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Evidence-based health reform: Sometimes research really does matter!

December 31, 2010 By Leave a Comment

Sometimes, people committed to evidence-based approaches and to the translation of research findings into practice can feel a bit down. Research findings seem to move into real-world settings at a glacial pace, and policy makers and the general public can seem dismissive of the empirical evidence.

So it’s very encouraging to note that the Health Reform bill was explicitly based on scientific findings from health services research. The Academy Health website features a special session from the 2010 AcademyHealth Annual Research Meeting that looked at how health services research helped inform Congressional health reform discussions. Experts report on how such research influenced design decisions about health insurance, payment and delivery systems.

Despite controversy about the health reform bill, you have to hand it to those who crafted it for taking research evidence seriously.

Filed Under: Evidence-Based Living, Health and Wellness, policy

Happy Evidence-Based New Year!

December 31, 2010 By Leave a Comment

Happy New Year from all of us at Evidence-Based Living! Thanks to the nearly 15,000 readers who have visited the site this year and provided positive feedback and advice. In 2010, we’ve covered topical issues, ranging from evidence about sports performance, to parenting, to nutrition, to child development, to aging, and much more. We’ve also looked at the broader issues of how science gets translated into practice and policy, providing information on topics like  systematic reviews of research,  evidence-based programs, and translational research. We’re looking forward to another year of what we hope is a lively and interesting take on how research evidence can be applied in the real world.

We’d like to take this opportunity to thank:

  • The College of Human Ecology at Cornell for supporting the Evidence-Based Living Blog
  • Cornell Cooperative Extension educators for their frequent visits and comments
  • Sheri Hall, our guest blogger, who has kept those interesting posts coming
  • And of course all of our readers, who provide the reason to keep blogging!

Our New Year’s Resolution: More involvement from you! We’d like to increase comments and dialogue about posts, and also get your suggestions for topics you would like covered. So get in touch – and keep looking at the evidence!

Karl and Rhoda

Filed Under: Evidence-Based Living

Does reading aloud to young children make a difference?

December 23, 2010 By 2 Comments

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.

Filed Under: Evidence-Based Living, The Learning Center, Youth Development Tagged With: , , ,

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

December 16, 2010 By 6 Comments

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!

Filed Under: Cornell Cooperative Extension, Evidence-Based Living, The Learning Center Tagged With: , , , ,

Drinking in college? Yep, it hurts your GPA

December 13, 2010 By Leave a Comment

When those in authority try to get college students to drink less, they typically go for scare tactics. They remind students about the dangers of alcohol poisoning, arrest, or accidents. Because binge drinking can be so hazardous, over 100 college presidents have signed on to a movement called the Amethyst Initiative that seeks to reduce bouts of heavy drinking. (And believe it or not, the main policy recommendation of this group is to lower the drinking age!)

So students have heard about the most extreme (and low-frequency) negative effects of alcohol consumption on campus. But what about more frequent outcomes? There’s one concern common to all college students: academic performance. There aren’t many people like the Delta frat brothers in the movie Animal House, who are proud when Dean Wormer tells them: “Here are your grade point averages. Mr. Kroger: two C’s, two D’s and an F. That’s a 1.2. Congratulations, Kroger. You’re at the top of the Delta pledge class.”

But it’s tricky to test the effects of alcohol consumption on academic performance. One big problem is that there may be another variable explaining both poor student performance and drinking (for example, mental health issues) so the connection could be what scientists call “spurious” (seemingly correlated, but there’s something in the background that promotes both behaviors).

I love to report on a truly clever research design, and that’s what we have from economists Scott Carrell of UC-Davis and his colleagues Mark Hoekstra and James West. Their article published by the National Bureau of Economic Research takes advantage of a unique data set, allowing them to test the effects of starting to drink more heavily.

Their data come from the 2000-2006 classes of the United States Air Force Academy (USAFA). Unlike most college campuses, the ban on underage drinking is strictly enforced and can lead to expulsion. Surveys show that drinking before age 21 is much lower at the USAFA than at most college campuses. Another advantage: The USAFA has a highly standardized curriculum where students don’t choose their subjects or professors in core courses and everyone takes the same exams.

So hand it to the researchers for finding an ideal research setting to answer their question (there ought to be a prize for this)!

Now if you’ve followed me this far, using these data, what would be the ideal test of the effects of alcohol? You’ve got it: Each cadet’s 21st birthday. Prior research clearly shows a sudden increase in drinking immediately following turning 21. So they were able to look at students who turned 21 shortly before final exams versus those who turned 21 afterwards.

The results: Drinking definitely affects academic performance. In an interview, Scott Carrell notes that the reduction is approximately half a letter grade. And the effect is strongest for high-performing students. The trend doesn’t just last for the week of the birthday party, but continues for around eight months afterward.

So college binge drinking doesn’t just lead to low-frequency, high-impact outcomes like fatalities. It can also lower GPA and, the authors’ suggest, future life chances as a result.

Filed Under: Evidence-Based Living, Health and Wellness, Youth Development Tagged With: , ,

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

December 2, 2010 By 1 Comment

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.

Filed Under: Evidence-Based Living, In The Media, policy, The Learning Center, Youth Development Tagged With: , , , ,

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

November 29, 2010 By 1 Comment

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.
Filed Under: Evidence-Based Living, Health and Wellness, The Learning Center Tagged With: , , ,

Your flu vaccine will help…a little

November 17, 2010 By 1 Comment

It’s the time of year when everyone is lining up for the annual flu vaccine.  Doctor’s offices and employers are holding special clinics, and even many drug stores are offering a poke in the arm to prevent influenza this winter.  But do these vaccines actually work?

