Showing papers by "RAND Corporation published in 2009"
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30 Sep 2009TL;DR: This chapter discusses Qualitative Data Analysis’s application to Codebooks and Coding, as well as its applications to Ethnographic Decision Models.
Abstract: Preface Acknowledgments PART I. THE BASICS Chapter 1. Introduction to Text: Qualitative Data Analysis Chapter 2. Collecting Data Chapter 3. Finding Themes Chapter 4. Codebooks and Coding Chapter 5. Introduction to Data Analysis Chapter 6. Conceptual Models PART II. THE SPECIFICS Chapter 7. First Steps in Analysis: Comparing Attributes of Variables Chapter 8. Cultural Domain Analysis: Free Lists, Judged Similarities, and Taxonomies Chapter 9. KWIC Analysis, Word Counts, and Semantic Network Analysis Chapter 10. Discourse Analysis: Conversation and Performance Chapter 11. Narrative Analysis Chapter 12. Grounded Theory Chapter 13. Content Analysis Chapter 14. Schema Analysis Chapter 15. Analytic Induction and Qualitative Comparative Analysis Chapter 16. Ethnographic Decision Models Chapter 17. Sampling Appendix: Resources for Analyzing Qualitative Data References Author Index Subject Index About the Authors
2,066 citations
TL;DR: In this article, a review of theoretical and operational approaches to financial literacy, as well as a conceptual model and composite definition of financial literacy is presented, along with a discussion of the issues involved in financial literacy.
Abstract: Provides a review of theoretical and operational approaches to financial literacy, as well as a conceptual model and composite definition of financial literacy.
483 citations
TL;DR: Strong initial evidence for reliability, construct validity, and responsiveness of the PEG among primary care and other ambulatory clinic patients is provided and it may be a practical and useful tool to improve assessment and monitoring of chronic pain in primary care.
Abstract: BACKGROUND
Inadequate pain assessment is a barrier to appropriate pain management, but single-item “pain screening” provides limited information about chronic pain. Multidimensional pain measures such as the Brief Pain Inventory (BPI) are widely used in pain specialty and research settings, but are impractical for primary care. A brief and straightforward multidimensional pain measure could potentially improve initial assessment and follow-up of chronic pain in primary care.
461 citations
TL;DR: In this article, the authors studied the year-to-year variability in value-added measures for elementary and middle school mathematics teachers from five large Florida school districts and found that the remaining variance is due to teacher-level time-varying factors, but little of it is explained by observed teacher characteristics.
Abstract: The utility of value-added estimates of teachers' effects on student test scores depends on whether they can distinguish between high- and low-productivity teachers and predict future teacher performance. This article studies the year-to-year variability in value-added measures for elementary and middle school mathematics teachers from five large Florida school districts. We find year-to-year correlations in value-added measures in the range of 0.2–0.5 for elementary school and 0.3–0.7 for middle school teachers. Much of the variation in measured teacher performance (roughly 30–60 percent) is due to sampling error from “noise” in student test scores. Persistent teacher effects account for about 50 percent of the variation not due to noise for elementary teachers and about 70 percent for middle school teachers. The remaining variance is due to teacher-level time-varying factors, but little of it is explained by observed teacher characteristics. Averaging estimates from two years greatly improves t...
366 citations
TL;DR: The authors provided a critical review and new analysis of subjective expectations data from developing countries and found that people in developing countries can generally understand and answer probabilistic questions, such questions are not prohibitive in time to ask, and the expectations are useful predictors of future behavior and economic decisions.
365 citations
TL;DR: Mothers' resources, especially their relationships with biological fathers, account for most of the associations between transitions and parenting stress, with posttransition resources being more important than pretransition resources.
Abstract: Data from the Fragile Families and Child Wellbeing Study (N = 4,176) are used to examine family structure transitions and maternal parenting stress. Using multilevel modeling, we found that mothers who exit coresidential relationships with biological fathers or enter coresidential relationships with nonbiological fathers reported higher levels of parenting stress than mothers in stable coresidential relationships. Mothers who enter coresidential relationships with biological fathers reported lower levels of parenting stress than mothers who remain single. Mothers' resources, especially their relationships with biological fathers, accounted for most of the associations between transitions and parenting stress, with posttransition resources being more important than pretransition resources. Mothers with high levels of education were less affected by transitions than mothers with less education.
