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My research addresses a wide range of public health problems across the lifespan, but shares a common theme of putting new knowledge into practice through behavioral epidemiology, program planning and evaluation, and implementation science. Beginning in 1985, I worked with Dr. Zybert and colleagues at Columbia University Medical Center (CUMC) to conduct a prospective longitudinal study of Hispanic children’s diet and physical activity. This study revealed that whole milk contributed 40% of children’s total daily saturated fat intake, which supported policies requiring low-fat milk in federally-funded school food programs, now mandated. Applying findings from that study, working with colleagues at CUMC, I directed the Washington Heights-Inwood Healthy Heart Program, a six-year community-wide cardiovascular disease prevention demonstration program (in the community for the proposed RCT). My subsequent work focused on an RCT demonstrating the efficacy of an educational intervention to increase rates of retinopathy screening among African Americans with Diabetes Mellitus (with colleagues at Albert Einstein College of Medicine) and two RCTs demonstrating the efficacy of alternative approaches to increase colon cancer screening in a hard-to-reach, largely immigrant, population of health care workers in New York City (conducted with Drs. Zybert and Wolf and colleagues at CUMC). These three RCTs (cited below) were among the first studies to demonstrate the value of direct interpersonal contact for affecting health behaviors among urban minority populations with low levels of literacy, the central strategy in the proposed RCT. The intervention strategies we studied, such as telephone outreach, have been widely adopted and used. As a behavioral epidemiologist, my work has and continues to discover determinants of various health behaviors that are amenable to change through education and to conceptualize and implement behavioral interventions that are acceptable, feasible and effective, so that they will be widely disseminated and used to prevent disease and promote health.
Basch CE, Walker, EA, Howard CJ, Shamoon H, Zybert, PA. The effect of health education on the rate of ophthalmic examinations among African Americans with Diabetes Mellitus. Am J Public Health. 1999; 89: 1878-82. PMID:10589324
Basch CE, Wolf RL, Brouse CH, Shmukler C, Neugut A, DeCarlo L, Shea S. Telephone outreach to increase colorectal cancer screening in an urban minority population. Am J Public Health. 2006; 96(12): 2246-53. PMID: 17077394
Basch CE, Zybert P, Wolf RL, Basch CH, Ullman R, Shumkler C, King F, Neugut AI, Shea S. A randomized trial to compare alternative educational interventions to increase colorectal cancer screening in a hard-to-reach urban minority population with health insurance. J Community Health. 2015; 40(5): 975-83. PMID: 25850386
Four lines of research relevant to the proposed study have been conducted over the past three decades: Implementation Science; Dietary Behavior in Hispanic Children; Behavioral Epidemiology and Health Education Theory and Practice; and Children’s Health and Academic Achievement.
Each is outlined below with respect to historical background that frames the scientific problem, central findings, influence of the findings on the progress of science or the application of the findings to health, and my specific role in the described work.
My earliest work focused on implementation science and I continue to retain interest in continuing to contribute new knowledge in this area. In 1984, I was commissioned by the NIH to write a White Paper on disseminating and implementing health education programs in schools. That was a first attempt to apply what little was known about diffusion of innovations to the fields of public health and health education. Related research emphasized the importance of measuring and monitoring implementation fidelity to enhance the validity of outcome evaluations (as in proposed RCT), and improving understanding about attributes of innovations and dissemination methods that increase the likelihood that innovations will be acceptable to their intended target population, feasible to implement, and effective. This research was conducted with my colleagues and mentors from Southern Illinois University.
Basch CE, Sliepcevich EM. Innovators, innovations and implementation: A framework for curricular research on school health education. Health Educ. 1983; 14(2): 20-24. PMID: 6443902
Basch CE. Research on disseminating and implementing health education programs in schools. In proceedings of the National Conference on School Health Education Research in the Heart, Lung, and Blood Areas, School Health Research, and combined issue of J Sch Health.1984; 54(6) and Health Educ.1984; 15(4): 57-66. PMID: 6565121
Basch CE, Sliepcevich EM, Gold RS, Duncan DF, Kolbe LJ. Avoiding type III errors in health education program evaluations: A case study. Health Educ Q. 1985; 12(4): 315-331. PMID: 407544
Basch CE, Eveland JD, Portnoy B. Diffusion systems for education and learning about health. Fam Community Health. 1986; 9(2): 1-26. PMID: 10280098
Dietary Behavior in Hispanic Children
In the 1980s little data had been collected to describe the dietary patterns of Hispanic immigrant families in New York City, and there were no published studies on the reliability or validity of dietary behavior measurements. We filled these gaps in knowledge through a 6-year prospective observational study involving ~240 Hispanic parent/child dyads from whom we collected dietary (and other) data through 18 in-person visits to our field site in northern Manhattan, the location for the proposed RCT. There were many distinct scientific contributions from this study, which yielded over 30 publications in the biomedical and public health literature. Those most relevant to the proposed RCT are demonstrating the reliability and validity of dietary measurements in young Hispanic children, and identifying low-fat milk as the primary source of saturated fat intake. Findings from this study contributed to national policy changes in the availability of low-fat milk in the nation’s multi-billion dollar school breakfast and lunch programs serving Title I schools. This work also demonstrated the importance of analyzing dietary behavior patterns and food sources rather than only nutrient intakes. My role was Principal Investigator.
