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Ginsburg O, Vanderpuye V, Beddoe AM, Bhoo-Pathy N, Bray F, Caduff C, Florez N, Fadhil I, Hammad N, Heidari S, Kataria I, Kumar S, Liebermann E, Moodley J, Mutebi M, Mukherji D, Nugent R, So WKW, Soto-Perez-de-Celis E, Unger-Saldaña K, Allman G, Bhimani J, Bourlon MT, Eala MAB, Hovmand PS, Kong YC, Menon S, Taylor CD, Soerjomataram I. Women, power, and cancer: a Lancet Commission. Lancet 2023; 402:2113-2166. [PMID: 37774725 DOI: 10.1016/s0140-6736(23)01701-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 10/01/2023]
Affiliation(s)
- Ophira Ginsburg
- Centre for Global Health, US National Cancer Institute, Rockville, MD, USA.
| | | | | | | | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Caduff
- Department of Global Health and Social Medicine, King's College London, London, UK
| | - Narjust Florez
- Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Nazik Hammad
- Department of Medicine, Division of Hematology-Oncology, St. Michael's Hospital, University of Toronto, Canada; Department of Oncology, Queens University, Kingston, Canada
| | - Shirin Heidari
- GENDRO, Geneva, Switzerland; Gender Centre, Geneva Graduate Institute, Geneva, Switzerland
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, New Delhi, India
| | - Somesh Kumar
- Jhpiego India, Johns Hopkins University Affiliate, Baltimore, MD, USA
| | - Erica Liebermann
- University of Rhode Island College of Nursing, Providence, RI, USA
| | - Jennifer Moodley
- Cancer Research Initiative, Faculty of Health Sciences, School of Public Health and Family Medicine, and SAMRC Gynaecology Cancer Research Centre, University of Cape Town, Cape Town, South Africa
| | - Miriam Mutebi
- Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Deborah Mukherji
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Clemenceau Medical Center Dubai, Dubai, United Arab Emirates
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Winnie K W So
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong Special Administrative Region, China
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | | | - Gavin Allman
- Center for Global Noncommunicable Diseases, RTI International, Durham, NC, USA
| | - Jenna Bhimani
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - María T Bourlon
- Department of Hemato-Oncology, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
| | - Michelle A B Eala
- College of Medicine, University of the Philippines, Manila, Philippines; Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Yek-Ching Kong
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Sonia Menon
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Ing CT, Clemens B, Ahn HJ, Kaholokula JK, Hovmand PS, Seto TB, Novotny R. Food Insecurity and Blood Pressure in a Multiethnic Population. Int J Environ Res Public Health 2023; 20:6242. [PMID: 37444090 PMCID: PMC10341426 DOI: 10.3390/ijerph20136242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
Food insecurity is a social determinant of health and is increasingly recognized as a risk factor for hypertension. Native Hawaiians bear a disproportionate burden of hypertension and known risk factors. Despite this, the relative effects of food insecurity and financial instability on blood pressure have yet to be investigated in this population. This study examines the relative effects of food insecurity and financial instability on blood pressure, controlling for potential confounders in a multiethnic sample. Participants (n = 124) were recruited from a U.S. Department of Agriculture-funded study called the Children's Healthy Living Center of Excellence. Biometrics (i.e., blood pressure, weight, and height) were measured. Demographics, physical activity, diet, psychosocial variables, food insecurity, and financial instability were assessed via self-report questionnaires. Hierarchical linear regression models were conducted. Model 1, which included sociodemographic variables and known biological risk factors, explained a small but significant amount of variance in systolic blood pressure. Model 2 added physical activity and daily intake of fruit, fiber, and whole grains, significantly improving the model. Model 3 added financial instability and food insecurity, further improving the model (R2 = 0.37, F = 2.67, p = 0.031). Food insecurity, female sex, and BMI were significantly and independently associated with increased systolic blood pressure. These results suggest a direct relationship between food insecurity and systolic blood pressure, which persisted after controlling for physical activity, consumption of fruits, fiber, and whole grains, and BMI. Efforts to reduce food insecurity, particularly among Native Hawaiians, may help reduce hypertension in this high-risk population.
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Affiliation(s)
- Claire Townsend Ing
- Department of Native Hawaiian Health, University of Hawaii at Mānoa, 677 Ala Moana Boulevard, Honolulu, HI 96813, USA
| | - Brettany Clemens
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Mānoa, 2528 McCarthy Mall, Honolulu, HI 96822, USA
| | - Hyeong Jun Ahn
- Department of Complementary & Integrative Medicine, University of Hawaii at Mānoa, 651 Ilalo Street, Honolulu, HI 96813, USA
| | | | - Peter S. Hovmand
- Center for Community Health Integration, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Todd B. Seto
- Cardiovascular Diseases, Queen’s Medical Center, 550 S Beretania Street, Honolulu, HI 96813, USA
| | - Rachel Novotny
- Human Nutrition, Food and Animal Sciences, University of Hawaii at Mānoa, 1955 East-West Road, Honolulu, HI 96822, USA
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3
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Economos CD, Calancie L, Korn AR, Allender S, Appel JM, Bakun P, Hennessy E, Hovmand PS, Kasman M, Nichols M, Pachucki MC, Swinburn BA, Tovar A, Hammond RA. Community coalition efforts to prevent childhood obesity: two-year results of the Shape Up Under 5 study. BMC Public Health 2023; 23:529. [PMID: 36941543 PMCID: PMC10026415 DOI: 10.1186/s12889-023-15288-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 02/17/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Cross-sector collaborations and coalitions are promising approaches for childhood obesity prevention, yet there is little empirical evidence about how they affect change. We hypothesized that changes in knowledge of, and engagement with, childhood obesity prevention among coalition members can diffuse through social networks to influence policies, systems, and environments. METHODS We studied a community coalition (N = 16, Shape Up Under 5 "SUU5 Committee") focused on early childhood obesity prevention in Somerville, MA from 2015-17. Knowledge, engagement, and social network data were collected from Committee members and their network contacts (n = 193) at five timepoints over two years. Policy, systems, and environment data were collected from the SUU5 Committee. Data were collected via the validated COMPACT Stakeholder-driven Community Diffusion survey and analyzed using regression models and social network analysis. RESULTS Over 2 years, knowledge of (p = 0.0002), and engagement with (p = 0.03), childhood obesity prevention increased significantly among the SUU5 Committee. Knowledge increased among the Committee's social network (p = 0.001). Significant changes in policies, systems, and environments that support childhood obesity prevention were seen from baseline to 24 months (p = 0.003). CONCLUSION SUU5 had positive effects on "upstream" drivers of early childhood obesity by increasing knowledge and engagement. These changes partially diffused through networks and may have changed "midstream" community policies, systems, and environments.
