Can we be scientific in the practice
of occupational health psychology? *
An homage to Don Campbell
Ted Scharf, Ph.D., Research Psychologist
National Institute for Occupational Safety and Health
Cincinnati, Ohio
* Unceremoniously stolen from: Campbell, D.T. (1984).
Can we be scientific in applied social science? In: Conner,
R.F., Altman, D.G., and Jackson, C. (Eds.). Evaluation
studies: Review Annual. v.9, 1984. Beverley Hills, Sage
Publications, pp. 26-48.
disclaimer –
The findings and conclusions in this presentation have
not been formally disseminated by the National Institute
for Occupational Safety and Health and should not be
construed to represent any agency determination or
policy. Any findings and conclusions in this
presentation are those of the author.
please ask questions as we move along . . .
Quasi-experimental methodology:
Campbell, D.T., & Stanley, J. (1966). Experimental and quasiexperimental designs for research. Boston: Houghton Mifflin
Co.
Cook, T.D., and Campbell, D.T. (1979). Quasi-experimentation:
Design and analysis issues for field settings. Chicago: Rand
McNally.
Shadish, W.R., Cook, T.D., and Campbell, D.T. (2002).
Experimental and quasi-experimental designs for generalized
causal inference. Boston: Houghton Mifflin Co.
Categories of validity:
•
statistical conclusion validity
•
internal validity
•
construct validity
•
external validity
Campbell, D.T. (1984). Can we be scientific in applied social
science? In: Conner, R.F., Altman, D.G., and Jackson, C. (Eds.).
Evaluation studies: Review Annual. v.9, 1984. Beverley Hills, Sage
Publications, pp. 26-48.
1. contagious cross-validation
2. competitive replication
i.e. replication is the scientific response to methodological
shortcomings or other problems with validity.
Example:
Experimentally trained researchers tend to focus on the requirements
of internal validity (e.g. requiring a “true” experiment) to the exclusion
of concerns related to external validity.
Inappropriate use of a Randomized Controlled Trial (RCT):
• CDC study regarding the prevention of transmission of HIV from
birth mother to baby, in Côte d’Ivoire and Thailand, using:
– reduced dosage of AZT, compared to a . . .
– placebo control group, rather than to the U.S. standard of care
• New England Journal of Medicine, v.337, no.12, September 18, 1997
e.g.:
– Angell, M. The ethics of clinical research in the third world. pp. 847-849.
– Lurie, P., and Wolfe, S.M. Unethical trials of interventions to reduce
perinatal transmission of the human immunodeficiency virus in
developing countries. pp.853-856.
In Cook and Campbell notation, the CDC research design:
O1
O2
X
O3
O4
-------------------O1
O2
Y
O3
O4
CDC design:
X = experimental, reduced AZT protocol
Y = placebo
participants:
HIV positive, pregnant women
A “comparison” group instead of a “control” group:
O1
O2
X
O3
O4
-------------------O1
O2
Y
O3
O4
--------------------
O1
O2
Z
O3
O4
Comparison groups design:
X = experimental, reduced AZT protocol
Y = U.S. standard AZT treatment
Z = AZT protocol, midway between X & Y
Remember:
The “Gold Standard” - Randomized Controlled Trial (RCT):
•
random selection of subjects / participants
•
random assignment to experimental conditions
•
a “no treatment” or “placebo” control group
•
The origins of the RCT are in experimental and clinical
medicine where physicians evaluate the efficacy of a
particular drug or treatment
•
Often described interchangeably as “evidence-based”
Quasi – experimental methods:
•
typically used with pre-existing, intact groups

measure and evaluate contributing or confounding
factors
•
between groups and within subjects analyses
•
compare between different treatments
•
origins of program evaluation methodology are in
primary and secondary education
• Reminder:
– When a new treatment is under test, AND . . .
– There is no conclusive evidence that the new treatment is
more effective than the current standard, THEN . . .
