Applying Tests of Equivalence for Multiple Group Comparisons: Demonstration of the Confidence Interval Approach

Assessing the comparability of different groups is an issue facing many researchers and evaluators in a variety of settings. Commonly, null hypothesis significance testing (NHST) is incorrectly used to demonstrate comparability when a non-significant result is found. This is problematic because a failure to find a difference between groups is not equivalent to showing that the groups are comparable. This paper provides a comparison of the confidence interval approach to equivalency testing and the more traditional analysis of variance (ANOVA) method using both continuous and rating scale data from three geographically separate medical education teaching sites. Equivalency testing is recommended as a better alternative to demonstrating comparability through its examination of whether mean differences between two groups are small enough that these differences can be considered practically unimportant and thus, the groups can be treated as equivalent. Accessed 12,813 times on https://pareonline.net from April 25, 2011 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

Impact of Sample Size and Variability on the Power and Type I Error Rates of Equivalence Tests: A Simulation Study

The question of equivalence between two or more groups is frequently of interest to many applied researchers. Equivalence testing is a statistical method designed to provide evidence that groups are comparable by demonstrating that the mean differences found between groups are small enough that they are considered practically unimportant. Few recommendations exist regarding the appropriate use of these tests under varying data conditions. A simulation study was conducted to examine the power and Type I error rates of the confidence interval approach to equivalence testing under conditions of equal and non-equal sample sizes and variability when comparing two and three groups. It was found that equivalence testing performs best when sample sizes are equal. The overall power of the test is strongly influenced by the size of the sample, the amount of variability in the sample, and the size of the difference in the population. Guidelines are provided regarding the use of equivalence test Accessed 20,707 times on https://pareonline.net from August 16, 2014 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

School Smoking Policy Characteristics and Individual Perceptions of the School Tobacco Context: Are They Linked to Students’ Smoking Status?

The purpose of this study was to explore individual- and school-level policy characteristics on student smoking behavior using an ecological perspective. Participants were 24,213 (51% female) Grade 10–11 students from 81 schools in five Canadian provinces. Data were collected using student self-report surveys, written policies collected from schools, interviews with school administrators, and school property observations to assess multiple dimensions of the school tobacco policy. The multi-level modeling results revealed that the school a student attended was associated with his/her smoking behavior. Individual-level variables that were associated with student smoking included lower school connectedness, a greater number of family and friends who smoked, higher perceptions of student smoking prevalence, lower perceptions of student smoking frequency, and stronger perceptions of the school tobacco context. School-level variables associated with student smoking included weaker policy intention indicating prohibition and assistance to overcome tobacco addiction, weaker policy implementation involving strategies for enforcement, and a higher number of students smoking on school property. These findings suggest that the school environment is important to tobacco control strategies, and that various policy dimensions have unique relationships to student smoking. School tobacco policies should be part of a comprehensive approach to adolescent tobacco use

The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention

Background: The home food environment may be an important target for addressing adolescent obesity. The aim of this study was to investigate associations between aspects of the home food environment and the diets of adolescents who present for obesity treatment. Methods: Cross-sectional baseline data were collected from 167 overweight/obese adolescent-parent pairs participating in an e-health lifestyle modification intervention. Adolescent intake of specific foods (fruit and vegetables, total fat, sugar-sweetened beverages, desserts/treats, and snacking occasions) was assessed by three 24-h dietary recalls, while household factors were collected from adolescent and parent questionnaires. Structural Equation Modeling, controlling for relevant covariates, was used to examine the relationship between adolescent diet and the following household factors: parent modeling, parenting style, family meal practices, and home food/beverage availability. Results: Findings reveal that few characteristics of the home food environment were associated with adolescent dietary intake. Greater home availability of high-fat foods was moderately associated with adolescent snack intake (β = 0.27, p < .001). Associations with fruit/vegetables and fat intake were small and some were in unexpected directions. Parent modeling of healthful food choices and healthier family meal practices were associated with lower availability of high-fat foods and treats in the home, but were not directly associated with adolescent diets. Conclusions: Parent modeling of healthy foods and positive mealtime routines might contribute to the healthfulness of foods offered in the homes of adolescents who are overweight/obese. Additional research is needed to better characterize the complex aspects of the household environment that influence adolescent diet.Land and Food Systems, Faculty ofMedicine, Faculty ofOther UBCNon UBCPopulation and Public Health (SPPH), School ofReviewedFacult

Tobacco dependence: adolescents' perspectives on the need to smoke

To address the need for a better understanding of the perspective of Canadian youths on tobacco dependence, a qualitative study using ethnographic techniques was conducted to describe the patterns of language that they use to describe tobacco dependence and the meaning that it has for them. The study was comprised of three inter-related phases: (1) A secondary analysis of 47 individual unstructured interviews with adolescents was completed to identify the words and phrases they use to explain tobacco dependence; (2) contrast and structural questions focusing on tobacco dependence were developed and used in open-ended interviews with 13 adolescents. Data analysis of the transcribed interviews resulted in a set of 60 key phrases that represented the primary ways youths describe the need to smoke; and (3) interviews were conducted with 14 adolescents that involved an open card sort using the set of 60 key phrases. All card sorts and transcribed interview data were analyzed to identify domains representing types of tobacco dependence and sub-types within each domain. From their descriptions about the need to smoke, five aspects of tobacco dependence were identified: social, pleasurable, empowering, emotional, and full-fledged. This study provides a step in elucidating the construct of tobacco dependence among the young. Further research is required to extend this understanding and to develop appropriate measures.Tobacco Adolescence Addiction Nicotine dependence Canada

Investigating the influence of institutions, politics, organizations, and governance on the COVID-19 response in British Columbia, Canada: a jurisdictional case study protocol

Background Research on public health responses to COVID-19 globally has largely focused on understanding the virus’ epidemiology, identifying interventions to curb transmission, and assessing the impact of interventions on outcomes. Only recently have studies begun to situate their findings within the institutional, political, or organizational contexts of jurisdictions. Within British Columbia (BC), Canada, the COVID-19 response in early 2020 was deemed highly coordinated and effective overall; however, little is understood as to how these upstream factors influenced policy decisions. Methods Using a conceptual framework we developed, we are conducting a multidisciplinary jurisdictional case study to explore the influence of institutional (I), political (P), organizational (O), and governance (G) factors on BC’s COVID-19 public health response in 2020–2021. A document review (e.g. policy documents, media reports) is being used to (1) characterize relevant institutional and political factors in BC, (2) identify key policy decisions in BC’s epidemic progression, (3) create an organizational map of BC’s public health system structure, and (4) identify key informants for interviews. Quantitative data (e.g. COVID-19 case, hospitalization, death counts) from publicly accessible sources will be used to construct BC’s epidemic curve. Key informant interviews (n = 15–20) will explore governance processes in the COVID-19 response and triangulate data from prior procedures. Qualitative data will be analysed using a hybrid deductive–inductive coding approach and framework analysis. By integrating all of the data streams, our aim is to explore decision-making processes, identify how IPOG factors influenced policy decisions, and underscore implications for decision-making in public health crises in the BC context and elsewhere. Knowledge users within the jurisdiction will be consulted to construct recommendations for future planning and preparedness. Discussion As the COVID-19 pandemic evolves, governments have initiated retrospective examinations of their policies to identify lessons learned. Our conceptual framework articulates how interrelations between IPOG contextual factors might be applied to such analysis. Through this jurisdictional case study, we aim to contribute findings to strengthen governmental responses and improve preparedness for future health crises. This protocol can be adapted to and applied in other jurisdictions, across subnational jurisdictions, and internationally.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofReviewedFacult