Tag Archives: prevention

cancerBy H. Roger Segelken
Reprinted from Cornell Chronicle, March 25, 2015

The doctor says: “We offer two kinds of surgery for your cancer. Both procedures have 80 percent cure rates. After the first kind, 4 percent of patients have serious complications. In the second type, 20 percent simply die. No pressure to decide, but the sooner we start …”

Wishing you hadn’t slept through statistics class – trying to remember what went wrong with Uncle Joe’s surgery, and longing for the days when doctors knew best – you seek counsel in a decision-support tool, online or at the nearest cancer resource center.

“In fact, there are more than 40 tools to help people make informed decisions in cancer prevention, screening and treatment,” says Valerie F. Reyna, professor of human development in Cornell’s College of Human Ecology. “The more effective decision-support aids help with the numeracy problem – is a 10 percent chance riskier than one in a thousand? But not all tools help patients use their values, emotions and life experience to make decisions that affect their lives and their families’ future.”

Writing in the February-March 2015 special issue of American Psychologist, in an article titled “Decision Making and Cancer,” Reyna and her research colleagues want support tools to accommodate what they call “bottom-line gist options” that swirl though a patient’s mind – along with “verbatim” details about probable risk and whatever else the doctor said.

Gist is at the core of Fuzzy Trace Theory (which Reyna applied most recently to patients’ decisions to take antibiotics even though the misery is probably caused by viruses, not bacteria), and there’s nothing wrong with listening to one’s heart, Reyna says.

Reyna and her co-authors explain that “gist involves understanding meaning (insight in the gestalt sense) – integrating dimensions of information to distill its essence, not just processing fewer dimensions of information that are ‘good enough.’” Although people incorporate both verbatim details and gist in decision making, “they generally have a fuzzy processing (gist) preference” for information, the authors report.

The researchers offer this prescription for a Fuzzy Trace Theory-based cancer-decision tool: Ensure that patients understand the essential gist meaning of information; remind patients of an array of simple social and moral values that are important to them and that have relevance to the decision at hand; and assist patients in applying their values throughout the decision process.

“Every phase of the cancer continuum – from prevention, screening and diagnosis to treatment, survivorship and end of life – is fraught with challenges to our abilities to make informed decisions,” says Reyna. “People are not optimal decision makers. We struggle with complex information about benefits and risks, tradeoffs and uncertainties in cancer treatment.”

An impassionate computer could make optimal decisions on our behalf – disregarding the gist of what we think is best for us, Reyna adds. But the computer is too literal to make the best decisions for people, Reyna says: “Decision support should strive to capture the gist, the essential bottom line, of patients’ options.”

Reyna, director of the Human Neuroscience Institute in the College of Human Ecology, is the first author on the paper along with Wendy L. Nelson, National Cancer Institute; Paul K. Han, Maine Medical Center, Scarborough, Maine; and Michael P. Pignone, University of North Carolina at Chapel Hill.

Preparation of the American Psychologist report was supported, in part, by awards from the National Cancer Institute of the National Institutes of Health and the National Institute of Nursing Research.

 
New York families will soon have more access to evidence-based programs that prevent substance abuse among middle school students and their families.

The PROSPER partnerships - which stands for PROmoting School-community-university Partnerships to Enhance Resilience  - are a model for implementing substance abuse prevention programming based on real evidence. The program links Cooperative Extension, public schools, and local communities to choose proven programs that serve the needs of individual communities.

Last month, New York was chosen as one of five states in that will continue the process of forming a PROSPER Partnership, with Cornell serving as the university partner. Read more

Kim KopkoCornell Cooperative Extension (CCE) is preparing communities across New York for an innovative system to more effectively deliver research-based programs to prevent substance abuse and risky behavior in young teens.

 
 

With a two-year, $60,000 Greater Opportunities (GO) grant from the National Institutes of Health, CCE will adapt the PROSPER (PROmoting School-community-university Partnerships to Enhance Resilience) Partnership Model, which pairs CCE systems with public schools to provide a range of interventions for at-risk youth. PROSPER offers proven prevention strategies backed by more than 20 years of NIH-funded research.

