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Critchfield TS. A peek into the room where it happens: Quantifying ABA's influence on public policy discussions. J Appl Behav Anal 2024; 57:288-303. [PMID: 38247278 DOI: 10.1002/jaba.1056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/21/2023] [Indexed: 01/23/2024]
Abstract
To maximize its influence, applied behavior analysis must both create solutions and shape public policy to implement those solutions at scale. From the perspective of data-driven decision making, it is illogical to talk about seeking public policy influence without consulting evidence showing when influence has been achieved. One relevant form of evidence is the attention that behavioral solutions receive in published discussions about policy issues, and here I show how much of this attention has been earned by articles published in Journal of Applied Behavior Analysis. I also propose using the same kind of data to support finer grained analyses focusing on specific behavior problems, specific types of interventions, and the research programs of individual investigators. Although this is far from a complete account of the influence of applied behavior analysis on policy, it is better to have data than none if the goal is to transform the quest for influence on policy from a matter of speculation and casual discussion into an evidence-based practice.
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Cherrie MPC, Sarran C, Osborne NJ. Climatic factors are associated with asthma prevalence: An ecological study using English quality outcomes framework general practitioner practice data. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 779:146478. [PMID: 34030283 DOI: 10.1016/j.scitotenv.2021.146478] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
Asthma is a complex disease with multiple environmental factors proposed to contribute to aetiology. Geographical analyses can shed light on the determinants of asthma. Ultraviolet radiation has been associated with asthma prevalence in past ecological studies. We have increased the detail of examining the association between asthma and ultraviolet radiation with addition of the variables of temperature, relative humidity and precipitation. An ecological study was designed to investigate meteorological factors associated with asthma prevalence in England. Data from the 2005 quality outcomes framework were used to determine the prevalence of asthma in primary care in England. This information was supplemented with indicators of obesity and smoking of the General Practitioner practice and population (by age and sex), deprivation and ethnicity at lower super output level from the 2001 and 2011 census. Annual mean meteorological data was attained from the Met Office and Joint Research Centre. We used a multiple linear regression to examine individual and multiple climatic factors through a principal components analysis. We tested for an association with asthma prevalence, after taking into account the spatial autocorrelation of the data. Asthma prevalence from general practice surgeries in England was 5.88% (95% CI 5.83 to 5.92). In the highest ultraviolet radiation weighted by the pre-vitamin D action spectrum (UVvitd) quartile (2.12 to 2.50 kJ/m2/day), asthma had a 5% reduction in prevalence; compared to the lowest quartile here (0.95 (95% CI 0.92 to 0.98)). Similar reductions were found in the higher temperature 0.93 (95% CI 0.90 to 96). The opposite was found with relative humidity 1.09 (95% CI 1.05 to 1.12). A combination of high temperature and UVvitd highlighted postcode districts in the South East of England with a climate beneficial to low asthma prevalence. The South West of England represented a climate which had both beneficial and detrimental associations with asthma development. Climate is associated with asthma prevalence in England. Understanding the contribution of multiple climatic factors and the relationship with the indoor environment could help to explain the population distribution of asthma.
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Affiliation(s)
- Mark P C Cherrie
- Institute of Occupational Medicine, Edinburgh, EH14 4AP, UK; Centre for Research on Environment Society and Health, University of Edinburgh, Scotland, UK; European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK
| | | | - Nicholas J Osborne
- European Centre for Environment and Human Health (ECEHH), University of Exeter Medical School, Knowledge Spa, Royal Cornwall Hospital, Truro, Cornwall, UK; School of Public Health, University of Queensland, Australia.
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Kim S, Park HK, Lee JH, Cho HJ, Sung NJ. Effect of usual source of care on receiving smoking cessation advice: Korean National Health Panel data analysis. Fam Pract 2021; 38:218-224. [PMID: 32975279 DOI: 10.1093/fampra/cmaa108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite various anti-smoking policies, the smoking rate in adults is still high in Korea. Doctors' advice is known to increase the smoking cessation success rate. However, few studies have reported the effect of having a usual source of care (USC) on receiving smoking cessation advice. OBJECTIVE To determine the effect of USC on receiving smoking cessation advice. METHODS We performed multiple panel logistic regression analyses to identify the effect of having a USC on the rate of receiving a doctor's smoking cessation advice using 2009, 2012 and 2013 datasets from the Korea Health Panel database. Only people who responded to questions regarding a USC and smoking cessation advice were analysed. Eventually, 5243 observations were included in the final analysis. RESULTS A higher percentage of people with a USC received smoking cessation advice from doctors (58.4% in 2009, 64.0% in 2012 and 59.6% in 2013) than those not having a USC (28.6% in 2009, 37.5% in 2012 and 34.8% in 2013). The odds ratios (ORs) of receiving smoking cessation advice in people with a USC were higher than those of people without a USC after performing multiple panel logistic regression analysis with random effects (OR: 2.24; 95% confidence interval: 1.90-2.63). CONCLUSIONS Having a USC increased the odds of receiving a doctor's smoking cessation advice in Koreans. The results of this study suggest that a health care policy that encourages having a USC is useful in receiving more smoking cessation advice in a Korean population.
