older adults.”

 If you or someone who love copes with chronic pain, the TRIPLL blog is a must-read to find out what the evidence says about pain management and hear stories from others coping with chronic pain.

“You can’t say, ‘You can’t play.’”

Over dozens of years in the classroom, author and veteran kindergarten teacher Vivian Paley noticed a disturbing trend among her students: Each year, some children developed the power to create the games, make the rules, and decide who was allowed to play and who would be left out.

So Paley decided to make a new rule in her classroom: “You can’t say, ‘You can’t play.”  Paley documented the children’s reaction to the new rule with audio recordings.  (You can hear some of them in an episode of the NPR show This American Life.)

The following year, Paley’s rule was expanded to her entire school. She’s written a book on the experiment. And, since then, educators across the country have adopted the rule and studied its implications.  My own son’s preschool subscribes to the rule, so I thought I’d do a little digging to find out what the research says about it.

While there is no meta-analysis available to date on “You can’t say, ‘You can’t play,” studies have shown the rule improves social acceptance among kindergarteners.  The non-profit research center Child Trends implemented an intervention program among 144 kindergarteners that involved storytelling and group discussion to help children become more aware the different ways they may exclude their peers and learn ways to act in more accepting ways.  Their study found that children in the program felt more accepted by their peers compared to the control group.

Another study investigated teacher’s perceptions about inclusive play for young children. The found programs to implement the rule must involve training and on-going support to help teachers communicate the rule to students and deal with problems that emerge as students struggle with inclusive play.

On the whole, I’m impressed with the data available on “You can’t say, ‘You can’t play.’”  It seems to be a positive way to teach young children about social acceptance and diversity.  This is one area, though, where I’d love to see some more comprehensive research or a literature review to clarify all of the benefits to our children.

Happy Birthday to Cooperative Extension!

As Cornell Cooperative Extension celebrates its 100th year, I thought it would be a good time to explain about bit about the Cooperative Extension system.  At Cornell, many of us collaborate with Cooperative Extension regularly.  But those of you in the real world might be thinking, “What the heck is Cooperative Extension, and why does it matter to me?”

The Cornell Cooperative Extension system was created a century ago to serve a function similar to what this very blog serves today – to help share evidence-based information and practices with the general public. 

In the age before the Internet, this meant disseminating information in workshops, classes and even visits to local homes and businesses. So the Cooperative Extension system opened offices in local communities with employees who would gather information from university professors, and then disseminate that information to people local communities. 

In New York State, the first such office opened in 1911 by a Cornell graduate named John H. Baron. Over the next eight years, 54 more extension offices opened across New York State.

Over the years, Cooperative Extension programs educated New York businesses and families everything from the safest way to defrost a turkey to the best methods for irrigating strawberry fields.

This system developed into a two-way street where community members and businesses pose questions that are funneled to university researchers, who conduct research to find the answers.

Today, Cornell Cooperative Extension is focused on helping families, businesses, government agencies, and other organizations in five key areas:  agriculture and food systems; children, youth and families; community and economic vitality; environment and natural resources; and nutrition and health.  Cooperative Extension professionals provide information on contemporary issues including renewable energy, early childhood education and cooking with local foods

The Cooperative Extension System is truly an invaluable resource for helping people and organizations from all walks of life make decisions based on the best available evidence.

Youth development that works: Positive findings on the 4-H program

On EBL, we’ve talked a lot about research evidence on problems affecting adolescents, from alcohol use, to  video games, to social networking, to sex (I can hear teens who read this starting to hum the tune to “These Are a Few of My Favorite Things”…).

One might ask: Okay, what about the positive side? We’re glad to say that there’s very encouraging news about a program that really works.

One of the most popular and extensive youth programs in the United States is the 4-H program. There are over 6,500,000 members in the U. S. The 4-H program offers activities for kids from 5-19 who are organized in 90,000 4-H clubs. Throughout its history, 4-H has promoted leadership skills, good citizenship, and life skills development. In recent years, it has branched into health promotion programs (like obesity prevention and fostering physical activity) and science, engineering, and technology (“SET”) programming.

All this sounds great, right? But as EBL readers know, we look for the evidence. And now we have it, thanks to the ground-breaking work of Prof. Richard Lerner of Tufts university, one of the country’s leading experts on youth development.  Lerner and colleagues expected that the mentoring from adult leaders and the structured learning that goes on in clubs might lead to number of desireable outcomes for children. This led them to do a longitudinal, controlled evaluation of the impact of being a 4-H member. Beginning in 2002, they have surveyed oaver 6,400 teens across the U. S.

