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Objectives To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease. Methods Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the ‘Social Determinants of Health’ module, which included economic instability and stress measures ( N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models. Results Adults with chronic obstructive pulmonary disease were more likely ( p Discussion Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

OBJECTIVE: To assess the prevalence of migraine or severe headache among US adults by inflammatory bowel disease (IBD) status. BACKGROUND: Emerging evidence in clinical settings suggests a higher prevalence of migraine among patients with IBD than those without IBD. METHODS: Data from 60,436 US adults aged ≥18 years participating in the 2015 and 2016 National Health Interview Survey (NHIS) were analyzed. The relationship between IBD status and migraine or severe headache was assessed overall and stratified by levels of selected characteristics including sex, age, race/ethnicity, education, poverty status, marital status, smoking status, obesity status, serious psychological distress, and major chronic condition status. RESULTS: Overall, the age-adjusted prevalence of migraine or severe headache was 15.4% (n = 9062) and of IBD was 1.2% (n = 862). A higher age-adjusted migraine or severe headache prevalence was reported among participants with IBD than those without IBD (28.1% vs. 15.2%, p

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). Although the percentage of all U.S. adults who smoke cigarettes has declined substantially since the mid-1960s (1,2), marked disparities persist, and declines have not been consistent across population groups (1,2). Studies have shown that cigarette smoking is as common, and sometimes more so, among adults with a history of epilepsy compared with those without a history of epilepsy, but reasons for this are unclear (3-6). Compared with adults without epilepsy, adults with epilepsy report lower household income, more unemployment and disability, worse psychological health, and reduced health-related quality of life (3,4,6,7). Trends in cigarette smoking among U.S. adults with epilepsy have not been previously assessed. CDC analyzed National Health Interview Survey (NHIS) data among 121,497 U.S. adults from 2010, 2013, 2015, and 2017 to assess current cigarette smoking by epilepsy status. From 2010 through 2017, the age-standardized percentages of current smoking were 24.9% among adults with active epilepsy, 25.9% among adults with inactive epilepsy, and 16.6% among adults with no history of epilepsy. After accounting for differences in data collection intervals and patterns in smoking status among subgroups, CDC found that current cigarette smoking declined significantly from 2010 to 2017 among adults with no history of epilepsy (19.3% to 14.0% [p

Objectives. To demonstrate a flexible and practical method to obtain near real-time estimates of the number of at-risk community-dwelling adults with a chronic condition in a defined area potentially affected by a public health emergency. Methods. We used small area estimation with survey responses from the 2016 Behavioral Risk Factor Surveillance System together with a geographic information system to predict the number of adults with chronic obstructive pulmonary disease who lived in the forecasted path of Hurricane Florence in North and South Carolina in 2018. Results. We estimated that a range of 32 002 to 676 536 adults with chronic obstructive pulmonary disease resided between 50 and 200 miles of 3 consecutive daily forecasted landfalls. The number of affected counties ranged from 8 to 10 (at 50 miles) to as many as 119 to 127 (at 200 miles). Conclusions. Community preparedness is critical to anticipating, responding to, and ameliorating these health threats. We demonstrated the feasibility of quickly producing detailed estimates of the number of residents with chronic conditions who may face life-threatening situations because of a natural disaster. These methods are applicable to a range of planning and response scenarios.

