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Children and adolescents with attention–deficit hyperactivity disorder (ADHD) have a higher likelihood of contact with child welfare services (CWS). Evidence on whether pharmacological treatment of ADHD reduces such contact is limited.
Aims
To estimate the causal effect of pharmacological treatment of ADHD on CWS contact.
Method
In this quasi-experimental study, we used nationwide registry data covering all individuals aged 5–14 years and diagnosed with ADHD during 2009–2011 in Norway. We used linear probability models and instrument variable analyses to estimate the associations and causal effects of pharmacological treatment on CWS contact up to 4 years after diagnosis. As instrument variable analysis uses natural variation in treatment decisions between clinics as pseudo-randomisation, estimates inform effects for children and adolescents at the margin of treatment, i.e. patients whose treatment is more influenced by variation in treatment practice, e.g. due to less severe or atypical symptom presentation.
Results
A total of 5930 children and adolescents aged 5–14 years were diagnosed with ADHD between 2009 and 2011 (mean (s.d.) age 10.1 (2.4) years; 4380 males (73.9%)). Instrument variable analyses showed a reducing effect of pharmacological treatment on the use of supportive interventions by 11.9 percentage points (95% CI: −20.12, −3.80) and out-of-home-placement by 3.30 percentage points (95% CI: −6.44, −0.15) at 2-year follow-up. This corresponds to the numbers needed to treat estimates of 8 and 30, respectively.
Conclusions
Pharmacological treatment of ADHD reduces CWS contact among children and adolescents at the margin of treatment, lowering the probability of receiving supportive interventions and out-of-home placements. Findings suggest that medication reduces behavioural symptoms, which may improve the family coping mechanism and reduces the need for CWS involvement.
This chapter focuses on the role of quantitative research design in applied linguistics. It enables you to systematically gather and analyze data, providing a foundation for measuring variables, testing hypotheses, and making predictions. The chapter explores various types of quantitative research designs commonly used in the field, including experimental, quasi-experimental, correlational, and survey research designs. It also discusses the characteristics of each design, highlighting their unique subtypes, advantages, and limitations. By the end of this chapter, you will be equipped to distinguish between different quantitative research designs, critically evaluate their application in applied linguistics research, and effectively apply these methods in your own research projects.
Once context–mechanism–outcome configurations (CMOCs) have been refined through qualitative research, they can be tested using quantitative data. A variety of different analyses can be used to assess the validity of CMOCs. Overall, analyses will not assess CMOCs but are nonetheless still useful in determining overall effects. Mediation analyses assess whether any intervention effect on an outcome is explained by intervention effects on intermediate outcomes, and so can shed light on mechanisms. Moderation analyses see how intervention effects vary between subgroups defined in terms of baseline context (settings or populations) and so shed light on contextual differences. Moderated mediation analyses assess whether mediation is apparent in some context but not others, and so can shed light on which mechanisms appear to generate outcomes in which contexts. Qualitative comparative analyses can examine whether more complex combinations of markers of context and mechanism co-occur with markers of outcome. Together, this set of analyses can provide nuanced and rigorous information on which CMOCs appear most usefully to explain how intervention mechanisms interact with context to generate outcomes.
In the Netherlands, the generic work-first support seems unable to mitigate the scarring effects of prior unemployment on ethnic minorities’ careers. This study compares the impact of vulnerable ethnic minorities participating in an alternative employer-based employment programme with a control group entitled to work-first support on employment up to ten years later. We look at how both labour market interventions with different time horizon strategies may close the employment gap with the regular labour force. Results indicate that programme participants from (non-)western groups achieve higher levels of (competitive) employment than the control group, but the programme’s impact is negligible for the most established ethnic groups. The improved short-term wage match can partially explain the additional programme effect when considering the different time horizon strategies. Our results call for more employer-based programmes providing vulnerable ethnic minorities with the desired skills for better employment prospects, e.g. skill-shortage jobs.
