This issue of CHP/PCOR's Quarterly Update covers news from the Summer 2007 quarter and includes articles about:

• two reports on care coordination -- one on care coordination strategies in general, and a second on care coordination specifically for children with special health care needs;

• an international health section that features work done by undergraduates this summer (with mentorship and guidance from CHP/PCOR staff) on the GOBI initiative, as well as a summary of a the new Children's Project established by core faculty member Paul H. Wise;
• two Research in Brief selections -- one highlights the impact of pay for performance reimbursement structures on end-stage renal disease care, and the second examines the link between obesity and wages in Europe;
• a Medicare restructuring and refinancing piece that highlights the work of director and core faculty member Alan M. Garber, core faculty member Victor R. Fuchs, and colleagues;
• a piece on the effect of chronic illnesses such as obesity on disability trends in the near-elderly population;
• a Staff Spotlight feature on two CHP/PCOR research assistants.

Note to the reader:

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Purpose: Lung cancer is a leading cause of cancer death worldwide. Although smoking remains the predominant cause of lung cancer, lung cancer in never smokers is an increasingly prominent public health issue. However, data on this topic, particularly lung cancer incidence rates in never smokers, are limited.

Methods: We reviewed the existing literature on lung cancer incidence and mortality rates among never smokers and present new data regarding rates in never smokers from the following large, prospective cohorts: Nurses' Health Study; Health Professionals Follow-Up Study; California Teachers Study; Multiethnic Cohort Study; Swedish Lung Cancer Register in the Uppsala/Orebro region; and First National Health and Nutrition Examination Survey Epidemiologic Follow-Up Study.

Results: Truncated age-adjusted incidence rates of lung cancer among never smokers age 40 to 79 years in these six cohorts ranged from 14.4 to 20.8 per 100,000 person-years in women and 4.8 to 13.7 per 100,000 person-years in men, supporting earlier observations that women are more likely than men to have non-smoking-associated lung cancer. The distinct biology of lung cancer in never smokers is apparent in differential responses to epidermal growth factor receptor inhibitors and an increased prevalence of adenocarcinoma histology in never smokers.

Conclusion: Lung cancer in never smokers is an important public health issue, and further exploration of its incidence patterns, etiology, and biology is needed.

This issue of CHP/PCOR's Quarterly Update covers news from the Fall 2006 quarter and includes articles about:

• the effect of health insurance on obese individuals' behaviors, as well as possible approaches and policy questions with regards to the obesity epidemic;
• the state of disaster preparedness in the United States. Are we ready yet? Experts provided comments at a fall conference and presented data on the intricacies of the topic;
• the state of children's health -- two pieces provide broad coverage of international and U.S.-based news on current policies and debates surrounding children's health;
• the health services and policy research scholarly concentration within the School of Medicine, with a special profile piece from a third-year medical student; and
• two Research in Brief selections, a new feature that highlights recently-published CHP/PCOR research and how such research is informing health care practices and public perceptions.

We use the National Health and Nutritional Examination Survey (NHANES) III to examine the effect of the availability of the school breakfast program (SBP). Our work builds on previous research in four ways: First, we develop a transparent difference-in-differences strategy to account for unobserved differences between students with access to SBP and those without. Second, we examine serum measures of nutrient in addition to intakes based on dietary recall data. Third, we ask whether the SBP improves the diet by increasing/or decreasing the intake of nutrients relative to meaningful threshold levels. Fourth, we examine the effect of the SBP on other members of the family besides the school-aged child. We have three main findings. First, the SBP helps students build good eating habits: SBP increases scores on the healthy eating index, reduces the percentage of calories from fat, and reduces the probability of low fiber intake. Second, the SBP reduces the probability of serum micronutrient deficiencies in vitamin C, vitamin E, and folate, and it increases the probability that children meet USDA recommendations for potassium and iron intakes. Since we find no effect on total calories these results indicate that the program improves the quality of food consumed. Finally, in households with school-aged children, both preschool children and adults have healthier diets and consume less fat when the SBP is available. These results suggest that school nutrition programs may be an effective way to combat both nutritional deficiencies and excess consumption among children and their families.

There has been concern about the dramatic growth in obesity seen in developed countries. This paper advances the view that a neoclassical interpretation of weight growth that relies on changing incentives does surprisingly well in explaining the observed trends, without resorting to psychological, genetic, or addictive models.

Past research has identified social and environmental causes and correlates of behaviors thought to be associated with obesity and weight gain among children and adolescents. Much less research has documented the efficacy of interventions designed to manipulate those presumed causes and correlates. These latter efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. The implications of this problem-oriented approach are responsible for leaving many of the most important applied research questions unanswered, and for slowing efforts to prevent obesity and improve individual and population health. An alternative, and complementary, solution-oriented research paradigm is proposed, emphasizing experimental research to identify the causes of improved health. This subtle conceptual shift has significant implications for phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice. The solution-oriented research paradigm encourages research with more immediate relevance to human health and a shortened cycle of discovery from the laboratory to the patient and population. Finally, a "litmus test" for evaluating research studies is proposed, to maximize the efficiency of the research enterprise and contributions to the promotion of health and the prevention and treatment of disease. A research study should only be performed if (1) you know what you will conclude from each possible result (whether positive, negative, or null); and (2) the result may change how you would intervene to address a clinical, policy, or public health problem.