Policy Points The historical mission of public health is to ensure the conditions in which people... more Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control trials, a lack of formal theoretical models, and a fear of politics. The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.
Behavioral economics is a collection of empirical results, without a theoretical framework to tie... more Behavioral economics is a collection of empirical results, without a theoretical framework to tie them together. Nonetheless, a strong heuristic of a two-system brain has been invoked by many behavioral economists to help communicate similarities across studies and implications for practice. This two-system heuristic holds that we make quick, intuitive decisions with a System 1 brain, and careful, deliberative decisions with a System 2 brain. Institutional economics provides a valuable critique and counterpoint to this twosystem theory. It argues that our thoughts are built up of cognitive habits and that more sophisticated decisions are constructed from simpler habits. Where two-system theory holds that deliberative decisions must be as rational as available information allows, the institutionalist perspective holds that deliberative decisions can and do inherit biases from basic intuitions. Institutionalism further holds that cognitive habits are not either rational or irrational,...
Research Methods in Medicine & Health Sciences, 2021
Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes... more Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this assumption is often done either by graphical examination or by statistical tests in the pre-treatment period. They result in a binary conclusion about the validity of the assumption. Purpose. This paper proposes a sensitivity analysis that quantifies the departure from parallel trends necessary to meaningfully change the estimated treatment effect. Results. Sensitivity analyses have an advantage over traditional parallel trends tests: they use all available data and thereby work even if only one pre-period is available, and they quantify the strength of unobserved confounder(s) required to change the conclusions of a study. Conclusions. We apply the sensitivity analysis metrics developed by Cinelli and Hazlett (2020) and illustrate them on two studies.
Background: The movement of firearm across state lines may decrease the effectiveness of state-le... more Background: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. Methods : Cross-sectional time series network analysis of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010 -2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state’s firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms. Results : O...
OBJECTIVE: To test the independent association of adult language input, television viewing, and a... more OBJECTIVE: To test the independent association of adult language input, television viewing, and adult-child conversations on language acquisition among infants and toddlers. METHODS: Two hundred seventy-five families of children aged 2 to 48 months who were representative of the US census were enrolled in a cross-sectional study of the home language environment and child language development (phase 1). Of these, a representative sample of 71 families continued for a longitudinal assessment over 18 months (phase 2). In the cross-sectional sample, language development scores were regressed on adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. In the longitudinal sample, phase 2 language development scores were regressed on phase 1 language development, as well as phase 1 adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. RESULTS: In fully adjusted regressions, the ef...
... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Departmen... more ... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Department of Health Services University of Washington Seattle, WA 98115 REFERENCES 1. Stevens T, Mulsow M. There is no meaningful relationship between television exposure and ...
To measure whether the implementation of Healthvana-an online patient engagement platform and sma... more To measure whether the implementation of Healthvana-an online patient engagement platform and smartphone application-reduced the number of days between sexually transmitted infection (STI) testing, notification, and treatment at AIDS Healthcare Foundation (AHF) Wellness Centers. We analyzed the retrospective data for 917 male clients who tested positive and received treatment for chlamydia, gonorrhea, or syphilis between January 1, 2014, and December 31, 2015. We included 8 AHF Wellness Centers from California and Florida in the study. We used regression models to evaluate the relationship between Healthvana implementation (pre-Healthvana vs post-Healthvana) and the number of days between the STI test, notification, and treatment. Following Healthvana implementation at the AHF Wellness Centers, the mean number of days decreased between the STI test and notification, from 8 to 6 days. The mean number of days between the overall STI test and treatment decreased from 12 to 10 days. Regression models found the reduction in the number of days from STI test to notification to be statistically significant. Smartphone applications like Healthvana are promising technologies to ensure clients are successfully and immediately notified of their STI test results.
Support for policies to combat obesity is often undermined by a public sense that obesity is larg... more Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectiv...
Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Af... more Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Africa Frederick J. Zimmerman ABSTRACT Fostering is a common institution throughout developing countries, where up to 25 percent of children are fostered. ...
Policy Points The historical mission of public health is to ensure the conditions in which people... more Policy Points The historical mission of public health is to ensure the conditions in which people can be healthy, and yet the field of public health has been distracted from this mission by an excessive reliance on randomized-control trials, a lack of formal theoretical models, and a fear of politics. The field of population health science has emerged to rigorously address all of these constraints. It deserves ongoing and formal institutional support.
