Primary prevention from the epidemiology perspective: three examples from the practice

Background: Primary prevention programmes are of increasing importance to reduce the impact of chronic diseases on the individual, institutional and societal level. However, most initiatives that develop and implement primary prevention programmes are not evaluated with scientific rigor. On the basis of three different projects we discuss necessary steps on the road to evidence-based primary prevention. Discussion: We first discuss how to identify suitable target groups exploiting sophisticated statistical methods. This is illustrated using data from a health survey conducted in a federal state of Germany. A literature review is the more typical approach to identify target groups that is demonstrated using a European project on the prevention of childhood obesity. In the next step, modifiable risk factors and realistic targets of the intervention have to be specified. These determine the outcome measures that in turn are used for effect evaluation. Both, the target groups and the outcome measures, lay the ground for the study design and the definition of comparison groups as can be seen in our European project. This project also illustrates the development and implementation of a prevention programme. These may require active involvement of participants which can be achieved by participatory approaches taking into account the socio-cultural and living environment. Evaluation is of utmost importance for any intervention to assess structure, process and outcome according to rigid scientific criteria. Different approaches used for this are discussed and illustrated by a methodological project developed within a health promotion programme in a deprived area. Eventually the challenge of transferring an evidence-based intervention into practice and to achieve its sustainability is addressed. Summary: This article describes a general roadmap to primary prevention comprising (1) the identification of target groups and settings, (2) the identification of modifiable risk factors and endpoints, (3) the development and implementation of an intervention programme, (4) the evaluation of structure, process and outcome and (5) the transfer of an evidence-based intervention into practice

Measuring the Impact of Youth Voluntary Service Programs

Summary and Conclusions of a meeting of international experts hosted by the World Bank and Innovations in Civic Participation to discuss evaluation of the impact of youth civic engagement on development

Civic Capital as the Missing Link

This chapter reviews the recent debate about the role of social capital in economics. We argue that all the difficulties this concept has encountered in economics are due to a vague and excessively broad definition. For this reason, we restrict social capital to the set of values and beliefs that help cooperation—which for clarity we label civic capital. We argue that this definition differentiates social capital from human capital and satisfies the properties of the standard notion of capital. We then argue that civic capital can explain why differences in economic performance persist over centuries and discuss how the effect of civic capital can be distinguished empirically from other variables that affect economic performance and its persistence, including institutions and geography.

An Analysis of the EPA's Proposed Lead Hazard Standards For Homes

Exposure to lead in homes poses such large risks to children's health that reducing it is a major public health priority. To limit these risks, the Environmental Protection Agency (EPA) recently proposed national standards to identify hazardous levels of lead dust and lead in soil, as well as hazardous conditions for lead-based paint. Meeting those standards would require controls that would cost an average of thousands of dollars per home in 21 million homes where lead-based paint is present, according to the EPA. Although the EPA believes its proposed standards reflect an appropriate balancing of benefits and costs, a proper assessment of its proposal suggests otherwise. Each of the EPA's proposed standards for paint, soil and dust would result in measures to control lead that have costs in excess of benefits. Together those costs, less the associated benefits, are likely to exceed $20 billion. Estimates of net costs would be still greater if based on an analysis that corrects remaining deficiencies in the EPA's work. The EPA's proposal would likely increase unnecessarily the premature abandonment of housing in instances where control costs are large relative to the market value of homes. Such abandonment is especially undesirable because it will occur mostly in low-income neighborhoods of older homes. Standards with lower costs would result in less abandonment. The EPA's media-specific, national standards would have other undesirable consequences. Perversely, about half of all the homes that do not meet the standards have risks of elevated blood-lead less than at other homes in full compliance with the standards. In addition, all homes built before 1978 would be subject to the same national standards, although exposure, risk and the cost of controls vary substantially among different households. As a consequence, the EPA's standards would result in controls in homes of more than one million middle-income families whose children face risks lower than the risks for children of poor families living in homes that meet the standards. Controls to reduce low risks are not likely to be cost-effective and are unfair to families facing lower risks who would bear the brunt of the control costs. The EPA can set standards that would offer greater net benefits and avoid controls in lower-risk homes. To provide greater net benefits, the EPA should set less stringent standards based on a more careful reappraisal of the benefits and costs of controlling residential lead hazards. To avoid control measures in lower-risk homes, the EPA should set standards based on lead levels in all media and establish a range of lead levels where recommendations to control lead depend on risk factors specific to individual homes.