– We test the new treatment on a sample of eligible subjects,
AND
– Deliver the standard (comparison) treatment to another,
different sample
– AND
• If there is no known effective treatment, a placebo
control group may be considered as a comparison
group
Victora, C.G., Habicht, J-P., and Bryce, J. (2004).
Evidence-based public health: Moving beyond
randomized trials. American Journal of Public Health,
v.94, no.3, pp. 400-405.
• clinical efficacy trials
• public health regimen efficacy
• public health delivery efficacy
• public health program efficacy
• public health program effectiveness
• Victora (2004)
– plausibility evaluation to document impact and rule out
alternative explanations, e.g. with a comparison group
• complex intervention, RCT is artificial
• large-scale demonstration required
• ethical concerns preclude use of RCT
– adequacy evaluation to document time trends
• assessment of intermediate steps
• evaluates each step in the presumed causal pathway
Mohr, L.B. (1995). Impact analysis for program evaluation.
2ed. Thousand Oaks, CA., Sage.
• “outcome line” – (especially ch.2, Fig 2.1, p.16)
– preliminary, intermediate and long-term outcomes
are modeled
– other measured factors may influence the
outcomes
– figure below, adapted from Mohr (1995, p.16):
Measured
Activity #1
Measured
Subobjective #1
Measured
Activity #2
Measured
Activity #3
Measured
Subobjective #2
Measured
Outcome of
Interest
Measured
Activity #4
Measured
Ultimate
Outcome
• Mohr, (1995), when:
– series of related outcomes,
– interim objectives, or sub-objectives,
– formative evaluation required,
then:
– attempt to measure all relevant influences in a study
Disagreements between experimentally trained researchers and
researchers trained in quasi-experimental social science
methodology are just one example of the ways in which our work
can be considered “unscientific.” Within NIOSH:
Rosenstock, L. and Thacker, S. B. (May, 2000). Toward a safe
workplace: The role of systematic reviews. American Journal of
Preventive Medicine. Supplement. v.18, no.4S. Rivara, F.P., and
Thompson, D.C. (Eds). , pp.4-5.
and the reply:
NORA Intervention Effectiveness Research Team, (May, 2001).
May 2000 Supplement on preventing occupational injuries. Letter
to the Editor. American Journal of Preventive Medicine. v.20,
no.4. pp. 308-309.
Theoretical perspective (a.k.a. “world views”) can
exert a great influence on the conduct of the research.
Altman, I., Rogoff, B., (1987). World views in psychology: Trait, interactional,
organismic, and transactional perspectives. In: D. Stokols and I. Altman, (Eds.).
Handbook of environmental psychology. v.1. New York: John Wiley and Sons.
World View
Perspective
Trait
Unit of Analysis over Time
person & individual psychological
processes; emphasis on stable features;
change is reflected in predictable,
ordered, usually developmental stages.
Interactional person, social, & physical environment
are independent entities; interaction of
the separate entities, resulting in
changes of state in the separate entities.
Organismic
holistic entities or integrated systems
composed of distinct person &
environment components in interaction;
interactions are predictable and trend
toward homeostasis.
Transactional holistic entities composed of aspects of
the whole, where the aspects are
mutually defining; change is continuous,
intrinsic, and not pre-determined.
Observers & Focus
separate, objective, & detached
observers; emphasis on traits and
universal laws.
separate, objective, & detached
observers; focus on relations between
separate elements.
separate, objective, & detached
observers; holistic systems in a hierarchy
with subsystems.
observers are aspects of the
phenomena, yielding different
observations from different observers;
focus on identifying the patterns of the
event under examination.
Example:
The “classic” hierarchy of control.
I. Engineering Controls
A. eliminate the hazard
B. substitution of material, equipment, or process
C. isolation of hazard, e.g., barriers and/or removing the worker(s)
D. ventilation of airborne contaminants
II. Administrative Controls to reduce exposure
A. reduced work hours
B. employee education and training
1. improved hazard recognition
2. improved work practices
III. Personal Protective Equipment (PPE)
(Adapted from Raterman, 1996, and Office of Technology Assessment, 1985.)
what else do we know about
hazardous work environments ??
