Obesity
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The rising U.S. obesity prevalence has disproportionately affected minority children. Previous studies have reported that among African American U.S.-born participants, those with foreign-born parents were significantly less likely to be obese than individuals with U.S.-born parents. Little is known about the children of Hispanic immigrants from Central and South America, and among 2-5 year olds in particular. The current study examined demographic characteristics of 307 children ages 2-5 year olds who participated in a randomized controlled obesity prevention intervention trial in 8 childcare centers in Miami, Florida. Anthropometric data collected included weight, height, waist circumference and body mass index (BMI). Overweight was defined as > 95th %ile for age and at- risk-for-overweight was defined as > 85th to <95th percentile, based on the Centers for Disease Control and Prevention (CDC) guidelines. Obese children were significantly more likely to be born in the US than another country (P<0.0001). Girls were equally as likely as boys to be overweight; 31% of the sample has a BMI percentile > 85th %ile. Children of Central American immigrants were significantly more likely than their Cuban or Caribbean immigrant parent counterparts to be obese (p< 0.01). Obesity prevention interventions need to target children as young as preschool age and should be tailored to the child’s ethnic background, particularly if the child was born in the US and the parents were not.

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Journal Articles
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International Journal of Interdisciplinary Social Sciences
Authors
Natale, R.
Messiah, S. E.
Barth, J.
Lopez-Mitnik, G.
Lee M. Sanders
Lee Sanders
Noya, M.

Encina Commons, Room 220
615 Crothers Way
Stanford, CA 94305-6006

(650) 721-2486 (650) 723-1919
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Professor, Health Policy
jeremy-fisch_profile_compressed.jpg
PhD

Jeremy Goldhaber-Fiebert, PhD, is a Professor of Health Policy, a Core Faculty Member at the Center for Health Policy and the Department of Health Policy, and a Faculty Affiliate of the Stanford Center on Longevity and Stanford Center for International Development. His research focuses on complex policy decisions surrounding the prevention and management of increasingly common, chronic diseases and the life course impact of exposure to their risk factors. In the context of both developing and developed countries including the US, India, China, and South Africa, he has examined chronic conditions including type 2 diabetes and cardiovascular diseases, human papillomavirus and cervical cancer, tuberculosis, and hepatitis C and on risk factors including smoking, physical activity, obesity, malnutrition, and other diseases themselves. He combines simulation modeling methods and cost-effectiveness analyses with econometric approaches and behavioral economic studies to address these issues. Dr. Goldhaber-Fiebert graduated magna cum laude from Harvard College in 1997, with an A.B. in the History and Literature of America. After working as a software engineer and consultant, he conducted a year-long public health research program in Costa Rica with his wife in 2001. Winner of the Lee B. Lusted Prize for Outstanding Student Research from the Society for Medical Decision Making in 2006 and in 2008, he completed his PhD in Health Policy concentrating in Decision Science at Harvard University in 2008. He was elected as a Trustee of the Society for Medical Decision Making in 2011.

Past and current research topics:

  1. Type 2 diabetes and cardiovascular risk factors: Randomized and observational studies in Costa Rica examining the impact of community-based lifestyle interventions and the relationship of gender, risk factors, and care utilization.
  2. Cervical cancer: Model-based cost-effectiveness analyses and costing methods studies that examine policy issues relating to cervical cancer screening and human papillomavirus vaccination in countries including the United States, Brazil, India, Kenya, Peru, South Africa, Tanzania, and Thailand.
  3. Measles, haemophilus influenzae type b, and other childhood infectious diseases: Longitudinal regression analyses of country-level data from middle and upper income countries that examine the link between vaccination, sustained reductions in mortality, and evidence of herd immunity.
  4. Patient adherence: Studies in both developing and developed countries of the costs and effectiveness of measures to increase successful adherence. Adherence to cervical cancer screening as well as to disease management programs targeting depression and obesity is examined from both a decision-analytic and a behavioral economics perspective.
  5. Simulation modeling methods: Research examining model calibration and validation, the appropriate representation of uncertainty in projected outcomes, the use of models to examine plausible counterfactuals at the biological and epidemiological level, and the reflection of population and spatial heterogeneity.
CV
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The main aim of this paper is to describe and estimate a new decomposition of disability trends among working age populations into two parts -- the part of the trend explained by changes in the prevalence of chronic disease and obesity and the part of the trend explained by changes in the prevalence of disability among people with chronic diseases. If most of the changes in disability in this population are due to change in chronic disease prevalence, then there is little room for statutory incentives as an explanation for ADL disability trends. More importantly, such a result would suggest that recent changes in disability in this population are permanent for the affected age cohorts. If this cohort survives to old age, the use of medical care by this group will place great demands on Medicare financing.

On the other hand, if an increase in disability prevalence among those with chronic disease is the explanation, then there arise two possibilities: that chronic diseases have become more severe over time, or that the incidence of even ADL-style disabilities are dependent on cultural, social, and economic determinants such as the disability insurance payments. Such a result would suggest that the increases in ADL disability seen among working age populations might not be permanent.