A systematic review of the literature says they do, a little bit.

The Cochrane Collaboration (one of our favorite resources here at EBL) reviewed 50 reports of the benefits of the influenza vaccine, including 40 randomized-controlled trials involving more than 70,000 people.

Before I explain the results, here’s a little background on the flu:  There are more than 200 different viruses that cause influenza with similar symptoms including fever, headache, cough and body aches.  It is difficult for vaccine-manufacturers to know which of these viruses will be active in any given year.  The World Health Organization does its best to predict what type of flu will be prevalent in a given season, and then recommends which viral strains should be included in vaccinations each year.

Under ideal conditions – meaning that the vaccine completely matches the active flu viruses – 33 healthy adults need to be vaccinated to avoid one person coming down with the flu. But the vaccine rarely matches the active flu viruses entirely. In more realistic conditions where the vaccine partially matches the active flu viruses, 100 people need to be vaccinated to avoid one set of influenza symptoms.

None of the studies showed that vaccines reduced the number of people hospitalized for the flu.  Also, studies show the vaccine caused one case of Guillian-Barré syndrome, a neurological condition leading to paralysis, for every one million vaccinations.

The bottom line:  The flu vaccine will reduce your chances of getting sick this winter, but provides no guarantees of completely avoiding the flu.

Filed Under: Evidence-Based Living, Health and Wellness, In The Media Tagged With: , ,

How children remember their worlds…and why

November 10, 2010 By Leave a Comment

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.

Filed Under: Evidence-Based Living, The Learning Center, Youth Development Tagged With: , ,

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

November 5, 2010 By Leave a Comment

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.

Filed Under: Evidence-Based Living, Health and Wellness, policy, The Learning Center Tagged With: , , ,

Youth development and the 4-H program: A gateway to the evidence (and more)

November 1, 2010 By Leave a Comment

When people hear the words “4-H program” they often think of the signature clover, the “head, heart, hands, and health” motto, and kids raising animals to show at the state fair. In fact, the 4-H program is one of the most extensive youth development programs in the world, involving millions of young people in a vast range of activities, including science and technology education, promotion of positive youth development, and community engagement. It also has a rich and interesting history over the past century.

Many studies have been conducted of the 4-H program. However, some of the research has been in unpublished form, including doctoral dissertations and master’s theses, which provide some very good research information but are hard to find. In addition, evaluations have taken place at the state or county level that may not be widely known.

Dr. Jan Scholl, Penn State University, has created two on-line searchable databases of 4-H studies. The first database, “Making the Best Even Better: Searchable Database of Over 800 4-H Research Studies, Agricultural Experiment Station Projects, Journal Articles and Proceedings and Other Papers,” is available at the following link: http://apps.libraries.psu.edu/agnic/state_national_search.cfm

The second database, “Making the Best Better: Searchable Database of 1700 4-H Graduate Studies,” is available at the following link: http://apps.libraries.psu.edu/agnic/thesis_studies_search.cfm

So if you are looking for the research base on the 4-H program, take a look at these sites. They are also looking for more studies to include, so if you’ve done one, submit your own!

Filed Under: Evidence-Based Living

Evidence-Based Elections: If the House changes over, is it the President’s fault?

October 31, 2010 By Leave a Comment

In all of the hubbub about the upcoming elections, Evidence-Based Living had to ask: Is there any research evidence that might help us interpret what’s going on? (And, of course, we always scratch our heads about why there isn’t more discussion of research evidence on something so important.)

One of the few enlightening discussions I’ve seen comes in article by Jonathan Chait. Chait notes the endless debate over “Did Obama Lose the 2010 Elections?” that is roiling in media discussions this week.

Folks on the left say Obama’s responsible because he: 1) didn’t stick more to progressive principles, and 2) didn’t more aggressively tout the Democrats accomplishments. People on the right argue that Obama’s responsible because he 1) is out of step with what the country wants, and 2) has moved too far to the left.

But the blaming in either direction hinges on one question: What if the predicted election results are simply, well, normal? That is, what if the ruling party losing seats in the mid-term election is a predictable, scientific phenomenon, rather than someone’s (Obama’s, the Democrat’s, the media’s, etc.) fault? Of course, if this were the case, major news organizations would have nothing to discuss and pundits would be out of a job. Still, it’s worth considering.

This points us to an analysis by Douglas Hibbs, professor of political economy, in a just-published report from the Center for Public Sector Research. Hibbs, like a good scientist, makes clear that his model isn’t designed to specifically predict the elections, but rather to explain midterm House election outcomes in terms of systematic predetermined and exogenous factors.

Based on prior research, Hibbs tells us there are three fundamental factors that predict midterm elections:

1) the number of House seats won by the party in power in the previous election

2) the margin of votes by which the party in power’s candidates won in the prior presidential election

3) the average growth rate of per capita real disposable personal income during the congressional term (a measure of economic prosperity).

From the available data plugged into this model, Hibbs predicts the Democrats will lose about 45 seats. In other words, based on the model alone, we would expect the Democrats to lose control of the house even if the President made no difference at all. And most predictions show the Democrats losing about this many seats (or 5-10 more, depending on which electoral prediction web sites you look at).

Hibbs provides the necessary caveats about his work not being definitive. But it is certainly strong enough to make us ask: Where’s the science behind a lot of the political debate and punditry? The evidence-based perspective encourages us to be careful in attributing cause and effect where none may exist.

Filed Under: Evidence-Based Living, In The Media, policy Tagged With: ,
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