Epidemiology, Clinical Research, and Evaluation

CDM designs and executes both large- and small-scale studies answering complex questions involving multiple program areas, research methods, and locations. Our experience includes national epidemiological studies, and clinical research and evaluation. It covers the areas of child, adolescent and adult health behavior; physical activity, sleep, and diet; adolescent driving behavior; peer relations; early childhood development; education; and diabetes management.

Epidemiology and Applied Research
Underage Drinking Graphic
Trajectory Outcomes of Teens that Ride with Impaired Drivers & Drive Impaired

Motor vehicle crashes are a leading cause of death for adolescents and young adults. In a study funded by the National Institute for Alcohol Abuse and Alcoholism, part of the National Institutes of Health (NIAAA-NIH), continuing through 2023, CDM is collaborating with Yale University to examine the life trajectories of adolescents who report impaired driving and/or riding with an impaired driver. The study explores the life trajectories of adolescents who report impaired driving and/or riding with an impaired driver. They will investigate social and environmental factors that contribute to impaired driving behavior among teens and the impact on adolescent health, employment, and higher education. Their work will deepen understanding of these behaviors and their influence on the transition into adulthood and lay a framework for developing a comprehensive prevention intervention. In addition, the study investigates social and environmental factors that contribute to the development of impaired driving behavior among teens and the impact on adolescent health, employment, and higher education. CDM is leading the development, administration, and analysis of structured interviews for this program. The survey sample includes participants of the NEXT Generation Health Study, a national longitudinal study of high schoolers run by the NIH and CDM that followed 2,785 young people over seven years.

NEXT Generation Health Study (NEXT)

Adolescence is a critical period for the development of unhealthy behavioral patterns that may be associated with subsequent adolescent and adult morbidity and mortality. Adolescence is also a critical period for physiological and behavioral changes and for the onset of obesity and substance use. NEXT is a nationally-representative, seven-year longitudinal study examining the health behaviors (physical activity, sedentary behavior, sleep, diet, substance use, driving behavior, and intimate partner violence) of 10th grade students through four years post-high school. Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), CDM conducts annual surveys and anthropometric measurements, and collected genetic material from 2,700 students as well as online surveys from school administrators.

NEXT Plus Study
NEXT Generation Health Study (NEXT Plus)

Obesity has become a major problem in the United States. Adolescents in the U.S. are more likely to suffer from obesity and being overweight than their peers in other developed countries, and adolescent obesity has been shown to lead to diabetes, heart disease, and many other health problems in adolescents and adults. To better understand this critical phase of U.S. adolescent health and expand on the findings from the NEXT survey of health status, health behaviors, and family, school, and community environmental factors that promote or sustain these, CDM is completing more extensive assessments for a subsample of 560 NEXT participants (280 normal weight; 280 overweight/obese). These annual assessments include objective measures of physical activity and sedentary behavior (accelerometry), sleep (actigraphy), and biological and genetic markers (including those for obesity, cardiovascular disease, and metabolic syndrome, including fasting blood glucose, HbA1c, total cholesterol, triglycerides, LDL-C, HDL, C-reactive protein, uric acid, cotinine, height, weight, waist circumference, and blood pressure).

CDM assisted in a study that examined the association of 3 diet-quality indicators (Diet quality of US adolescents during the transition to adulthood: changes and predictors).

NEXT Pulse: Study of Carotid Intima-Media Thickness (CIMT) Assessments of Cardiovascular Risk in Young Adults

CDM is pilot-testing the feasibility of obtaining valid measures of carotid intima-media thickness (CIMT) to provide information about the pathophysiology of subclinical disease development and progression and its role in clinical cardiovascular disease in young adults. One hundred NEXT Plus participants (50 obese/overweight and 50 normal weight; mean age 19.5 years old) were recruited to the study. Each weight category group contains similar distributions of participants based on gender and race/ethnicity. Each assessment team, which consists of a certified cardiac sonographer and health researcher, meet with participants in their homes to perform bilateral imaging of the right and left common carotid arteries, right and left carotid bifurcation, right and left internal carotid arteries (and plaque presence per segment), and the carotid bulb.

Neighborhood Characteristics

Using Geographic Information System (GIS) software and spatial analysis in conjunction with traditional statistics, information from established data sets about neighborhood social, economic, crime, and demographic statistics will be connected to NEXT participants and NEXT schools by CDM via geocodes to build secondary datasets addressing broader community characteristics in the overall analytic plan. Neighborhood characteristics explored include the adolescents’ access to public recreational facilities, walking/biking trails, commercial facilities, walkable neighborhoods, neighborhood safety, fresh produce, shopping areas, fast food restaurants, and schools/playgrounds.