Common features in hazardous work environments –
constant change:
Variability in: time
space / location
motion
Characteristics or properties of workplace hazards:
force(s) creating or causing the hazard
types of efforts to control the hazard
traditional hierarchy of control
degree worker control
likelihood of failure of controls
predictability and salience
work process hazard
severity of risk, following exposure
interactions with other hazards
Worker-centered approach to hazardous work
environments:
Contrary to the traditional Hierarchy of Control:
1) except where a hazard has been completely eliminated
from the environment, worker control and participation in
managing the hazard are essential; and
2) when the work process is extremely time-limited - or is
an actual emergency - workers are most likely to neglect
their own safety to complete the emergent task.
thus, especially in hazardous work environments,
there appears to be an incompatible and conflicting
set of demands that impinge on front-line workers
(in particular):
dual-attention demand:
safety vs. productivity
HOWEVER, from the point-of-view of OHP, our
perspective on this problem must be:
dual-attention demand:
safety AND productivity
How can we approach this problem?
How can we train workers to adopt this perspective and
attitude?
brief digression:
Aren’t we compromising safety when we permit
considerations of productivity to enter into
discussions of safety?
brief digression:
Aren’t we compromising safety when we permit
considerations of productivity to enter into
discussions of safety?
Traditional workplace safety and health viewpoint:
- economics and productivity never mentioned with
respect to safety
- to include economics is to balance a worker’s life
in the same equation with the costs of production
- fundamental principle: safety may not be
compromised for any reason
brief digression:
Aren’t we compromising safety when we permit
considerations of productivity to enter into discussions
of safety?
The real world:
- safety is compromised every day on the job,
especially in hazardous work environments
- employees will take risks with their own lives to
maintain production, (including in situations where
they will not directly benefit)
- especially when fatigued, attention to the production
task becomes rote, and attention to changing
hazards in the surrounding environment ceases
brief digression:
Aren’t we compromising safety when we permit
considerations of productivity to enter into discussions of
safety?
NIOSH and others have come to realize that if we are truly
interested in worker safety, we must develop realistic
safety training that incorporates day-to-day productivity
pressures into the training.
By addressing safety in its real-world context, we:
- enhance safety as a practical, usable, workplace skill
- strive to incorporate safety into the production process,
such that, “the safest way is also the easiest and most
productive way.” (Susan Baker, Johns Hopkins)
“what gets measured,
gets managed”
Professor Peter Chen
Colorado State University
University of South Australia
Orlando, FL., May 18, 2011
Stokols, D. (1987). Conceptual strategies of environmental
psychology. In: D. Stokols and I. Altman, (Eds.). Handbook
of environmental psychology. v.1. New York: John Wiley
and Sons.
and
Stokols, D. (1992). Establishing and maintaining healthy
environments: Toward a social ecology of health
promotion. American Psychologist. v.47, no.1, pp.6-22.
and
Stokols, D. (2006). Toward a science of transdisciplinary
action research. American Journal of Community
Psychology, v.38, pp.63-77.
Establishing a contextual perspective; the core assumptions (Stokols,
1987, pp.42-43):
1. psychological phenomena should be viewed in the spatial, temporal,
and sociocultural milieu in which they occur;
2. a focus on individuals’ responses to discrete stimuli and events in
the short run should be supplemented by more molar and longitudinal
analyses of people’s everyday activities and settings;
3. the search for lawful and generalizable relationships between
environment and behavior should be balanced by a sensitivity to, and
an analysis of, the situation specificity of psychological phenomena;
4. the criteria of ecological and external validity should be explicitly
considered (along with the internal validity of the research) not only
when:
- designing behavioral studies,
but also when:
- judging the applicability of research findings to the development of
public policies and community interventions.
This is the search for and identification of the
target phenomenon and the relevant contextual
variables.