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Affiliation(s)
- Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
| | - Larissa Calancie
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Steven Allender
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Julia M Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Peter Bakun
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Peter S Hovmand
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH, USA
| | - Matt Kasman
- Economic Studies, Brookings, Washington, D.C., USA
| | - Melanie Nichols
- Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Mark C Pachucki
- Sociology and Computational Social Science Institute, University of Massachusetts, Amherst, MA, USA
| | - Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Alison Tovar
- Behavioral and Social Sciences, Brown University, Providence, RI, USA
| | - Ross A Hammond
- Economic Studies, Brookings, Washington, D.C., USA
- Brown School, Washington University in St Louis, St Louis, MO, USA
- Santa Fe Institute, Santa Fe, NM, USA
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4
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Fowler PJ, Marcal KE, Hovmand PS. Meeting housing needs of child welfare-involved families: Policy insights from simulation modeling. Child Abuse Negl 2022; 132:105809. [PMID: 35882089 DOI: 10.1016/j.chiabu.2022.105809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/24/2022] [Accepted: 07/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Inadequate housing contributes to the risk of family separation in nearly one-quarter of child maltreatment investigations. Child welfare struggles to identify and address the demand for housing assistance. A range of housing interventions shows promise for stabilizing families. Still, aid remains difficult to access, and little evidence exists for prioritizing households to interventions. Inefficient decisions about who to serve with scarce housing resources threaten to diminish resources and unintentionally place children at greater risk. OBJECTIVE The present study leverages computational modeling to simulate the complex dynamics of coordinated child welfare response to inadequate housing. Simulations address the lack of microdata on current service delivery to inform policy-making that protects children from family insecurity. PARTICIPANTS AND SETTINGS A series of simulated policy experiments test strategies for maximizing access to appropriate housing assistance and minimizing system-wide family separations using US estimates of housing insecurity and child welfare involvement. Models incorporate the feedback loops involved in seeking and waiting for needed services, using information on national rates of housing insecurity among child welfare-involved families. RESULTS Results demonstrate population-level improvements in family stability from enhanced targeting of housing assistance to families most likely to benefit, plus expanded access to housing interventions. Neither improved screening procedures nor more housing supports alone improve child welfare outcomes. CONCLUSIONS Findings emphasize the importance of data-driven upstream policies for protecting inadequately housed children at risk of maltreatment.
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Affiliation(s)
- Patrick J Fowler
- The Brown School, Washington University in St. Louis, USA; Division of Computational and Data Sciences, Washington University in St. Louis, USA.
| | | | - Peter S Hovmand
- School of Medicine, Case Western Reserve University, USA; Mandel School of Applied Social Sciences, Case Western Reserve University, USA
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5
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Brown AD, Bolton KA, Clarke B, Fraser P, Lowe J, Kays J, Hovmand PS, Allender S. System dynamics modelling to engage community stakeholders in addressing water and sugar sweetened beverage consumption. Int J Behav Nutr Phys Act 2022; 19:118. [PMID: 36088361 PMCID: PMC9463801 DOI: 10.1186/s12966-022-01363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 09/04/2022] [Indexed: 08/24/2023] Open
Abstract
Abstract
Background
Participatory approaches to develop community-based system dynamics models to tackle complexity are promising, but research is needed in how simulation models can be developed with community stakeholders to yield significant system insights. This study presents the results of a community-based system dynamics modelling process to increase water consumption and decrease sugar sweetened beverage consumption in Portland, Victoria, a regional town in Australia.
Methods
A series of group model building workshops with 11 community stakeholders addressing the topic of water and sugar sweetened beverage consumption was conducted in Portland. A simulating system dynamics model was built with stakeholders to inform action planning.
Results
A system dynamics model was created to provide insight into water and sugar sweetened beverage consumption in Portland. The model included six feedback loops describing the causal effects of sugar sweetened beverage consumption habits and norms, water taste, water consumption norms, public water availability, and public health benefits. For example, the sugar sweetened beverage consumption norm loop modelled how people overestimating others’ consumption may motivate an increase in their own consumption, feeding back and further amplifying an increase in sugar sweetened beverage consumption. The model contributed to the foundation of a strong partnership to improve the taste of water and educate the public on water consumption.
Conclusions
Engaging stakeholders in system dynamics modelling about water and sugar sweetened beverage consumption increased engagement and collaboration to address the problem among community stakeholders.