IMPORTANCE: The coronavirus disease 2019 (COVID-19) pandemic, associated mitigation measures, and social and economic impacts may affect mental health, suicidal behavior, substance use, and violence. OBJECTIVE: To examine changes in US emergency department (ED) visits for mental health conditions (MHCs), suicide attempts (SAs), overdose (OD), and violence outcomes during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program to examine national changes in ED visits for MHCs, SAs, ODs, and violence from December 30, 2018, to October 10, 2020 (before and during the COVID-19 pandemic). The National Syndromic Surveillance Program captures approximately 70% of US ED visits from more than 3500 EDs that cover 48 states and Washington, DC. MAIN OUTCOMES AND MEASURES: Outcome measures were MHCs, SAs, all drug ODs, opioid ODs, intimate partner violence (IPV), and suspected child abuse and neglect (SCAN) ED visit counts and rates. Weekly ED visit counts and rates were computed overall and stratified by sex. RESULTS: From December 30, 2018, to October 10, 2020, a total of 187 508 065 total ED visits (53.6% female and 46.1% male) were captured; 6 018 318 included at least 1 study outcome (visits not mutually exclusive). Total ED visit volume decreased after COVID-19 mitigation measures were implemented in the US beginning on March 16, 2020. Weekly ED visit counts for all 6 outcomes decreased between March 8 and 28, 2020 (March 8: MHCs = 42 903, SAs = 5212, all ODs = 14 543, opioid ODs = 4752, IPV = 444, and SCAN = 1090; March 28: MHCs = 17 574, SAs = 4241, all ODs = 12 399, opioid ODs = 4306, IPV = 347, and SCAN = 487). Conversely, ED visit rates increased beginning the week of March 22 to 28, 2020. When the median ED visit counts between March 15 and October 10, 2020, were compared with the same period in 2019, the 2020 counts were significantly higher for SAs (n = 4940 vs 4656, P = .02), all ODs (n = 15 604 vs 13 371, P

The science-policy nexus has long puzzled scholars and managers working across diverse public policy areas, including environment. The rise of science-based management, especially in an era of big data, assumes science can improve environmental policy. At the same time, increasing attention to stakeholder engagement provides avenues for non-scientists to participate in collaborative environmental management, which might displace science in decision-making processes. Prior research points to a variety of factors thought to affect the degree to which science is used in collaborative partnerships. Drawing on such research, we examine the use of science across 9 collaborative partnerships structured and resourced from the top-down by a state government agency. All of these partnerships are working in the U.S.’s second largest estuary, the Puget Sound in Washington State. Data from partnership meeting minutes indicates that science is scarcely discussed in executive committee meetings, but is more commonly discussed in technical committee meetings. We thus might expect that the ecosystem management plans produced by these technical committees would be closely informed by science. Results indicate these plans include few citations to peer-reviewed scientific studies, but they do draw consistently on scientific information from grey literature including scientific and technical reports from federal and state agencies. These results raise important questions about government efforts to foster the use of science in collaborative partnerships, including the benefits and drawbacks of using grey literature rather than scientific articles directly, the interaction of science with other forms of knowledge, and local actors’ capacity to understand and access science.

This chapter introduces the next section of the book which is about sustainability and finance when it comes to cross-sector collaboratives for population health improvements. It states that the focus should be on closing the gap when it comes to health disparities and a goal needs to be reducing the need for health care services. Effectively acquiring, managing, and sustaining financial investments in health is fundamental to the success of multi-sector and community-led health improvement initiatives. The chapter outlines the topics covered by the individual chapters in this section.

Collaborative governance applied to environmental issues is becoming more common, and evaluation of such efforts can provide useful information for multiple audiences. However, due to a variety of challenges, collaborative governance practitioners rarely evaluate the outcomes of collaboration and their contributions to these efforts. With these challenges in mind, the William D. Ruckelshaus Center designed an evaluation framework that can meet multiple parties’ objectives, be integrated into practitioners’ existing services, and balance flexibility and practicality with rigor and replicability. The Center conducted a pilot of this framework on a collaborative watershed management effort in southeastern Washington State, where the Center had previously assisted with organizational development. The resulting evaluation highlights a variety of social, knowledge-based, and economic outcomes for the collaborative, as well as lessons for practitioners and evaluators of collaborative governance. We suggest that this methodology can be useful for practitioners interested in evaluating similar collaborative efforts.

Collaboration has become a common alternative to traditional top-down approaches to environmental management and conservation. One critique of collaborative processes is that science is not sufficiently linked to conservation actions. To better understand how science is used in collaborative decisions, we asked how the use of science is affected by the structure of collaborative processes, paying specific attention to the role of explanatory variables such as stakeholder engagement, how information is gathered, and how decisions are made. Case survey methods (a form of systematic review) were used to analyze 30 case studies of collaborative management of marine, estuarine, and coastal systems across the United States. We found that increased stakeholder participation (i.e., two-way flow of information between parties), face-to-face communication among stakeholders, increased contribution of information from academic stakeholders, careful consideration and selection of participants (e.g., stakehold...