The contextual variables may be identified
through:
- an exploratory and atheoretical process, or
- a fully developed contextual theory
Example: Florida Department of Health responses to the 2004 hurricane season
Structural equation (two) models:
1. Both work organization and hurricane exposure
measures. Purpose: to establish that the work
organization measures contribute to a model in
which the hurricane exposure measures are
included as predictors.
2. Work organization measures alone. Purpose: to
identify an upper-bound estimate for the effects
of the work organization measures (i.e. without
competing with hurricane exposure measures).
prior
hurricane
training
before
2004
W
O
R
K
O
R
G
A
N
I
Z
A
T
I
O
N
amount
of sleep
2004
number of
hurricanes
worked
2004
USUHS
hurricane
exposure
scale - 2004
prior
hurricane
experience
before
2004
ill
health
6/2005
difficulty
balancing
work & family
2004
return
to
normal
20042005
distress
during
hurricanes
2004
T
O
P
I
C
S
bad
mental
health
days
6/2005
job
dissatisfaction
2004-2005
2004
hours
worked
2004
emotional
experiences of
hurricanes
2004
presenteeism
6/2005
p<0.001
p<0.01
p<0.05
hypothesized direction (sign of the coefficient)
opposite the hypothesized direction (opposite sign of the coefficient)
measured
variable
latent
variable
(construct)
Structural equation (two) models:
1. Both work organization and hurricane exposure
measures. Purpose: to establish that the work
organization measures contribute to a model in
which the hurricane exposure measures are
included as predictors.
2. Work organization measures alone. Purpose: to
identify an upper-bound estimate for the effects
of the work organization measures (i.e. without
competing with hurricane exposure measures).
role conflict/
compatibility
2004
workload
2004
return
to normal
2004-2005
social
support
2004
safety
conflict
2004
control
2004
ill - health
6/2005
difficulty
balancing
work & family
2004
distress
during
hurricanes
2004
bad
mental
health
days
6/2005
job
dissatisfaction
2004-2005
communication
& work
organization
prob. 2004
presenteeism
6/2005
The social ecology of health promotion core assumptions (Stokols,
1992, pp.7-8):
1. efforts to promote human well-being should be based on an
understanding of the dynamic interplay among diverse environmental
and personal factors;
2. analyses of health and health promotion should address the
multidimensional and complex nature of human environments,
including:
- physical and social components
- objective and subjective qualities
- scale or immediacy (proximal vs. distal) to individuals and groups
- independent environmental attributes or composite relationships
among several environmental features;
The social ecology of health promotion core assumptions (Stokols,
1992, pp.7-8), continued:
3. environmental scale and complexity:
- individuals
- small groups
- organizations
- populations
i.e. multiple levels of analysis using diverse methodologies;
4. dynamic interrelations (or transactions) between people and
environments:
- physical and social features of settings influence participants’
health
- participants modify their surroundings
- interdependencies between immediate & distant environments,
e.g. local, state, and national-level regulations for safety &
health
Scope of transdisciplinary research, (Stokols, 2006, p.66):
What are the disciplinary boundaries of OHP ?
Put another way, what are the most important
disciplines with which OHP must interact ?
Some candidate disciplines that are essential to OHP:
health,
industrial/organizational,
community, and
environmental psychology,
plus
epidemiology,
public health,
occupational medicine,
industrial hygiene,
safety engineering,
and
anthropology,
sociology,
economics.
Stokols, D. (2006). Toward a science of transdisciplinary action research.
American Journal of Community Psychology, v.38, pp.63-77.
and
Rosenfield, P.L., (1992). The potential of transdisciplinary research for sustaining
and extending linkages between the health and social sciences. Social Science
and Medicine. v.35, no.11, pp.1343-1357.