Personality Psychology and Economics

This paper explores the power of personality traits both as predictors and as causes of academic and economic success, health, and criminal activity. Measured personality is interpreted as a construct derived from an economic model of preferences, constraints, and information. Evidence is reviewed about the "situational specificity" of personality traits and preferences. An extreme version of the situationist view claims that there are no stable personality traits or preference parameters that persons carry across different situations. Those who hold this view claim that personality psychology has little relevance for economics. The biological and evolutionary origins of personality traits are explored. Personality measurement systems and relationships among the measures used by psychologists are examined. The predictive power of personality measures is compared with the predictive power of measures of cognition captured by IQ and achievement tests. For many outcomes, personality measures are just as predictive as cognitive measures, even after controlling for family background and cognition. Moreover, standard measures of cognition are heavily influenced by personality traits and incentives. Measured personality traits are positively correlated over the life cycle. However, they are not fixed and can be altered by experience and investment. Intervention studies, along with studies in biology and neuroscience, establish a causal basis for the observed effect of personality traits on economic and social outcomes. Personality traits are more malleable over the life cycle compared to cognition, which becomes highly rank stable around age 10. Interventions that change personality are promising avenues for addressing poverty and disadvantage.personality, behavioral economics, cognitive traits, wages, economic success, human development, person-situation debate

The Impact of Microcredit on the Poor in Bangladesh: Revisiting the Evidence

The most-noted studies on the impact of microcredit on households are based on a survey fielded in Bangladesh in the 1990s. Contradictions among them have produced lasting controversy and confusion. Pitt and Khandker (PK, 1998) apply a quasi-experimental design to 1991–92 data; they conclude that microcredit raises household consumption, especially when lent to women. Khandker (2005) applies panel methods using a 1999 resurvey; he concurs and extrapolates to conclude that microcredit helps the extremely poor even more than the moderately poor. But using simpler estimators than PK, Morduch (1999) finds no impact on the level of consumption in the 1991–92 data, even as he questions PK’s identifying assumptions. He does find evidence that microcredit reduces consumption volatility. Partly because of the sophistication of PK’s Maximum Likelihood estimator, the conflicting results were never directly confronted and reconciled. We end the impasse. A replication exercise shows that all these studies’ evidence for impact is weak. As for PK’s headline results, we obtain opposite signs. But we do not conclude that lending to women does harm. Rather, all three studies appear to fail in expunging endogeneity. We conclude that for non-experimental methods to retain a place in the program evaluator’s portfolio, the quality of the claimed natural experiments must be high and demonstrated.microcredit; impact evaluation; Grameen Bank; Bangladesh; replication; mixed-process models

