Browsing by Author "Emery, Herb"
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Item Open Access Addressing Misleading Nutrition Marketing on Children's Foods(2013-08) Veit, Christine; Emery, HerbChildhood obesity is a complex issue with many contributing factors. Today, children live in an obesogenic environment that promotes the consumption calorie dense foods high in sugar, fat, and sodium. While much of the previous research has focused on linking the consumption of junk foods to obesity, an important area that has been overlooked until recently is how regular children’s foods are contributing to the childhood obesity epidemic. Today, a large proportion of children’s foods are being marketed with nutrition claims, health claims, and industry generated front-of-package nutrition logos despite the fact that they contain high levels, of sugar, fat, and sodium. A study by Elliott (2008) found that 89% of the children’s foods in Canadian grocery stores were marketed with nutrition and health claims, yet 63% of them could be classified “as of poor nutritional quality” due to their high levels of sugar, fat, and sodium. Similarly, a study by Colby (2010) examining a large sample of foods in the US found that 42% of children’s foods contained both nutrition marketing and high levels of saturated fat, sugar, and sodium. These regular foods which include granola bars, breakfast cereals, fruit leathers, and yogourts are often marketed with claims such as ‘excellent source of calcium’, ‘reduced fat’, and ‘made with real fruit juice’ in large font on the front of the packaging of children’s foods in order to appeal to parents. Claims that prominently single out one nutrient in large bold font of the front of a food package in a nutritionally inferior product high in sugar, fat, and sodium could be construed as misleading advertisement. The misleading information conveyed by claims on children’s food packaging can be framed as a problem of information asymmetry. Foods boldly displaying large nutrition claims that draw attention one nutrient in an otherwise unhealthy product interfere with parents’ ability to accurately judge the nutritional quality of the foods they are purchasing for their children. As a result, many uninformed parents swayed by health and nutrition claims may end up purchasing foods for their children that are high in sugar, fat, and salt. Regulated nutrition and health claims as well as unregulated industry generated nutrition logos constitute the two main sources of information asymmetry. Although the Food and Drugs Regulations lay out specific criteria for the use of nutrition and health claims, it falls short in two major areas: it does not prohibit foods high in sugar, fat, and sodium from carrying health or nutrition claims, nor does it prohibit food manufacturers from displaying their own unregulated nutrition logos on the front of children’s food packages. As a result, food manufacturers are free to continue aggressively marketing their unhealthy foods to parents with important consequences for children’s weight and their future health.Item Embargo Educational Outcomes for Students with Autism and the Factors that Contribute to these Outcomes(2015-11) Lukmanji, Sara; Emery, HerbThe rising prevalence of autism spectrum disorder (ASD) diagnoses, combined with the importance of education to many aspects of quality of life in adulthood, makes determining the educational outcomes of individuals with ASD an important investigation. Two literature searches are conducted to determine first, the educational outcomes for students with ASD, and second, the factors that contribute to these outcomes. Subsequently, taking these findings into consideration, policy recommendations regarding ways to better support students with ASD and facilitate positive educational outcomes are proposed. Based on the first literature search, the educational outcomes for individuals with ASD are worse compared to many of their peers with disabilities as well as the general population. In terms of secondary school, students with ASD generally perform several levels below their grade level. In addition, in spite of their low drop out rates, students with ASD have low secondary school completion rates. The postsecondary outcomes of students with ASD are also not as good as they could be. Similar to their secondary school performance, the post-secondary school enrollment rate for students with ASD was lower when compared with many of their peers with disabilities as well as neurotypicals. In addition, students with ASD had one of the lowest post-secondary completion rates in comparison with other students with disabilities. Based on a second literature search, several individual factors, as well as factors external to the individual, are identified as contributors to the educational outcomes of students with ASD as determined by the first literature search. The individual factors that contribute to these outcomes are: severity of the ASD condition, functional ability and independence, social skills, and age and ethnicity. The factors external to the individual that contribute to the aforementioned outcomes include: the education system, family expectations, and family income. These factors all interact in a complex way to influence educational outcomes for students with ASD. Although it is not a simple task, these factors can be addressed through policy changes. For example, changes can be made within the education system (i.e. extending the transition period) as well as on a broader level (i.e. creating provincial standards) in order to help improve educational outcomes for students with ASD.Item Open Access The Effectiveness of Education Based Programs Delivered by Nondental Professionals for Preventing Early Childhood Caries(2015-03) Brar, Pamneet; Emery, HerbEarly childhood caries is the most common chronic infectious disease in children, yet completely preventable with proper oral hygiene. With Severe ECC, children require costly dental surgery, especially for those from low socioeconomic families. This is due to the fact that children under five years of age do not routinely encounter a dental care provider