"The initial PROSPER/GO funding is a great opportunity to build capacity for community- and school-based family and youth programs that have a track record of success," said Kimberly Kopko, New York state liaison for PROSPER and extension associate in policy analysis and management. "PROSPER/GO aligns closely with the missions of CCE and Human Ecology and will also bring resources for our faculty researchers looking at designing interventions to engage youth."

Valerie Reyna is PI on a new three-year federal formula funds project called Reducing Risk Taking in Adolescence Using Gist-Based Curricula. Reyna’s research team will partner with Cornell University Cooperative Extension in New York City to refine and test interventions to reduce unplanned pregnancy, sexually transmitted diseases, and the incidence of obesity among youth in New York State. Three interdependent lines of research form the basis for the project: research on human judgment and decision making, on adolescent risky decision making, and on sexual risk interventions for youth.  Most recently, Reyna and colleagues completed a 5- year grant funded by from the National Institutes of Health to implement fuzzy-trace theory’s principles of representation and retrieval in a randomized trial with high school students designed to reduce premature pregnancy and sexually transmitted infections.  This research will directly inform the current project.
The project will further refine and test the Gist-Enhanced Reducing the Risk (RTR+) curriculum, a successful sexually transmitted disease and pregnancy prevention curriculum based on Dr. Reyna’s research on adolescent decision making. A recent randomized control trial has shown the RTR+ curriculum to be effective.  The purpose of this study is to further increase the magnitude and duration of these effects and develop a teaching guide to facilitate implementation in New York State.

The project will also develop and test a “gist-enhanced” healthy lifestyles curriculum by applying Dr. Reyna’s research to another critical risk domain – obesity.  The thrust of this effort will be to enhance an existing evidence-based healthy lifestyles curriculum to incorporate new ways of “framing” healthy lifestyle decisions for youth.  Research indicates this will increase the effectiveness of interventions.  Data will be collected in preparation for a larger funding proposal. Finally, through an online professional development presentation, the project will seek to share the research and lessons learned with extension educators and others.

Through this research-community partnership, the project will combine empirical research from Reyna’s work, with practical knowledge gained through implementation of the two curricula, and use this knowledge to inform and facilitate future replications of the programs in New York and elsewhere.

For Further Information
Risky Decision Making in Adolescents
Laboratory for Rational Decision Making

Human Development Outreach & Extension

Human Development Today e-News

When people hear about elder abuse in nursing homes, they usually think of staff members victimizing residents. However, research by Professor Karl Pillemer suggests that a more prevalent and serious problem may be aggression and violence that occurs between residents themselves.

Such “resident-to-resident mistreatment” can have serious consequences for both aggressors and victims. However, the issue has received little attention from researchers to date and few proven solutions exist to prevent resident altercations.

Pillemer, Director of the Cornell Institute for Translational Research on Aging at the College of Human Ecology, has co-authored two articles in Aggression and Violent Behavior and the Journal of the American Geriatrics Society on the subject with Weill Cornell Medical College collaborators Mark S. Lachs and Tony Rosen. Both find that verbal and physical aggression between residents is common and problematic and that more research is necessary to identify risk factors and preventative measures.

“Anyone who spends much time in a nursing home will observe arguments, threats, and shouting matches among residents, as well as behaviors like pushing, shoving, and hitting,” Pillemer said.

“Given that nursing homes are environments where people live close together and many residents have lowered inhibitions because of dementia, such incidents are not surprising,” he said. “Because of the nature of nursing home life, it is impossible to eliminate these abusive behaviors entirely, but we need better scientific evidence about what works to prevent this problem.”

The joint research project found 35 different types of physical and verbal abuse between residents at a large urban nursing home Screaming was the most common form of aggression, followed by physical violence such as pushing and punching or fighting. In related work, the authors found that 2.4 percent of residents reported personally experiencing physical aggression from another resident and 7.3 percent reported experiencing verbal aggression over just a two-week period.

Most respondents rated the events as moderately or extremely disruptive to daily activities. In another study, 12 nurse-observers identified 30 episodes of resident-to-resident aggression on a just a single eight-hour shift, 17 of which were physical.

Research also indicates that residents who are victims of aggression are more likely to be male, have behavioral problems like wandering, and be cognitively impaired. However, they tend to be more physically independent.

