Is severity of obesity associated with diagnosis or health education practices?

Is severity of obesity associated with diagnosis or health education practices?
Int J Obes (Lond). 2012 Jan 24. doi: 10.1038/ijo.2012.1. 

Leventer-Roberts M, Patel A and Leonardo Trasande.

To assess the association of the severity of obesity with diagnosis and health education, and to identify any differences within demographic or other subgroups.
Clinician visits for 2-18 year olds from the 2005-2008 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined. Descriptive, bivariate and multivariate analyses were used to compare diagnosis of obesity and health education (nutrition, exercise and weight reduction) across elevated body mass index (BMI) groups (overweight, obese and extreme or very obese, defined as >120% of the 95th percentile for age and gender), patient socio-demographic characteristics, physician specialty and type of visit (well child visits (WCV) versus non-well child visits (non-WCV).
A total of 17 808 visits had a calculated BMI, of which 5.8% were extremely obese, 13% were obese and 15.2% were overweight, with the highest percentages among older children, blacks and Hispanics. Diagnosis and weight reduction education were higher among children with an extreme BMI. Nutrition and exercise education were not correlated with severity of obesity. Race, ethnicity or gender biases were not identified. Severity of obesity was significantly associated with presentation to a non-WCV rather than a WCV.
Extremely obese children have higher, but still insufficient, rates of diagnosis and health education. Nutrition and exercise education are not prevalent throughout all age groups. Providers may be relying inconsistently and insufficiently on visual cues to drive their obesity prevention practices. Furthermore, lower rates of diagnosis and education at non-WCV may result in a missed opportunity to prevent comorbidities. This is of particular concern as overweight children are less likely to be seen at WCV than non-WCV.International Journal of Obesity advance online publication, 24 January 2012; doi:10.1038/ijo.2012.1.


The Long-Term Effects of Military Conscription on Mortality: Estimates From the Vietnam-Era Draft Lottery

The Long-Term Effects of Military Conscription on Mortality: Estimates From the Vietnam-Era Draft Lottery

Conley, Dalton and Jennifer Heerwig.

Research on the effects of Vietnam military service suggests that Vietnam veterans experienced significantly higher mortality than the civilian population at large. These results, however, may be biased by nonrandom selection into the military if unobserved background differences between veterans and nonveterans affect mortality directly. To generate unbiased estimates of exposure to conscription on mortality, the present study compares the observed proportion of draft-eligible male decedents born 1950–1952 to the (1) expected proportion of draft-eligible male decedents given Vietnam draft-eligibility cutoffs; and (2) observed proportion of draft-eligible decedent women. The results demonstrate no effect of draft exposure on mortality, including for cause-specific death rates. When we examine population subgroups—including splits by race, educational attainment, nativity, and marital status—we find weak evidence for an interaction between education and draft eligibility. This interaction works in the opposite direction of putative education-enhancing, mortality-reducing effects of conscription that have, in the past, led to concern about a potential exclusion restriction violation in instrumental variable (IV) regression models. We suggest that previous research, which has shown that Vietnam-era veterans experienced significantly higher mortality than nonveterans, might be biased by nonrandom selection into the military and should be further investigated.

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison

Converging Evidence for Neighborhood Effects on Children’s Test Scores: An Experimental, Quasi-Experimental, and Observational Comparison
Whither Opportunity? Rising Inequality, Schools, and Children’s Life Chances, G. Duncan and R. Murnane, eds. New York: Russell Sage.

Burdick-Will, J., J. Ludwig, S. Raudenbush, R. Sampson, L. Sanbonmatsu, and P. Sharkey

Rising income inequality has been found to be associated with rising segregation at the neighborhood level, generating concern about whether neighborhood environments themselves may influence children’s life chances, independent of other individual child and family characteristics. Because poor and minority Americans are overrepresented in our most disadvantaged neighborhoods, any “neighborhood effects” on children may contribute to persistent disparities in overall schooling outcomes across race and class lines in the United States.

A large body of nonexperimental research dating back to the Coleman Report in 1966 has produced evidence consistent with the idea of large neighborhood effects on children’s schooling outcomes. However, drawing causal inferences from these studies is complicated by the fact that the attributes of a neighborhood in which a family lives is likely correlated with characteristics of the family that predict schooling outcomes. These studies are therefore vulnerable to selection bias. The one formal randomized experiment in this literature is the five-city Moving to Opportunity (MTO) experiment, data from which suggests no statistically significant impacts, on average, on reading or math test scores for children in MTO measured four to seven years after baseline. How one should weight the findings from the MTO experiment versus the larger body of nonexperimental research remains the topic of ongoing debate within the research and policy communities.

In this chapter, we try to reconcile the experimental, quasi-experimental, and observational research literature regarding neighborhood effects on children, and we argue that the available findings are more convergent than many people believe. Drawing on a number of recent and unusually high-quality quasi-experimental and observational studies, together with a reexamination of MTO findings across the individual MTO demonstration sites, we believe that the available - 3 - evidence allows us to reject the null hypothesis that neighborhood environments never matter for children’s outcomes. Yet at the same time, the data also do not support the hypothesis that neighborhoods always matter.

In our view, the key question for research and public policy is to learn more about the conditions under which neighborhoods matter for children’s academic outcomes and why. Our ability to answer this question in the present chapter is restricted by the limited number of studies that have employed sufficiently strong research designs to support inferences about neighborhood effects on children’s outcomes, and by the fact that a disproportionate share of the studies that meet this research-design threshold have been carried out in a single city (Chicago).

