10 research outputs found
Addressing tobacco smoking and drinking to improve TB treatment outcomes, in South Africa : a feasibility study of the ProLife program
Alcohol and tobacco use may lead to negative treatment outcomes in tuberculosis (TB) patients, and even more so if they are HIV-infected. We developed and tested the feasibility of a complex behavioral intervention (ProLife) delivered by lay health workers (LHWs) to improve treatment outcomes in TB patients who smoke tobacco and/or drink alcohol, at nine clinics in South Africa. The intervention comprised three brief motivational interviewing (MI) sessions augmented with a short message service (SMS) program, targeting as appropriate: tobacco smoking, harmful or hazardous drinking and medication adherence. Patients received SMSs twice a week. We measured recruitment and retention rates and assessed fidelity to the MI technique (MI Treatment Integrity 4.1 tool). Finally, we explored LHWs' and patients' experiences through interviews and semi-structured questionnaires, respectively. We screened 137 TB patients and identified 14 smokers, 13 alcohol drinkers, and 18 patients with both behaviors. Participants' mean age was 39.8 years, and 82.2% were men. The fidelity assessments pointed to the LHWs' successful application of key MI skills, but failure to reach MI competency thresholds. Nevertheless, most patients rated the MI sessions as helpful, ascribed positive attributes to their counselors, and reported behavioral changes. SMSs were perceived as reinforcing but difficult language and technical delivery problems were identified as problems. The LHWs' interview responses suggested that they (a) grasped the basic MI spirit but failed to understand specific MI techniques due to insufficient training practice; (b) perceived ProLife as having benefitted the patients (as well as themselves); (c) viewed the SMSs favorably; but (d) considered limited space and privacy at the clinics as key challenges. The ProLife program targeting multiple risk behaviors in TB patients is acceptable but LHW training protocol, and changes in wording and delivery of SMS are necessary to improve the intervention. Trial registration: ISRCTN62728852
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Evaluating the Impact of Transit-Oriented Development
This report examines the impact of transit-oriented development. Transit-oriented development (TOD) is an increasingly popular urban form. Based on a survey of residents of TOD projects in areas served by Dallas Area Rapid Transit, Fort Worth T, and Capital Metro (Austin) rail transit, moving into TOD decreases VMT by an average of 15 percent, or about 3,500 miles per year, which impacts TxDOT motor fuel tax revenues. The data also indicate that these households shift their choice of route to include more arterial roads versus highways. Differential behavior is observed among the three areas studied with the greatest impact being on the DART system and the Capital Metro system showing smaller changes in TOD resident travel behaviors. Residents of TOD choose their housing based mostly on commuting distance and lifestyle characteristics, such as proximity to dining and entertainment venues. Proximity to a transit rail station is at least moderately important for 57 percent of respondents. The report recommends that TxDOT look to incorporate TOD into facility planning and design and seek ways to extract value from TOD projects
Presidential Address: The Cost of Active Investing
I compare the fees, expenses, and trading costs society pays to invest in the U.S. stock market with an estimate of what would be paid if everyone invested passively. Averaging over 1980-2006, I find investors spend 0.67% of the aggregate value of the market each year searching for superior returns. Society's capitalized cost of price discovery is at least 10% of the current market cap. Under reasonable assumptions, the typical investor would increase his average annual return by 67 basis points over the 1980-2006 period if he switched to a passive market portfolio. Copyright (c) 2008 The American Finance Association.