334 citations
TL;DR: Immigrants and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born and the foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination.
Abstract: Inadequate access and poor quality care for immigrants could have serious consequences for their health and that of the overall U.S. population. The authors conducted a systematic search for post-1996, population-based studies of immigrants and health care. Of the 1,559 articles identified, 67 met study criteria of which 77% examined access, 27% quality, and 6% cost. Noncitizens and their children were less likely to have health insurance and a regular source of care and had lower use than the U.S. born. The foreign born or non-English speakers were less satisfied and reported lower ratings and more discrimination. Immigrants incurred lower costs than the U.S. born, except emergency department expenditures for immigrant children. Policy solutions are needed to improve health care for immigrants and their children. Research is needed to elucidate immigrants' nonfinancial barriers, receipt of specific processes of care, cost of care, and health care experiences in nontraditional U.S. destinations.
326 citations
TL;DR: In this article, the authors measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends, and estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group.
Abstract: Health insurance characteristics shift at age 65 as most people become eligible for Medicare. We measure the impacts of these changes on patients who are admitted to hospitals through emergency departments for conditions with similar admission rates on weekdays and weekends. The age profiles of admissions and comorbidities for these patients are smooth at age 65, suggesting that the severity of illness is similar on either side of the Medicare threshold. In contrast, the number of procedures performed in hospitals and total list charges exhibit small but statistically significant discontinuities, implying that patients over 65 receive more services. We estimate a nearly 1-percentage-point drop in 7-day mortality for patients at age 65, equivalent to a 20% reduction in deaths for this severely ill patient group. The mortality gap persists for at least 9 months after admission.
317 citations
TL;DR: The findings suggest that neighborhood social factors as well as the physical environment should be considered in the development of health policy and interventions to reduce childhood obesity.
Abstract: Data on 650 children and their primary caregivers was collected during phase 1 of Healthy Passages, a multisite, community-based, cross-sectional study of health risk behaviors and health outcomes in children. Independent systematic neighborhood observations were conducted to measure neighborhood physical characteristics, and we analyzed survey data on social processes. Children's physical activity and obesity status were modelled with structural equation models that included latent variables for the physical and social environments. After controlling for children's sociodemographic factors, it was found that a favorable social environment was positively associated with several measures of physical activity and that physical activity was negatively associated with obesity in these children. Physical environment was not significantly associated with physical activity. The findings suggest that neighborhood social factors as well as the physical environment should be considered in the development of health policy and interventions to reduce childhood obesity.
315 citations
TL;DR: Valid comparisons of hospital performance require that reported hospital scores be adjusted for survey mode and patient mix, which are consistent across hospitals and are generally larger than total patient-mix effects.
Abstract: Objective
To evaluate the need for survey mode adjustments to hospital care evaluations by discharged inpatients and develop the appropriate adjustments.
313 citations
TL;DR: Youths who experienced each type of bullying separately or in combination were more likely to report use of each substance in spring 2005, and this finding held after controlling for gender, grade level, ethnicity and substance use in fall 2004.
TL;DR: This investigation suggests that the OASIS is a valid instrument for measurement of anxiety severity and impairment in clinical samples and its brevity and applicability to a wide range of anxiety disorders enhance its utility as a screening and assessment tool.
TL;DR: This article examined whether teacher licensure test scores and other teacher attributes affect elementary student achievement and found that teachers' test scores are unrelated to teacher success in the classroom, while student achievement is unaffected by whether classroom teachers have advanced degrees.
TL;DR: Comparison of subjective probabilities with actual outcomes shows that the probabilities have considerable predictive power in situations where individuals have considerable private information such as survival and retirement and the subjective probability of a stock market gain varies greatly across individuals.