until it is too late. Nondental healthcare providers, on the other hand, are uniquely positioned to intervene. The objectives of this literature review was to determine whether dental health education programs provided by nondental care providers could improve outcomes related to early childhood caries for low-income children. And secondly, to identify effective dental education programs for caries prevention. A comprehensive review of current literature was conducted to meet these objectives. Home visitation delivered by nurses was found to be an effective and cost-efficient ways to deliver dental education. When support in terms of screening, oral hygiene instruction, and dental referrals are combined with education, the positive impact on early childhood caries increased. In conclusion, policymakers should implement oral health promotion programs using a combination of education and support delivered by nursing staff in client’s homes. Programs can be embedded into existing healthcare services across the province. However, services should be concentrated in low socioeconomic status communities and regions within Alberta. Furthermore, nurses must collaborate across disciplines to ensure seamless integration of oral health with general health and push for more rigorous research in this area to guide best practice. In conclusion, a combination of tailored approaches is necessary to achieve a sustained improvement in oral health throughout early childhood.Item Open Access Essays in Labor, Public and Health Economics(2017) Zaresani, Arezou; Staubli, Stefan; Emery, Herb; Campa, Pamela; Magesan, ArvindThis thesis consists of three chapters. In the first chapter, I investigate how important are ad- justment costs for individuals when they face incentives to work induced by a policy change. I provide the first estimate of heterogeneous adjustment costs by exploiting a unique policy change that induces large incentives to work. The policy change dramatically decreased marginal tax rates on earnings in a non-linear tax schedule on earnings in a disability in- surance program in Canada. Individuals continue to bunch at the location of a kink even when the kink no longer exists, suggesting that they face adjustment costs when changing their labor supply. I use the amount of bunching at the kinks before and after the policy change to estimate the size of adjustment costs that vary by individuals’ ability to work. The estimated adjustment costs are higher for individuals with lower ability; varying from zero to 8 percent of their potential earnings. The estimated elasticity of earnings with respect to tax rates – accounting for heterogeneous adjustment costs – is 0.2 which is double the size of the one estimated with no adjustment costs. The policy change also decreased the marginal tax rates far away from the kinks. I then evaluate the overall effects of the policy change on the labor supply using a Difference-in-Differences design. I find that some individuals work more and some others start working in response to the large induced incentives to work. Accounting for the adjustment costs then might explain the disparate findings on the effects of increase in incentives to work on labor supply in disability insurance programs. My find- ings therefore have important implications for designing policies and targeting heterogeneous groups to increase labor supply in disability insurance programs. In the second chapter, I describe statistical determinants of Labor Force Participation (LFP) of adults with Autism Spectrum Disorder (ASD) and investigate what might explain their lower LFP than those with the other developmental, neuro-cognitive and physical dis- abilities. The estimated Average Marginal Effect of completing high school on probability of LFP from Probit models is the highest for those with ASD among all the other comparison groups of those living with the other disabilities. The estimated effects are higher for younger adults than that for the older ones. These findings suggests that improving education attain- ments of younger individuals with ASD could comparatively be more effective in improving their LFP. Blinder-Oaxaca decompositions show that considerable portion of the lower LFP of adults with ASD than the other comparison groups is not explained by their observable characteristics, suggesting that they might be subject to stigma and discrimination more often than the others with disabilities. In the last chapter, co-authored with Lucie Schmidt and Lindsay Tedds, we investigate whether insurance coverage of medical treatments with high out-of-pocket costs affects pa- tients’ utilization. We exploit a policy intervention that mandates coverage for In-Vitro- Fertilization (IVF) –an expensive infertility treatment with low success rates in one cycle of treatment– in private health insurance in the US. Mandated coverage varies from one cycle of treatment in some states to unlimited cycles in some others. Patients’ might increase their chances of conceiving an infant by more aggressive treatments, resulting in risky and costly multiple births. We provide the first estimate of the effects on adverse outcome of aggressive treatments from number of IVF cycles covered in mandated health insurances. We use a Generalized Synthetic Control framework to estimate causal effects. Our estimated effects varies from 0.31 percentage points decrease in share of multiple births in states with only one covered cycle to more than 35 percentage points increase in states with unlimited coverage. Our estimates of effects of mandated IVF coverage on adoption –the main alternative for IVF patients with low chances of success– furthermore shows that adoption rates in states with more covered cycles is lower. These findings suggests that high out-of-pocket costs has strong behavioural responses from patients. In states with more coverage, more patients with low chance of success –who would prefer aggressive treatments– use the treatment. These patients otherwise would have adopted a child. Our findings have important implications for designing policy interventions to increase accessibility of expensive and technologically advance