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Hovmand PS, Calzada EJ, Gulbas LE, Kim SY, Chung S, Kuhlberg J, Hausmann-Stabile C, Zayas LH. Correction to: System Dynamics of Cognitive Vulnerabilities and Family Support Among Latina Children and Adolescents. Clin Child Fam Psychol Rev 2022; 25:150. [PMID: 35303198 PMCID: PMC8948111 DOI: 10.1007/s10567-022-00397-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Peter S Hovmand
- School of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Esther J Calzada
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Lauren E Gulbas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Su Yeong Kim
- Department of Human Ecology, The University of Texas, Austin, USA
| | | | | | | | - Luis H Zayas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
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7
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Hovmand PS, Calzada EJ, Gulbas LE, Kim SY, Chung S, Kuhlberg J, Hausmann-Stabile C, Zayas LH. System Dynamics of Cognitive Vulnerabilities and Family Support Among Latina Children and Adolescents. Clin Child Fam Psychol Rev 2022; 25:131-149. [PMID: 35244814 PMCID: PMC8948134 DOI: 10.1007/s10567-022-00395-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 11/28/2022]
Abstract
The paper describes an approach to developing a data-driven development of a feedback theory of cognitive vulnerabilities and family support focused on understanding the dynamics experienced among Latina children, adolescents, and families. Family support is understood to be a response to avoidant and maladaptive behaviors that may be characteristic of cognitive vulnerabilities commonly associated depression and suicidal ideation. A formal feedback theory is developed, appraised, and analyzed using a combination of secondary analysis of qualitative interviews (N = 30) and quantitative analysis using system dynamics modeling and simulation. Implications for prevention practice, treatment, and future research are discussed.
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Affiliation(s)
- Peter S Hovmand
- School of Medicine, Case Western Reserve University, Cleveland, USA.
| | - Esther J Calzada
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Lauren E Gulbas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
| | - Su Yeon Kim
- Department of Human Ecology, The University of Texas, Austin, USA
| | | | | | | | - Luis H Zayas
- Steve Hicks School of Social Work, The University of Texas, Austin, USA
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8
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Hovmand PS, Pronk NP, Kyle TK, Nadglowski J, Nece PM, Lynx CT. Obesity, Biased Mental Models, and Stigma in the Context of the Obesity COVID-19 Syndemic. NAM Perspect 2021; 2021:202104a. [PMID: 34532689 DOI: 10.31478/202104a] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | | | | | - Cypress T Lynx
- National Academies of Sciences, Engineering, and Medicine
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9
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Payne-Sturges DC, Cory-Slechta DA, Puett RC, Thomas SB, Hammond R, Hovmand PS. Defining and Intervening on Cumulative Environmental Neurodevelopmental Risks: Introducing a Complex Systems Approach. Environ Health Perspect 2021; 129:35001. [PMID: 33688743 PMCID: PMC7945198 DOI: 10.1289/ehp7333] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 02/05/2021] [Accepted: 02/10/2021] [Indexed: 05/21/2023]
Abstract
BACKGROUND The combined effects of multiple environmental toxicants and social stressor exposures are widely recognized as important public health problems contributing to health inequities. However cumulative environmental health risks and impacts have received little attention from U.S. policy makers at state and federal levels to develop comprehensive strategies to reduce these exposures, mitigate cumulative risks, and prevent harm. An area for which the inherent limitations of current approaches to cumulative environmental health risks are well illustrated is children's neurodevelopment, which exhibits dynamic complexity of multiple interdependent and causally linked factors and intergenerational effects. OBJECTIVES We delineate how a complex systems approach, specifically system dynamics, can address shortcomings in environmental health risk assessment regarding exposures to multiple chemical and nonchemical stressors and reshape associated public policies. DISCUSSION Systems modeling assists in the goal of solving problems by improving the "mental models" we use to make decisions, including regulatory and policy decisions. In the context of disparities in children's cumulative exposure to neurodevelopmental stressors, we describe potential policy insights about the structure and behavior of the system and the types of system dynamics modeling that would be appropriate, from visual depiction (i.e., informal maps) to formal quantitative simulation models. A systems dynamics framework provides not only a language but also a set of methodological tools that can more easily operationalize existing multidisciplinary scientific evidence and conceptual frameworks on cumulative risks. Thus, we can arrive at more accurate diagnostic tools for children's' environmental health inequities that take into consideration the broader social and economic environment in which children live, grow, play, and learn. https://doi.org/10.1289/EHP7333.
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Affiliation(s)
- Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, University of Maryland School of UMD Public Health, College Park, Maryland, USA
| | | | - Robin C. Puett
- Maryland Institute for Applied Environmental Health, University of Maryland School of UMD Public Health, College Park, Maryland, USA
| | - Stephen B. Thomas
- Department of Health Policy and Management and Maryland Center for Health Equity, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Ross Hammond
- Brown School of Social Work, Washington University, St. Louis, Missouri, USA
- Center on Social Dynamics and Policy, The Brookings Institution, Washington, DC, USA
| | - Peter S. Hovmand
- Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
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10
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Abstract
Homeless shelters throughout the U.S. are overcrowded and under-resourced. Families with children face substantial barriers to timely, successful shelter exit, and prolonged shelter stays threaten child mental health. This community-based system dynamics study explored barriers to timely, successful shelter exit and feedback mechanisms driving length of stay and child mental health risk. Group model building - a participatory systems science tool - and key informant interviews were conducted with clients (N = 37) and staff (N = 6) in three family homeless shelters in a Midwestern region. Qualitative content analysis with emergent coding identified key themes feedback loops. Findings indicated overcrowding delayed successful shelter exit; longer stays exacerbated crowding and stress in a vicious cycle. Furthermore, longer stays exacerbated child risk for mental disorder both directly and indirectly via crowding and caregiver stress. Capacity constraints limited families served, while contributing to ongoing unmet need. Future research should investigate the roles of these dynamic feedback relationships in the persistent vulnerability of homeless families. Service design should prioritize interventions that alleviate crowding and subsequent threats to mental health such as private or scattered-site shelter accommodations, affordable child care, and homelessness prevention to facilitate successful shelter exit and mitigate child mental health risk.