Abstract: Subjective probabilities are now collected on a number of large household surveys with the objective of providing data to better understand intertemporal decision making. Comparison of subjective probabilities with actual outcomes shows that the probabilities have considerable predictive power in situations where individuals have considerable private information, such as survival and retirement. In contrast, the subjective probability of a stock market gain varies greatly across individuals even though no one has private information and the outcome is the same for everyone. An explanation is that there is considerable variation in accessing and processing information. Further, the subjective probability of a stock market gain is considerably lower than historical averages, providing an explanation for the relatively low frequency of stock holding. An important research objective will be to understand how individuals form their subjective probabilities.
TL;DR: This work considers models of the spread of disease or opinion through social networks, represented as graphs, called an irreversible k-threshold process, where a vertex enters state 1 if at least k of its neighbors are in state 1, andwhere a vertex never leaves state 1 once it is in it.
TL;DR: The cost and quality of care and the delivery of preventive services for patients who received care for 3 conditions commonly treated in retail clinics were compared with that received in physician offices, urgent care centers, and emergency departments.
Abstract: Mehrotra and colleagues found that for otitis media, pharyngitis, and urinary tract infection, overall costs of care were substantially lower at retail clinics than at physician offices, urgent car...
TL;DR: Improvements in teen depression might have benefits that extend beyond clinical symptoms, improving peer, family, and school functioning over time.
Abstract: This study aimed to determine the impact of teen depression on peer, family, school, and physical functioning and the burden on parents.
TL;DR: Efficiency measures have been subjected to few rigorous evaluations of reliability and validity, and methods of accounting for quality of care in efficiency measurement are not well developed at this time.
Abstract: Objective
To review and characterize existing health care efficiency measures in order to facilitate a common understanding about the adequacy of these methods.
TL;DR: The authors argues that society can make effective adaptation decisions in the absence of accurate and precise climate predictions, and suggests limits to predictability, and argues that societies can adapt successfully to changing climate.
Abstract: Many scientists have called for a substantial new investment in climate modeling to increase the accuracy, precision, and reliability of climate predictions. Such investments are often justified by asserting that failure to improve predictions will prevent society from adapting successfully to changing climate. This Forum questions these claims, suggests limits to predictability, and argues that society can (and indeed must) make effective adaptation decisions in the absence of accurate and precise climate predictions.
TL;DR: Measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.
Abstract: Dietary patterns may be influenced by the availability and accessibility within stores of different types of foods. However, little is known about the amount of shelf space used for healthy and unhealthy foods in different types of stores. We conducted measurements of the length of shelf space used for fruits, vegetables, and snack foods items in 419 stores in 217 urban census tracts in southern Louisiana and in Los Angeles County. Although supermarkets offered far more shelf space of fruits and vegetables than did other types of stores, they also devoted more shelf space to unhealthy snacks (mean 205 m for all of these items combined) than to fruits and vegetables (mean 117 m, p < 0.001). After supermarkets, drug stores devoted the most shelf space to unhealthy items. The ratio of the total shelf space for fruits and vegetables to the total shelf space for these unhealthy snack items was the lowest (0.10 or below) and very similar in convenience stores, drug stores, and liquor stores, was in a middle range (0.18 to 0.30) in small food stores, and was highest in medium-sized food stores (0.40 to 0.61) and supermarkets (0.55 to 0.72). Simple measurements of shelf space can be used by researchers to characterize the healthfulness of the food environment and by policymakers to establish criteria for favorable policy treatment of stores.
TL;DR: In this article, the adverse impact of a 12-week delay between resection of muscle-invasive bladder cancer and radical cystectomy using nationally representative data was examined. But the authors focused on the survival impact of such a delay.
Abstract: BACKGROUND:
Single-institution series have documented the adverse impact of a 12-week delay between resection of muscle-invasive bladder cancer and radical cystectomy. These data are derived from tertiary centers, in which referral populations may confound outcomes. The authors sought to examine the survival impact of a delay in radical cystectomy using nationally representative data.
METHODS:
From the linked Surveillance, Epidemiology, and End Results–Medicare dataset, the authors identified subjects with stage II transitional cell carcinoma (TCC) of the bladder who underwent radical cystectomy between 1992 and 2001. They examined delays of 8, 12, and 24 weeks and incorporated these delay cutoffs into multivariate Cox proportional hazards survival models. Covariates included age, race/ethnicity, marital status, Charlson comorbidity index, and cancer grade.
