Network Effects of Risk Behavior Change Following Prophylactic Interventions

We formulated a network-based model to understand how risk behavior change in conjunction with failure of prophylactic interventions can lead to unintended outcomes where “less (intervention) is more (effective).” Our model captures the distinction between one- and two-sided risk behavior change. In one-sided situations (e.g. influenza/H1N1) it is sufficient for either individual in an interaction to exhibit risk behavior change whereas in two-sided situations (e.g. AIDS/HIV) it is necessary for both individuals in the interaction to exhibit risk behavior change, for a potential transmission of the disease. A central discovery is that this phenomenon occurs at differing levels of intervention coverage depending upon the “sidedness” of the interaction. We find that for one-sided interactions, sufficiently high vaccination coverage is necessary for mitigating the effects of risk behavior; for two-sided interactions, it is essential to combine prophylactic treatments with programs aimed at reducing risky behavior. Furthermore, again dependent on the “sidedness,” targeting highly connected nodes can be strictly worse than uniformly random interventions at the same level of coverage.     

A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes

Background

We systematically reviewed interventions that attempted to change staff practice to improve long-term care resident outcomes.

Methods

Studies met criteria if they used a control group, included 6 or more nursing home units and quantitatively assessed staff behavior or resident outcomes. Intervention components were coded as including education material, training, audit and feedback, monitoring, champions, team meetings, policy or procedures and organizational restructure.

Results

Sixty-three unique studies were broadly grouped according to clinical domain—oral health (3 studies), hygiene and infection control (3 studies), nutrition (2 studies), nursing home acquired pneumonia (2 studies), depression (2 studies) appropriate prescribing (7 studies), reduction of physical restraints (3 studies), management of behavioral and psychological symptoms of dementia (6 studies), falls reduction and prevention (11 studies), quality improvement (9 studies), philosophy of care (10 studies) and other (5 studies). No single intervention component, combination of, or increased number of components was associated with greater likelihood of positive outcomes. Studies with positive outcomes for residents also tended to change staff behavior, however changing staff behavior did not necessarily improve resident outcomes. Studies targeting specific care tasks (e.g. oral care, physical restraints) were more likely to produce positive outcomes than those requiring global practice changes (e.g. care philosophy). Studies using intervention theories were more likely to be successful. Program logic was rarely articulated, so it was often unclear whether there was a coherent connection between the intervention components and measured outcomes. Many studies reported barriers relating to staff (e.g. turnover, high workload, attitudes) or organizational factors (e.g. funding, resources, logistics).

Conclusion

Changing staff practice in nursing homes is possible but complex. Interventionists should consider barriers and feasibility of program components to impact on each intended outcome.     

Short- and long-term effects of small bowel resection: a unique histological study in a piglet model of short bowel syndrome

If we are to develop successful interventions to improve clinical outcomes for short bowel syndrome patients we require (1) knowledge of changes within the epithelial population following small bowel resection (SBR) and (2) an idea of when these changes occur to inform on the timing of potential interventions aimed at enhancing the adaptive response. The aim of this study was to produce a temporal map of epithelial changes within the crypt and villus at early and late adaptation phases. Four-week-old piglets underwent a 75% SBR or sham operation and were studied at 2, 4 and 6 weeks post-operation to allow analysis of early and late adaptation responses. Piglets received polymeric infant formula (PIF). Immunohistochemistry with specific cell markers was used to quantitate intestinal cell types and the total cell numbers. Changes within the crypt were temporally dependent on an early significant increase in enterocytes and proliferative cells not sustained at 6 weeks. Goblet cell numbers were increased at all time points. Despite a significant increase in total villus cell numbers at 6 weeks there was no change in specific cell types. We observed two distinct phases of cellular change following SBR. An early increase in enterocytes and proliferative cells was not reflected in increased weight gain indicating the early increase represents immature enterocytes. Interventions aimed at increasing differentiation of the rapidly changing crypt population would allow for an earlier increase in absorption.     