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11
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Barton CM, Alberti M, Ames D, Atkinson JA, Bales J, Burke E, Chen M, Diallo SY, Earn DJD, Fath B, Feng Z, Gibbons C, Hammond R, Heffernan J, Houser H, Hovmand PS, Kopainsky B, Mabry PL, Mair C, Meier P, Niles R, Nosek B, Osgood N, Pierce S, Polhill JG, Prosser L, Robinson E, Rosenzweig C, Sankaran S, Stange K, Tucker G. Call for transparency of COVID-19 models. Science 2020; 368:482-483. [PMID: 32355024 DOI: 10.1126/science.abb8637] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- C Michael Barton
- Director, Network for Computational Modeling in Social and Ecological Sciences, Tempe, AZ, USA.
| | - Marina Alberti
- Director, Urban Eco-Evolutionary Research Network, Seattle, WA, USA
| | - Daniel Ames
- President, International Environmental Modelling and Software Society, Manno, Ticino, Switzerland
| | - Jo-An Atkinson
- Managing Director, Computer Simulation and Advanced Research Technologies, Sydney, NSW, Australia.,Head, Systems Modeling and Simulation at the Brain and Mind Centre, University of Sydney, NSW, Australia
| | - Jerad Bales
- Executive Director, Consortium of Universities for the Advancement of Hydrologic Science Inc., Cambridge, MA, USA
| | - Edmund Burke
- President, Operational Research Society, Birmingham, West Midlands, UK
| | - Min Chen
- Director, Open Geographic Modeling and Simulation at Nanjing Normal University, Nanjing, Jiangsu, China
| | - Saikou Y Diallo
- President, Society for Modeling and Simulation International, Suffolk, VA, USA
| | - David J D Earn
- Governing Committee, Mathematical Epidemiology Subgroup of the Society for Mathematical Biology, West Lafayette, IN, USA
| | - Brian Fath
- Secretary-General, International Society for Ecological Modeling, Severna Park, MD, USA
| | - Zhilan Feng
- Governing Committee, Mathematical Epidemiology Subgroup of the Society for Mathematical Biology, West Lafayette, IN, USA
| | - Christopher Gibbons
- Director, Business Intelligence Team of the City of Sheffield, Sheffield, South Yorkshire, UK
| | - Ross Hammond
- Director, Center on Social Dynamics and Policy at the Brookings Institution, Washington, DC, USA
| | - Jane Heffernan
- Governing Committee, Mathematical Epidemiology Subgroup of the Society for Mathematical Biology, West Lafayette, IN, USA
| | - Heather Houser
- Chair, Planet Texas 2050 Bridging Barriers Program at the University of Texas, Austin, TX, USA
| | - Peter S Hovmand
- Director, Social System Design Lab of Washington University, St. Louis, MO, USA
| | - Birgit Kopainsky
- Director, System Dynamics Group at the University of Bergen, Bergen, Norway
| | - Patricia L Mabry
- Research Investigator, HealthPartners Institute, Minneapolis, MN, USA
| | - Christina Mair
- Director, Center for Social Dynamics and Community Health of the University of Pittsburgh, Pittsburgh, PA, USA
| | - Petra Meier
- Director, Systems Science in Public Health and Health Economics Research Consortium, Sheffield, South Yorkshire, UK
| | - Rebecca Niles
- Executive Director, System Dynamics Society, Albany, NY, USA
| | - Brian Nosek
- Director, Center for Open Science, Charlottesville, VA, USA
| | - Nathaniel Osgood
- Director, Computational Epidemiology and Public Health Informatics at the University of Saskatchewan, Saskatoon, SK, Canada.,Founder, System Science in Health, Saskatoon, SK, Canada
| | - Suzanne Pierce
- Director, Intelligent Systems and Geosciences Research Coordination Network, Austin, TX, USA
| | - J Gareth Polhill
- President, European Social Simulation Association, Zürich, Zürich, Switzerland
| | - Lisa Prosser
- President, Society for Medical Decision Making, Bridgewater, NJ, USA
| | - Erin Robinson
- Executive Director, Earth Science Information Partners, Boulder, CO, USA
| | - Cynthia Rosenzweig
- Co-Leader, Agricultural Model Intercomparison and Improvement Project, New York, NY, USA
| | - Shankar Sankaran
- President, International Society for the Systems Sciences, Ashland, KY, USA
| | - Kurt Stange
- Director, Center for Community Health Integration at Case Western Reserve University, Cleveland, OH, USA
| | - Gregory Tucker
- Executive Director, Community Surface Dynamics Modeling System, Boulder, CO, USA
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Fowler PJ, Marcal KE, Chung S, Brown DS, Jonson-Reid M, Hovmand PS. Scaling Up Housing Services Within the Child Welfare System: Policy Insights From Simulation Modeling. Child Maltreat 2020; 25:51-60. [PMID: 31096774 DOI: 10.1177/1077559519846431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Housing insecurity and homelessness contribute to risk of maltreatment among one in five of the nearly 3.5 million children annually investigated for maltreatment in the United States. The Family Unification Program (FUP)-a federal initiative-connects inadequately housed families involved in child welfare with long-term rental subsidies to avoid foster placement. However, FUP remains understudied and underutilized with funding levels that serve only a fraction of eligible households. The present study uses system dynamics modeling to inform decision-making by testing policies for scaling FUP. METHOD Simulations model delivery of FUP within child welfare from a feedback perspective. Calibrated on national data, models replicate trends in child welfare involvement from 2013 through 2016, and analyses forecast rates through 2019. Experiments test policies that enhance FUP. Outcomes track system-wide rates of family separation and returns on investment of expanded housing interventions. RESULTS Dramatic expansions of FUP benefit more families and improve marginal return on investment. Yet, scale-up fails to reduce system-wide rates of family separation or generates substantial cost-savings. CONCLUSIONS Simulations demonstrate structural challenges for scaling FUP. Constant demand for affordable housing constrains sustainable improvements in child protection. Child welfare responses to homelessness require innovations that reduce demand for housing services through prevention and earlier intervention.