With these important qualifications in mind, we believe that there is at least a suggestive case to be made that children’s test scores may be most strongly affected by community violence or may respond nonlinearly to concentrated neighborhood disadvantage or community violence. Put differently, what may matter most for children’s cognitive development is to avoid living in the most severely economically distressed or dangerous neighborhoods in the country, neighborhoods that are found in cities like Baltimore and Chicago but, surprisingly, are less prevalent even in other major urban areas such as Boston, Los Angeles, and New York. Given the limitations of the available evidence, we offer these as hypotheses to be tested further rather than as strong conclusions.

Geographic Variations in Health Care Workforce Training in the US: The Case of Registered Nurses (RNs)

Geographic Variations in Health Care Workforce Training in the US: The Case of Registered Nurses (RNs)
Med Care. 2011 Aug;49(8):769-74.

Blustein, Jan.

Background: In the United States, registered nurses [RNs] are trained through one of three educational pathways: a diploma course; an associate's degree, or a baccalaureate degree in nursing (the BSN). A national consensus has emerged that the proportion of RNs that are baccalaureate-trained should be substantially increased. Yet achieving that goal may be difficult in areas where college graduates are unlikely to reside.

Objectives: To determine whether the level of training of the hospital registered nurse [RN] workforce varies geographically, along with the education of the local general workforce.

Research design: Cross sectional, ecological study.

Subjects: Hospital nurses who participated in the National Sample Survey of Registered Nurses [NSSRN] in 2004 (n = 16,567).

Measures. Registered Nurse training was measured as Diploma, Associates degree, or Baccalaureate degree or above. County-level general workforce quality was assessed as the adult college graduation rate. Counties were divided into US population quartiles, with the highest quartile (Q4) having more than 29.3% college graduates, and the lowest quartile (Q1) having fewer than 16.93% college graduates.

Results: Hospital RNs have a higher level of training in counties where the general population is better
educated. For example, in Q4, 55.2% of hospital RNs are baccalaureate-trained, in Q3, 50.2%; in Q2,45.2%; and in Q1, 34.9% (p < .001 for all pairwise comparisons). The association between RN training and general workforce education is found in cities, towns and rural areas.

Conclusions: Nationwide, there are substantial geographic variations in the training of hospital RNs. Educational segregation (the tendency for educated people to cluster geographically) may make it more difficult to achieve a BSN-rich nursing workforce in some areas of the US. Further work is needed to assess whether educational segregation similarly influences the distribution of other health care professionals, and whether it leads to variations in the local quality of care.

Does Losing Your Home Mean Losing Your School? Effects of Foreclosure on the School Mobility of Children

Does Losing Your Home Mean Losing Your School? Effects of Foreclosure on the School Mobility of Children
Regional Science and Urban Economics, 41(4), 2011: 407-414.

Bean, Vicky, Ingrid Ellen, Amy Ellen Schwartz, Leanna Stiefel and Meryle Weinstein

In the last few years, millions of homes around the country have entered foreclosure, pushing many families out of their homes and potentially forcing their children to move to new schools. Unfortunately, despite considerable attention to the causes and consequences of mortgage defaults, we understand little about the distribution and severity of these impacts on school children. This paper takes a step toward filling that gap through studying how foreclosures in New York City affect the mobility of public school children across schools. A significant body of research suggests that, in general, switching schools is costly for students, though the magnitude of the effect depends critically on the nature of the move and the quality of the origin and destination schools.

Does Municipally Subsidized Housing Improve School Quality? Evidence from New York City

Does Municipally Subsidized Housing Improve School Quality? Evidence from New York City
Journal of the American Planning Association, 77 (2): 127-141.

Chellman, Colin, Ingrid Ellen, Brian McCabe, Amy Ellen Schwartz and Leanna Stiefel

Problem: Policymakers and community development practitioners view increasing subsidized owner-occupied housing as a mechanism to improve urban neighborhoods, but little research studies the impact of such investments on community amenities.

Purpose: We examine the impact of subsidized owner-occupied housing on the quality of local schools and compare them to the impacts of city investments in rental units.

Methods: Using data from the New York City Department of Education (DOE) and the New York City Department of Housing Preservation and Development (HPD), we estimate three main sets of regressions, exploring student characteristics, school resources, and school outcomes.

Results and conclusions: The completion of subsidized owner-occupied housing is associated with a decrease in schools’ percentage of free-lunch eligible students, an increase in schools’ percentage of White students, and, controlling for these compositional changes, an increase in scores on standardized reading and math exams. By contrast, our results suggest that investments in rental housing have little, if any, effect.

Takeaway for practice: Policies promoting the construction of subsidized owner-occupied housing have solidified in local governments around the country. Our research provides reassurance to policymakers and planners who are concerned about the spillover effects of subsidized, citywide investments beyond the households being directly served. It suggests that benefits from investments in owner occupancy may extend beyond the individual level, with an increase in subsidized owner-occupancy bringing about improvements in neighborhood school quality.

School Cost Accounting: What Do We Know and How Do We Get There?

School Cost Accounting: What Do We Know and How Do We Get There?
Public Performance & Management Review, 35 (1): 29-53.

Denison, Dwight, William Hartman, Leanna Stiefel and Michele Deegan

This paper describes a model for assessing and reporting schoollevel resources. State and local decision-makers have been seeking ways to obtain such information for more than a decade, but there is as yet no easy, accessible way to do so and no way to satisfy both internal and external users of the information. The model, based on case studies in Pennsylvania (with successful replication in New York), resolves many of the issues. The seven principles that guide the model are explained, challenges in developing school-level reports are generalized, and resolutions to the challenges in three states are compared. The conclusion draws out implications for the future of regularly collected school resource data.


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