An assessment of the use of drug and non-drug interventions in the treatment of Ichthyophthirius multifiliis Fouquet, 1876, a protozoan parasite of freshwater fish

Infection by the ciliate protozoan Ichthyophthirius multifiliis Fouquet, 1876 causes significant economic losses in freshwater aquaculture worldwide. Following the ban on the use of malachite green for treating food fish, there has been extensive research aimed at identifying suitable replacements. In this paper we critically assess drug and non-drug interventions, which have been tested for use or have been employed against this parasite and evaluate possibilities for their application in farm systems. Current treatments include the administration of formaldehyde, sodium chloride (salt), copper sulphate and potassium permanganate. However, purportedly more environmentally friendly drugs such as humic acid, potassium ferrate (VI), bronopol and the peracetic acid-based products have recently been tested and represent promising alternatives. Further investigation, is required to optimize the treatments and to establish precise protocols in order to minimize the quantity of drug employed whilst ensuring the most efficacious performance. At the same time, there needs to be a greater emphasis placed on the non-drug aspects of management strategies, including the use of non-chemical interventions focusing on the removal of free-swimming stages and tomocysts of I. multifiliis from farm culture systems. Use of such strategies provides the hope of more environmentally friendly alternatives for the control of I. multifiliis infections.     

Improving physical activity in COPD: towards a new paradigm

Chronic obstructive pulmonary disease (COPD) is a debilitating disease affecting patients in daily life, both physically and emotionally. Symptoms such as dyspnea and muscle fatigue, lead to exercise intolerance, which, together with behavioral issues, trigger physical inactivity, a key feature of COPD. Physical inactivity is associated with adverse clinical outcomes, including hospitalization and all-cause mortality. Increasing activity levels is crucial for effective management strategies and could lead to improved long-term outcomes. In this review we summarize objective and subjective instruments for evaluating physical activity and focus on interventions such as pulmonary rehabilitation or bronchodilators aimed at increasing activity levels. To date, only limited evidence exists to support the effectiveness of these interventions. We suggest that a multimodal approach comprising pulmonary rehabilitation, pharmacotherapy, and counselling programs aimed at addressing emotional and behavioural aspects of COPD may be an effective way to increase physical activity and improve health status in the long term.     

A network modelling approach to assess non-pharmaceutical disease controls in a worker population: An application to SARS-CoV-2

As part of a concerted pandemic response to protect public health, businesses can enact non-pharmaceutical controls to minimise exposure to pathogens in workplaces and premises open to the public. Amendments to working practices can lead to the amount, duration and/or proximity of interactions being changed, ultimately altering the dynamics of disease spread. These modifications could be specific to the type of business being operated. We use a data-driven approach to parameterise an individual-based network model for transmission of SARS-CoV-2 amongst the working population, stratified into work sectors. The network is comprised of layered contacts to consider the risk of spread in multiple encounter settings (workplaces, households, social and other). We analyse several interventions targeted towards working practices: mandating a fraction of the population to work from home; using temporally asynchronous work patterns; and introducing measures to create ‘COVID-secure’ workplaces. We also assess the general role of adherence to (or effectiveness of) isolation and test and trace measures and demonstrate the impact of all these interventions across a variety of relevant metrics. The progress of the epidemic can be significantly hindered by instructing a significant proportion of the workforce to work from home. Furthermore, if required to be present at the workplace, asynchronous work patterns can help to reduce infections when compared with scenarios where all workers work on the same days, particularly for longer working weeks. When assessing COVID-secure workplace measures, we found that smaller work teams and a greater reduction in transmission risk reduced the probability of large, prolonged outbreaks. Finally, following isolation guidance and engaging with contact tracing without other measures is an effective tool to curb transmission, but is highly sensitive to adherence levels. In the absence of sufficient adherence to non-pharmaceutical interventions, our results indicate a high likelihood of SARS-CoV-2 spreading widely throughout a worker population. Given the heterogeneity of demographic attributes across worker roles, in addition to the individual nature of controls such as contact tracing, we demonstrate the utility of a network model approach to investigate workplace-targeted intervention strategies and the role of test, trace and isolation in tackling disease spread.     

Why Do Some People Do “More” to Mitigate Climate Change than Others? Exploring Heterogeneity in Psycho-Social Associations

The urgency of climate change mitigation calls for a profound shift in personal behavior. This paper investigates psycho-social correlates of extra mitigation behavior in response to climate change, while also testing for potential (unobserved) heterogeneity in European citizens'' decision-making. A person''s extra mitigation behavior in response to climate change is conceptualized—and differentiated from common mitigation behavior—as some people''s broader and greater levels of behavioral engagement (compared to others) across specific self-reported mitigation actions and behavioral domains. Regression analyses highlight the importance of environmental psychographics (i.e., attitudes, motivations, and knowledge about climate change) and socio-demographics (especially country-level variables) in understanding extra mitigation behavior. By looking at the data through the lens of segmentation, significant heterogeneity is uncovered in the associations of attitudes and knowledge about climate change—but not in motivational or socio-demographic links—with extra mitigation behavior in response to climate change, across two groups of environmentally active respondents. The study has implications for promoting more ambitious behavioral responses to climate change, both at the individual level and across countries.     