While such incidents are difficult to prevent, these types of studies will help nursing home staff manage aggression among patients, Pillemer said.

Dr. Lachs, co-Chief of Geriatrics at Weill, added: “At present, staff have few solutions available to them and typical interventions in the nursing home may have negative consequences for aggressive residents, including the use of psychotropic medications or isolation of the resident. We hope our work will help inspire a vigorous search for programs that work to prevent aggression and violence among residents in long-term care.”

Kimberly Kopko, Ph.D., Associate Director of Cornell Cooperative Extension and Associate Director of Extension and Outreach in the College of Human Ecology

John Eckenrode, Ph.D., Professor of Human Development and Associate Director of the Bronfenbrenner Center for Translational Research, conducts research and participates in extension-related activities in the area of child abuse and neglect. Dr. Eckenrode has spent part of his academic career examining the long-term effects of the Nurse-Family Partnership program (NFP) on the life-course of high-risk mothers and the development of their children. This research-based and theory driven early intervention program has been successful in reducing the incidence of child abuse and neglect in at-risk families and has evolved into a nationally-known and recognized applied program with both practice and policy applications.

Nurse-Family Partnership

Dr. David Olds, who received his Ph.D. in Human Development, initially conducted the Nurse-Family Partnership Project in 1977 in Elmira, New York. Four hundred young women, most of whom were young, unmarried, low-income and pregnant for the first time, participated in this study. The participants were assigned to different groups: a treatment group of mothers who received an average of 9 nurse home visits during pregnancy and 23 home visits from the child’s birth until the child’s second birthday, and a control group of mothers who did not receive nurse visits. During the visits, the nurses discussed 1) health-related behaviors during pregnancy and the early years of the child’s life; 2) the care parents provide to their children; and 3) personal life course development for mothers (family planning, educational achievement, and work force participation).

Fifteen-Year Follow-up Studies

Fifteen years following the original study, Eckenrode joined Dr. Olds and his colleagues to investigate the long-term effects of this intervention on the health and development of these women and children. Results from this study revealed the beneficial, long-term effects of the nurse home visitation program, including a reduction in the number of reports of child abuse and neglect, the number of subsequent pregnancies and births, use of welfare, fewer behavioral problems resulting from drug and alcohol abuse and a reduction in criminal behavior among the study participants.

A separate study headed by Eckenrode sought to answer a specific question: whether the presence of domestic violence limited the effects of nurse home visitation in reducing reports of child abuse and neglect. Findings showed that reports of child maltreatment did not decrease in those households where domestic violence was the highest during the 15-year period following the birth of the first child. This finding prompted the researchers to conclude that the presence of domestic violence may limit the effectiveness of interventions to reduce the incidence of child abuse and neglect. However, it is important to note that the impact of domestic violence did not affect the other program outcomes (e.g. subsequent birth rate, use dependence on welfare) but rather was specific to child abuse and neglect.

In addition to the positive maternal outcomes, analyses using the same 15-year follow up data revealed that nurse home visitation also reduced the prevalence of certain problematic behaviors—including arrests, alcohol use, and promiscuous sexual behavior—among the 15-year-old children born to the high risk mothers.

The positive outcomes for youth in the nurse-visited group prompted a further study in which Eckenrode and his colleagues examined the early onset of antisocial behaviors for the 15-year-old youth. Findings revealed a relationship between child maltreatment and early-onset problem behaviors for youth who did not receive home visits. However, no relationship between maltreatment and early onset problem behaviors was found for the youth in the nurse-visited group.

Eckenrode and his collaborators suggest that the nurse home visits prevented the occurrence of many types and chronic forms of maltreatment and also prevented maltreatment that extended across several important development stages (e.g., maltreatment that occurred both in childhood and early adolescence). The maltreatment that did occur in the treatment group children tended to occur earlier in the children’s lives and did not continue over long periods of time. These findings suggest that home visiting by nurses reduces the risk of child maltreatment as well as potential future conduct problems and antisocial behavior among children and youth born into at-risk families.