The researchers have issued a major new report, looking at the findings on youth outcomes over nearly a decade. To really dig into the results, you should read the very accessible report. Among the many findings, according to the report summary, is that 4-H participants:

  • Have higher educational achievement and motivation for future education
  • Are more civically active and make more civic contributions to their communities
  • Are less likely to have sexual intercourse by Grade 10
  • Are 56% more likely to spend more hours exercising or being physically active
  • Have had significantly lower drug, alcohol and cigarette use than their peers
  • Report better grades, higher levels of academic competence, and an elevated level of engagement at school,
  • Are nearly two times more likely to plan to go to college
  • Are more likely to pursue future courses or a career in science, engineering, or computer technology

All in all, very impressive findings. So let’s join in the 4-H pledge (can you find the four “H”s?):

I pledge my head to clearer thinking,
my heart to greater loyalty,
my hands to larger service
and my health to better living,
for my club, my community, my country, and my world.

A pretty good approach to living, and one that seems to work for millions of children and teens!

Randomized, controlled designs: The “gold standard” for knowing what works

You’re having trouble sleeping one night, so you finally give up and turn on the TV. It’s 2 AM, so instead of actual programs, much of what you get are informercials. As you flip through these slick “infotainment” shows, you hear enthusiastic claims about the effectiveness of diet pills, exercise equipment, and a multitude of other products

You will soon see that almost every commercial uses case studies and testimony of individuals for whom the product has supposedly worked. “I lost 50 pounds,” exults a woman who looks like a swimsuit model. “I got ripped abs in 30 days,” crows a man who, well, also looks like a swimsuit model.

The problem is that this kind of case study and individual testimony is essentially worthless in deciding if a product or program works. The main problem is that it’s very hard to disprove case study evidence. Look at the informercials – they seem to have worked for some people, but what about all the people who failed? And how do we know that the people who lost weight, for example, wouldn’t have done so without buying the product?

So case studies and testimonials aren’t worth much because they don’t give us the kind of comparative information needed to rule out alternative explanations.

To the rescue comes experiments using randomized, controlled designs (RCD). Such experiments are rightly called the “gold standard” for knowing whether a treatment will work. In a RCDs, we create a test so that one explanation necessarily disconfirms the other explanation. Think of it like a football game. Both teams can’t win, and one eventually beats the other. It’s the same with science: our knowledge can only progress if one explanation can knock out another explanation.

 The main weapon in our search for truth is control group designs.  Using control groups, we test a product or program (called the “treatment”) against a group that doesn’t get whatever the treatment is.

 Case studies simply don’t have the comparative information needed to prove that a particular treatment is better than another one, or better than just doing nothing. And that’s important because of the “placebo effect.” It turns out that people tend report that a treatment has helped them, whether or not there is any actual therapy delivered. In medicine, placebo effects very strong, and in some cases (like drugs for depression) the placebos have occasionally been found to work more effectively than the drugs.

 So what is a randomized, controlled design? There are four components of RCDs:

 1. There is a treatment to be studied like a program, a drug, or a medical procedure)

 2. There is a control condition. Sometimes, this is a group that doesn’t’ get any treatment at all. Often it is a group that gets some other kind of treatment, but of a different kind or smaller amount.

3.  Now here’s the key point:The participants must be randomly assigned to treatment or control groups. It is critical that nobody – not the researchers, not the people in the experiment – can participate in the decision about which group people fall into. Some kind of randomization procedure is used to put people into groups – flipping a coin, using a computer, or some other method. This is the only way we can make sure that the people who get the intervention will be similar to those who do not.

4. There must be carefully defined outcome measures, and they must be measured before and after the treatment occurs.

Lots of the bogus claims you see on TV and elsewhere look only at people who used the product. Without the control group, however, we can’t know if the participants would have gotten better with no treatment at all, or with some other treatment.

Catherine Greeno, in an excellent article on this topic, sums up why we need to do RCDs if we want to understand if something really does or doesn’t work. She puts it this way:

  • We study a treatment compared to a control group because people may get better on their own.
  • We randomly assign to avoid the problem of giving worse off people the new treatment because we think they need it more.
  • We measure before and after the treatment so that we have measured change with certainty, instead of relying on impressions or memories.

 So when you are wondering if a therapy, treatment, exercise program, product, etc. are likely to work, keep those three little words in mind: Randomized, Controlled Design!

Fairs and exhibitions: We love them in Cooperative Extension, but is there evidence?

I have always loved the county fair. So much so – yes, I’m going to admit it – that on the day after my wedding many years ago we took the entire gang to the the Lorain County Fair in Ohio. And Cooperative Extension staff and participants also  enjoy county and state fairs – and devote considerable time throughout the year to planning and preparing for them.