We tested whether exposure to gun or knife violence over two decades is a cause of depression in young adulthood using data from a nationally representative sample in the United States. The National Longitudinal Study of Adolescent to Adult Health is a sample of 20,745 adolescents, assessed in 1994–95 with follow-ups in 1995–1996 (n = 14,738), 2001–2002 (n = 15,197) and 2007–2008 (n = 15,701; 24 to 32 years old). At each wave, respondents reported exposure to gun or knife violence and symptoms of depression. Regression and sibling fixed effects analyses were conducted to test whether cumulative exposure to gun or knife violence was associated with depression. In fully adjusted models, greater cumulative exposure to gun or knife violence was associated with more symptoms of depression (b = 0.12, 95% C. I. = 0.05; 0.19, p < 0.01) and higher risk for clinically significant depression in young adulthood (OR = 1.07, 95% C. I. = 1.02; 1.13, p < 0.01). Results replicated in sibling fixed effects models (b = 0.21, 95% C. I. = 0.01; 0.42, p < 0.05). These quasi-experimental data suggest that exposure to gun or knife violence is a cause of depression in young adulthood.
To investigate the effects of providing a daily healthy school snack on children’s nutritional, social and educational outcomes and explore stakeholders’ perceptions of an emergency school feeding programme (SFP).
Design:
Convergence triangulation mixed-methods study design. Associations were examined between receiving the school feeding intervention and children’s outcomes using multivariable regression models. Quantitative data were complemented with interviews and focus group discussions with parents and staff.
Setting:
In vulnerable communities in Lebanon, the World Food Programme has implemented an emergency SFP targeting Lebanese (attending morning sessions) and Syrian refugee children (attending afternoon sessions) in public schools.
Participants:
Children from ten intervention schools (morning n 403; afternoon n 379) and ten matched control schools (morning n 399; afternoon n 401), as well as twenty-nine parents and twenty-two school staff members.
Results:
Diet diversity was higher in intervention schools as compared with control with a significantly higher consumption of dairy products, nuts and fruit in both sessions. Child-reported food insecurity experience was lower in children attending the afternoon session of intervention v. control schools. The SFP intervention was associated with higher school engagement and sense of school community in the morning session only. While the SFP was significantly associated with higher attendance for children in afternoon sessions only, it was significantly associated with school retention of children in both sessions.
Conclusions:
A daily healthy snack potentially acts as an incentive to improve children’s nutritional outcomes, school engagement, sense of belonging, equality between students and improvement in children’s attendance and retention in public schools.
Primary schools contribute to promoting healthy eating behaviour and preventing overweight and obesity by providing nutrition education. Research highlights the importance of improving teachers’ programme implementation to enhance intervention effectiveness. An integrative approach has been suggested to reduce time barriers that teachers currently experience in teaching nutrition. This scoping review explores use and effectiveness of integrative teaching in primary-school-based nutrition education programmes. Six databases were searched for primary-school-based interventions on nutrition education. Papers reporting on integration of nutrition topics within core curriculum were included. Abstracts and full texts of potentially relevant articles were screened to determine eligibility. Next, data were extracted and tabulated. Findings were collated and summarised to describe intervention characteristics, subject integration and effectiveness of the included programmes. Data describing integration of nutrition into the primary school curriculum were extracted from 39 eligible papers. Nutrition education programmes often involve lessons about food groups and are frequently embedded within the mathematics, science or literacy syllabus. Although articles report on the integration of nutrition, the use of this approach was not commonly described in detail. Only seven papers discussed student outcomes related to the integration of nutrition education within core subjects. The ability to draw strong conclusions about school-based nutrition intervention effectiveness is limited by the current lack of programme description and methodological issues. Hence, more research is warranted to inform evidence on effectiveness of integrative nutrition education for both teacher and student outcomes. Future studies that include greater detail regarding the integrative approach are needed.