Interventions aimed at increasing research use in nursing: a systematic review

Background

There has been considerable interest recently in developing and evaluating interventions to increase research use by clinicians. However, most work has focused on medical practices; and nursing is not well represented in existing systematic reviews. The purpose of this article is to report findings from a systematic review of interventions aimed at increasing research use in nursing.

Objective

To assess the evidence on interventions aimed at increasing research use in nursing.

Methods

A systematic review of research use in nursing was conducted using databases (Medline, CINAHL, Healthstar, ERIC, Cochrane Central Register of Controlled Trials, and Psychinfo), grey literature, ancestry searching (Cochrane Database of Systematic Reviews), key informants, and manual searching of journals. Randomized controlled trials and controlled before- and after-studies were included if they included nurses, if the intervention was explicitly aimed at increasing research use or evidence-based practice, and if there was an explicit outcome to research use. Methodological quality was assessed using pre-existing tools. Data on interventions and outcomes were extracted and categorized using a pre-established taxonomy.

Results

Over 8,000 titles were screened. Three randomized controlled trials and one controlled before- and after-study met the inclusion criteria. The methodological quality of included studies was generally low. Three investigators evaluated single interventions. The most common intervention was education. Investigators measured research use using a combination of surveys (three studies) and compliance with guidelines (one study). Researcher-led educational meetings were ineffective in two studies. Educational meetings led by a local opinion leader (one study) and the formation of multidisciplinary committees (one study) were both effective at increasing research use.

Conclusion

Little is known about how to increase research use in nursing, and the evidence to support or refute specific interventions is inconclusive. To advance the field, we recommend that investigators: (1) use theoretically informed interventions to increase research use, (2) measure research use longitudinally using theoretically informed and psychometrically sound measures of research use, as well as, measuring patient outcomes relevant to the intervention, and (3) use more robust and methodologically sound study designs to evaluate interventions. If investigators aim to establish a link between using research and improved patient outcomes they must first identify those interventions that are effective at increasing research use.     

Intimate Partner Violence and Pregnancy: A Systematic Review of Interventions

Background

Intimate partner violence (IPV) around the time of pregnancy is a widespread global health problem with many negative consequences. Nevertheless, a lot remains unclear about which interventions are effective and might be adopted in the perinatal care context.

Objective

The objective is to provide a clear overview of the existing evidence on effectiveness of interventions for IPV around the time of pregnancy.

Methods

Following databases PubMed, Web of Science, CINAHL and the Cochrane Library were systematically searched and expanded by hand search. The search was limited to English peer-reviewed randomized controlled trials published from 2000 to 2013. This review includes all types of interventions aiming to reduce IPV around the time of pregnancy as a primary outcome, and as secondary outcomes to enhance physical and/or mental health, quality of life, safety behavior, help seeking behavior, and/or social support.

Results

We found few randomized controlled trials evaluating interventions for IPV around the time of pregnancy. Moreover, the nine studies identified did not produce strong evidence that certain interventions are effective. Nonetheless, home visitation programs and some multifaceted counseling interventions did produce promising results. Five studies reported a statistically significant decrease in physical, sexual and/or psychological partner violence (odds ratios from 0.47 to 0.92). Limited evidence was found for improved mental health, less postnatal depression, improved quality of life, fewer subsequent miscarriages, and less low birth weight/prematurity. None of the studies reported any evidence of a negative or harmful effect of the interventions.

Conclusions and implications

Strong evidence of effective interventions for IPV during the perinatal period is lacking, but some interventions show promising results. Additional large-scale, high-quality research is essential to provide further evidence about the effect of certain interventions and clarify which interventions should be adopted in the perinatal care context.     

Comparison of tobacco control scenarios: quantifying estimates of long-term health impact using the DYNAMO-HIA modeling tool

Background

There are several types of tobacco control interventions/policies which can change future smoking exposure. The most basic intervention types are 1) smoking cessation interventions 2) preventing smoking initiation and 3) implementation of a nationwide policy affecting quitters and starters simultaneously. The possibility for dynamic quantification of such different interventions is key for comparing the timing and size of their effects.