Challenges such as living with a chronic illness, living in poverty, or simply undergoing life’s transitions test the strength of adolescents, children and parents every day. Through a compassionate assessment of the factors that affect wellness, development, and academic achievement, CDM has been able to recommend improvements for a variety of programs that affect the health and well-being of children, adolescents, and their families.
NEXT Plus Peer Survey

During the years after high school, young adults spend more time outside the family environment and the influence of close friends and social networks becomes more and more significant. Research with adolescents has found that the selection of new friends is intertwined with changes in health behaviors. That is, youth may select friends because they exhibit health behaviors they intend to emulate and the health behaviors of friends are related to the health behaviors of the youth. Social relationships can be supportive of positive health behaviors or health risk behaviors. Although the impact of social networks on health and health behaviors is of increasing interest and importance, longitudinal research during late adolescence and early adulthood is limited and no studies have followed social networks continuously through the high school and post-high school years. One methodological limitation has been the use of proxy-report by one participant to describe the health and behavior of other members of the network. In this NICHD-funded study, CDM asks NEXT Plus participants (n=560) to identify and recruit their romantic partner (if they have one) and up to five ‘best friends’ (n=3,360) to complete a short version of the NEXT survey. Friends report on their own health status and health behaviors, and also provide information about the characteristics (duration, frequency, quality) of their relationship with the referring NEXT Plus participant. These friends also report generally on the health behaviors of THEIR closest friends (without providing names).

Health Behavior in School-aged Children Survey (HBSC)

CDM researchers conducted the 2005-06 and 2009-10 cohorts of the [Health Behavior in School-aged Children (HBSC) Survey], a cross-national research study conducted in collaboration with the World Health Organization (WHO) Regional Office for Europe. Funded by NICHD and the Health Resources and Services Administration, the HBSC aims to increase understanding of young people's health. Findings from HBSC surveys are used to inform and influence health promotion and health education policy and practice at national and international levels. HBSC was initiated in 1982 by researchers from three countries and shortly afterwards the project was adopted by WHO as a collaborative study. There are now more than 40 participating countries and regions. CDM surveyed a total of 21,000 students, and visited 545 schools across the United States.

Coordinating Centers

Coordinating Centers provide the vital infrastructure for multi-site studies, supporting cross-site study design, protocol development, data collection, and analysis. Collaborative technical assistance for individual site activities is also provided.

Healthy Weight Coordinating Center

The CDM Group led the Coordinating Center for the Healthy Weight in Lesbian and Bisexual Women project for the Office of Women’s Health (OWH). The project was developed in response to a growing body of evidence that lesbian and bisexual (LB) women tend to have higher rates of obesity than heterosexual women, and little intervention research has been funded thus far to address this issue and related health inequities. Five projects in place in communities across the United States were targeted at LB women 40 years and older at risk for (or with) heart disease, cancer, diabetes, musculoskeletal problems, asthma, and other morbidities related to overweight and obesity. Interventions focused on activity and nutrition with the goals of improving health, healthy behaviors, and fitness. In support of this project, CDM conducted a cross-site evaluation of the five OWH-funded contracts. The Coordinating Center role included analysis of core survey data and anthropometric measures collected by all five sites; provision of site technical assistance; facilitation of the creation and dissemination of study-related publications; logistical support for the OWH; and facilitation of multiple cross-site committees.

Family Management of Childhood Diabetes (Type 1)

CDM was one of two firms partnering to serve as the coordinating center for a large, multi-site clinical trial investigating a behavioral intervention that targeted improved adherence and glycemic control among adolescents with Type 1 diabetes. This coordinating center collected five waves of data via home visits and telephone interviews for 480 parent-child dyads (960 subjects) and provided data management and analysis.

Clinical Research

Clinical research and its application in communities is a vital component of improving America’s health. CDM has led most of the following important projects, many of which were funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD):

Diabetes Management Personal Trainer Study

CDM collected data for a randomized trial investigating the role of parents and youth in managing children’s Type 1 diabetes, as well as the feasibility and effectiveness of a personal diabetes trainer in promoting adherence to a management regimen among early adolescents. A sample of 90 youth (ages 11 to 16) and their parents (180 subjects) were followed for a period of two years.