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Affiliation(s)
| | | | - Saras Chung
- Brown School, Washington University, St. Louis, MO, USA
| | - Derek S Brown
- Brown School, Washington University, St. Louis, MO, USA
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Morshed AB, Kasman M, Heuberger B, Hammond RA, Hovmand PS. A systematic review of system dynamics and agent-based obesity models: Evaluating obesity as part of the global syndemic. Obes Rev 2019; 20 Suppl 2:161-178. [PMID: 31317637 DOI: 10.1111/obr.12877] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 04/14/2019] [Accepted: 04/15/2019] [Indexed: 11/28/2022]
Abstract
The problem of obesity has recently been reframed as part of the global syndemic-the co-occurring, interacting pandemics of obesity, undernutrition, and climate change that are driven by common underlying societal drivers. System science modeling approaches may help clarify how these shared drivers operate and the best ways to address them. The objective of this paper was to determine to what extent existing agent-based and system dynamics computational models of obesity provide insights into the shared drivers of the global syndemic. Peer-reviewed studies published until July 2018 were identified from Scopus, Web of Science, and PubMed databases. Thirty-eight studies representing 30 computational models were included. They show a growing use of system dynamics and agent-based modeling in the past decade. They most often examined mechanisms and interventions in the areas of social network-based influences on obesity, physiology and disease state mechanics, and the role of food and physical activity environments. Usefulness for identifying common drivers of the global syndemic was mixed; most models represented Western settings and focused on obesity determinants close to the person (eg, social circles, school settings, and neighborhood environments), with a relative paucity in models at mesolevel and macrolevel and in developing country contexts.
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Affiliation(s)
| | | | | | - Ross A Hammond
- Brown School, Washington University in St. Louis, St. Louis, Missouri.,The Brookings Institution, Washington, DC.,The Santa Fe Institute, Santa Fe, New Mexico
| | - Peter S Hovmand
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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14
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Appel JM, Fullerton K, Hennessy E, Korn AR, Tovar A, Allender S, Hovmand PS, Kasman M, Swinburn BA, Hammond RA, Economos CD. Design and methods of Shape Up Under 5: Integration of systems science and community-engaged research to prevent early childhood obesity. PLoS One 2019; 14:e0220169. [PMID: 31369570 PMCID: PMC6675039 DOI: 10.1371/journal.pone.0220169] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 07/04/2019] [Indexed: 11/21/2022] Open
Abstract
Shape Up Under 5 (SUU5) was a two-year early childhood obesity prevention pilot study in Somerville, Massachusetts (2015-2017) designed to test a novel conceptual framework called Stakeholder-driven Community Diffusion. For whole-of-community interventions, this framework posits that diffusion of stakeholders' knowledge about and engagement with childhood obesity prevention efforts through their social networks will improve the implementation of health-promoting policy and practice changes intended to reduce obesity risk. SUU5 used systems science methods (agent-based modeling, group model building, social network analysis) to design, facilitate, and evaluate the work of 16 multisector stakeholders ('the Committee'). In this paper, we describe the design and methods of SUU5 using the conceptual framework: the approach to data collection, and methods and rationale for study inputs, activities and evaluation, which together may further our understanding of the hypothesized processes within Stakeholder-driven Community Diffusion. We also present a generalizable conceptual framework for addressing childhood obesity and similar complex public health issues through whole-of-community interventions.
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Affiliation(s)
- Julia M. Appel
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Karen Fullerton
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Ariella R. Korn
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, South Kingston, Rhode Island, United States of America
| | - Steven Allender
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
| | - Peter S. Hovmand
- Social System Design Lab, George Warren Brown School of Social Work, Washington University, Saint Louis, Missouri, United States of America
| | - Matt Kasman
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Boyd A. Swinburn
- Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Australia
- School of Population Health, University of Auckland, Aukland, New Zealand
| | - Ross A. Hammond
- Center on Social Dynamics and Policy, The Brookings Institution, Washington D.C, United States of America
| | - Christina D. Economos
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, United States of America
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15
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Abstract
Homelessness represents an enduring public health threat facing communities across the developed world. Children, families, and marginalized adults face life course implications of housing insecurity, while communities struggle to address the extensive array of needs within heterogeneous homeless populations. Trends in homelessness remain stubbornly high despite policy initiatives to end homelessness. A complex systems perspective provides insights into the dynamics underlying coordinated responses to homelessness. A constant demand for housing assistance strains service delivery, while prevention efforts remain inconsistently implemented in most countries. Feedback processes challenge efficient service delivery. A system dynamics model tests assumptions of policy interventions for ending homelessness. Simulations suggest that prevention provides a leverage point within the system; small efficiencies in keeping people housed yield disproportionately large reductions in homelessness. A need exists for policies that ensure reliable delivery of coordinated prevention efforts. A complex systems approach identifies capacities and constraints for sustainably solving homelessness.