Many of the beneficial effects of the program found in the Elmira trial and concentrated in higher risk groups were reproduced in a trial in Memphis, Tennessee (1988). Similar results were likewise found in a Denver, Colorado trial (1994). Consistent program effects from the Elmira and Memphis trials include: improvement in women’s prenatal health, fewer childhood injuries, fewer subsequent pregnancies, increased intervals between births, increased employment for mothers, reductions in welfare and food stamps, and improved school readiness for children. Overall, The Elmira and Memphis trials demonstrate that the nurse home visitation program achieved two of its most important goals—improved prenatal and subsequent care of children and improved effects on women’s life course. Findings from NFP research has received national attention from the United States Advisory Board on Child Abuse and Neglect which recommended the availability of home visitation services to all parents of newborns as a preventive measure against child abuse and neglect.

From Science to Practice

The National Center for Children, Families, and Communities was established at the University of Colorado Health Sciences Center to help new communities develop the Nurse-Family Partnership. The National Center is organized around nurturing community and state development of the capacities necessary for the success of the program. As of 2006, the Nurse-Family Partnership served clients in approximately 150 sites across 21 states.

This program of prenatal and infancy home visiting by nurses shows considerable promise for reducing some of the most damaging and widespread problems faced by low-income children and families in our society.

For Further Information:

Family Life Development Center: http://www.human.cornell.edu/fldc/

Nurse-Family Partnership: www.nursefamilypartnership.org

Nurse-Family Partnership Newsletter:  http://www.nursefamilypartnership.org/about/news/nfp-newsletter

National Data Archive on Child Abuse and Neglect: http://www.ndacan.cornell.edu/

Child Abuse Prevention Network: http://child.cornell.edu/

Child Abuse Recovery Programs: http://www.recovery.org/topics/choosing-the-best-inpatient-child-abuse-and-addiction-recovery-center/

STATISTICS: 15-YEAR FOLLOW-UP STUDIES

Long-term effects of nurse home visitation on low-income, unmarried mothers’ behavior:

79% fewer verified reports of child abuse and neglect
32% fewer subsequent births 30 fewer months of welfare use
44% fewer behavioral problems due to alcohol and drug abuse
61% fewer arrests

Long-term effects of nurse home visitation on children’s criminal and antisocial behavior:

59% fewer arrests
69% fewer convictions
58% fewer sexual partners
28% fewer cigarettes smoked per day
51% fewer days having consumed alcohol (last 6 months)

References

Eckenrode, J., Ganzel, B., Henderson, C.R., Smith, E., Olds, D., Powers, J., Cole, R., Kitzman, H., & Sidora, K. (2000). Preventing child abuse and neglect with a program of nurse home visitation: The limiting effects of domestic violence. Journal of the American Medical Association, 284, 1385-1391.

Eckenrode, J., Zielinski, D., Smith, E., Marcynyszyn, L.A., Henderson, C.R., Jr., Kitzman, H., Cole, R., Powers, J., & Olds, D.L. (2001). Child maltreatment and the early onset of problem behaviors: Can a program of nurse home visitation break the link? Development and Psychopathology, 13, 873-890.

Olds, D.L. (2002). Prenatal and infancy home visiting by nurses: From randomized trials to community replication. Prevention Science, 3, 153-172.

Olds, D.L., Eckenrode, J., Henderson, C.R., Jr., Kitzman, H., Powers, J., Cole, R., Sidora, K., Morris, P., Pettitt. L.M., & Luckey, D. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect: 15-year follow-up of a randomized trial. Journal of the American Medical Association, 278, 637- 643.

Janis Whitlock

A new project, “Youth-Development Based Resources for Preventing Self-Inflicted Violence and Promoting Positive Coping in Adolescents” has received 3 year funding through a Smith-Lever grant. The project is intended to develop downloadable materials and presentations that increase awareness of individual and environmental factors leading to non-suicidal self-injury (NSSI), offer YD-based approaches to enhance coping in adolescents, and build capacity to detect and respond to NSSI and other signs of distress and violence in youth. The materials will be designed for use by Cooperative Extension Educators but are intended to be of value and use to others as well. The Principal Investigators are Janis Whitlock, John Eckenrode, and Jane Powers and the grant will be administered out of the Family Life Development Center (FLDC).

Further Resources

Cornell Research Program on Self-Injurious Behavior

video logo The Cutting Edge: What Parents Need to Know About Self-Injury in Adolescents. Dr. Janis Whitlock, February 28, 2007.