Building a More Effective, Equitable, and Compassionate Educational System: The Role of Direct Instruction.

In a recent book, Anthony Biglan describes how strong social research can be used to build a compassionate and more caring society that promotes the well-being of all. This article asserts that a strong educational system needs to be part of this transformation and that widespread use of Direct Instruction (DI) could be key in the process. Analysis of the underlying theory, development, and use of DI describes the way it is based on careful developmental research. It promotes effective and efficient learning while embodying respect for students and teachers. The results of a recent large meta-analysis of research on DI's effectiveness show it is more effective than other educational approaches, with effect sizes that surpass the effect associated with the difference in achievement of students from lower income and other homes. Alternative approaches to educational change are reviewed and it is suggested that DI is a more effective and efficient method of improving student success. Powerful actors within the educational establishment have expressed opposition to DI and have worked to hide evidence of its effectiveness. This paper identifies other social actors who could work together to counter the resistance to DI and build an educational system that promotes the well-being of all.

Equity for women and underrepresented minorities in STEM: Graduate experiences and career plans in chemistry.

Recent events prompted scientists in the United States and throughout the world to consider how systematic racism affects the scientific enterprise. This paper provides evidence of inequities related to race-ethnicity and gender in graduate school experiences and career plans of PhD students in the top 100 ranked departments in one science, technology, engineering, and math (STEM) discipline, chemistry. Mixed-model regression analyses were used to examine factors that might moderate these differences. The results show that graduate students who identified as a member of a racial/ethnic group traditionally underrepresented in chemistry (underrepresented minorities, URM) were significantly less likely than other students to report that their financial support was sufficient to meet their needs. They were also less likely to report having supportive relationships with peers and postdocs. Women, and especially URM women, were significantly less likely to report supportive relationships with advisors. Despite their more negative experiences in graduate school, students who identified as URM expressed greater commitment to finishing their degree and staying in the field. When there was at least one faculty member within their departments who also identified as URM they were also more likely than other students to aspire to a university professorship with an emphasis on research. Men were significantly more likely than women to express strong commitment to finishing the PhD and remaining in chemistry, but this difference was stronger in top-ranked departments. Men were also more likely than women to aspire to a professorship with an emphasis on research, and this difference remained when individual and departmental-level variables were controlled.

Salad bar selection patterns of elementary school children.

From the perspective of child-focused nutrition research, the analysis of the school cafeteria culture and environment is critical. Most children eat at least one meal at school per school day, thus elementary schools are a good setting for influencing the early development of healthy eating habits. The salad bar in particular has gained attention as a means of increasing fruit and vegetable consumption. The purpose of the present study was to provide insight about the types of items children choose or do not choose from the salad bar. Our aims were to document elementary school children's food selection patterns by examining photographs of 2903 cafeteria trays. Our results show students in this study took very few items - and a substantial number did not take any at all. We examined three factors, gender, grade, and item placement, in relation to food selection. Gender was the most significant factor, with girls being more likely to choose both fruits and vegetables. Students in lower grades were more likely to select vegetables and to choose more of them. Finally, item placement did not affect choice. Our findings lead us to suggest the importance of integrating information about fruits and vegetables into the school curriculum and that schools strongly consider which items to offer because our results indicate children consistently do not choose certain items and probably do not conceive of them in the context of the adult concept of a salad. Finally, because a child's choice of food is not always a simple act we suggest ethnographic research on how children perceive and use salad bars would provide important insight into the value of retaining or expanding salad bars in elementary schools.

Two Worlds of Obesity: Ethnic Differences in Child Overweight/Obesity Prevalence and Trajectories.

OBJECTIVES: Research on childhood obesity has examined the prevalence of overweight and obesity during childhood and developmental trajectories. This study focuses on the extent to which Hispanic and non-Hispanic white elementary students differ in prevalence of overweight and obesity by grade level, time, gender, and school setting. It also focuses on comparison of the trajectories in weight status for the Hispanic and non-Hispanic white students. METHODS: BMI values were examined both using standard scores (z-scores) and as categorical variables. Cross-sectional data from 4 years were used to examine prevalence, and panel data across 2-year periods examined trajectories. Descriptive statistics and mixed models, controlling for school setting, were used. RESULTS: Hispanic students began first grade with higher prevalence of obesity and overweight, and the differences were larger in higher grades and later years. The majority of students had stable weight status over the 2-year periods of the trajectory analysis, but Hispanic students began the panel with higher BMI-Z values and were more likely to increase and less likely to decrease BMI-Z. CONCLUSIONS: The findings suggest that the degree of childhood overweight/obesity, especially among Hispanics, is substantial and will likely have profound impacts on adult obesity and other associated health issues in the future. Findings confirm the need for early childhood interventions to influence BMI.

Continuity and change in values in midlife: testing the age stability hypothesis.