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Affiliation(s)
- Patrick J Fowler
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Peter S Hovmand
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Katherine E Marcal
- The Brown School, Washington University in St. Louis, St. Louis, Missouri 63130, USA; , ,
| | - Sanmay Das
- Department of Computer Science and Engineering, Washington University in St. Louis, St. Louis, Missouri 63130, USA;
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16
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Swinburn BA, Kraak VI, Allender S, Atkins VJ, Baker PI, Bogard JR, Brinsden H, Calvillo A, De Schutter O, Devarajan R, Ezzati M, Friel S, Goenka S, Hammond RA, Hastings G, Hawkes C, Herrero M, Hovmand PS, Howden M, Jaacks LM, Kapetanaki AB, Kasman M, Kuhnlein HV, Kumanyika SK, Larijani B, Lobstein T, Long MW, Matsudo VKR, Mills SDH, Morgan G, Morshed A, Nece PM, Pan A, Patterson DW, Sacks G, Shekar M, Simmons GL, Smit W, Tootee A, Vandevijvere S, Waterlander WE, Wolfenden L, Dietz WH. The Global Syndemic of Obesity, Undernutrition, and Climate Change: The Lancet Commission report. Lancet 2019; 393:791-846. [PMID: 30700377 DOI: 10.1016/s0140-6736(18)32822-8] [Citation(s) in RCA: 1142] [Impact Index Per Article: 228.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/10/2018] [Accepted: 10/29/2018] [Indexed: 12/15/2022]
Affiliation(s)
- Boyd A Swinburn
- School of Population Health, University of Auckland, Auckland, New Zealand; Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia.
| | - Vivica I Kraak
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA
| | - Steven Allender
- Global Obesity Centre, School of Health & Social Development, Deakin University, Geelong, VIC, Australia
| | | | - Phillip I Baker
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia
| | - Jessica R Bogard
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | | | | | - Olivier De Schutter
- Institute for Interdisciplinary Research in Legal Sciences, Catholic University of Louvain, Louvain-la-Neuve, Belgium
| | - Raji Devarajan
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, ACT, Australia
| | - Shifalika Goenka
- Public Health Foundation of India, Centre for Chronic Disease Control, New Delhi, India
| | - Ross A Hammond
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA; Public Health & Social Policy Department, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Corinna Hawkes
- Centre for Food Policy, City University, University of London, London, UK
| | - Mario Herrero
- Commonwealth Scientific and Industrial Research Organisation, Brisbane, QLD, Australia
| | - Peter S Hovmand
- Social System Design Lab, Brown School, Washington University in St Louis, St Louis, MO, USA
| | - Mark Howden
- Climate Change Institute, Australian National University, Canberra, ACT, Australia
| | - Lindsay M Jaacks
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Ariadne B Kapetanaki
- Department of Marketing and Enterprise, Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Matt Kasman
- Center on Social Dynamics & Policy, The Brookings Institution, Washington, DC, USA
| | - Harriet V Kuhnlein
- Centre for Indigenous Peoples' Nutrition and Environment, McGill University, Montreal, QC, Canada
| | | | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Michael W Long
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Victor K R Matsudo
- Physical Fitness Research Laboratory of São Caetano do Sul, São Caetano do Sul, São Paulo, Brazil
| | - Susanna D H Mills
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - Alexandra Morshed
- Prevention Research Center, Brown School, Washington University in St Louis, St Louis, MO, USA
| | | | - An Pan
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | | | - Gary Sacks
- Global Obesity Centre, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia
| | - Meera Shekar
- Health, Nutrition, and Population Global Practice, The World Bank, Washington, DC, USA
| | | | - Warren Smit
- African Centre for Cities, University of Cape Town, Cape Town, South Africa
| | - Ali Tootee
- Diabetes Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Stefanie Vandevijvere
- School of Population Health, University of Auckland, Auckland, New Zealand; Scientific Institute of Public Health (Sciensano), Brussels, Belgium
| | - Wilma E Waterlander
- Department of Public Health Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Luke Wolfenden
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
| | - William H Dietz
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
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17
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Brown A, Millar L, Hovmand PS, Kuhlberg J, Love P, Nagorcka-Smith P, Odenthal M, Owen B, Whelan J, Allender S. Learning to track systems change using causal loop diagrams. Obes Res Clin Pract 2019. [DOI: 10.1016/j.orcp.2016.10.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Fowler PJ, Wright K, Marcal KE, Ballard E, Hovmand PS. Capability Traps Impeding Homeless Services: A Community-Based System Dynamics Evaluation. J Soc Serv Res 2018; 45:348-359. [PMID: 31680707 PMCID: PMC6824475 DOI: 10.1080/01488376.2018.1480560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/21/2018] [Indexed: 06/10/2023]
Abstract
Continuums of Care (CoCs) are the primary coordinating bodies for homeless services in the United States. However, the complexities involved in delivering homeless services across interagency networks challenges coordination and system improvement. CoC governance, planning, and service provision have received little attention in academic literature, and thus, Continuums attempt to manage complex systems with little guidance. This evaluation applied community-based system dynamics with homeless consumers and service providers to (1) identify capability traps that impede services delivery and to (2) engage stakeholders in a structured system improvement process. Results revealed organizational structures for governance and planning that inhibit system outcomes. Insights led to policy and practice recommendations for the homeless system.
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Fowler PJ, Farrell AF, Marcal KE, Chung S, Hovmand PS. Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services. Am J Community Psychol 2017; 60:134-144. [PMID: 28815623 PMCID: PMC5975075 DOI: 10.1002/ajcp.12155] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale-up for the child welfare system. In child welfare, scale-up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale-up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system.