The public policy and public management literatures together support a vibrant discussion of collaborative governance. Much of this scholarship takes a broad perspective focusing on questions such as what collaborative governance is; why collaborative governance emerges; or why individuals and organizations choose to participate in voluntary, nonbinding collaborative efforts. This paper focuses specifically on the role of public managers as leaders, encouragers, and followers of collaborative governance. We examine the decision calculus factoring into the choice of collaborative governance as a toolbox for achieving desired policy goals. That is, we ask why public managers choose to devote public resources to collaborative governance. What motivates public managers to pick up the phone, write a check, or otherwise change their current behavior? We develop 20 propositions that contextualize this choice in terms of two overarching questions: (i) How do institutional structure and organizational strategy intersect to influence the ways in which public managers design and implement collaborative governance?; and (ii) Why do public managers choose particular roles within collaborative institutions? In doing so, we demonstrate how the public policy and public management literatures can be coupled to better understand a theoretical issue that each research body struggles to encapsulate in isolation.

We describe an evidence-based framework to define and assess the impact of quality improvement (QI) in public health. Developed to address programmatic and research-identified needs for articulating the value of public health QI in aggregate, this framework proposes a standardized set of measures to monitor and improve the efficiency and effectiveness of public health programs and operations. We reviewed the scientific literature and analyzed QI initiatives implemented through the Centers for Disease Control and Prevention’s National Public Health Improvement Initiative to inform the selection of 5 efficiency and 8 effectiveness measures. This framework provides a model for identifying the types of improvement outcomes targeted by public health QI efforts and a means to understand QI’s impact on the practice of public health.

The shift from government to governance and the increasing reliance on public-private partnerships are well documented, but there is less clarity regarding how to measure the performance of these new arrangements. Performance measures based on traditional governmental forms, such as centralized planning and regulation, are relatively straightforward. In collaborative governance, however, the wide range of policy tools for enabling and encouraging public-private partnerships—such as grants, contracts, and technical assistance—requires more nuance in distinguishing outputs from outcomes. Choosing appropriate output and outcome measures is necessary if public-private partnerships are to be held accountable for performance. Drawing on evidence regarding inconsistent use of performance measures from the Performance Assessment Rating Tool (PART), a classification system is presented for defining outputs and outcomes for different types of programs. PART data are used to demonstrate the need for a consistent cla...

SUMMARYOver the last decade, hundreds of payments for ecosystem services (PES) programmes have been initiated around the world, but evidence of their environmental benefits remains limited. In this study, two PES programmes operating in the municipality of Coatepec (Mexico) were evaluated to assess their effectiveness in protecting the region's endangered upland forests. Landsat satellite data were analysed to assess changes in forest cover before and after programme implementation using a difference-in-differences estimator. Additionally, surveys and interviews were conducted with local residents and a subset of PES programme participants to evaluate the programmes’ social and environmental impacts, particularly the effect of the programmes on landowner behaviour. The remote-sensing data show that deforestation was substantially lower on properties receiving PES payments compared to properties not enrolled in the programmes, but the programmes did not prevent the net loss of forests within Coatepec. Moreover, the on-site interviews suggest that the payments may have had little impact on deforestation rates, and that other factors contributed to the conservation of forests in PES properties. These findings suggest that risk-targeted payments, robust monitoring and enforcement programmes, and additional conservation initiatives should be included in all PES schemes to ensure environmental effectiveness.

Community-based management has increasingly replaced centralized planning and regulation as an alternative means for conserving natural resources. But there is little empirical evidence to suggest whether community-based management has a positive or negative impact on the actual condition of natural resources. If, as is commonly argued, conservation success depends largely on local context, then we must think carefully about the entire causal chain of community-based management activities, from the inputs supporting decision-making processes to management outputs and environmental outcomes. We accordingly discuss appropriate methodologies for demonstrating the causal impacts of community-based management on natural resource conservation.