Basch CE, Shea S, Arliss R, Contento IR, Rips J, Gutin B, Irigoyen M, Zybert P. Validation of mothers’ reports of dietary intake by four to seven year-old children. Am J Public Health. 1990; 81(11): 1314-1317. PMID: 2240296
Basch CE, Shea S, Zybert P. Food sources, dietary behavior and the saturated fat intake of Latino children. Am J Public Health. 1992; 82(6): 810-815. PMID: 1580243
Basch CE, Zybert P, Shea S. 5-A-DAY: Food sources, dietary behavior and the fruit and vegetable intake of Latino children. Am J Public Health. 1994; 84(5): 814-818. PMID: 8179054.
Basch CE, Shea S, Zybert P. The reproducibility of a semi-quantitative food frequency questionnaire among low-income Hispanic mothers and children. Am J Public Health. 1994; 84(5): 860-863. PMID: 8179065
Behavioral Epidemiology and Health Education Theory and Practice.
One of the greatest challenges and limitations in health education practice is that the causal mechanisms explaining why interventions work are not well understood. The field has moved away from a nomothetic conceptualization of health behavior—thinking that behavior patterns of a group can be understood in one way—to recognizing their idiosyncratic nature. Nevertheless, the status quo in the continuum of research is that even when rigorous efficacy trials demonstrate that interventions can work, in too many cases they do not confer benefits to their intended population because they are too time consuming, costly, complicated or otherwise unacceptable and unfeasible. Understanding the causal mechanisms—constructs that explain what works for whom—results in defining innovations that are much easier to translate to the public because they enable flexibility in accomplishing goals rather than requiring strict adherence to highly scripted implementation protocols. The main contribution of my work in this area has been to develop behavioral measurement methods to improve understanding about the acquisition and maintenance of health behaviors. Findings reveal the importance of understanding the ‘models of rationality’ used by individuals to form health habits. In turn, this has informed approaches to intervention development, which is philosophically and ethically grounded in helping people make informed decisions about health. Most of this work was conducted independently.
Basch CE, Gold RS. The validity of reliability assessments. J School Health. 1985; 55(5): 191-195. PMID: 3847676.
Basch CE. Focus group interview: An underutilized research technique for improving theory and practice in health education. Health Educ Q 1987; 14(4): 409-446. PMID: 3319971
Basch CE. Preventing AIDS through education: Concepts, strategies and research priorities. J Sch Health. 1989; 59(7): 296-300. PMID: 2796306
Basch CE, De Cicco IM, Malfetti JL. A focus group study on decision processes of young drivers: Reasons that may support a decision to drink and drive. Health Educ Q. 1989; 16(3): 389-396. PMID: 2793494
Children’s health and academic achievement
Schools are one of the most powerful social institutions that shape the lives of youth. But schools have never embraced addressing students’ health needs as fundamental to their mission. The central finding from my research, which integrates cross-disciplinary knowledge from fields ranging from molecular biology and neurosciences to child development and public health, is that health barriers to learning exert powerful, yet largely overlooked, effects on children’s life trajectories. A second central finding was that academic achievement among urban minority youth is affected simultaneously by multiple health problems that have synergistic effects, and, therefore, a set of problems affecting youth must be addressed to increase the magnitude and consistency of effects on academic achievement. This is antithetical to current research, evaluation, policy and practice that address students’ health problems in a categorical way. A third original contribution to science was to delineate the causal pathways through with specific health problems affect academic achievement—sensory perceptions, cognition, school connectedness, absenteeism, and dropping out. This line of research is a priority for improving the health of the nation because educational attainment is one of the strongest predictors of overall health status, quality of life and longevity. I have been fortunate to assist school systems in many parts of the United States to develop policies and practices addressing children’s health problems that, in turn, influence their access to educational opportunity and their life trajectories. This work has largely been conducted on my own, and taken the form of knowledge synthesis, and increasing awareness and interest about the reciprocal causal relationships in the health—education connection, for example through consultation and presentations with the Institute of Medicine, National Academy of Sciences; Surgeon General’s Working Group on Education and Health; National Coordinating Committee on School Health and Safety; Centers for Disease Control and Prevention; many state and urban education agencies; many professional organizations; National Conference of State Legislators; Education Commission of the States; Educational Testing Service; National Public Radio (WNYC); and, most recently, the White House. This work is primarily conducted independently.
Basch CE. Healthier Students are Better Learners: A missing Link in School Reforms to Close the Achievement Gap. Reprt commissioned by the Campaign for Educational Equity. New York: Teachers College, Columbia University, 2010, pp. 1-106. (http://www.equitycampaign.org/i/a/document/12557_EquityMattersVol6_Web03082010.pdf).
Basch CE. Healthier students are better learners: high-quality, strategically planned, and effectively coordinated school health programs must be a fundamental mission of schools to help close the achievement gap. J Sch Health. 2011; 81(10): 650–62. PMID: 21923878.
Basch CE, Basch CH, Ruggles KV, Rajan S. Prevalence of sleep duration on an average school night among 4 nationally representative successive samples of American high school students, 2007-2013. Prev Chronic Dis. 2014; 11(E216): no pp, epub. PMID: 25496556
Basch CE, Gracy D, Johnson D, Fabian A. Health barriers to learning and the education opportunity gap. Progress of Educational Reform 2015;15(3)1-8. Report commissioned by the Education Commission of the States (http://www.ecs.org/clearinghouse/01/20/69/12069.pdf ).