The Use of Simulation Models for the Surveillance, Justification and Understanding of Tobacco Control Policies

Debates over national tobacco legislation and the use of state settlement funds demonstrate a need for information on the effects of tobacco control policies. Computer simulation models that are based on empirical evidence and that account for the variety of influences on tobacco use can be useful tools for informing policy makers. They can identify the effects of different policies, convey the importance of policy approaches to tobacco control, and help policy planners and researchers to better understand policies. This paper examines the role of simulation models in public policy, and discusses several recent models and limitations of those models.     

Models to Guide System Reform for At-Risk Youth

Policy reform for at-risk youth is complicated by involvement of various service sectors. Issues related to coordinating systems of care in a dynamic policy environment are not new, but surprisingly little has been written to guide practitioners and policymakers in addressing them (Friedman in Journal of Emotional and Behavioral Disorders 11:11–18, 2003). To that end, a social worker, community psychologist, and nurse, working as part of a multidisciplinary team reviewed the practice literature on models to guide policy reform in justice and behavioral health systems. Five models are presented to assist community practitioners assessing similar policy reform.     

Estimating Population Size and Demographic Characteristics of Lesbian,Gay, Bisexual,and Transgender Youth in Middle School

PurposeTo estimate the size and demographic characteristics of the lesbian, gay, bisexual, and transgender youth populations using data from the 2011 Youth Risk Behavior Survey (YRBS) administered in San Francisco Unified School District middle schools.MethodsThe YRBS was administered to a stratified random sample of 2,730 youth (grades 6–8) across all 22 public middle schools in San Francisco. Cross-tabulations using complex samples analyses were used to derive population estimates and confidence intervals.Results and conclusionsResults show that 3.8% of middle school students identify as lesbian, gay, or bisexual, and 1.3% of middle school students identify as transgender. To improve our understanding of the size of these populations across the nation, researchers conclude it is imperative that all YRBS administration sites include items on sexual orientation and gender identity as they would any other demographic item, such as race/ethnicity, sex, or age. The current lack of reliable data on the size and characteristics of the lesbian, gay, bisexual, and transgender youth population limits the capacity of policy makers, administrators, and practitioners to address their needs.     

Quality of research on community partnerships: developing the evidence base

Recent years have witnessed broad public health transformations. Central to these changes is that partnership work is increasingly mandated and employed as a vehicle for health education and promotion and disease prevention. Such efforts involve partnerships that span National Health Service bodies, local authorities and health and social care organizations, with stakeholders from the public, private, voluntary and community sectors. However, a more adequate evidence base is required to guide policy and action. The aims of this paper are to draw attention to some of the issues that have hampered the quality of partnership research and to discuss ways in which this research can be improved, in an effort to encourage the development of a more valuable evidence base for researchers, practitioners and policy makers. Multimethod approaches to research on partnership context, functioning and outcomes are advocated, and policy recommendations are made.     

The research, policy and practice interface: reflections on using applied social research to promote equity in health in Malawi

The case for research to promote equity in health in resource poor contexts such as Malawi is compelling. In Malawi, nearly half of all the people with tuberculosis cannot afford to access free tuberculosis services. In this scenario, there is a clear need to understand the multiple barriers poor women and men face in accessing services and pilot interventions to address these in a way that engages policy makers, practitioners and communities. This paper provides a critical reflection on our experience as applied social researchers working at the REACH (Research for Equity and Community Health) Trust in Malawi. Our work largely uses qualitative research methodologies as a tool for applied social research to explore the equity dimensions of health services in the country. We argue that a key strength of qualitative research methods and analysis is the ability to bring the perceptions and experiences of marginalised groups to policy makers and practitioners. The focus of this paper is two-fold. The first focus lies in synthesising the opportunities and challenges we have encountered in promoting the use of applied social research, and in particular qualitative research methods, on TB and HIV in Malawi. The second focus is on documenting and reflecting on our experiences of using applied social research to promote gender equity in TB/HIV policy and practice in Malawi. In this paper, we reflect on the strategic frameworks we have used in the Malawian context to try and bring the voices of poor women and men to policy makers and practitioners and hence intensify the research to policy and practice interface.     

Models,measures, and methods: variability in aging research

The purpose of this paper is to review the models and measurement strategies used in studies evaluating the predictors of nursing home placement, hospitalization, functional impairment and mortality. To do so we examine 167 multivariate equations abstracted from 78 longitudinal studies published between 1985 and 1998 that assess the risk factors of one or more adverse outcomes. We find that both comparatively straightforward concepts such as age and income and widely used scales such as activities of daily living and the short-portable mental status questionnaire display considerable variability in operationalization and coding. We also find that few researchers employ explicit conceptual models to assist with variable choice, while some predictors-demographics, physical and cognitive functioning-were studied much more frequently than others-service, market, and policy characteristics. Variability in measurement highlights the lack of standardization in this area of aging research and leaves room for improvements in validity and reliability. Limited use of conceptual models has led researchers to include some predictors in their analyses to the exclusion of others.     