The authors reflect on public health services and systems research (PHSSR). They suggest that in order to advance the field of public health services and systems research, challenges that are apparent within the research will need to be addressed. They argue that with a collaborative effort new, relevant and translatable PHSSR findings can be found that can be used to understand and address public health problems.

Many tout the benefits of collaborative environmental management as an alternative to centralized planning and command and control regulation, but the excitement over collaborative processes has not been matched by evidence that these processes actually improve the environment. The most crucial question in collaborative environmental management remains unanswered and often unasked: To what extent does collaboration lead to improved environmental outcomes? We know much about why collaboration is occurring and how collaborative processes and outputs vary. The primary goal of future research on collaborative environmental management should be to demonstrate whether collaboration improves environmental conditions more than traditional processes and newer market-based processes. Collaboration is not a panacea; it is a choice that policy makers and public managers should make based on evidence about expected outcomes.

An intervention to increase condom use by undermining perceptions of invulnerability to HIV was tested in a sample of 128 college students. Participants were randomly assigned to the invulnerability undermined (IU) condition or a demand characteristic control (DCC) condition. The IU condition used tasks that highlighted past failures to protect oneself and the failure of illusory protection strategies. Participants in the DCC condition watched a video on protecting oneself from HIV. Participants in the IU condition, relative to those in the DCC group, had lower perceptions of invulnerability to HIV and higher intentions to use condoms on the immediate postintervention measures; they reported more condom use at the 3-month follow-up. Contrary to prediction, perceptions of invulnerability did not mediate the effects of the intervention on condom use intentions or condom use. The advantage of indirect methods of reducing denial of vulnerability is discussed.

Objective. Satellite-based remote-sensing analysis is a beneficial, yet underused, tool for environmental policy, planning, and evaluation. We identify its benefits and costs to encourage social scientists to consider the use of remote sensing as a tool for planning and evaluating environmental institutions. Methods. We analyze two multispectral Landsat Thematic Mapper satellite images to evaluate a habitat conservation plan (HCP) implemented pursuant to the Endangered Species Act. Results. Image analysis provides useful broad spatial scale information on HCP performance that is not discernible to the naked eye or through other methodologies. Conclusions. Satellite image analysis should be considered as a tool for planning and evaluating environmental institutional designs—despite the financial costs and requisite technical training. These images provide ecological and land cover change information that may not be available elsewhere. We provide lessons learned to help make analysts cognizant of some important issues surrounding the use of satellite-based imagery for environmental institutional analysis.

Introduction Continuous quality improvement is a central tenet of the Public Health Accreditation Board's (PHAB) national voluntary public health accreditation program. Similarly, the Centers for Disease Control and Prevention launched the National Public Health Improvement Initiative (NPHII) in 2010 with the goal of advancing accreditation readiness, performance management, and quality improvement (QI). Objective Evaluate the extent to which NPHII awardees have achieved program goals. Design NPHII awardees responded to an annual assessment and program monitoring data requests. Analysis included simple descriptive statistics. Setting Seventy-four state, tribal, local, and territorial public health agencies receiving NPHII funds. Participants NPHII performance improvement managers or principal investigators. Main outcome measure(s) Development of accreditation prerequisites, completion of an organizational self-assessment against the PHAB Standards and Measures, Version 1.0, establishment of a performance management system, and implementation of QI initiatives to increase efficiency and effectiveness. Results Of the 73 responding NPHII awardees, 42.5% had a current health assessment, 26% had a current health improvement plan, and 48% had a current strategic plan in place at the end of the second program year. Approximately 26% of awardees had completed an organizational PHAB self-assessment, 72% had established at least 1 of the 4 components of a performance management system, and 90% had conducted QI activities focused on increasing efficiencies and/or effectiveness. Conclusions NPHII appears to be supporting awardees' initial achievement of program outcomes. As NPHII enters its third year, there will be additional opportunities to advance the work of NPHII, compile and disseminate results, and inform a vision of high-quality public health necessary to improve the health of the population.