Continuum of
collaboration
disciplinary
Characteristics of the degree of collaboration and subsequent
approach to investigation and research
the study of a scientific phenomenon from one perspective, typically
reflecting 1) distinctive substantive concerns, 2) analytic levels, and
3) concepts, measures and methods; boundaries between
disciplines may be overlapping, and may spawn a new focused
discipline
multidisciplinary different disciplines working independently or sequentially on a
common problem
interdisciplinary different disciplines sharing information, but the component
disciplinary models and methods remain unchanged
transdisciplinary researchers from different disciplines create a shared conceptual
framework that integrates and extends discipline-based concepts,
theories, and methods to address a common research topic.
something to ask your students:
“which comes first . . .
the question or the answer ?”
and:
“where do research
hypotheses come from ?”
brief review:
quantitative methods –
-
test existing hypotheses (e.g., consider or rule-out)
assess concepts we have measured (quantitatively)
reduce observed results to manageable findings
enable systematic, replicable, and verifiable
measurement, i.e. fundamental science
quantitative methods do not –
- generate novel explanations about things or events,
e.g. propose new causal pathways
- suggest explanations not previously measured
qualitative methods –
- describe and/or explain phenomena or events
- interpret and/or “model” processes or events
- may replicate and verify . . . or suggest unknown processes
or relationships, at same time they provide empirical
data to generate hypotheses or verify a quantifiably
testable hypothesis
qualitative methods provide data specific to a sample and
target population from which it was derived
series of qualitative interviews or focus groups produces
an iterative and progressive investigation of the selected
topic
qualitative methods usually are not designed to –
- generalize beyond the actual sample, unless data collected
for this purpose, and replicated with subsequent,
independent groups
- test hypotheses empirically, unless the sample size is
appropriate, i.e., group characteristics sufficiently
known to determine heterogeneous or
homogeneous, and every participant responds to
each question or hypothesis
Example using qualitative methods:
• topic of investigation: risks for injury among family
farmers, e.g. Kidd, et al., 1996
• method of investigation: series of focus groups
• farm family members are judges regarding the farm
environment – look for agreement between the
participants both within groups and across the series
of groups
• sample the maximum variability in farm environments
• different regions
• different enterprises (crops, livestock, etc.)
• different sizes of operations
• each group should be relatively cohesive / homogenous
Example of a qualitative method generating a model to
be tested quantitatively:
(+)
- Physical
PERCEPTION/
- Psychosocial
ASSESSMENT/
- Non-Hazardous
JUDGMENT
(+)
- Hazardous
(-)
PSYCHOLOGICAL
Environm ental
Conditions (+/-)
Environm ental
Conditions
as
Stressors
(+/-)
(-)
SAFETY
DEMAND
(-)
(-)
MAKING
(+/-)
(+/-)
Individual
Factors
(+/-)
SAFETY
PERFORMANCE
(+)
(+/-)
(+)
(-)
Kidd, et al., 1996
(-)
DECISION
- Tasks,
(-)
CHRONIC
STRAIN
(+)
(-)
(-)
Conditions
(+/-)
ACUTE STRESS
REACTION
(-)
(+)
Equipm ent,
(+)
PHYSIOLOGICAL
ACUTE STRESS
REACTION
(-)
(+)
(+)
(-)
WORK
ENVIRONMENT
SAFETY MARGIN
(+)
(-)
INCIDENT/
INJURY
(-)
Building a Research Team
• Organizational representation (local)
clinic professionals & staff
business owners/managers
labor union(s) representatives
social service agencies
• Community representation
• Professional / technical expertise
academia/research
manufacturer(s)
non-governmental organizations (NGO’s)
public health & other government orgs.
Also:
•
•
•
•
Research subjects / patients
Patient advocates
Family members of clients, patients, or workers
Other workers & community members
• Typically NOT part of research team – why?
– why not?
• Traditional experimental science measures subjects’
behavior, attitudes, etc., but does not involve the
“objects” of the research in the planning.
• However, qualitative methods show us the way to
systematically elicit research hypotheses from our
subjects.
• Therefore, asking members of the subject class or group
to help plan the implementation of the research is just an
extension of our focus group example.