RESULTS:
The authors identified 441 subjects with stage II TCC who underwent cystectomy during the study period. Compared with immediate surgery (ie, within 4-8 weeks of transurethral resection), longer time to cystectomy increased the risk of both disease-specific and overall mortality (hazard ratio [HR], 2.0; P < .01 and HR, 1.6; P < .01, respectively, for those delayed 12-24 weeks; HR, 2.0; P < .01 for disease-specific and overall death among those delayed beyond 24 weeks 1 year after diagnosis). Covariates associated with overall mortality included older age (HR, 1.04; P < .01) and comorbidity (HR, 2.0 for Charlson ≥3 vs Charlson 0-1; P < .01).
CONCLUSIONS:
Delay in definitive surgical treatment beyond 12 weeks conferred an increased risk of disease-specific and all-cause mortality among subjects with stage II bladder cancer. Cancer 2009. © 2009 American Cancer Society.
TL;DR: Whether adjusting using weights or matching on a small set of variables makes the distributions of target variables representative of the population is investigated, which casts doubt on the common procedure to use only a few variables to correct for the selectivity of convenience samples.
Abstract: Web surveys are a popular survey mode, but the subpopulation with Internet access may not represent the population of interest. The authors investigate whether adjusting using weights or matching on a small set of variables makes the distributions of target variables representative of the population. This application has a rich sampling design; the Internet sample is part of an existing probability sample, the Health and Retirement Study, that is representative of the U.S. population aged 50 and older. For the dichotomous variables investigated, the adjustment helps. On average, the sample means in the Internet access sample differ by 6.5 percent before and 3.7 percent after adjustment. Still, a large number of adjusted estimates remain significantly different from their target estimates based on the complete sample. This casts doubt on the common procedure to use only a few variables to correct for the selectivity of convenience samples.
TL;DR: The Total GIT Score, developed by averaging 6 of 7 scales (excluding constipation), was reliable and provided greater discrimination between mild, moderate, and severe self-rated GIT involvement than individual scales.
Abstract: Objective. To refine the previously developed scleroderma (systemic sclerosis [SSc]) gastrointestinal tract (GIT) instrument (SSC-GIT 1.0). Methods. We administered the SSC-GIT 1.0 and the Short Form 36 to 152 patients with SSc; 1 item was added to the SSC-GIT 1.0 to assess rectal incontinence. In addition, subjects completed a rating of the severity of their GIT involvement (from very mild to very severe). Evaluation of psychometric properties included internal consistency reliability, test– retest reliability (mean time interval 1.1 weeks), and multitrait scaling analysis. Results. Study participants were mostly women (84%) and white (81%); 55% had diffuse SSc. Self-rated severity of GIT involvement ranged from no symptoms to very mild (39%), mild (21%), moderate (31%), and severe/very severe (9%). Of an initial 53 items in the SSC-GIT 1.0, 19 items were excluded, leaving a 34-item revised instrument (the University of California, Los Angeles Scleroderma Clinical Trial Consortium GIT 2.0 [UCLA SCTC GIT 2.0]). Analyses supported 7 multi-item scales: reflux, distention/bloating, diarrhea, fecal soilage, constipation, emotional well-being, and social functioning. Test–retest reliability estimates were >0.68 and coefficient alphas were >0.67. Participants who rated their GIT disease as mild had lower scores on a 0 –3 scale on all 7 scales. Symptom scales were also able to discriminate subjects with corresponding clinical GIT diagnoses. The Total GIT Score, developed by averaging 6 of 7 scales (excluding constipation), was reliable and provided greater discrimination between mild, moderate, and severe self-rated GIT involvement than individual scales. Conclusion. This study provides support for the reliability and validity of the UCLA SCTC GIT 2.0, an improvement over the SSC-GIT 1.0, and supports a Total GIT Score in SSc patients with GIT.
TL;DR: It is indicated that living in low NSES neighborhoods is most strongly associated with greater cumulative biological risk profiles in the black U.S. population.
TL;DR: Multivariable models permit a more accurate estimation of health literacy than single predictors and can be applied to readily available administrative or census data to produce estimates of average health literacy and identify communities that would benefit most from appropriate, targeted interventions in the clinical setting.