medical treatments while simultaneously decreasing utilization costs.Item Open Access Exploring the possibility for a universal dental insurance program in Alberta for the prevention of Early Childhood Caries in preschoolers(2014-01) Sholdice, Katrina; Emery, HerbEarly childhood caries (ECC) is a common bacterial infection which causes severe tooth decay in infants and young children. ECC is the most common chronic infection in children under five and the leading cause of day surgery for preschoolers. Surgery is painful and expensive, and incidence of ECC increases a child's risk for future oral and general health problems. All of these surgeries occur despite the fact that ECC is entirely preventable through good oral hygiene and early access to preventive dental services. This paper consists of a literature review to emphasize the importance of oral health in children and explore the evidence for various prevention approaches, as well as a policy scan of childhood dental programs across Canadian jurisdictions. The goal of this paper is to provide policymakers with the tools to determine whether the Government of Alberta should invest in a universal children's dental msurance program. The findings produce tentative support for a universal dental program that provides an annual fluoride varnish for Albertan preschoolers. However, evidence in support of ECC intervention strategies, in both clinical and case studies, is limited. No robust recommendations can be made regarding the introduction of a universal children's dental program until more research is completed in this area.Item Open Access Funding Leads to Better Health Outcomes – Case study of Alberta Sepsis Network demonstrates how research initiative reduced mortality(2018-08-01) Haq, Anwar; Emery, HerbAlberta’s spending on healthcare has outpaced both economic growth and growth in government revenue, and its access to services and health outcomes are only comparable to provinces and countries that spend much less. Plenty of literature exists in favour of investments in biomedical research benefiting patients and society. While many of these studies looked at the impact of research funding at program level, this paper reviewed one of the five Interdisciplinary Team Grants (ITGs) – the Alberta Sepsis Network (ASN). The project was funded by the Alberta Innovates. Using the ASN as a case study, we aimed to find evidence if investment in sepsis research contributed toward better health outcomes such as reduced mortality for individuals with sepsis across in-patients (IPs) and Emergency Departments (EDs) in Alberta. The raw sepsis data was requested from Alberta Health Services’ (AHS) administrative data system called DIMR (Data Integration Measurement and Reporting). The sepsis data for this study was complex and presented as confirmed sepsis diagnosis and query sepsis diagnosis for IPs and EDs across Alberta. Since the ASN team had specific focus on certain sites in Calgary and Edmonton, each data group was categorized as either non-ASN site data or ASN site data and compared as evidence of impact. For overall sepsis cases confirmed as well as queried across IP and ED, the number of sepsis cases increased over the study period (2003 to 2016) both for non-ASN and ASN sites. However, increases in sepsis cases for ASN sites was higher compared to non-ASN particularly during the ASN project period of 2010 to 2016. Furthermore, a similar pattern was also recorded when the data was further separated as confirmed sepsis cases or query sepsis cases within IP or ED. The increased number of confirmed sepsis cases was, in particular, higher for ASN facilities during the ASN project period of 2010 to 2016. In addition, data also revealed that IP departments showed a larger increase in sepsis cases compared to ED. The only exception to this was query diagnosed sepsis cases both for non-ASN as well as ASN sites. Considering ASN focused sites, sepsis mortality trends were similar to that of sepsis diagnosis data trends for ASN facilities. A higher reduction in mortality rates was observed during the ASN period of 2010 to 2016 for ASN sites when compared to non-ASN sites. This can viii be attributed to additional staff dedicated to ED departments within ASN sites. The reduction in mortality rates were only observed for ASN IP sites for confirmed sepsis diagnosed cases; mortality data from query sepsis cases and from ED sites both for non-ASN and ASN sites remained non-conclusive. Research in general is an expensive undertaking with delayed or difficult to capture benefits. Despite the complexity around sepsis data, this case study was able to demonstrate that the investment in ASN research had concrete impacts on patients’ lives that made it worthwhile. While it is difficult to put a direct value for money for this publicly funded research, the sepsis data has suggested that the ASN might have saved lives particularly within ASN focused sites. Additionally, the investment in ASN offered a wide range of benefits that ultimately improved innovation and continue to save lives in other areas that have not been captured under this case study. Since government has capacity to trigger innovation and take larger risks, it should not hesitate to invest in research. Researchers and policy makers must work jointly to familiarize themselves with the research value chain and influence decision makers to not shy away from investing in research programs such as ASN.Item Open Access A Guaranteed Annual Income Benefits the Health of Canadians with Chronic Illness(2016-03) Abinader, Joseph; Forest, P.G.; Emery, HerbChronic illness is currently the number one cause of death in Canada and the largest cost to our increasingly unsustainable healthcare system. Unfortunately, the massive fiscal and social cost of chronic illness is only expected to get worse as the Canadian population ages. Economists, researchers and politicians across Canada have suggested that novel approaches to health and wellness are required to reduce the rate of chronic illness in Canadian populations. One of these novel approaches is alleviating poverty through a guaranteed Annual Income (GAI). For over forty