So my interest was piqued by the title of a recent article in the Journal of Extension: “Fairs and other Exhibitions: Have We Really Thought this Through?” Author Donald Nicholson points out that the investment of effort and time by staff makes makes fairs the largest single program in Cooperative Extension. As he puts it: “There is no doubt that “The Fair” is deeply woven into the very DNA of Extension.” But that, he argues, keeps us from evaluating what we get from all the investment.

Nicholson asks: What do we actually know about whether participation in fairs actually promotes youth development?The answer, surprisingly, is that there is almost no scientific evidence of any kind on this topic. He notes that the public, and commodity groups. heavily support the fair, and that it is extremely popular among extension staff and program participants. But he poses a set of thought-provoking questions for state and county extension programs to consider:

  • What is the 5-year or 10-year goal of Extension in regard to our role, goals, and mission with the fairs in your local or state Extension program?
  • What is the research agenda and intention regarding fairs in your state?
  • Are the procedures used and the time invested by Extension truly guided by research-based information?
  • Could the same educational content be more effectively delivered in other ways with a similar or lesser investment of time and resources?

What is lacking is any solid research evidence regarding the benefits of fair activities to youth participants. Nicholson was able to identify only two pilot studies that addressed this issue. Given that  fairs are probably the single biggest investment of extension, he argues for the development of a knowledge base on what youth development outcomes are achieved by fairs.

Very thought-provoking – as are the comments that follow the article. Some commenters agree with a closer examination of the effectiveness of fairs in extension, whereas others argue for the economic and public-relations benefits of the fair, regardless of scientifically-assessed outcomes.

Leave us a comment with your thoughts on this topic!

New York continues PROSPER Partnership to prevent substance abuse

We heard some exciting news at EBL this week!  New York families will soon have more access to evidence-based programs that prevent substance abuse among middle school students and their families.

You might remember that we wrote about PROSPER Partnerships – which stands for PROmoting School-community-university Partnerships to Enhance Resilience – as an ideal model for implementing substance abuse prevention programming based on real evidence. The program links Cooperative Extension, public schools, and local communities to choose proven programs that serve the needs of individual communities.

Last month, New York was chosen as one of five states in that will continue the process of forming a PROSPER Partnership, with Cornell serving as the university partner.

The goal is for New York to become a full PROSPER State Partnership by August of this year.

Kim Kopko, Extension Associate in the Department of Policy Analysis and Management and New York State Liaison for PROSPER, is excited to continue with the program.

“This is indeed a very positive development and an exciting opportunity to utilize the Cornell Cooperative Extension System to bring evidence-based programming to families and communities in New York,” she said.
As you might expect, PROSPER uses plenty of evidence to determine if a state is ready to enter a full partnership. PROSPER staff collected and analyzed data from a state survey, in-depth interviews with Cooperative Extension staff and partnering agencies, and information garnered from various activities in New York.

PROSPER has also 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.

All of that is great news for New York families, who will soon have even greater access to evidence-based programming.

How to convince volunteers to care for trees

The evidence shows that trees are an important part of our landscape – whether here in forested Ithaca, or in densely populated urban areas.

Studies have found that trees help improve focus, promote a sense of community, and deter crime. So it’s no surprise that major cities across the nation are launching initiatives to plant trees. New York City is undertaking one such project.  Called the MillionTreesNYC initiative, it aims to plant one million trees across all five city boroughs by 2017.

But urban forestry projects typically encounter a problem, explained Gretchen Ferenz, a senior extension associate at Cornell Cooperative Extension in New York City.

“Capital project funds will support planting and immediate care of trees for a couple of years, but costs for longer term care to ensure a young tree’s growth often are not included in municipal budgets,” she told the Cornell Chronicle for a story. “As a result, many urban trees do not survive into maturity.”

Ferenz’s office has joined forces with Cornell’s Department of Natural Resources to create the Urban Forestry Community Engagement Model, a program that provides workshops about the importance of trees to community members in two New York City neighborhoods. The goal is to enlist residents and organizations to become stewards of their community’s trees and, ultimately, to develop resources to help groups around the country do the same.

As part of the program, they’re collecting evidence to learn how to get more community members involved in caring for trees in their neighborhoods. They recently published a study that examines motivations and recruitment strategies for urban forestry volunteers.

Through a survey and focus groups, as well as a review of existing literature on the topic, the team found volunteer who plant and care for trees in their communities are motivated by a wide range of factors.  And most have a limited knowledge of the benefits of urban forests.

This type of work is an important first step in helping cities learn how to engage community members to help care for trees in their neighborhoods – and ultimately in making our world a bit greener.

(You can learn more about the Urban Forestry Community Engagement Model by clicking here.)

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