Perception of Childhood Diabetes Study

CDM collected data from 90 parent-child dyads (180 subjects) for a longitudinal study of factors that predict adherence to a diabetes regimen for children with Type 1 diabetes, with a particular focus on adolescent developmental transitions.

Transition from Pediatric to Adult Endocrinology Care (PAC)

This study assessed the management of diabetes in adolescents during the transition into young adulthood, evaluated a transition intervention designed to increase adherence to the diabetes regimen in 50 patients undergoing the transition and their parents, and surveyed 110 young adults who had already been through the transition.

X-Pack: Testing the Efficacy of a Smoking Cessation Aid for Young Smokers.

This experimental design study tests the acceptability and efficacy of a smoking cessation aid for young smokers. The aid, called the X-Pack, includes cigarette alternatives, a list of reasons for quitting, a quitting commitment, information about smoking and quitting, and motivational advice. Using a CATI system, CDM conducted two telephone interviews (2 months and 6 months post intervention) with 80 undergraduate college students.

Adverse Childhood Experiences (ACES) and Weight

CDM was recently awarded a contract with the Office of Women’s Health (OWH) to provide technical and logistical support for the design of an intervention for women who are obese and have experienced adverse childhood experiences (ACEs). A history of complex trauma in childhood has been shown to increase adult health risk behaviors and outcomes, including obesity. Working with OWH and an expert panel, CDM will provide research protocol design recommendations for an intervention trial that incorporates a trauma-informed, healthy weight approach. The protocol will address several research questions, including:

  • What are the key characteristics of a trauma-informed healthy weight intervention that would effectively address weight issues?
  • What aspects of an intervention are most likely to be accepted by women who have experienced ACEs and are currently obese?
  • What recruitment and retention strategies will be most effective for different population groups at high risk for ACEs?

For more than a decade, CDM has been continuously involved in several national and local studies of the Head Start program. The goal of this work has always been to collect data that assists Head Start in its efforts to improve services to the low-income families it serves. The following evaluation studies have been used to improve Head Start activities and services, including health, family, outreach, and recruitment.

Head Start Family and Child Experiences Survey: Cohorts 1, 2, and 3

CDM was part of the research team for the first three cohorts of the Head Start Family and Child Experiences Survey (FACES). Funded by the Administration for Children and Families (ACF), FACES provides descriptions of the characteristics and experiences of children and families served by Head Start grantees, information about individual programs and their staff, and information on the communities in which Head Start provides services (Head Start FACES Technical Report I).

Reaching Out to Families: Head Start Recruitment and Enrollment Practices

This ACF-funded study examined Head Start recruitment and enrollment efforts from a variety of perspectives: staff, Head Start parents, and families eligible for Head Start but not enrolled. Findings from the study were used to inform the Head Start Impact Study (Reaching Out to Families: Head Start Recruitment and Enrollment Practices).

Descriptive Study of Head Start Health Services

This study provided the first nationally representative sample of Head Start families and programs by providing a "national snapshot" of how local Head Start programs met the medical, dental, nutritional, and mental health needs of the children and families served (Descriptive Study of Head Start Health Services).

Messages of the Built Environment: Formative Evaluation Study

Funded by a private non-profit organization, this evaluation was a one-year outcome study assessing the impact of the Messages of the Built Environment enhancement curriculum in two Head Start programs in the District of Columbia. The evaluation focused on assessing the impact of the program on teacher’s classroom instruction, parent’s involvement in their child’s education, and student’s cognitive outcomes over the course of one year.

CDM has supported a wide range of research and evaluation efforts in education and also helped evaluate the impact of the USDA School Breakfast Program in elementary and middle schools as well as the Department of Education’s Smaller Learning Communities program in high schools. Many of these studies are in response to Congress’ questions about the impact of federally funded programs on school performance.

Classroom Literacy Intervention and Outcomes Study (CLIO)

The main objective of this U.S. Department of Education collaboration was to test two different two-generation family literacy interventions in a sample of 120 Even Start projects randomly assigned to one of the interventions or to a control condition (i.e., using their traditional curricula).

Implementation Study of Smaller Learning Communities

The primary goal of this four-year study was to describe the implementation of projects funded under the U.S. Department of Education’s Smaller Learning Communities (SLC) program. The program was designed to encourage large high schools to develop, implement, or expand subschool structures and strategies that offered smaller, more personalized educational opportunities for students.

Evaluation of the School Breakfast Pilot Project

This U.S. Department of Agriculture project involved an evaluation of the implementation of the universal school breakfast project in six selected school districts across the country. Child- and school-level outcomes were assessed as part of this longitudinal study.