years, the concept of a guaranteed annual income has been part of welfare discussions in Canada. Canadian research has suggested that a guaranteed income can reduce the cost of healthcare by addressing income security and poverty as upstream determinant of health. By manipulating extracted data from the Canadian Community Health Survey, this study also provides evidence that a guaranteed income is an effective healthcare innovation that warrants further research. This study concludes that a GAI policy is worth investigating as it can help alleviate poverty and the burden of chronic illness in Canada.Item Open Access Media Translation of Evidence Based Research: Vitamin D Portrayal in Print Media(2015-09) Haddadin, Yara; Emery, HerbThe goal of this capstone research paper is to explore how the media translates evidencebased research into recommendations for the public through an examination of how newspapers reported on scientific studies of the health benefits of vitamin D. Vitamin D is controversial because the medical community is still at odds on the proper dosage for preventing health care various conditions. That becomes a matter of public policy because vitamin D is sold without a prescription and is not otherwise controlled for consumer purchase and is taken at the public’s discretion. Therefore, when news media translates research-based evidence on dosage (as well as other information), that translation directly influences the public’s choices for how much vitamin D to take. When the media misses details or miscommunicates scientific evidence and conclusions, the public does not have the information required to make a fully informed health decision. This paper explores six research reviews and corresponding media treatment of those reviews. Additionally, the paper includes discussion of several Cochrane Reviews on controlled clinical trials of vitamin D. Next , I conduct a news content analysis to compare the media’s translation of the information from the scientific evidence. Finally, the capstone paper includes several public policy recommendations to encourage more accurate reporting of scientific evidence, in this area and others. The main findings of this paper are that most news outlets fail to accurately portray a comprehensive overview of the scientific research. There were common issues, with news articles missing scientific details, staying too close to their primary sources, and overemphasizing the conclusions they wished to forward while ignoring contrary information. Aside from the news articles, the scientific evidence indicates that very few conclusions can be drawn at present due to a lack of research. Most news articles did not note this important detail.Item Open Access Preventing Domestic Violence in Alberta: A Cost Savings Perspective(2012-06) Wells, Lana; Boodt, Casey; Emery, HerbRecent studies show that Alberta has the second highest rate of self reported spousal violence in Canada. Rates of violence against women alone are 2.3 percentage points higher than the national average. In fact, every hour of every day, a woman in Alberta will undergo some form of interpersonal violence from an ex-partner or ex-spouse. Besides the devastating toll that domestic violence has on victims and their families, the ongoing cost to Albertans is significant. In the past five years alone it is estimated that over $600 million has been spent with $521 million coming directly from taxpayers. Fortunately, investment in quality prevention and intervention initiatives can be very cost effective, returning as much as $20 for every dollar invested.Item Open Access Scaling Up [to] a Population Health Intervention: A Readiness Assessment Framework(2016) Nguyen, Duyen Thi Kim; McIntyre, Lynn; McLaren, Lindsay; Emery, Herb; Oelke, NellyBackground: Attempts to scale up a population health intervention (PHI) have achieved variable success, which, in part, is attributable to limited knowledge of scale up and lack of systematic guidance to support successful scale up. The concept of readiness is underrepresented in scale up and its consideration may improve the likelihood of success. Objective: To develop and assess a conceptual framework focused on the successful scale up of a PHI, which may be employed to gauge a PHI’s readiness for scale up success. Theoretical framework: This study integrated diffusion of innovations, organizational readiness for change, and complex adaptive systems theories. Methods and Results: The Scale Up Readiness Assessment Framework was developed and refined through a primarily qualitative methods design with three complementary studies, which were informed by the theoretical and empirical literature. Study one used a critical interpretive synthesis of the literature to develop the Framework. The synthesis identified 11 important actions in the successful scale up of a PHI, which were organized into three phases: Groundwork, Implementation, and Sustainment. Key components and hallmarks of a successful scale up approach were also determined. Study two used a modified Delphi method to assess content and face validity of the Framework’s actions and phases. A panel of PHI and scale up experts agreed all phases and actions were important; the Groundwork phase and six actions were representative of a successful scale up; and all were logically presented. Experts’ assessments guided the Framework’s second version. Study three involved pilot tests with potential users of the Framework (version 2.0), who commented how the Framework’s utility, value, and face validity might apply to their PHI. Participants concluded the Framework was informative, offered valuable guidance, and may serve multiple purposes beyond readiness assessment. Pilot feedback led to a final Framework revision (version 3.0). Conclusion: This research provides important conceptual advancements and insights regarding the practice of successful scale up. The research produced a usable product, the Framework, which may be used by academic and government PHI stakeholders for scale up readiness assessment and planning. Learnings from this framework have potentially diverse applications beyond its initial intended purpose.