Neighbourhood effects and endogeneity issues

A recent body of research suggests that the spatial structure of cities might influence the socioeconomic characteristics and outcomes of their residents. In particular, the literature on neighbourhood effects emphasizes the potential influence of the socioeconomic composition of neighbourhoods in shaping individual’s behaviours and outcomes, through social networks, peer influences or socialization effects. However, empirical work still has not reached a consensus regarding the existence and magnitude of such effects. This is mainly because the study of neighbourhood effects raises important methodological concerns that have not often been taken into account. Notably, as individuals with similar socio-economic characteristics tend to sort themselves into certain parts of the city, the estimation of neighbourhood effects raises the issue of location choice endogeneity. Indeed, it is difficult to distinguish between neighbourhood effects and correlated effects, i.e. similarities in behaviours and outcomes arising from individuals having similar characteristics. This problem, if not dequately corrected for, may yield biased results. In the first part of this paper, neighbourhood effects are defined and some methodological problems involved in measuring such effects are identified. Particular attention is paid to the endogeneity issue, giving a formal definition of the problem and reviewing the main methods that have been used in the literature to try to solve it. The second part is devoted to an empirical illustration of the study of neighbourhood effects, in the case of labour-market outcomes of young adults in Brussels. The effect of living in a deprived neighbourhood on the unemployment probability of young adults residing in Brussels is estimated using logistic regressions. The endogeneity of neighbourhood is addressed by restricting the sample to young adults residing with their parents. Then, a ensitivity analysis is used to assess the robustness of the results to the presence of both observed and unobserved parental covariates.neighbourhood effects, endogeneity, self-selection, sensitivity analysis, Brussels

The Effect of Shapedown on Habits and Self-Esteem for Overweight and Obese Children

Obesity in children is increased in the United States and globally which creates both physical and psychological health risks and co-morbidities affecting the development of positive self-esteem (Sinton & Birch, 2005; Whetstone, Morrissey, & Cummings, 2007). The development of poor self-esteem in children increases the risk of problem behaviors such as aggression, crime, teenage pregnancy, drug and alcohol use, tobacco use, and eating disorders (Brook et al., 2007). Treatment of childhood obesity is multifaceted, requiring behavioral and lifestyle changes for both child and family to achieve a healthy weight (De-Santis-Moniaci & Altshuler, 2007; Plourde, 2006; Ritchie, Crawford, Hoelscher, & Sothern, 2006; Spear et al., 2007; Vaughn & Waldrop, 2007; Wofford, 2008). Therapeutic intervention must enlist the support of the family to reshape children\u27s perception of him- or herself (Harter, 1999). One method shown to result in positive improvements in attaining healthy weight and lifestyle with children is family-based behavioral treatment (FBBT). The purpose of this study was to evaluate the effect of SHAPEDOWN, an interventional FBBT program, on self-esteem and lifestyle habits and family lifestyle habits. The theoretical models for this research was Bandura\u27s social cognitive theory (1999), and the conceptual framework was based on Familial Approach to the Treatment of Childhood Obesity; Parent and Child Collaboration (Golan & Weitzman, 2001). A convenience sample of 12 children and 11 parents were recruited from elementary schools and referred by pediatric primary care providers. The data collection measures included a revised self-esteem scale (Harter, 1985), and the Children\u27s Habit and Family Habit inventories. The inventories were administered pre- and post- a SHAPEDOWN intervention for healthy lifestyle and weight management. Descriptive and inferential statistics were used to describe the study sample and variables. Pearson product moment correlation and dependent group\u27 t-test was used to analyze the data. Although there were no statistically significant results, correlation demonstrated trending toward the positive effect of SHAPEDOWN and its relationship with children self-esteem and lifestyles habits for families and children. The study was limited by attrition and sample size. This study highlights the continued need to explore the barriers associated with effective provision of treatment for overweight children

The Effects Of Delay Of Gratification On The Academic Achievement, Substance Abuse, And Violent Behavior Of Middle-school Students In Alternative Learning Settings

This study examined the effects of delay of gratification on academic success, substance abuse, and violent behavior. The participants in this study were chosen from an alternative learning school comprised of middle school students in Florida. The hypothesis for this study is as follows: Delay of gratification is negatively related to substance abuse and violent behavior, and positively related to academic achievement. The analysis of the data was conducted on the primary predictor variable (delay of gratification), alternate predictor variables (substance abuse & violent behavior) and the ultimate outcome variable (academic achievement) of this study. Initial statistical inquiry involved descriptive statistics (mean, standard deviation, kurtosis and skew) of the aforementioned variables, partial correlations (variable interrelationships), and the formulation of a multiple regression path analysis to investigate the particular paths individually within the proposed theoretical model (Wagner, 1993)