Rossi, et al. Chapters 3, 5

Wholey, et al. Chapters 3

Reserve #1 & #2, #9

One of the challenges to crafting a logic model is operationalizing terms and concepts.  Read this thoughtful essay about the importance of language for managers and policy analysts from a recent issue of the PA Times (Nov/Dec 2010).  Managers often forget that it matters a great deal in terms of how concepts are operationalized and measured. 

While it is important to have some understanding of the logic underlying a program, there are instances where programs seem very effective but the reasons for its effectiveness are unclear.  Read this interesting article in Wired on Alcoholics Anonymous (AA) (Jun '10).  What do you think makes this program work?  What is its logic model?

It is also important not to confuse correlations with causality.  See this interesting article with examples of spurious correlations from Business Insider (5/14)

Policy analysts often have to think counter-intuitively because the world doesn't always work the way we think it does.  Give some thought to the problems identified in these articles.  What are the cause and effect relationships? 

	Why are ICU deaths higher on the weekend (7/10)?
	Why do heavy drinkers outlive non-drinkers (8/10)?
	Why is weight loss toxic (9/10)?
	Why do Black men live longer in prison (Reuters 7/11)?
	What really makes Urban Roads Safer (USA Today Jan '11)?
	Why is the life expectancy of some U.S. Women beginning to fall according (Wall Street Journal 3/4/13)?
	Is it actually safer to be modestly overweight than underweight?  See this report in the JAMA on Obesity and Death (2005) and a related article about CDC linking risk of death to obesity (2005).
	Does your job make you fat?  See this interesting article questioning whether the changing nature of work is responsible for increasing obesity (NY Times - 5/11)?
	Does summer make your kids dumber and fatter?  See this article in Bloomberg (7/12).
	Does the neighborhood you live in make you fat?  These articles in CNN and the USA Today  (10/11) imply that if you move to a better neighborhood your risks of obesity and type 2 diabetes decline.  See the corresponding report from the New England Journal of Medicine that the articles' are based on that reports the results of a randomized social experiment conducted by Ludwig, et al. (10/20/11).  What do you think the causal model is or should be?
	Do you really need 8 hours of sleep or is that another generally accepted myth  (BBC 2/22/12)?
	Is it really important eat more vegetables (MailOnline 1/11)?  See this rebuttal of the study's conclusions from January '11.  However, it does appear that vegetarians live longer than meat eaters according to the report of a recent study (Wall Street Journal 6/3/13)
	Is too much exercise bad for you?  See this interesting report of a study of those who exercise to the extreme from the MailOnline (6/3/12). It turns out excess exercise can be very bad for you.
	If men want to improve there chances of having a baby, apparently being overweight, smoking, drinking, alcohol, and using recreational drugs make little difference but you choice of underwear style does.  See this interesting story from the UK Independent (6/13/12).  However, increasing the probability for sex for a man appears to result from doing less housework (France24 - 1/30/13).
	I hope you do not bother taking multivitamins.  Research shows they do not boost health (CBS 12/13).  Perhaps you should drink more coffee instead.  New research shows coffee drinkers live longer (FoxNews 5/17/12) once you control for coffee drinkers other bad habits like smoking.
	What if you just engage in a little exercise?  That cannot possibly be bad for you can it?  See this interesting article from the NY Times (5/31/12) that notes the potentially harmful effects of exercise on some people.
	Why does snoring raise your risk of cancer five-fold (Telegraph 5/20/12)?
	Are calcium supplements actually for you?  A new study reported in the USA Today (5/23/12) finds that they increase risks for heart attacks.
	Apparently exposure to diesel fumes increases your risk of cancer enough that the World Health Organization (WHO) added it to its list of known carcinogens (NY Times 6/12/12).
	Why do women make roughly 18 percent less than men?  See this interesting NY Times article (6/12/12) that looks at the causes of the wage disparity.  Perhaps, the paper should try to use these explanations to justify the recent firing of its executive editor Jill Abramson and the revelation that she was paid significantly less salary than her previous male counterpart.
	After reading all of these articles reporting somewhat confounding or contradictory findings, you might become a bit pessimistic or fearful about the future.  Good news!  A recent study reported that people with high levels of pessimism and fear for the future are more likely to live longer.  It also found that people who are overly optimistic about the days ahead had greater risk of disability and death in the next 10 years (UK Telegraph 2/28/13).  This might actually be good news a pessimist might like.