Parent Refugee Status, Immigration Stressors, and Southeast Asian Youth Violence

Purpose: To assess the effects of parents’ experience of traumatic events on violence among Southeast Asian and Chinese youth. The study examines independent effects of parents’ refugee camp experiences and immigration stress on serious or family/partner violence among youth. Findings contribute evidence on the intergenerational effects of community-level trauma that can help policy makers better integrate family and community strategies to reduce youth violence. Methods: Obtained cross-sectional, face-to-face interview data including peer delinquency, parental engagement, parental discipline, serious violence, and family/partner violence from a sample of 329 Chinese and Southeast Asian adolescents. Measures of socioeconomic status, refugee status, and immigration stressors were collected from their respective parents. Data were analyzed using LISREL 8.54 for structural equation modeling. Results: Findings show that parents’ refugee status facilitated serious violence, and was fully mediated by peer delinquency and parental engagement, but for Vietnamese only. Parents’ refugee status was also significantly related to family/partner violence, and mediated by peer delinquency. This relationship was not observed among the other Asian ethnic groups. The immigration stress variable had no significant effects on either serious violence or family/partner violence. Conclusions: Refugee communities may not transform easily into stereotypical immigrant Asian communities characterized by little youth violence. Results suggest that the refugee process, as experienced second-hand through the children of refugees, has a strong effect on externally oriented violence (serious violence) and on family/partner violence for particular subgroups. Therefore, community-oriented policy makers should join social workers in developing programs to address youth violence in Southeast Asian families and communities. Findings have implications for other forms of community trauma such as natural disasters.     

Looking back to move forward: Reflections and lessons learned about transitions to adulthood for youth with disabilities

Background

Transition to adulthood is a significant development process experienced by all youth. Since the mid 1990s, researchers at the CanChild Centre for Childhood Disability Research have been studying this process to assist transitioning youth with disabilities and their families. The objective of this narrative review is to reflect on the work conducted by CanChild researchers, in collaboration with stakeholders, about transitions to adulthood for youth and young adults with disabilities since the publication of the best practice guidelines in 2009.

Methods

A narrative review was undertaken through a reflective approach to critically review and summarize all the transition studies completed at CanChild since 2009. The following data were systematically extracted from articles and research reports: study (authors and year of publication), purpose, methods, sample, and lessons learned.

Results

Five studies were identified. An analysis of the findings revealed five key themes that represented lessons learned since the publication of the Ontario‐based best practice guidelines: promoting a noncategorical and lifecourse approach to care; active collaboration among stakeholders involved in transition; capacity building through peer mentorship; greater understanding of the significance of opportunities and experiences; as well as the significance of information, education, and research.

Conclusions

This is the first review to provide perspective on trends in transition research since the publication of the best practice guidelines in 2009. It is hoped that this reflection will assist in the ongoing work of researchers, service providers, policy makers, communities, and families in the area of adult transitions for youth with disabilities.     

Achieving 'best practice' in health promotion: improving the fit between research and practice

This paper is based on the proposition that transfer of knowledge between researchers and practitioners concerning effective health promotion interventions is less than optimal. It considers how evidence concerning effectiveness in health promotion is established through research, and how such evidence is applied by practitioners and policy makers in deciding what to do and what to fund when addressing public health problems. From this examination it is concluded that there are too few rewards for researchers which encourage research with potential for widespread application and systematic development of promising interventions to a stage of field dissemination. Alternatively, practitioners often find themselves in the position of tackling a public health problem where evidence of efficacy is either lacking, or has to be considered alongside a desire to respond to expressed community needs, or the need to respond to political imperative. Several different approaches to improving the fit between research and practice are proposed, and they include improved education and training for practitioners, outcomes focussed program planning, and a more structured approach to rewarding research development and dissemination.     

Protective factors, resiliency and healthy youth development

The last decade has been characterized by an increasing focus on the question: "What works to promote and protect the health and well-being of adolescents?" This question is raised in multiple arenas, from pregnancy prevention to substance use and violence prevention, as well as for broad populations of young people. An accumulating body of evidence underscores the effectiveness of a dual strategy of enhancing protective factors and promoting healthy youth development while seeking to reduce risk factors in the lives of youth. Building upon research frameworks of the 1970s and 1980s that emphasized the concepts of resiliency, risk, vulnerability, and protective factors, this research provides insights into best practices when the weight of evidence is sufficiently developed, as well as ideas about "best bets" when strategies show particular promise. Critical to the ongoing advancement of adolescent health is a powerful, evidence-based response to the argument that "nothing can be done" for high-risk youth. This perspective must be superseded by practitioners, researchers, and advocates who demonstrate, at multiple points of intervention, that the dual approach of risk reduction and enhancement of protective factors constitutes an effective strategy for adolescent health promotion.     