The decline of public trust in government in the United States is well documented. We know comparatively little, however, about how to maintain or restore the public’s trust. This article attempts to advance our understanding of trust in government by addressing a relatively narrow question: How can we create, maintain, or restore public trust in government agencies and their employees? The article reviews several conceptions of trust and lays out a series of hypotheses regarding means for building and maintaining public trust. Although the hypotheses have not been empirically tested, they are grounded in well-established social science theories and suggest several avenues for future research.

Efforts to respond to performance-based accountability mandates for public health emergency preparedness have been hindered by a weak evidence base linking preparedness activities with response outcomes. We describe an approach to measure development that was successfully implemented in the Centers for Disease Control and Prevention Public Health Emergency Preparedness Cooperative Agreement. The approach leverages insights from process mapping and experts to guide measure selection, and provides mechanisms for reducing performance-irrelevant variation in measurement data. Also, issues are identified that need to be addressed to advance the science of measurement in public health emergency preparedness.

America faces a new frontier in preventing chronic disease. Nearly 80% of the 10,000 people who turn 65 each day have at least 1 chronic health condition, and most have multiple chronic conditions (1). The costs of braving this new world are staggering, especially given the nation’s strained economy and budget cuts that have forced health departments to reduce their workforce and impose furloughs and reduce or eliminate chronic disease programs. Despite these daunting challenges, government public health agencies have opportunities to be the driving force behind improving the nation’s health. The Office for State, Tribal, Local, and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC) was established in 2010 to better position CDC to support health departments. The mission of OSTLTS is to advance US public health agency and system performance, capacity, agility, and resilience (2). OSTLTS recognizes health departments as the front line of prevention and promotes a systems approach that works across sectors, partners, and programs to address the complex community and economic challenges that affect the public’s health. An important and recent advancement in the practice of public health is the establishment of a national public health accreditation program and the Public Health Accreditation Board (PHAB). Funded by OSTLTS and the Robert Wood Johnson Foundation, PHAB seeks to advance the quality and performance of public health departments through national standards, which more than 3,000 health agencies can use to continuously improve performance. Based on the 10 Essential Public Health Services (3), PHAB accreditation offers a means to ensure comprehensive and quality programs for a range of public health areas, including chronic disease prevention. In March 2013, the first 11 public health departments were accredited by PHAB, and many more applications are in process (4). To support accreditation readiness, OSTLTS launched the National Public Health Improvement Initiative, which currently provides 73 state, local, territorial, and tribal health agencies with funding and assistance to prepare for accreditation and to strengthen agencies’ performance management and quality improvement capacity (5). Each grantee is required to hire or identify a performance improvement manager, thus creating a national network of performance improvement managers. The National Public Health Improvement Initiative is the first noncategorical cooperative agreement at CDC that supports assessment against the PHAB standards to address critical gaps in service delivery and the implementation of quality improvement methods and practices for greater program efficiency and effectiveness. National Public Health Improvement Initiative funding has focused on several chronic disease program areas, including tobacco-use prevention; healthy living (obesity, physical activity, and nutrition); healthy aging (heart disease, stroke prevention, and hypertension); diabetes; cancer prevention; and asthma. For example, the Philadelphia Public Health Department created the first citywide estimate of hypertension based on local health care data rather than sample survey data; New York City added more than 500 clinical practices to its information system, increasing data and information reporting on diseases and conditions such as diabetes, hypertension, obesity, and cancer. Montana is developing a colorectal cancer screening toolbox, and it has improved coordination between medical care and home and school environments through its asthma home visiting program (5). To understand and address public health’s most pressing challenges, OSTLTS works closely with a state, tribal, local, and territorial workgroup that makes recommendations to the Advisory Committee to the Director (6). The workgroup has recommended ways for CDC to better support health departments in the future, and OSTLTS, along with the offices of the Associate Director for Program and the Associate Director of Policy, oversees the implementation and adoption of the advisory committee recommendations. One of the first workgroup recommendations was to improve the technical assistance and services delivered to state, local, tribal, and territorial grantees by CDC project officers. In response, OSTLTS initiated the Technical Assistance and Services Improvement Initiative, which provides agency-wide training, information, and support to project officers. OSTLTS also administered to field staff the first-ever survey, which focused on improving grants management, project officer competencies, and types of assistance needed to enhance program operations and improve health outcomes. Other system-wide improvements include the development of a standard template for all new funding opportunity announcements to reduce inconsistency in the development of new announcements and strengthen program accountability to funders and the field. Other recommendations touch on the future of public health with a focus on promoting the intersection of clinical medicine and public health. In early 2012, OSTLTS launched the Primary Care and Public Health Initiative. This initiative is designed to make it easier for residency program faculty members to incorporate population health into the curriculum. It also provides up-to-date public health data for evidence-based decision making. OSTLTS recognizes that the success of public health programs and chronic disease programs is grounded in a well-trained and skilled workforce. To enhance the workforce, OSTLTS was charged with the growth and development of the Public Health Associate Program, which trains college graduates to be the public health advisors of the future. The curriculum and competencies for this program have been carefully crafted according to the needs of the future workforce; the program will continue to be flexible and dynamic. Health departments can apply to be a host site for an associate’s 2-year training. Many of the associates in this program have been assigned to chronic disease as their area of focus. As an example, a 2011 associate working in New Orleans searched for grant opportunities to sustain the Fit NOLA Partnership, which aims to make New Orleans one of the United States’ 10 fittest cities by 2018 (7). The City of New Orleans Health Department received grants from Blue Cross and Blue Shield of Louisiana, the Partnership for a Healthier America, and the Robert Wood Johnson Foundation as a result of the associate’s work. Finally, OSTLTS sees leadership development as crucial to responding effectively to the challenges inherent in a changing public health landscape. OSTLTS designed an applied multisector leadership development model for the National Leadership Academy for the Public’s Health, which has been implemented by the Public Health Institute through a competitive cooperative agreement with CDC (8). Focused on community-level projects, the academy will train several Community Transformation Grant leadership teams, with a focus on addressing problems in preventing chronic diseases at the local level. Change is difficult, requiring strong leadership, perseverance, and openness to new ideas. As health reform evolves, systems thinking and multisector engagement will continue to be priorities for OSTLTS and will serve as critical components of our efforts to improve the health and wellness of Americans.

