Coalition for a Healthier Community: Lessons learned and implications for future work

The Coalition for a Healthier Community (CHC) initiative was implemented to improve the health and well-being of women and girls. Underpinning CHC is a gender-based focus that uses a network of community partners working collaboratively to generate relevant behavior change and improved health outcomes. Ten programs are trying to determine whether gender-focused system approaches are cost-effective ways to address health disparities in women and girls. Programs implemented through coalitions made up of academic institutions, public health departments, community-based organizations, and local, regional, and national organizations, are addressing health issues such as domestic violence, cardiovascular disease prevention, physical activity, and healthy eating. Although these programs are ongoing, they have made significant progress. Key factors contributing to their early success include a comprehensive needs assessment, robust coalitions, the diversity of populations targeted, programs based on findings of the needs assessments, evaluations taking into consideration the effect of gender, and strong academic–community partnerships. A noteworthy impact of these programs has been their ability to shape and impact public, social, and health policies at the state and local levels. However, there have been challenges associated with the implementation of such a complex program. Lessons learned are discussed in this paper.     

An approximation of logarithmic functions in the regression setting

We consider a method of moments approach for dealing with censoring at zero for data expressed in levels when researchers would like to take logarithms. A Box–Cox transformation is employed. We explore this approach in the context of linear regression where both dependent and independent variables are censored. We contrast this method to two others, (1) dropping records of data containing censored values and (2) assuming normality for censored observations and the residuals in the model. Across the methods considered, where researchers are interested primarily in the slope parameter, estimation bias is consistently reduced using the method of moments approach.     

Predicting body fat using weight–height indices

While body fat is the most accurate measure of obesity, its measurement requires special equipment that can be costly and time consuming to operate. Attention has thus typically focused on the easier to calculate body mass index (BMI). However, the ability of BMI to accurately identify obesity has been increasingly questioned. This paper focuses attention on whether more general body mass indices are appropriate measures of body fat. Using a data set of body fat, height, and weight measurements, general models are estimated which nest a wide variety of weight–height indices as special cases. In the absence of a race and gender categorisation, the conventional BMI was found to be the appropriate index with which to predict body fat. When such a categorisation was made, however, the BMI was never selected as the appropriate index. In general, predicted female body fat was some 10 kg higher than that of a male of identical build and predicted % body fat was over 11 percentage points higher, but age effects were smaller for females. Considerable racial differences in predicted body fat were found for males, but such differences were less marked for females. The implications of this finding for interpreting recent research on the effect of obesity on health, society, and economic factors are considered.     

Correlates of honor ratings in a clinical clerkship employing a faculty forum evaluation system

5he purpose of this study was to determine whether or not suspected variables affected a surgery clerk's chances of being awarded an honor rating. Findings indicated a significant relationship between a student receiving an honor rating and his or her preceptor's predetermined level of student advocacy, the number of completed patient interview and physical examination write-ups, and final examination scores. There was no significant relationship found between honor ratings and the preceptor's status, the sequence in which the student was discussed or the length of time spent discussing the student at the final evaluation meeting, or the number of clinical faculty present at the meeting. These results lend support to the faculty forum evaluation approach, but suggest a need for further scrutiny of some influencing variables to ensure all students are fairly considered and honor ratings judiciously awarded.     

Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Network analysis in evaluation: some words of caution

Network analysis, a methodology derived from general systems' theory, can be utilized as a community mental health administrative-evaluation procedure. Evaluation parameters derived from analysis of patient data as they “flow” through a network of agency services, provide measures of systemic functioning. These parameters include “longest paths” and various ratio relationships as evaluation measures of service delivery. The limitations of network analysis are examined by means of conceptual analyses, and phenomena that emerged from research experience. The necessity for both quantitative and qualitative data to ensure a meaningful evaluation of mental health services is explained. Conclusions about the value of the network analysis approach are considered.     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.     

Notes on Interval Estimation of Odds Ratio in Matched Pairs under Stratified Sampling

We develop four asymptotic interval estimators and one exact interval estimator for the odds ratio (OR) under stratified random sampling with matched pairs. We apply Monte Carlo simulation to evaluate the performance of these five interval estimators. We note that the conditional score test-based interval estimator with a monotonic transformation and the interval estimator based on the Mantel–Haenszel (MH) type point estimator with the logarithmic transformation are generally preferable to the others considered here. We also note that the conditional exact confidence interval can be of use when the total number of matched pairs with discordant responses is small.