UNLABELLED: BACKGROUND/STUDY CONTEXT: The "age stability" hypothesis suggests that adults have significant continuities in values over time, whereas the "situational influence" hypothesis suggests that change continues, especially in response to new events and experiences. Deeply ingrained, terminal values may be more stable than other, more instrumental, values. Less research examines changing values than examines changing personality traits and attitudes. METHODS: Hypotheses were tested with data from A Study of Leisure During Adulthood (ASOLDA), a 9-year panel study of middle-aged adults (average age of 45 at the beginning of data collection). Mixed-model regressions and descriptive statistics were used to examine changes and stability over time in global values, measured by the List of Values (LOV), and instrumental values related to leisure. RESULTS: Significant correlations were found in both terminal and instrumental values over time (autocorrelations ranging from .13 to .23). There was no linear or curvilinear pattern of change over time. Respondents reported a wide range of positive and negative life events and variations over time in reflections on their life structure, but these variations were unrelated to changes in values. CONCLUSION: Results support the age stability hypothesis, rather than the situational influence hypothesis, with similar results for both terminal and instrumental values. It is suggested that the consistent values of respondents may have helped them weather the wide range of often-difficult circumstances many reported experiencing. Future research should examine this hypothesis.

The rising share of nonmarital births: fertility choice or marriage behavior?

Much of the sharp rise in the share of nonmarital births in the United States has been attributed to changes in the fertility choices of unmarried and married women-in response, it is often argued, to public policy. In contrast, we develop and test a model that attributes the rise to changes in marriage behavior, with no necessary changes infertility. A variety of empirical tests strongly support this conclusion and invites focused attention to issues related to marriage behavior as well as to the interactions between marriage and fertility.

Development and testing of a short form of the patient activation measure.

OBJECTIVE: The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. STUDY METHODS: We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. DATA SOURCES: The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. CONCLUSIONS: The results of the analysis indicate that the shortened 13-item version is both reliable and valid.

Hospital performance reports: impact on quality, market share, and reputation.

This study builds on earlier work by assessing the long-term impact of a public hospital performance report on both consumers and hospitals. In doing so, we shed light on the relative importance of alternative assumptions about what stimulates quality improvements. The findings indicate that making performance data public results in improvements in the clinical area reported upon. An earlier investigation indicated that hospitals included in the public report believed that the report would affect their public image. Indeed, consumer surveys suggest that inclusion did affect hospitals' reputations.

It isn't just about choice: the potential of a public performance report to affect the public image of hospitals.

Can a well-designed public performance report affect the public image of hospitals? Using a pre/postdesign and telephone interviews, consumer views and reports of their use of public hospital report are examined. The findings show that the report did influence consumer views about the quality of individual hospitals in the community 2 to 4 months after the release of the report.

Development of the Patient Activation Measure (PAM): conceptualizing and measuring activation in patients and consumers.

BACKGROUND: Controlling costs and achieving health care quality improvements require the participation of activated and informed consumers and patients. OBJECTIVES: We describe a process for conceptualizing and operationalizing what it means to be "activated" and delineate the process we used to develop a measure for assessing "activation," and the psychometric properties of that measure. METHODS: We used the convergence of the findings from a national expert consensus panel and patient focus groups to define the concept and identify the domains of activation. These domains were operationalized by constructing a large item pool. Items were pilot-tested and initial psychometric analysis performed using Rasch methodology. The third stage refined and extended the measure. The fourth stage used a national probability sample to assess the measure's psychometric performance overall and within different subpopulations. STUDY SAMPLE: Convenience samples of patients with and without chronic illness, and a national probability sample (N=1,515) are included at different stages in the research. CONCLUSIONS: The Patient Activation Measure is a valid, highly reliable, unidimensional, probabilistic Guttman-like scale that reflects a developmental model of activation. Activation appears to involve four stages: (1) believing the patient role is important, (2) having the confidence and knowledge necessary to take action, (3) actually taking action to maintain and improve one's health, and (4) staying the course even under stress. The measure has good psychometric properties indicating that it can be used at the individual patient level to tailor intervention and assess changes.

Does publicizing hospital performance stimulate quality improvement efforts?

This study evaluates the impact on quality improvement of reporting hospital performance publicly versus privately back to the hospital. Making performance information public appears to stimulate quality improvement activities in areas where performance is reported to be low. The findings from this Wisconsin-based study indicate that there is added value to making this information public.

Variations in age-specific homicide death rates: a cohort explanation for charges in the age distribution of homicide deaths.

An age-period-cohort characteristic model previously used to explain age-period-specific rates of homicide arrests for those 15 to 49 from 1960 to 1995 is applied to measures of age-period-specific homicide deaths. The extension of this model to the examination of homicide victimization is significant because we are able to test the utility of the model across a longer time span (1930 to 1995) and a wider range of ages (10 to 79) and disaggregated by sex and race (Whites and non-Whites). Although the results indicate that past and recent shifts in age-period-specific rates of homicide deaths are associated with specific characteristics of cohorts, there are some important differences across race and sex groupings in the effects of these characteristics. The effects of the cohort variables examined in our model are independent of age and period, often substantively large, and last throughout the life course. The results are consistent with Durkheimian explanations of lethal violence, hypotheses from victimization theory, and basic tenets of cohort theory.