Health systems and the implementation of disease programmes: Case studies from South Africa

Abstract

This paper analyses the transfer and implementation of two internationally formulated infectious disease strategies in South Africa, namely, directly observed therapy (DOTS) for TB and syndromic management (SM) for sexually transmitted infections (STIs). Using the tools of policy analysis, this paper seeks to draw conclusions from contrasting experiences with the two strategies. DOTS and SM differ with respect to styles of engagement by World Health Organization (WHO), the international agency promoting the ideas, in the following ways: continuity and networking between policy makers, practitioners and researchers nationally; and approaches to sub-national implementation. We show how these factors may have been important to national uptake, and conclude on the need for a context sensitive approach to policy transfer and a balance between bottom-up and top-down implementation strategies. These insights may have relevance for the current global wave of treatment programmes for HIV and other infectious diseases.     

Developmental Issues in School-Based Aggression Prevention from a Social-Cognitive Perspective

Contemporary research on the development and prevention of aggressive behavior in childhood and adolescence emphasizes the importance of social-cognitive factors such as perceptual biases, problem-solving skills, and social-moral beliefs in the maintenance of aggression. Indeed, school-based social-cognitive intervention approaches have been identified as best practices by the Centers for Disease Control and Prevention. However, because child age is an important covariate of both intervention effectiveness and social-cognitive ability, school-based prevention program designers should keep in mind a number of issues identified through developmental research. In this paper, we review the social-cognitive model of aggressive behavior development as applied to prevention programming. We then discuss some of the ways in which the broader developmental research base can inform the design of aggression prevention programs. Editors' Strategic Implications: Educational administrators and policy makers will find evidence in this review that school-based programs that employ a social-cognitive model represent a strategy that works for preventing violence. Prevention researchers will also benefit from the authors' insights regarding theoretical mediating processes and the importance of a developmental view.     

Online Mentoring: The Promise and Challenges of an Emerging Approach to Youth Development

This paper reports on an electronic mentoring program, the Digital Heroes Campaign (DHC), in which 242 youth were matched with online mentors over a two-year period. Survey, focus group, and interview data, in addition to analyses of the e-mails that pairs exchanged, were examined in order to assess the nature, types, and quality of the relationships that were formed. Despite youths’ generally positive self-reports, deep connections between mentors and mentees appeared to be relatively rare. The findings suggest that online mentoring programs face significant challenges and that further research is needed to determine under what conditions online mentoring is likely to be most effective. Editors' Strategic Implications: Given the infrequent occurrence of close connections, youth mentoring practitioners and researchers must consider whether online mentoring is likely to promote the kind of “relationships” that might be expected to promote positive youth development.     

National policy development for cotrimoxazole prophylaxis in Malawi,Uganda and Zambia: the relationship between Context,Evidence and Links

Background

Several frameworks have been constructed to analyse the factors which influence and shape the uptake of evidence into policy processes in resource poor settings, yet empirical analyses of health policy making in these settings are relatively rare. National policy making for cotrimoxazole (trimethoprim-sulfamethoxazole) preventive therapy in developing countries offers a pertinent case for the application of a policy analysis lens. The provision of cotrimoxazole as a prophylaxis is an inexpensive and highly efficacious preventative intervention in HIV infected individuals, reducing both morbidity and mortality among adults and children with HIV/AIDS, yet evidence suggests that it has not been quickly or evenly scaled-up in resource poor settings.

Methods

Comparative analysis was conducted in Malawi, Uganda and Zambia, using the case study approach. We applied the ‘RAPID’ framework developed by the Overseas Development Institute (ODI), and conducted a total of 47 in-depth interviews across the three countries to examine the influence of context (including the influence of donor agencies), evidence (both local and international), and the links between researcher, policy makers and those seeking to influence the policy process.

Results

Each area of analysis was found to have an influence on the creation of national policy on cotrimoxazole preventive therapy (CPT) in all three countries. In relation to context, the following were found to be influential: government structures and their focus, donor interest and involvement, healthcare infrastructure and other uses of cotrimoxazole and related drugs in the country. In terms of the nature of the evidence, we found that how policy makers perceived the strength of evidence behind international recommendations was crucial (if evidence was considered weak then the recommendations were rejected). Further, local operational research results seem to have been taken up more quickly, while randomised controlled trials (the gold standard of clinical research) was not necessarily translated into policy so swiftly. Finally the links between different research and policy actors were of critical importance, with overlaps between researcher and policy maker networks crucial to facilitate knowledge transfer. Within these networks, in each country the policy development process relied on a powerful policy entrepreneur who helped get cotrimoxazole preventive therapy onto the policy agenda.