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Affiliation(s)
- Sollip Kim
- Department of Laboratory Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Hye Kyeong Park
- Department of Pulmonary and Critical Care Medicine, Inje University Ilsan Paik Hospital, Goyang
| | - Jae Ho Lee
- Department of Family Medicine, Catholic University of Korea, School of Medicine, Seoul
| | - Hong-Jun Cho
- Department of Family Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Nak Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
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Razvi S, Korevaar TIM, Taylor P. Trends, Determinants, and Associations of Treated Hypothyroidism in the United Kingdom, 2005-2014. Thyroid 2019; 29:174-182. [PMID: 30501570 DOI: 10.1089/thy.2018.0251] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent reports suggest that prescriptions for thyroid hormones have increased. Recent trends in and determinants of the prevalence of treated hypothyroidism across the United Kingdom were therefore analyzed. METHODS Data covering the whole of the United Kingdom held by the National Health Service and the Office of National Statistics were examined. The main outcome measured was trends in the prevalence of treated hypothyroidism between 2005 and 2014. In addition, linear trend forecasting was performed to estimate projected trends in the prevalence of treated hypothyroidism up to the year 2025. Furthermore, determinants of variation of treated hypothyroidism prevalence across each of the 237 health areas in the United Kingdom in 2014 and its association with other health conditions were explored by multivariate linear regression analyses. RESULTS The prevalence of treated hypothyroidism increased from 2.3% (1.4 million) to 3.5% (2.2 million) of the total British population between the years 2005 and 2014 and is projected to rise further to 4.2% (2.9 million) by 2025. There was large geographical variation of treated hypothyroidism across the United Kingdom, with London having the lowest (1.4%) and the Western Isles of Scotland having the highest (6.3%) prevalence. This variation was attenuated, but did not completely disappear, after some potential determinants were accounted for. The prevalence of treated hypothyroidism was independently related to health areas, with a higher proportion of individuals who were female, white, and obese, and negatively associated with prevalent cigarette smoking. The prevalence of treated hypothyroidism was significantly associated with the frequency of prevalent atrial fibrillation but not with other major health conditions, including ischemic heart disease and osteoporosis. CONCLUSIONS Between 2005 and 2014, the prevalence of treated hypothyroidism increased across the United Kingdom, has wide geographical variation, and is likely to increase further for the foreseeable future. Clinical effects and cost-effectiveness of the trend in increasing treatment of hypothyroidism remains to be evaluated.
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Affiliation(s)
- Salman Razvi
- 1 Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
- 2 Department of Endocrinology, Gateshead Health NHS Foundation Trust, Gateshead, United Kingdom
| | - Tim I M Korevaar
- 3 Rotterdam Thyroid Centre, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Peter Taylor
- 4 Thyroid Research Group, Systems Immunity Research Institute, Cardiff University School of Medicine, Cardiff, United Kingdom
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Role of individual-housing-based socioeconomic status measure in relation to smoking status among late adolescents with asthma. Ann Epidemiol 2016; 26:455-460. [PMID: 27266369 DOI: 10.1016/j.annepidem.2016.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 04/29/2016] [Accepted: 05/01/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE We aimed to assess whether smoking status among individuals in late adolescence (19-22 years) with asthma was associated with socioeconomic status (SES) defined by HOUSES, an individual-housing-based SES measure. METHODS A population-based cross-sectional study was conducted among the 1988-1989 Olmsted County, Minnesota Birth Cohort, with physician-diagnosed asthma and that lived in the community during the study period (November 1, 2008-October 31, 2012). Using a z score for housing value, actual square footage, and numbers of bedrooms and bathrooms, HOUSES was formulated and categorized into quartiles. Smoking status (both current and past smoker) was compared among subjects with different SES as measured by HOUSES using logistic regression, adjusting for age and sex. RESULTS Among 289 eligible subjects, 287 (99%) were successfully geo-coded to real property data for HOUSES. Of the 257 subjects whose smoke exposure was recorded, 70 (27%) had a history of smoking (either past or current). An inverse association was observed between HOUSES and smoking status after accounting for age, gender, and General Medical Examination status (adjusted OR = 0.39, 95% CI = 0.18-0.87 for comparing highest vs. lowest HOUSES in quartile; overall P = .02). CONCLUSIONS A significant proportion of individuals with asthma in late adolescence was smokers during the study period, disproportionally affecting those with lower SES.