Behavioral economics is a collection of empirical results, without a theoretical framework to tie... more Behavioral economics is a collection of empirical results, without a theoretical framework to tie them together. Nonetheless, a strong heuristic of a two-system brain has been invoked by many behavioral economists to help communicate similarities across studies and implications for practice. This two-system heuristic holds that we make quick, intuitive decisions with a System 1 brain, and careful, deliberative decisions with a System 2 brain. Institutional economics provides a valuable critique and counterpoint to this twosystem theory. It argues that our thoughts are built up of cognitive habits and that more sophisticated decisions are constructed from simpler habits. Where two-system theory holds that deliberative decisions must be as rational as available information allows, the institutionalist perspective holds that deliberative decisions can and do inherit biases from basic intuitions. Institutionalism further holds that cognitive habits are not either rational or irrational,...
Research Methods in Medicine & Health Sciences, 2021
Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes... more Background. Difference-in-Difference makes a critical assumption that the changes in the outcomes, over the post-treatment period, are similar between the treated and control groups—the parallel trends assumption. Evaluation of this assumption is often done either by graphical examination or by statistical tests in the pre-treatment period. They result in a binary conclusion about the validity of the assumption. Purpose. This paper proposes a sensitivity analysis that quantifies the departure from parallel trends necessary to meaningfully change the estimated treatment effect. Results. Sensitivity analyses have an advantage over traditional parallel trends tests: they use all available data and thereby work even if only one pre-period is available, and they quantify the strength of unobserved confounder(s) required to change the conclusions of a study. Conclusions. We apply the sensitivity analysis metrics developed by Cinelli and Hazlett (2020) and illustrate them on two studies.
Background: The movement of firearm across state lines may decrease the effectiveness of state-le... more Background: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. Methods : Cross-sectional time series network analysis of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010 -2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state’s firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms. Results : O...
OBJECTIVE: To test the independent association of adult language input, television viewing, and a... more OBJECTIVE: To test the independent association of adult language input, television viewing, and adult-child conversations on language acquisition among infants and toddlers. METHODS: Two hundred seventy-five families of children aged 2 to 48 months who were representative of the US census were enrolled in a cross-sectional study of the home language environment and child language development (phase 1). Of these, a representative sample of 71 families continued for a longitudinal assessment over 18 months (phase 2). In the cross-sectional sample, language development scores were regressed on adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. In the longitudinal sample, phase 2 language development scores were regressed on phase 1 language development, as well as phase 1 adult word count, television viewing, and adult-child conversations, controlling for socioeconomic attributes. RESULTS: In fully adjusted regressions, the ef...
... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Departmen... more ... Dimitri A. Christakis, MD, MPH Department of Pediatrics Frederick J. Zimmerman, PhD Department of Health Services University of Washington Seattle, WA 98115 REFERENCES 1. Stevens T, Mulsow M. There is no meaningful relationship between television exposure and ...
To measure whether the implementation of Healthvana-an online patient engagement platform and sma... more To measure whether the implementation of Healthvana-an online patient engagement platform and smartphone application-reduced the number of days between sexually transmitted infection (STI) testing, notification, and treatment at AIDS Healthcare Foundation (AHF) Wellness Centers. We analyzed the retrospective data for 917 male clients who tested positive and received treatment for chlamydia, gonorrhea, or syphilis between January 1, 2014, and December 31, 2015. We included 8 AHF Wellness Centers from California and Florida in the study. We used regression models to evaluate the relationship between Healthvana implementation (pre-Healthvana vs post-Healthvana) and the number of days between the STI test, notification, and treatment. Following Healthvana implementation at the AHF Wellness Centers, the mean number of days decreased between the STI test and notification, from 8 to 6 days. The mean number of days between the overall STI test and treatment decreased from 12 to 10 days. Regression models found the reduction in the number of days from STI test to notification to be statistically significant. Smartphone applications like Healthvana are promising technologies to ensure clients are successfully and immediately notified of their STI test results.
Support for policies to combat obesity is often undermined by a public sense that obesity is larg... more Support for policies to combat obesity is often undermined by a public sense that obesity is largely a matter of personal responsibility. Industry rhetoric is a major contributor to this perception, as the soda/fast food/big food companies emphasize choice and individual agency in their efforts to neutralize policies that are burdensome. Yet obesity experts recognize that environmental forces play a major role in obesity. We investigate whether exposure to a taste-engineering frame increases support for food and beverage policies that address obesity. A taste-engineering frame details strategies used by the food industry to engineer preferences and increase the over-consumption of processed foods and sugary beverages. We also examine the effects of exposure to two contextualized values that have recently been promoted in expert discourse-consumer knowledge and consumer safety - on public support of policies. Our research shows how causal frames and contextualized values may effectiv...
Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Af... more Page 1. Cinderella Goes to School The Effects of Child Fostering on School Enrollment in South Africa Frederick J. Zimmerman ABSTRACT Fostering is a common institution throughout developing countries, where up to 25 percent of children are fostered. ...
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