"Climate change will increasingly challenge ecosystem managers' ability to protect species diversity and maintain ecosystem function. In response, the National Park Service and the United States Forest Service have promoted climate change adaptation as a management strategy to increase ecosystem resilience to changing climatic conditions. However, very few examples of completed adaptation plans or projects exist. Here, we examine managers' perceptions of internal and external institutional barriers to implementing adaptation strategies. We conducted semi-structured interviews (n=32) with regional managers and agency staff in six park and forest units in Washington State. We found that internal barriers, including unclear mandates from superiors and bureaucratic rules and procedures, are perceived as greater constraints than external barriers related to existing federal environmental laws. Respondents perceived process-oriented environmental laws, such as the National Environmental Policy Act, as enablers of adaptation strategies, and prescriptive laws, such as the Endangered Species Act, as barriers. Our results suggest that climate change adaptation is more often discussed than pursued, and that institutional barriers within agencies limit what can be accomplished."

Evaluating emergency risk communications is fraught with challenges since communication can be approached from both a systemic and programmatic level. Therefore, one must consider stakeholders' perspectives, effectiveness issues, standards of evidence and utility, and channels of influence (e.g., mass media and law enforcement). Evaluation issues related to timing, evaluation questions, methods, measures, and accountability are raised in this dialogue with emergency risk communication specialists. Besides the usual evaluation competencies, evaluators in this area need to understand and work collaboratively with stakeholders and be attuned to the dynamic contextual nature of emergency risk communications. Sample resources and measures are provided here to aid in this emerging and exciting field of evaluation.

