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Purpose

This study investigates the degree to which the racial composition of the school environment may influence the body mass index (BMI) of children aged 10 to 18 years. This research may be viewed as extending prior work that has found that the prevalence of risk behaviors among nonwhite adolescents is influenced by exposure to white adolescents.

Methods

This research used data from the Survey of Adults and Youth, which was conducted as part of the evaluation of the Robert Wood Johnson Foundation's Urban Health Initiative. The study population for this analysis is comprised of parent and child respondents in the 2004 to 2005 survey wave who lived in one of the five program cities: Baltimore, Detroit, Oakland, Philadelphia, and Richmond. We constructed two-level school random effects models and added school and census tract-level variables that describe the racial composition of the residential community and the school attended.

Results

Black and Hispanic adolescent girls who attend schools with a mostly nonwhite student body have higher BMIs than do their white counterparts. However, black girls in predominately white schools do not have higher BMIs than white girls. Further, black and Hispanic girls whose schoolmates are predominately white have significantly lower BMIs than black and Hispanic girls in schools where fewer than half the students are white. These associations are not found among boys, and are net of a broad variety of individual, household, and group level characteristics.

Conclusions

Our findings suggest that the BMI of minority adolescent girls is influenced by the norms of the social environment.

This article uses the evaluation of the Robert Wood Johnson Foundation’s (RWJF) Urban Health Initiative (UHI), a 10-year effort to improve health and safety outcomes in distressed cities, to demonstrate the strength of an evaluation design that integrates theory of change and quasiexperimental
approaches, including the use of comparison cities. This paper focuses on the later stages of implementation and, especially, our methods for estimating program impacts. While the theory of change was used to make preliminary identification of intended outcomes, we used the sites’ plans and early implementation to refine this list and revisit our strategy for estimating impacts. Using our integrated design, differences between program and comparison cities are considered impacts only if they were predicted by program theory, local plans for action, and early implementation. We find small, measurable changes in areas of greatest programmatic effort. We discuss the importance of the integrated design in identifying impacts.

Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.

Objective. To identify strategies that facilitate readiness for local Institutional Review Board (IRB) review, in multicenter studies.

Study Setting. Eleven acute care hospitals, as they applied to participate in a foundation-sponsored quality improvement collaborative.

Study Design. Case series.

Data Collection/Extraction. Participant observation, supplemented with review of written and oral communications.

Principal Findings. Applicant hospitals responded positively to efforts to engage them in early planning for the IRB review process. Strategies that were particularly effective were the provisions of application templates, a modular approach to study description, and reliance on conference calls to collectively engage prospective investigators, local IRB members, and the evaluation/national program office teams. Together, these strategies allowed early identification of problems, clarification of intent, and relatively timely completion of the local IRB review process, once hospitals were selected to participate in the learning collaborative.

Conclusions. Engaging potential collaborators in planning for IRB review may help expedite and facilitate review, without compromising the fairness of the grant-making process or the integrity of human subjects protection.

Objective: To use publicly available secondary data to assess the impact of Brazil's Family Health Program on state level infant mortality rates (IMR) during the 1990s.

Design: Longitudinal ecological analysis using panel data from secondary sources. Analyses controlled for state level measures of access to clean water and sanitation, average income, women's literacy and fertility, physicians and nurses per 10 000 population, and hospital beds per 1000 population. Additional analyses controlled for immunisation coverage and tested interactions between Family Health Program and proportionate mortality from diarrhoea and acute respiratory infections.

Setting: 13 years (1990-2002) of data from 27 Brazilian states.

Main results: From 1990 to 2002 IMR declined from 49.7 to 28.9 per 1000 live births. During the same period average Family Health Program coverage increased from 0% to 36%. A 10% increase in Family Health Program coverage was associated with a 4.5% decrease in IMR, controlling for all other health determinants (p<0.01). Access to clean water and hospital beds per 1000 were negatively associated with IMR, while female illiteracy, fertility rates, and mean income were positively associated with IMR. Examination of interactions between Family Health Program coverage and diarrhoea deaths suggests the programme may reduce IMR at least partly through reductions in diarrhoea deaths. Interactions with deaths from acute respiratory infections were ambiguous.

Conclusions: The Family Health Program is associated with reduced IMR, suggesting it is an important, although not unique, contributor to declining infant mortality in Brazil. Existing secondary datasets provide an important tool for evaluation of the effectiveness of health services in Brazil.

Federal social program evaluation has blossomed over the past quarter century. Despite this growth, there has been little accompanying public debate on research ethics. This essay explores the origins and the implications of this relative silence on ethical matters. It reviews the federal regulations that generally govern research ethics, and recounts the history whereby the evaluation of federal programs was specifically exempted from the purview of those regulations. Through a discussion of a recent evaluation that raised ethical concerns, the essay poses - but does not answer - three questions: (1) Are there good reasons to hold federal social program evaluations to different standards than those that apply to other research?; (2) If so, what ethical standards should be used to access such evaluations?; and (3) Should a formal mechanism be developed to ensure that federal social program evaluations are conducted ethically?

This article describes the nature and utility of fiscal analysis in evaluating complex community interventions. Using New York University's evaluation of the Robert Wood Johnson Foundation's Urban Health Initiative as an example, the authors describe issues arising in defining and operationalizing constructs for fiscal analysis. The approach's utility is demonstrated in the use of interim findings to help redefine the program's goals for resource allocation, to modify its theory of change to include greater emphasis on state-level action, and to emphasize the importance of local public schools as resource centers and intervention targets. The fiscal analysis also provides new insights into the limitations of "preventive" versus "corrective" spending categories and helps make goals for such functional reallocation more realistic. The authors discuss limitations of fiscal analysis due to available data quality, the extent of cooperation needed from public officials to collect relevant data, and the level of expertise needed to interpret the data.