Conclusions

This analysis underscores the importance of considering national level variables in the explanation of the uptake of evidence into national policy settings, and recognising how local policy makers interpret international evidence. Local priorities, the ways in which evidence was interpreted, and the nature of the links between policy makers and researchers could either drive or stall the policy process. Developing the understanding of these processes enables the explanation of the use (or non-use) of evidence in policy making, and potentially may help to shape future strategies to bridge the research-policy gaps and ultimately improve the uptake of evidence in decision making.

     

Key Issues in the Practice of Youth Development

Three significant trends in youth development practice are discussed: movement toward consensus in models guiding practice, movement toward science‐based practice, and increasing resources available to practitioners. Consensus on an ecological framework for risk reduction and competence building among advocates for prevention, resilience, and developmental paradigms improves selection of appropriate strategies for all youth audiences, as does research‐based evidence on effective programs. Practitioners enjoy an increasing number of print and Internet resources for information, curriculum, program evaluation and improvement, and professional training. Continued improvements in programming and research can significantly enhance existing programs and related areas, but cuts in funding for program sustainability and expansion to all cultural groups represent a major threat to youth development.     

Development and use of a tool for assessing sidewalk maintenance as an environmental support of physical activity

The importance of regular physical activity is well documented, yet according to epidemiological surveillance data, physical inactivity among all age groups persists. Past attempts to promote physical activity focused on individual-level changes; current approaches focus on environmental changes that will provide opportunities for whole communities to be active. The current ecological focus has led to an increase in funding and research regarding environmental supports of physical activity. As this is a new area of research, much work needs to be done to improve the ability to assess environmental features that support physical activity. This article describes a partnership between researchers and community members to develop and test an objective tool to measure sidewalk maintenance. Community members used data collected with the tool to increase awareness about sidewalk maintenance issues among local policy makers. Collaboration between researchers and community partners was critical for the success of this study.     

Remarriage Preparation: Usage,Perceived Helpfulness,and Dyadic Adjustment

This study provides a contemporary evaluation of 10 different forms of remarriage preparation. Utilizing a subsample of 303 remarried couples from a larger study of newlyweds, we report usage of remarriage preparation and perceived helpfulness as well as differences in dyadic adjustment between respondents who did or did not prepare. Those who participated in some form of preparation generally found it helpful. The majority of those who did not prepare felt it was unnecessary. Differences in dyadic adjustment varied by the form of preparation. Implications for scholars, practitioners, and policy makers include the need for more research‐based materials that counter popular stepfamily myths as well as resources that can be made available to the public through mediums that are trusted and commonly accessed.     

Models of health: pervasive, persuasive and politically charged

In the current mood of reform that has enveloped much, if notall, of the health sector in Canada, there is considerable interestin refocusing the emphasis from health care onto disease preventionand health promotion, in order to address the determinants ofhealth and illness. Such a reform, in the absence of an explicitconceptual model of health, has the potential to focus onlyon parts of the problem, with little overall benefit. However,models of health are themselves problematic, as without a supportingtext which explicitly details the policy implications intended,they have the potential to be misunderstood and misused, particularlyas a vehicle for justifying cost-cutting. A model of health is proposed that attempts to provoke usersinto a critical analysis of the full spectrum, at both the individualand the community level, of the determinants of health. Itstheoretical orientation, potential flaws and intended uses inpublic-policy and health-promotion contexts are explored. Toplace this model in the context of other frameworks which arecurrently topical in Ontario, two other models of health arefirst considered and their political and theoretical orientationdiscussed. As a result of this analysis, some key componentsfor inclusion in the text accompanying schematic models of health,which attempt to ‘safe guard’ the models againstmisuse, are identified.     

Economic analysis of nutrition interventions for chronic disease prevention: methods, research, and policy

Increased interest in the potential societal benefit of incorporating health economics as a part of clinical translational science, particularly nutrition interventions, led the Office of Dietary Supplements at the National Institutes of Health to sponsor a conference to address key questions about the economic analysis of nutrition interventions to enhance communication among health economic methodologists, researchers, reimbursement policy makers, and regulators. Issues discussed included the state of the science, such as what health economic methods are currently used to judge the burden of illness, interventions, or healthcare policies, and what new research methodologies are available or needed to address knowledge and methodological gaps or barriers. Research applications included existing evidence-based health economic research activities in nutrition that are ongoing or planned at federal agencies. International and US regulatory, policy, and clinical practice perspectives included a discussion of how research results can help regulators and policy makers within government make nutrition policy decisions, and how economics affects clinical guideline development.