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Affiliation(s)
| | | | | | - Saras Chung
- Washington University in St. Louis, St. Louis, MO, USA
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20
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Hovmand PS. First Eight Years: A Case Study of Starting a Social System Design Lab. Syst Dyn Rev 2017; 33:347-358. [PMID: 30555209 PMCID: PMC6292437 DOI: 10.1002/sdr.1593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 05/17/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Peter S Hovmand
- CB 1196, One Brookings Drive, Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130
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21
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Colditz GA, Gehlert S, Bowen DJ, Carson K, Hovmand PS, Lee JA, Moley KH. Toward a Modern Science of Obesity at Washington University: How We Do It and What is the Payoff? Cancer Prev Res (Phila) 2016; 9:503-8. [PMID: 27059763 DOI: 10.1158/1940-6207.capr-15-0060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/21/2016] [Indexed: 11/16/2022]
Abstract
In our Cancer Prevention Program at Washington University in Saint Louis (WUSTL), we have made extraordinary efforts to create the kind of cancer prevention and control program that is both translational and transdisciplinary in nature, to accelerate the march from basic discoveries to population change. Here we present an overview of our obesity-related research currently ongoing in our Center, paying particular attention to both the translational- transdisciplinary process and to community-based participatory research. We end with our future directions for improving obesity-related cancer outcomes research. Cancer Prev Res; 9(7); 503-8. ©2016 AACR.
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Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Sarah Gehlert
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Deborah J Bowen
- Bioethics and Humanities, University of Washington, Seattle, Washington.
| | - Kenneth Carson
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Peter S Hovmand
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Jung Ae Lee
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Kelle H Moley
- Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri
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22
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Williams F, Zoellner N, Hovmand PS. Understanding Global Cancer Disparities: The Role of Social Determinants from System Dynamics Perspective. Transdiscipl J Eng Sci 2016; 7:10.22545/2016/00072. [PMID: 30792830 PMCID: PMC6380520 DOI: 10.22545/2016/00072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND In 2012, almost 57% of all cancer cases and 65% of cancer deaths occurred in low-and middle-income countries. If the current trend continues, the burden of cancer will increase to 22 million new cases annually by 2030, with 81% of new cases and almost 88% of mortality occurring in less developed countries. METHODS A qualitative review of the literature was conducted. This included a systematic search of eight electronic databases namely, PubMed, Academic Search Premier, CINAHL, Applied Social Sciences Index, EMBASE, SCOPUS, Cochrane and PsycINFO. The reference list of articles retrieved were also thoroughly searched. Inclusion criteria were studies that addressed global health, cancer disparities and global or economic development. RESULTS Thirty-one articles were identified that met the eligibility criteria. Results were synthesized in the form of a system dynamics causal loop diagram or map which led to identification of eight major stocks or system variables. These included, children and adult population, overall population health, pollution, quality of healthcare delivery, quality of neighborhood and built environment, social and community cohesiveness, healthy and social norms and attitudes, and literacy level. Based on this, a dynamic hypothesis of global health cancer disparities was developed. The causal loop diagram showed the role of multiple interacting feedback mechanisms as explanations for trends in global health cancer disparities and the underlying consequences. CONCLUSIONS Addressing these determinants of health requires an effective dynamic approach to improving global cancer health. Application of a systems thinking methodological approach has the potential to provide new understanding to how global development trends in combination with global health efforts to improve population health could shift cancer disparities and burden associated with the disease.
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Affiliation(s)
- Faustine Williams
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, USA,
- Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO USA
| | - Nancy Zoellner
- Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO USA
| | - Peter S Hovmand
- Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO USA
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23
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Homa L, Rose J, Hovmand PS, Cherng ST, Riolo RL, Kraus A, Biswas A, Burgess K, Aungst H, Stange KC, Brown K, Brooks-Terry M, Dec E, Jackson B, Gilliam J, Kikano GE, Reichsman A, Schaadt D, Hilfer J, Ticknor C, Tyler CV, Van der Meulen A, Ways H, Weinberger RF, Williams C. A participatory model of the paradox of primary care. Ann Fam Med 2015; 13:456-65. [PMID: 26371267 PMCID: PMC4569454 DOI: 10.1370/afm.1841] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The paradox of primary care is the observation that primary care is associated with apparently low levels of evidence-based care for individual diseases, but systems based on primary care have healthier populations, use fewer resources, and have less health inequality. The purpose of this article is to explore, from a complex systems perspective, mechanisms that might account for the effects of primary care beyond disease-specific care. METHODS In an 8-session, participatory group model-building process, patient, caregiver, and primary care clinician community stakeholders worked with academic investigators to develop and refine an agent-based computer simulation model to test hypotheses about mechanisms by which features of primary care could affect health and health equity. RESULTS In the resulting model, patients are at risk for acute illness, acute life-changing illness, chronic illness, and mental illness. Patients have changeable health behaviors and care-seeking tendencies that relate to their living in advantaged or disadvantaged neighborhoods. There are 2 types of care available to patients: primary and specialty. Primary care in the model is less effective than specialty care in treating single diseases, but it has the ability to treat multiple diseases at once. Primary care also can provide disease prevention visits, help patients improve their health behaviors, refer to specialty care, and develop relationships with patients that cause them to lower their threshold for seeking care. In a model run with primary care features turned off, primary care patients have poorer health. In a model run with all primary care features turned on, their conjoint effect leads to better population health for patients who seek primary care, with the primary care effect being particularly pronounced for patients who are disadvantaged and patients with multiple chronic conditions. Primary care leads to more total health care visits that are due to more disease prevention visits, but there are reduced illness visits among people in disadvantaged neighborhoods. Supplemental appendices provide a working version of the model and worksheets that allow readers to run their own experiments that vary model parameters. CONCLUSION This simulation model provides insights into possible mechanisms for the paradox of primary care and shows how participatory group model building can be used to evaluate hypotheses about the behavior of such complex systems as primary health care and population health.