Abstract: INTRODUCTION
Low health literacy (LHL) remains a formidable barrier to improving health care quality and outcomes. Given the lack of precision of single demographic characteristics to predict health literacy, and the administrative burden and inability of existing health literacy measures to estimate health literacy at a population level, LHL is largely unaddressed in public health and clinical practice. To help overcome these limitations, we developed two models to estimate health literacy.
TL;DR: The local fast food environment has a stronger association with BMI for local residents who do not have access to cars, and higher restaurant density is associated with higher BMI among local residents.
Abstract: Eating away from home and particularly fast food consumption have been shown to contribute to weight gain. Increased geographic access to fast food outlets and other restaurants may contribute to higher levels of obesity, especially in individuals who rely largely on the local environment for their food purchases. We examined whether fast food and restaurant concentrations are associated with body mass index and whether car ownership might moderate this association. We linked the 2000 US Census data and information on locations of fast food and other restaurants with the Los Angeles Family and Neighborhood Study database, which consists of 2,156 adults sampled from 63 neighborhoods in Los Angeles County. Multilevel modeling was used to estimate associations between body mass index (BMI), fast food and restaurant concentration, and car ownership after adjustment for individual-level factors and socioeconomic characteristics of residential neighborhoods. A high concentration of local restaurants is associated with BMI. Car owners have higher BMIs than non-car owners; however, individuals who do not own cars and reside in areas with a high concentration of fast food outlets have higher BMIs than non-car owners who live in areas with no fast food outlets, approximately 12 lb more (p = 0.02) for an individual with a height of 5 ft. 5 in. Higher restaurant density is associated with higher BMI among local residents. The local fast food environment has a stronger association with BMI for local residents who do not have access to cars.
TL;DR: A systematic review of community-level characteristics such as social capital found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access.
Abstract: There is a growing interest in community-level characteristics such as social capital and its relationship to health care access. To assess the rigor with which this construct has been empirically applied in research on health care access, a systematic review was conducted. A total of 2,396 abstracts were reviewed, and 21 met the criteria of examining some measure of social capital and its effects on health care access. The review found a lack of congruence in how social capital was measured and interpreted and a general inconsistency in findings, which made it difficult to draw firm conclusions about the effects of social capital on health care access. Insights from the social network literature can help improve the conceptual and measurement problems. Future work should distinguish among bonding, bridging, and linking social capital and their sources and benefits, and examine whether three dimensions of social capital actually exist: cognitive, behavioral, and structural.
TL;DR: In mid-1995, a government effort to reduce the supply of methamphetamine precursors successfully disrupted the methamphetamine market and interrupted a trajectory of increasing usage, and methamphetamine use among arrestees declined 55 percent.
Abstract: In mid-1995, a government effort to reduce the supply of methamphetamine precursors successfully disrupted the methamphetamine market and interrupted a trajectory of increasing usage. The price of methamphetamine tripled and purity declined from 90 percent to 20 percent. Simultaneously, amphetaminerelated hospital and treatment admissions dropped 50 percent and 35 percent, respectively. Methamphetamine use among arrestees declined 55 percent. Although felony methamphetamine arrests fell 50 percent, there is no evidence of substantial reductions in property or violent crime. The impact was largely temporary. The price returned to its original level within four months; purity, hospital admissions, treatment admissions, and arrests approached preintervention levels within eighteen months. (JEL I12, K42).
01 Jan 2009
TL;DR: This PDF document was made available from www.rand.org as a public service of the RAND Corporation and is provided for non-commercial use only.
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TL;DR: Computer‐assisted CBT programs provide a practice‐based system for disseminating evidence‐based mental health treatment in primary‐care settings while maintaining treatment fidelity, even in the hands of novice clinicians.
Abstract: Objectives: This article describes a computer-assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced-based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary-care settings. The purpose of the current report is to (1) present the structure and format of the computer-assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. Methods: Thirteen clinicians using the computer-assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert-scale ratings and open-ended responses about the program. Rating scale data from 261 patients who completed at least one CBTsession were also collected Results: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N 574), in terms of self ratings of anxiety, depression, and expectations for improvement. Conclusions: Computer-assisted CBT programs provide a