I have been blogging lightly as of late because tomorrow is my oldest’s Bar Mitzvah, and that has consumed much of my free time this week. But there are some papers worthy of note, and I will point you to them. First up, JAMA, with “Wearable Devices as Facilitators, Not Drivers, of Health Behavior Change“:
Several large technology companies including Apple, Google, and Samsung are entering the expanding market of population health with the introduction of wearable devices. This technology, worn in clothing or accessories, is part of a larger movement often referred to as the “quantified self.” The notion is that by recording and reporting information about behaviors such as physical activity or sleep patterns, these devices can educate and motivate individuals toward better habits and better health. The gap between recording information and changing behavior is substantial, however, and while these devices are increasing in popularity, little evidence suggests that they are bridging that gap.
Only 1% to 2% of individuals in the United States have used a wearable device, but annual sales are projected to increase to more than $50 billion by 2018.1 Some of these devices aim at individuals already motivated to change their health behaviors. Others are being considered by health care organizations, employers, insurers, and clinicians who see promise in using these devices to better engage less motivated individuals. Some of these devices may justify that promise, but less because of their technology and more because of the behavioral change strategies that can be designed around them.
My skepticism of this technology’s inherent ability to change health en masse is already on record. This piece highlights one of the issues – that in order for them to be effective, they have to be part of an engagement strategy that uses the technology to affect behavior change. Unfortunately, that won’t come in the package, and it’s much harder to do. Go read it. It’s short.
Next up is Pediatrics, “Children’s Academic Achievement and Foster Care“:
BACKGROUND AND OBJECTIVES: Poor school outcomes for children in out-of-home placement (OHP) raise concerns about the adequacy of child welfare and educational policy for this vulnerable population. We analyzed the relation between OHP and academic achievement, focusing on reading and math achievement in grades 3 through 8.
METHODS: Linked administrative data were used for our analytic sample comprising 529 597 child-year observations for 222 049 children who experienced OHP or were in a comparison group. Three models were estimated: a pooled ordinary least squares regression that considered placement status and test scores net of the full set of control variables; an identical model that added the previous year’s test scores as an additional control; and a final model that included child-specific fixed effects.
A number of studies have found that kids placed in foster care suffer from a number of adverse outcomes, including poorer academic achievement. This study looked at a large data set to try and understand this better. They found, in a simple bivariate analysis, that kids in foster settings did have test scores more than a half of a standard deviation below average. But, they also found that this deficit was associated not only with current and past foster placement, but also with future foster placement.
Moreover, in the model that was preferred (ie most robust) by the authors, because it controlled for child-specific fixed effects, foster placement had no effect at all on academic achievement. In other words, foster placement is associated with poorer academic achievement, but likely not causing it. Something else, which is associated with foster placement, is likely the cause.
This means that while we should be concerned about kids in foster care, and recognize that it’s, perhaps, a marker for kids at risk for lower academic achievement, it’s not the an independent predictor of school troubles. Many have often viewed it negatively for this reason, mistakenly so.