Methods and Results

We developed a software tool, DYNAMO-HIA, which allows for a quantitative comparison of the health impact of different policy scenarios. We illustrate the outcomes of the tool for the three typical types of tobacco control interventions if these were applied in the Netherlands. The tool was used to model the effects of different types of smoking interventions on future smoking prevalence and on health outcomes, comparing these three scenarios with the business-as-usual scenario. The necessary data input was obtained from the DYNAMO-HIA database which was assembled as part of this project. All smoking interventions will be effective in the long run. The population-wide strategy will be most effective in both the short and long term. The smoking cessation scenario will be second-most effective in the short run, though in the long run the smoking initiation scenario will become almost as effective. Interventions aimed at preventing the initiation of smoking need a long time horizon to become manifest in terms of health effects. The outcomes strongly depend on the groups targeted by the intervention.

Conclusion

We calculated how much more effective the population-wide strategy is, in both the short and long term, compared to quit smoking interventions and measures aimed at preventing the initiation of smoking. By allowing a great variety of user-specified choices, the DYNAMO-HIA tool is a powerful instrument by which the consequences of different tobacco control policies and interventions can be assessed.     

Biodiversity change under adaptive community dynamics

Compositional change is a ubiquitous response of ecological communities to environmental drivers of global change, but is often regarded as evidence of declining “biotic integrity” relative to historical baselines. Adaptive compositional change, however, is a foundational idea in evolutionary biology, whereby changes in gene frequencies within species boost population-level fitness, allowing populations to persist as the environment changes. Here, we present an analogous idea for ecological communities based on core concepts of fitness and selection. Changes in community composition (i.e., frequencies of genetic differences among species) in response to environmental change should normally increase the average fitnessof community members. We refer to compositional changes that improve the functional match, or “fit,” between organisms' traits and their environment as adaptive community dynamics. Environmental change (e.g., land-use change) commonly reduces the fit between antecedent communities and new environments. Subsequent change in community composition in response to environmental changes, however, should normally increase community-level fit, as the success of at least some constituent species increases. We argue that adaptive community dynamics are likely to improve or maintain ecosystem function (e.g., by maintaining productivity). Adaptive community responses may simultaneously produce some changes that are considered societally desirable (e.g., increased carbon storage) and others that are undesirable (e.g., declines of certain species), just as evolutionary responses within species may be deemed desirable (e.g., evolutionary rescue of an endangered species) or undesirable (e.g., enhanced virulence of an agricultural pest). When assessing possible management interventions, it is important to distinguish between drivers of environmental change (e.g., undesired climate warming) and adaptive community responses, which may generate some desirable outcomes. Efforts to facilitate, accept, or resist ecological change require separate consideration of drivers and responses, and may highlight the need to reconsider preferences for historical baseline communities over communities that are better adapted to the new conditions.     

Development of a core outcome set for diabetes after pregnancy prevention interventions (COS-DAP): a study protocol

Background

Gestational diabetes mellitus (GDM) increases the risk of adverse short- and long-term outcomes, including development of type 2 diabetes. The US Diabetes Prevention Program demonstrates this risk can be halved with an intensive health behavior change intervention in women with pre-diabetes averaging 12?years since a GDM pregnancy. In recent years, the number of studies looking at changing the behaviors of women with previous GDM closer to the time of delivery has steadily grown, but reported outcomes vary and most studies are not long enough or large enough to examine incident diabetes. This initiative aims to develop a core outcome set (COS) for interventions seeking to prevent diabetes after pregnancy (DAP) in both women with prior GDM and their families.

Methods

The COS-DAP project will use established COS methodology, in four stages: (1) a systematic literature review of DAP prevention intervention studies following GDM; (2) discussion and cataloguing of outcomes measured and implementation components at an investigator meeting; (3) a two-round online Delphi survey aimed at prioritizing the identified outcomes; and (4) a consensus meeting with key stakeholders to review, discuss, and refine suitable COS measures, using nominal group technique.

Discussion

COS-DAP aims to develop a COS for health behavior change interventions to prevent DAP. The COS is expected to enhance opportunities for comparison of future studies and allow for better synthesis of the effects. The inclusion of multiple stakeholder perspectives will increase the final COSs applicability and relevance.

Trial registration

Comet Initiative, COMET 1083; PROSPERO, CRD42018084853. Registered in prospero on 03/01/2018.