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Working Papers
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Proceedings from the Institute of Medicine workshop, "Disability in America: An Update," Aug. 1-2, 2005 in Washington, D.C.
Authors
Jay Bhattacharya
Jay Bhattacharya
Kavita Choudhry
Darius Lakdawalla
Jay Bhattacharya
Jay Bhattacharya
Kavita Choudhry
Darius Lakdawalla
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BACKGROUND: Recent work has shown that rates of severe disability, measured by the inability to perform basic activities of daily living, have been rising in working age populations. At the same time, the prevalence of important chronic diseases has been rising, while others falling, among working age populations. Chronically ill individuals are more likely than others to have activity of daily living limitations.

OBJECTIVE: We examine the extent to which chronic disease trends can explain these disability trends. DATA: We use nationally representative survey data from the 1984-1996 National Interview Survey, which posed a consistent set of questions regarding limitations in activities of daily living over that period.

METHODS: We decompose trends in disability into 2 parts-1 part due to trends in the prevalence of chronic disease and the other due to trends in disability prevalence among those with chronic disease.

RESULTS:: Our primary findings are that for working age populations between 1984 and 1996: (1) disability prevalence fell dramatically among the nonchronically ill; (2) rising obesity prevalence explains about 40% of the rise in disability attributable to trends chronic illness; and (3) rising disability prevalence among the chronically ill explains about 60% of the rise in disability attributable to trends in chronic illness.

CONCLUSIONS: Disability prevention efforts in working age populations should focus on reductions in obesity prevalence and limiting disability among chronically ill populations. Given the rise in disability among these population subgroups, it is unclear whether further substantial declines in elderly disability can be expected.

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Journal Articles
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Med Care
Authors
Jay Bhattacharya
Jay Bhattacharya
Choudhry K
Lakdawalla D
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Context: Without detailed evidence of their effectiveness, pedometers have recently become popular as a tool for motivating physical activity.

Objective: To evaluate the association of pedometer use with physical activity and health outcomes among outpatient adults.

Data Sources: English-language articles from MEDLINE, EMBASE, Sport Discus, PsychINFO, Cochrane Library, Thompson Scientific (formerly known as Thompson ISI), and ERIC (1966-2007); bibliographies of retrieved articles; and conference proceedings.

Study Selection: Studies were eligible for inclusion if they reported an assessment of pedometer use among adult outpatients, reported a change in steps per day, and included more than 5 participants.

Data Extraction and Data Synthesis: Two investigators independently abstracted data about the intervention; participants; number of steps per day; and presence or absence of obesity, diabetes, hypertension, or hyperlipidemia. Data were pooled using random-effects calculations, and meta-regression was performed.

Results: Our searches identified 2246 citations; 26 studies with a total of 2767 participants met inclusion criteria (8 randomized controlled trials [RCTs] and 18 observational studies). The participants' mean (SD) age was 49 (9) years and 85% were women. The mean intervention duration was 18 weeks. In the RCTs, pedometer users significantly increased their physical activity by 2491 steps per day more than control participants (95% confidence interval [CI], 1098-3885 steps per day, P .001). Among the observational studies, pedometer users significantly increased their physical activity by 2183 steps per day over baseline (95% CI, 1571-2796 steps per day, P .0001). Overall, pedometer users increased their physical activity by 26.9% over baseline. An important predictor of increased physical activity was having a step goal such as 10,000 steps per day (P = .001). When data from all studies were combined, pedometer users significantly decreased their body mass index by 0.38 (95% CI, 0.05-0.72; P = .03). This decrease was associated with older age (P = .001) and having a step goal (P = .04). Intervention participants significantly decreased their systolic blood pressure by 3.8 mm Hg (95% CI, 1.7-5.9 mm Hg, P .001). This decrease was associated with greater baseline systolic blood pressure (P = .009) and change in steps per day (P = .08).

Conclusions: The results suggest that the use of a pedometer is associated with significant increases in physical activity and significant decreases in body mass index and blood pressure. Whether these changes are durable over the long term is undetermined.

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Journal Articles
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Journal of the American Medical Association
Authors
Dena M. Bravata
C Smith-Spangler
Vandana Sundaram
Allison Gienger
Nancy D. Lin
Robyn Lewis
CD Stave
Ingram Olkin
JR Sirard
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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.
The newsletter also contains various other news items that may be of interest to our readers.

Note to the reader:

The newsletter is fully-navigational. Any text that is surrounded by a dashed box is clickable and will allow the reader to navigate the newsletter more efficiently. The end of each article contains a special symbol (§) that, when clicked, will take the reader back to the table of contents. Please feel free to contact Amber Hsiao with any questions.

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Newsletters
Publication Date
Journal Publisher
Quarterly Update
Authors
Amber Hsiao
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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.
The newsletter also contains a special Letter from the Director and various other news items that may be of interest to our readers. Note to the reader: The newsletter is fully-navigational. Any text that is surrounded by a dashed box is clickable and will allow the reader to navigate the newsletter more efficiently. The end of each article contains a special symbol (§) that, when clicked, will take the reader back to the table of contents. Please feel free to contact Amber Hsiao with any questions.
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Quarterly Update
Authors
Amber Hsiao
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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.

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Journal Articles
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Journal Publisher
American Economic Review
Authors
Lakdawalla, D.
Philipson, T.
Jay Bhattacharya
Jay Bhattacharya
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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.

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Publication Type
Journal Articles
Publication Date
Journal Publisher
American Journal of Preventive Medicine
Authors
Thomas N. Robinson
Thomas Robinson
JR Sirard
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