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Affiliation(s)
- Laura Homa
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Johnie Rose
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Peter S Hovmand
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Sarah T Cherng
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Rick L Riolo
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Alison Kraus
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Anindita Biswas
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Kelly Burgess
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Heide Aungst
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Kurt C Stange
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger).
| | - Kalanthe Brown
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Margaret Brooks-Terry
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Ellen Dec
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Brigid Jackson
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Jules Gilliam
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - George E Kikano
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Ann Reichsman
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Debbie Schaadt
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Jamie Hilfer
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Christine Ticknor
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Carl V Tyler
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Anna Van der Meulen
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Heather Ways
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Richard F Weinberger
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
| | - Christine Williams
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio (Homa, Rose, Biswas, Burgess, Aungst, Stange); System Dynamics Design Laboratory, George Warren Brown School of Social Work, Washington University, St Louis, Missouri (Hovmand, Kraus); Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan (Riolo); Cleveland, Ohio (Brown, Dec, Gilliam, Schaadt, Hilfer, Van der Meulen); Case Western Reserve University, Cleveland, Ohio (Brooks-Terrry, Ticknor); Metro-Health System, Cleveland, Ohio (Jackson); College of Medicine, Central Michigan University, Mount Pleasant, Michigan (Kikano); Neighborhood Family Practice, Cleveland, Ohio (Reichsman, Ways, Williams); Cleveland Clinic, Cleveland, Ohio (Tyler); Weinberger & Vizy, LLC (Weinberger)
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Munar W, Hovmand PS, Fleming C, Darmstadt GL. Scaling-up impact in perinatology through systems science: Bridging the collaboration and translational divides in cross-disciplinary research and public policy. Semin Perinatol 2015; 39:416-23. [PMID: 26184341 DOI: 10.1053/j.semperi.2015.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite progress over the past decade in reducing the global burden of newborn deaths, gaps in the knowledge base persist, and means of translating empirical findings into effective policies and programs that deliver life-saving interventions remain poorly understood. Articles in this issue highlight the relevance of transdisciplinary research in perinatology and calls for increased efforts to translate research into public policy and to integrate interventions into existing primary care delivery systems. Given the complexity and multi-causality of many of the remaining challenges in newborn health, and the effects that social and economic factors have over many newborn conditions, it has further been proposed that integrated, multi-sector public policies are also required. In this article, we discuss the application of systems science methods to advance transdisciplinary research and public policy-making in perinatology. Such approaches to research and public policy have been used to address various global challenges but have rarely been implemented in developing country settings. We propose that they hold great promise to improve not only our understanding of complex perinatology problems but can also help translate research-based insights into effective, multi-pronged solutions that deliver positive, intended effects. Examples of successful transdisciplinary science exist, but successes and failures are context specific, and there are no universal blueprints or formulae to reproduce what works in a specific context into different social system settings. Group model building is a tool, based in the field of System Dynamics, that we have used to facilitate transdisciplinary research and, to a lesser extent, policy formulation in a systematic and replicable way. In this article, we describe how group model building can be used and argue for scaling its use to further the translation of empirical evidence and insights into policy and action that increase maternal and neonatal survival and well-being.
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Affiliation(s)
- Wolfgang Munar
- Global Health Center, Washington University in St. Louis, St. Louis, MO; Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, Box 1196, 1 Brookings Drive, St. Louis, MO 63130.
| | - Peter S Hovmand
- Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, Box 1196, 1 Brookings Drive, St. Louis, MO 63130
| | - Carrie Fleming
- Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, Box 1196, 1 Brookings Drive, St. Louis, MO 63130
| | - Gary L Darmstadt
- Department of Pediatrics, and March of Dimes Prematurity Research Center, Stanford University School of Medicine, Stanford, CA
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Abstract
OBJECTIVES Our objective was to create a system dynamics model specific to weight gain and obesity in women of reproductive age that could inform future health policies and have the potential for use in preconception interventions targeting obese women. METHODS We used our system dynamics model of obesity in women to test various strategies for family building, including ovulation induction versus weight loss to improve ovulation. Outcomes included relative fecundability, postpartum body mass index, and mortality. RESULTS Our system dynamics model demonstrated that obese women who become pregnant exhibit increasing obesity levels over time with elevated morbidity and mortality. Alternatively, obese women who lose weight prior to pregnancy have improved reproductive outcomes but may risk an age-related decline in fertility, which can affect overall family size. CONCLUSIONS Our model highlights important public health issues regarding obesity in women of reproductive age. The model may be useful in preconception counseling of obese women who are attempting to balance the competing risks associated with age-related declines in fertility and clinically meaningful weight loss.
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Affiliation(s)
- Nasim S Sabounchi
- Nasim S. Sabounchi and Peter S. Hovmand are with the Social System Design Lab, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO. Nathaniel D. Osgood is with the Department of Computer Science, University of Saskatchewan, Saskatoon. Roland F. Dyck is with the Department of Medicine, College of Medicine, University of Saskatchewan. Emily S. Jungheim is with the Department of Obstetrics and Gynecology, Washington University School of Medicine, St. Louis, MO
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Abstract
Community responses to domestic violence typically involve the introduction of multiple interventions. Yet very little is known about the impact of the timing and sequencing of these interventions on community outcomes. A reason for this is the inherent limitations of traditional methods in social science. New methods are needed to understand the effect of varying the sequence and timing of interventions. This study responds to the issue by introducing system dynamics as a method for modeling community interventions. The paper presents a model of domestic violence cases moving through a criminal justice response, and uses the simulation model to evaluate the impact of implementing three interventions-mandatory arrest, victim advocacy, and changes in level of cooperation-on two system-level outcomes: improving offender accountability and increasing victim safety. Results illustrate the complex nature of these relationships. Implications for community practice and future research are also discussed.
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Affiliation(s)
- Peter S Hovmand
- George Warren Brown School of Social Work, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130, USA.
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