I argue for thinking of program evaluation as a decision problem. There are two steps. First, a counselor determines which program (treatment or control) each individualjoins,based for example on maximizing the probability of employment or expected earnings.

Second, the policymaker decides whether: to assign all individuals to treatment or to control, or to allow the counselor to choose.This framework has two advantages. Individualized assignment rules (known as profiling) can raise the average impact, improving cost effectiveness by exploiting treatment-impact heterogeneity. Second, it accounts systematically for inequality and uncertainty, and the policymaker's attitude toward these, in the evaluation.

To assess the cost-effectiveness of Intervention for HIV-Seropositive injection drug users-Research and Evaluation (INSPIRE), designed to reduce risky sexual and needle-sharing behaviors in research sites in four US cities (2001-2003). Methods: We collected data on program and participant costs. We used a mathematical model to estimate the number of sex partners of injection drug users expected to become infected with human immunodeficiency virus (HIV) (with and without intervention), cost of treatment for sex partners who became infected, and the effect of infection on partners' quality-adjusted life expectancy. We determined the minimum effect that INSPIRE must have on condom use among participants for the intervention to be cost-saving (intervention cost less than savings from averted HIV infections) or cost-effective (net cost per quality-adjusted life year saved less than $50,000). Results: The intervention cost was $870 per participant. It would be cost-saving if it led to 53 percent reduction in the proportion of participants who had any unprotected sex in 1 year and cost-effective with 17 percent reduction. If behavior change lasted 3 months, the cost-effectiveness threshold was 66 percent; if 3 years, the threshold was 6 percent. Conclusions: Although cost-saving thresholds may not be achievable by the intervention, we anticipate that cost-effectiveness thresholds will be attained.

This paper examines public spending on children between 1997 and 2000 in five localities: Baltimore, Detroit, Oakland, Philadelphia, and Richmond. These cities participate in the Urban Health Initiative (UHI), a ten-year Robert Wood Johnson Foundation program aimed at improving health and safety for young people in these cities. The Center for Health and Public Service Research at New York University is evaluating the program. The evaluation seeks to determine whether collaborative efforts of interested organizations can develop and implement plans to change service delivery systems for children, and whether such changes result in better outcomes for children. A group of ten additional cities serves as a comparative benchmark.

The Resolving Conflict Creatively Program (RCCP) is one of the oldest and largest school-based conflict resolution programs in the United States. Beginning in 1994, we planned and implemented a rigorous scientific evaluation of the RCCP, involving over 350 teachers and 11,000 children from 15 public elementary schools in New York City. In this chapter, we describe the RCCP, explain the rationale for and design of the study, summarize the major results related to the program's impact on children's trajectories of social and emotional learning (SEL) and academic achievement, and discuss the implications of these findings for research, practice, and policy.

Awareness of youth violence has increased in recent years, resulting in more interest in programs that can prevent violent and aggressive behavior. Although overall rates of violence among young people have declined since the mid-1990s, rates of some forms of youth aggression, violence, and crime remain high. National data reveal that, each year, about 15 percent of high school students are involved in a physical fight at school and 8 percent are threatened or injured with a weapon. 1 Urban youth are at particular risk for exposure to violence and victimization.

This report describes one of the largest and longest running school-based violence prevention programs in the country-the Resolving Conflict Creatively Program (RCCP)-and discusses the results of a rigorous evaluation conducted by the National Center for Children in Poverty (NCCP) at Columbia University's Mailman School of Public Health. The evaluation provides concrete evidence that early, school-based prevention initiatives such as the RCCP can work and should be included in communities' efforts to prevent violence among children and youth.

This paper discusses the problem of evaluating and predicting the treatment impact of a program that is implemented at multiple sites. Two issues arise: is information from other sites relevant in estimating the impact at a given site? and how can we account for predictive uncertainty in the site effects? Using data from the Greater Avenues for Independence evaluation, I develop a hierarchical model for earnings which allows both for site effects and for smoothing the estimated impact across sites.

I show that the degree to which the estimated impact is smoothed across sites does not affect the estimate; i.e. most of the differences across sites are due to differences in the composition of participants. Second I show that predictive uncertainty regarding site effects is important; for example, when the predictive uncertainty regarding site effects is ignored, the treatment impact at the Riverside sites is significant, but when we consider predictive uncertainty, the impact for the Riverside sites is insignificant.

Third, I show that the hierarchical model is able to extrapolate site effects with reasonable accuracy when the site for which the prediction is being made does not differ substantially from the sites already observed. For example, the San Diego treatment effects could have been predicted based on observable site characteristics, but the Riverside effects are consistently underestimated.

As the centerpiece of policymakers' efforts to "deconcentrate" poverty in urban America, the Moving to Opportunity (MTO) project gave roughly 4,600 volunteer families the chance to move out of public housing projects in deeply impoverished neighborhoods in five cities-Baltimore, Boston, Chicago, Los Angeles, and New York. Researchers wanted to find out to what extent moving out of a poor neighborhood into a better-off area would improve the lives of public housing families. Choosing a Better Life? is the first distillation of years of research on the MTO project, the largest rigorously designed social experiment to investigate the consequences of moving low-income public housing residents to low-poverty neighborhoods. In this book, leading social scientists and policy experts examine the legislative and political foundations of the project, analyze the effects of MTO on lives of the families involved, and explore lessons learned from this important piece of U.S. social policy.