Maize production is central to rural livelihoods in the hills of Nepal. Access to affordable improved maize seed has long been a barrier to productivity gains and livelihood improvement. This study evaluates the direct and indirect (spillover) impacts of a community-based seed production program in Nepal using a quasi-experimental method for selected outcome indicators. Our results show that community-based seed production provides a significant positive direct impact on maize income and female leadership opportunities. The impacts were particularly favorable for disadvantaged households (HHs) from lower castes and HHs that owned less land. There is also strong evidence of spillover impacts on improved seed adoption, yield, and household maize self-sufficiency. Community-based seed production thereby could help Nepal attain cereal self-sufficiency and nutritional security as envisioned in the national agricultural development strategy and seed vision.
The US National Institutes of Health (NIH) established the Clinical and Translational Science Award (CTSA) program in response to the challenges of translating biomedical and behavioral interventions from discovery to real-world use. To address the challenge of translating evidence-based interventions (EBIs) into practice, the field of implementation science has emerged as a distinct discipline. With the distinction between EBI effectiveness research and implementation research comes differences in study design and methodology, shifting focus from clinical outcomes to the systems that support adoption and delivery of EBIs with fidelity.
Methods:
Implementation research designs share many of the foundational elements and assumptions of efficacy/effectiveness research. Designs and methods that are currently applied in implementation research include experimental, quasi-experimental, observational, hybrid effectiveness–implementation, simulation modeling, and configurational comparative methods.
Results:
Examples of specific research designs and methods illustrate their use in implementation science. We propose that the CTSA program takes advantage of the momentum of the field's capacity building in three ways: 1) integrate state-of-the-science implementation methods and designs into its existing body of research; 2) position itself at the forefront of advancing the science of implementation science by collaborating with other NIH institutes that share the goal of advancing implementation science; and 3) provide adequate training in implementation science.
Conclusions:
As implementation methodologies mature, both implementation science and the CTSA program would greatly benefit from cross-fertilizing expertise and shared infrastructures that aim to advance healthcare in the USA and around the world.
Forest conservation incentives are a popular approach to combatting tropical deforestation. Here we consider a case where direct economic incentives for forest conservation were offered to newly titled smallholders in a buffer zone of a protected area in the northeastern Ecuadorian Amazon. We used quasi-experimental impact evaluation methods to estimate changes in forest cover for 63 smallholders enrolled in Ecuador's Socio Bosque program compared to similar households that did not enroll. Focus group interviews in 15 communities provided insight into why landowners enrolled in the program and how land use is changing. The conservation incentives program reduced average annual deforestation by 0.4–0.5% between 2011 and 2013 for those enrolled, representing as much as a 70% reduction in deforestation attributable to Socio Bosque. Focus group interviews suggested that some landowners chose to ‘invest’ in conservation because the agricultural capacity of their land was limited and economic incentives provided an alternative livelihood strategy. Interviews, however, indicated limits to increasing enrollment rates under current conditions, due to lack of trust and liquidity constraints. Overall, a hybrid public–private governance approach can lead to larger conservation outcomes than restrictions alone.
This study's focus is to evaluate a sexual coercion prevention program in adolescents. Using a beforeand- after design with both a treatment group (n = 93) and a control group (n = 76), an intervention of seven sessions was completed. Said sessions included such content as conceptualizing sexual freedom, sexual coercion and voluntary consent, analyzing different sexual coercion tactics and the contexts in which they occur, empathy toward the victim, and developing abilities to avoid risky situations. Other risk factors for coercive behavior and sexual victimization are explored as well, such as alcohol use, sexist attitudes and inadequate communication, among others. The intervention's results include a decrease in stereotypical beliefs about the opposite sex and increased empathy toward victims of sexual coercion. These changes were maintained with the passage of time. Also, in the treatment group, a more acute decline was observed in the proportion of young people engaging in sexually coercive behaviors. This article emphasizes the importance, necessity and efficacy of such interventions, and discusses and analyzes possible improvements to the program for its future implementation.
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