Did you ever wonder if using too much Salt is really bad for you?  I bet you have because I remember this being taught in health class in high school in the 1980s, and my Doctor has advised me to reduce my salt in-take countless times of the last 3 decades.  The Center for Disease Control (CDC) and prevention not only recommends reducing salt in-take but even helped promote a World Salt Awareness week during March 26 - April 1, 2011.  Mayor Bloomberg of New York City was not to be outdone.  New York City has now embarked upon a controversial voluntary program to reduce Salt consumption (See Fox News Story from 1/12/10) complete with an educational campaign.  With sugary sodas now subject to regulation can the salt shaker be far behind?  The funny thing is that all of this may actually be exaggerating the harmful effects of Salt Consumption (see commentary from the Reason website 1/11/10).  In fact, long-term consumption of salt at the levels recommended by the CDC may actually cause more harm than good.  While no one doubts the short-term beneficial effects of reduced salt consumption on blood pressure (Download 2001 Dash Study Results).  As this article in the Scientific American (July 6, 2011) reporting the results of the meta-analyses conducted by the Cochrane Collaboration, it turns out that extrapolating those findings to a wider range of diseases is problematic at best.  As a result, a growing number of commentators are beginning to point out the disconnect between the "conventional wisdom" and what the data from scientific studies actually supports in terms of the harmful impacts of salt consumption.  See this excellent oped from the New York Times (June 3, 2012) and this one from the Scientific American (July 8, 2011) (note how the commentators echo the same observations about what happens to anyone who challenges the conventional wisdom).  For those that like a little salt on your food, you have nothing to fear.  If scientific research studies don't deter the anti-salt movement, fortunately the Salt Industry has taken matters into its own hands and is working behind the scenes politically to ensure its business model stays in tact (See this story from the NY Times on May 29, 2010). 

According the World Health Organization (WHO), cell phones can cause brain tumors and the press seems to agree (See this collection of news reports of the WHO finding).  But do they? See this critique of their finding and a news account from 2 weeks prior to the WHO meeting that said the researchers concluded that there was no clear link?  Also be sure to read page 5 of the WHO press release that describes what a group 2b finding is and think about what evidence is needed to reach that conclusion.  A statistical correlation is one thing but what about the substantive significance of their finding.  Understanding that would require first understanding the baseline risk of getting any type of brain cancer in the first place (See NIH fact sheet) and then understanding that gliomas are a subset of the various types of brain cancer and are relatively rare amount the different types.  Moreover, if cell phones did cause cancer, shouldn't there be some detectable increase in brain tumors considering they have been in widespread use for more than a decade?  There does not appear to be much evidence in the medical literature that this is the case. 

Did you know that the health risks for diabetics is declining?  The biggest declines were in heart attacks which dropped by more than 60 percent from 1990 to 2010.  Rates of strokes and lower extremity amputations fell by half and end stage kidney failure dropped by 30 percent.  This is despite the fact that the number of people with type 2 diabetes more than tripled to nearly 26 million with almost all it attributed to the more common form of Type 2 diabetes, which is often associated with obesity.  Why such a big decline in the complications associated with type 2 diabetes?  Many are now attributing the decline to all of the efforts associated with reducing the risk of diabetes by controlling blood sugar, cholesterol, and blood pressure (NY Time 4/16/14). 

Maybe there is another explanation.  At its annual meeting in June 1997, the American Diabetes Association announced the conclusions of an expert committee that changed the choice of diagnostic method and cut-off value used to define the disease, which was then endorsed by the National Institute of Health, American Medical Association (AMA), and is now followed by Drs and insurance companies.  However, the change in diagnostic methods quickly produced a rapid increase in the number of new "diabetics"  with some critics noting that the new definition might increase the number of diabetics by nearly 50%.  It is hard to know precisely home many "new" diabetics can be attributed to the change in diagnostic tests and cutoffs because not everyone goes to the doctor on a regular basis.  So while older adults will get added to the pool of diabetics relatively quickly because they visit doctors more regularly, there should be a lag effect as younger adults age and get added to the growing number of "diabetics" but would not have done so under the old standard.  If you look at the trend data, you can see the gradual trend in both the number of people and number of adults diagnosed with diabetes increasing exponentially since the changes in diagnostic tests.  If the relatively healthy diabetics (those between the new and old standard) increased by say 40 - 50% and then we see big declines by the same percentages for heart disease over the same time frame, maybe all we did was ad relatively healthy people and more younger people to the pool of diabetics and then put more people on high blood pressure and cholesterol reducing medicine for preventative purposes.  In other words, maybe the changes we are observing now have more to do with changes in the composition of the population of "diabetics" than they do to with the types of treatments being provided.

Download as a PDF file (supplemental notes from lecture and figure)

W. K. Kellogg Foundation. 2004. Logic Model Development Guide. Battle Creek, MI: W. K. Kellog Foundation. (Download by Clicking Here)

Kellogg Foundation, Evaluation tool kit

University of Wisconsin - Cooperative Extension Presentation with guidance for logic model development (Download by Clicking here)

Innovation Network - Logic Model Workbook

Planning and Evaluation Resource Center