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Baker R, Honeyford K, Levene LS, Mainous AG, Jones DR, Bankart MJ, Stokes T. Population characteristics, mechanisms of primary care and premature mortality in England: a cross-sectional study. BMJ Open 2016; 6:e009981. [PMID: 26868945 PMCID: PMC4762103 DOI: 10.1136/bmjopen-2015-009981] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Health systems with strong primary care tend to have better population outcomes, but in many countries demand for care is growing. We sought to identify mechanisms of primary care that influence premature mortality. DESIGN We developed a conceptual model of the mechanisms by which primary care influences premature mortality, and undertook a cross-sectional study in which population and primary care variables reflecting the model were used to explain variations in mortality of those aged under 75 years. The premature standardised mortality ratios (SMRs) for each practice, available from the Department of Health, had been calculated from numbers of deaths in the 5 years from 2006 to 2010. A regression model was undertaken with explanatory variables for the year 2009/2010, and repeated to check stability using data for 2008/2009 and 2010/2011. SETTING All general practices in England were eligible for inclusion and, of the total of 8290, complete data were available for 7858. RESULTS Population variables, particularly deprivation, were the most powerful predictors of premature mortality, but the mechanisms of primary care depicted in our model also affected mortality. The number of GPs/1000 population and detection of hypertension were negatively associated with mortality. In less deprived practices, continuity of care was also negatively associated with mortality. CONCLUSIONS Greater supply of primary care is associated with lower premature mortality even in a health system that has strong primary care (England). Health systems need to sustain the capacity of primary care to deliver effective care, and should assist primary care providers in identifying and meeting the needs of socioeconomically deprived groups.
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Affiliation(s)
- Richard Baker
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kate Honeyford
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Louis S Levene
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Arch G Mainous
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida, USA
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida, USA
| | - David R Jones
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - M John Bankart
- Department of Primary Care and Health Sciences, University of Keele, Keele, UK
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Greiver M, Aliarzadeh B, Meaney C, Moineddin R, Southgate CA, Barber DTS, White DG, Martin KB, Ikhtiar T, Williamson T. Are We Asking Patients if They Smoke?: Missing Information on Tobacco Use in Canadian Electronic Medical Records. Am J Prev Med 2015; 49:264-8. [PMID: 25997907 DOI: 10.1016/j.amepre.2015.01.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/22/2014] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
Abstract
INTRODUCTION All adolescent and adult patients should be asked if they smoke. Data entered in electronic medical records offer new opportunities to study tobacco-related clinical activities. The purpose of this study is to examine the recording of tobacco use in Canadian electronic medical records. METHODS Data were collected on September 30, 2013, and analyzed in 2014. Data on 249,223 patients that were aged ≥16 years as of September 30, 2013 and had at least one primary care encounter in the previous 2 years were included. The proportion of patients with information on tobacco use entered in a summative health profile was calculated. Associations between data gaps and patient or physician factors were examined. RESULTS Information on tobacco use was available for 64.4% of patients. Physicians using an electronic medical record for ≥4 years were more likely to have data (AOR=4.57, 95% CI=1.84, 7.29, p<0.0001). Patients aged ≥30 years were more likely to have tobacco information present (AOR=2.92, 95% CI=2.82, 3.02, p<0.0001, for patients aged 30-59 compared to those aged <30 years), as were patients with any comorbidities (AOR=1.41, 95% CI=1.36, 1.45, p<0.0001, for patients with one or two comorbidities compared with none) or more visits. CONCLUSIONS A third of Canadians in this sample lacked data on tobacco in their electronic medical record. Younger, healthier people were less likely to have information about their smoking status. Efforts to improve the recording of tobacco-related information in electronic medical records, especially for younger patients, are needed.
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Affiliation(s)
- Michelle Greiver
- Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto.
| | - Babak Aliarzadeh
- Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto
| | | | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto
| | - Chris A Southgate
- Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto
| | - David T S Barber
- Department of Family Medicine, Queen's University, Kingston, Ontario
| | - David G White
- Department of Family and Community Medicine, University of Toronto; North York General Hospital, Toronto
| | - Ken B Martin
- Department of Family Medicine, Queen's University, Kingston, Ontario
| | - Tabassum Ikhtiar
- Department of Family and Community Medicine, University of Toronto
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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