     

Fluorescence-based sensing of glucose using engineered glucose/galactose-binding protein: a comparison of fluorescence resonance energy transfer and environmentally sensitive dye labelling strategies

Fluorescence-based glucose sensors using glucose-binding protein (GBP) as the receptor have employed fluorescence resonance energy transfer (FRET) and environmentally sensitive dyes, but with widely varying sensitivity. We therefore compared signal changes in (a) a FRET system constructed by transglutaminase-mediated N-terminal attachment of Alexa Fluor 488/555 as donor and QSY 7 as acceptor at Cys 152 or 182 mutations with (b) GBP labelled with the environmentally sensitive dye badan at C152 or 182. Both FRET systems had a small maximal fluorescence change at saturating glucose (7% and 16%), badan attached at C152 was associated with a 300% maximal fluorescence increase with glucose, though with badan at C182 there was no change. We conclude that glucose sensing based on GBP and FRET does not produce a larger enough signal change for clinical use; both the nature of the environmentally sensitive dye and its site of conjugation seem important for maximum signal change; badan-GBP152C has a large glucose-induced fluorescence change, suitable for development as a glucose sensor.     

Design characteristics of worksite environmental interventions for obesity prevention

Objective: This paper describes the design characteristics of the National Heart, Lung, and Blood Institute (NHLBI)‐funded studies that are testing innovative environmental interventions for weight control and obesity prevention at worksites. Research Methods and Procedures: Seven separate studies that have a total of 114 worksites (～48,000 employees) across studies are being conducted. The worksite settings include hotels, hospitals, manufacturing facilities, businesses, schools, and bus garages located across the U.S. Each study uses its own conceptual model drawn from the literature and includes the socio‐ecological model for health promotion, the epidemiological triad, and those integrating organizational and social contexts. The interventions, which are offered to all employees, include environmental‐ and individual‐level approaches to improve physical activity and promote healthful eating practices. Environmental strategies include reducing portion sizes, modifying cafeteria recipes to lower their fat contents, and increasing the accessibility of fitness equipment at the workplace. Across all seven studies about 48% (N = 23,000) of the population is randomly selected for measurements. The primary outcome measure is change in BMI or body weight after two years of intervention. Secondary measures include waist circumference, objective, and self‐report measures of physical activity, dietary intake, changes in vending machines and cafeteria food offerings, work productivity, healthcare use, and return on investment. Discussion: The results of these studies could have important implications for the design and implementation of worksite overweight and obesity control programs.     

Effectiveness of Cultural Adaptations of Interventions Aimed at Smoking Cessation,Diet, and/or Physical Activity in Ethnic Minorities. A Systematic Review

Background

The importance of cultural adaptations in behavioral interventions targeting ethnic minorities in high-income societies is widely recognized. Little is known, however, about the effectiveness of specific cultural adaptations in such interventions.

Aim

To systematically review the effectiveness of specific cultural adaptations in interventions that target smoking cessation, diet, and/or physical activity and to explore features of such adaptations that may account for their effectiveness.

Methods

Systematic review using MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials registers (1997–2009). Inclusion criteria: a) effectiveness study of a lifestyle intervention targeted to ethnic minority populations living in a high income society; b) interventions included cultural adaptations and a control group that was exposed to the intervention without the cultural adaptation under study; c) primary outcome measures included smoking cessation, diet, or physical activity.

Results

Out of 44904 hits, we identified 17 studies, all conducted in the United States. In five studies, specific cultural adaptations had a statistically significant effect on primary outcomes. The remaining studies showed no significant effects on primary outcomes, but some presented trends favorable for cultural adaptations. We observed that interventions incorporating a package of cultural adaptations, cultural adaptations that implied higher intensity and those incorporating family values were more likely to report statistically significant effects. Adaptations in smoking cessation interventions seem to be more effective than adaptations in interventions aimed at diet and physical activity.

Conclusion

This review indicates that culturally targeted behavioral interventions may be more effective if cultural adaptations are implemented as a package of adaptations, the adaptation includes family level, and where the adaptation results in a higher intensity of the intervention. More systematic experiments are needed in which the aim is to gain insight in the best mix of cultural adaptations among diverse populations in various settings, particularly outside the US.     

Relative health effects of education, socioeconomic status and domestic gender inequity in Sweden: a cohort study

Introduction

Limited existing research on gender inequities suggests that for men workplace atmosphere shapes wellbeing while women are less susceptible to socioeconomic or work status but vulnerable to home inequities.

Methods

Using the 2007 Northern Swedish Cohort (n = 773) we identified relative contributions of perceived gender inequities in relationships, financial strain, and education to self-reported health to determine whether controlling for sex, examining interactions between sex and other social variables, or sex-disaggregating data yielded most information about sex differences.