In this chapter, we address one of the central themes of development charted in the FLS, intelligence. The interface and overlap between temperament and cognitive ability from infancy though adolescence are examined. As noted in chapter 1, five issues will be addressed: 1 1. Which dimensions of temperament correlate with concurrently-administered standardized tests of intelligence? The temperamental concomitants of intelligence are examined across the infant, preschool, middle childhood, and adolescent eras. 2 2. Can the temperament-intelligence relationship be explained by test-taking behaviors during the administration of the intellectual tests? At three points in time during the FLS, test-taking behavior as a possible mediating variable between temperament and intelligence test scores was examined. 3 3. Are the relations evident between temperament and cognitive skills as measured by standardized tests also evident when parent reports of developmental progress are used? As another approach to explore the possible mediating effect of test taking behavior on the relation between temperament and intelligence, we examined the relation between temperament and parent reports of developmental progress on standardized inventories of child development. 4 4. To what extent do aspects of earlier temperament forecast or predict intellectual development throughout childhood and adolescence? A necessary but not sufficient observation for temperament to influence children’s cognitive/intellectual growth is that earlier temperament relate to subsequent intelligence. In this section, the degree of relation between earlier temperament and intelligence across shorter and longer intervals of time are examined. 5 5. To what extent do earlier measures of children’s intelligence predict temperament and personality? In the final section, FLS measures of intelligence are examined as potential predictors of children’s behavioral style and personality. Concurrent temperament-intelligence relations do not elucidate whether individual differences in children’s ability to process and coordinate information and communicate their needs effectively may impact their behavioral styles. Hence, earlier measures of intelligence as predictors of subsequent temperament are examined to ascertain whether empirical evidence exists to support this possible direction of relation. Furthermore, discussion regarding the intersection between personality and intelligence has been revisited recently (Collis & Messick, 2001). In chapter 3, data from the FLS failed to show direct links between temperament during infancy, preschool years, or middle childhood with personality at age 17. To conclude chapter 5, we examine the extent to which early measures of intelligence foretell personality.

The Fullerton Longitudinal Study is somewhat unique in terms of methodology in comparison to much of the extant research on the relation of temperament to various aspects of children’s experiences in the school context. Much, if not most, prior research on temperament in the school context uses intact classrooms of students, often utilizing teacher reports of temperament based on their observations of the children’s behavior in the classroom environment. This arrangement provides numerous research advantages, including, for example, temperament ratings of children based in somewhat standard settings with somewhat consistent demands/stressors and expectations, temperament ratings by teachers who are experienced and knowledgeable observers of behavior who have had a wealth of opportunity to observe the range of behavioral styles present in most classrooms, and access to regularly-collected indicators of academic performance (grade reports, standardized tests, etc.). In contrast, the FLS is not restricted to a single, isolated classroom, school district, or region. The FLS sample is comprised of children attending a variety of types of schools (e.g., private non-sectarian, private with religious affiliation, public) across a broad geographic region spanning not only Southern California, where all study children were born, but, as the study progressed, increasingly diverse geographic locations. Indeed, as the study participants advanced through their formal education, they were living in states as varied as California, Oregon, Washington, Arizona, Texas, Ohio, and Minnesota, for example.

In a state-wide survey of lead poisoning in Illinois, blood specimens were obtained from 6,151 children ages 1 to 6 years who resided in 14 Illinois cities of intermediate size (10,000 to 150,000 population). Of the total number tested, 1,147 (18.6%) were found to have evidence of undue absorption of lead (greater than or equal to 40μg/100 ml) while in 51 (0.8%) of the children unequivocal instances of lead poisoning occurred (greater than or equal to 80μg/100 ml), according to the guidelines of the Surgeon General. The percentage of children evidencing undue absorption of lead in each city varied from 9.6% to 31.3%, while the main blood lead levels of the samples from the different cities varied from 19.8μg/100 ml to 32.9μg/ 100 ml. The findings suggest that pediatric lead intoxication is not confined to urban slums, but does occur with alarming frequency in smaller communities.