Results and Discussion

Men had lower education but also less financial strain, and experienced less gender inequity. Overall, low education and financial strain detracted from health. However, sex-disaggregated data showed this to be true for women, whereas for men only gender inequity at home affected health. In the relatively egalitarian Swedish environment where women more readily enter all work arenas and men often provide parenting, traditional primacy of the home environment (for women) and the work environment (for men) in shaping health is reversing such that perceived domestic gender inequity has a significant health impact on men, while for women only education and financial strain are contributory. These outcomes were identified only when data were sex-disaggregated.     

Does an ‘Activity-Permissive’ Workplace Change Office Workers’ Sitting and Activity Time?

Introduction

To describe changes in workplace physical activity, and health-, and work-related outcomes, in workers who transitioned from a conventional to an ‘activity-permissive’ workplace.

Methods

A natural pre-post experiment conducted in Vancouver, Canada in 2011. A convenience sample of office-based workers (n=24, 75% women, mean [SD] age = 34.5 [8.1] years) were examined four months following relocation from a conventional workplace (pre) to a newly-constructed, purpose-built, movement-oriented physical environment (post). Workplace activity- (activPAL3-derived stepping, standing, and sitting time), health- (body composition and fasting cardio-metabolic blood profile), and work- (performance; job satisfaction) related outcomes were measured pre- and post-move and compared using paired t-tests.

Results

Pre-move, on average (mean [SD]) the majority of the day was spent sitting (364 [43.0] mins/8-hr workday), followed by standing (78.2 [32.1] mins/8-hr workday) and stepping (37.7 [15.6] mins/8-hr workday). The transition to the ‘activity-permissive’ workplace resulted in a significant increase in standing time (+18.5, 95% CI: 1.8, 35.2 mins/8-hr workday), likely driven by reduced sitting time (-19.7, 95% CI: -42.1, 2.8 mins/8-hr workday) rather than increased stepping time (+1.2, 95% CI: -6.2, 8.5 mins/8-hr workday). There were no statistically significant differences observed in health- or work-related outcomes.

Discussion

This novel, opportunistic study demonstrated that the broader workplace physical environment can beneficially impact on standing time in office workers. The long-term health and work-related benefits, and the influence of individual, organizational, and social factors on this change, requires further evaluation.     

A Sustainable Building Promotes Pro-Environmental Behavior: An Observational Study on Food Disposal

In order to develop a more sustainable society, the wider public will need to increase engagement in pro-environmental behaviors. Psychological research on pro-environmental behaviors has thus far focused on identifying individual factors that promote such behavior, designing interventions based on these factors, and evaluating these interventions. Contextual factors that may also influence behavior at an aggregate level have been largely ignored. In the current study, we test a novel hypothesis – whether simply being in a sustainable building can elicit environmentally sustainable behavior. We find support for our hypothesis: people are significantly more likely to correctly choose the proper disposal bin (garbage, compost, recycling) in a building designed with sustainability in mind compared to a building that was not. Questionnaires reveal that these results are not due to self-selection biases. Our study provides empirical support that one''s surroundings can have a profound and positive impact on behavior. It also suggests the opportunity for a new line of research that bridges psychology, design, and policy-making in an attempt to understand how the human environment can be designed and used as a subtle yet powerful tool to encourage and achieve aggregate pro-environmental behavior.     

A Propensity-Score-Weighted Population-Based Study of the Health Benefits of Dogs and Cats for Children

There is a widely held belief that children’s general and psychological health benefits from owning and/or interacting with pets. In our study, we aimed to determine whether children who live with a dog or cat in their home have better mental and physical health outcomes compared with children without such a pet. Our study design consisted of a secondary analysis of household survey data from the 2003 California Health Interview Survey. Children in pet-owning households (n = 2,236 households with a dog or cat) were compared with children in non-pet owning households (n = 2,955 house-holds) using a weighted propensity score regression approach. Double robust regression analyses were used to examine the association between living with a dog or cat and health outcomes, while accounting for confounding factors. Our results demonstrated strong confounding effects. Unadjusted analyses found that children in pet-owning households were significantly healthier than children in non-owning households in terms of, for example, better general health, higher activity level, and less concern from parents regarding mood, behavior, and learning ability. However, when estimates were adjusted using the double robust approach, the effects were smaller and no longer statistically significant. The results indicate that the benefits of owning pets observed in this study were largely explained by confounding factors.