• Result: ordinary research / evaluation study with the
insight and participation of representatives of your
subjects as research team members.
Example:
• Simple Solutions – nursery tool development process
– multi-disciplinary team from University of California,
Davis
– three large nursery companies
• OSHA 200 logs
• ergonomic checklist completed by workers and
supervisors
• interviews with workers and supervisors
Janowitz, et al., 1998; and Prof. John Miles, personal communication, 2004.
• Simple Solutions – nursery tool development process
– high risk job tasks selected (high risk for workrelated musculo-skeletal disorders)
– tool design involved nursery workers and university
team
• workers and team – together – designed the tools
• imperfect or incorrect designs were manufactured because
workers made the suggestion
• then the workers helped design improvements
Janowitz, et al., 1998; and Prof. John Miles, personal communication, 2004.
Summary: Participatory Action Research (PAR) in hazardous work environments.
Project
Partners
Partners’ role
Researchers’ role
Kentucky
Kentucky
Describing, explaining,
Creating a model based on
Farm Family farmers
and interpreting the key
the farmers’ interpretations
Health and
issues and how these
Hazard
topics are linked.
Surveillance
Program
Cross-cutting KY livestock
Iteratively developing and Recording and organizing the
Research and farmers/
testing checklist items;
results; seeking input from
Interventions ranchers
prioritizing checklist items; independent subject matter
in Hazardous Small
suggesting modifications
experts; editing the final lists;
Work
and additional items in
developing formal evaluation
construction
Environments company
subsequent iterations
studies with new groups of
workers.
owners in KY
Hazard
Journeymen
Participate in exploratory Developing and revising
recognition:
ironworkers;
and confirmatory focus
focus group interview guide;
preventing
primarily
groups; confirmatory
probing new areas of inquiry
falls and
apprentice
groups proposed the
identified by focus group
close calls
trainers
project: “Unreported
participants; identifying new
Incidents...” (below).
questions based on the focus
group statements.
Proposed
project:
Unreported
Incidents,
Injuries, &
Illnesses with
Ironworkers.
Core team
composed of
journeymen
ironworkers
who train
apprentices in
union locals.
Create, direct, and
implement an
investigation of the
actual number of
incidents, injuries, and
illnesses among
Ironworkers, starting
with apprentices.
Technical support to the
project: assembling Core
Team decisions into the
components of a research
project; HSRB protocol and
review; developing analytic
templates for reporting the
findings.
p – 2 – r results
Model: “Linking stress
and injury in the
farming
environment:...”
Checklist: Safe Cattle
Handling Critical
Action Factors.
Checklists:
Guidelines for
Extension Ladder
Safety
Summary of the focus
group findings
Goal: on-going
electronic surveillance
tool for use by the
Ironworkers and other
union locals.
What does all this mean for OHP, NIOSH and all of CDC?
National Institute FOR Occupational Safety and Health
National Center FOR Injury Prevention and Control
National Center FOR Environmental Health
National Center FOR HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
National Center FOR Chronic Disease Prevention and Health Promotion
All in the:
Centers FOR Disease Control and Prevention
Conclusion: like NIOSH, Occupational Health Psychology promotes
safety and health at work.
Perspective on evaluation methodology:
• Health care interventions, changes to improve workplace safety
and health, and even pre-placement exams are (essentially)
components of natural experiments
• Identifying and developing systematic measurements of
interventions and workplace programs are tasks of research
• Once systematic measurements are collected, the interventions
and workplace programs will then include a study of intervention
effectiveness
• Results from the evaluation of effectiveness may be used to:
– improve current effectiveness
– identify additional program needs
– promote diffusion of the intervention to additional
communities, occupations, other participants
Interventions for injury prevention and health promotion, or a
few specifics that illustrate the preceding discussion:
Training style:
•
•
•
•
•
•
•
learner centered training
active participation
problem solving
discussions among / between co-workers
crew-based solutions to problems
encourage creative approaches to problems
transfer of skills from experienced to less
experienced job / task performers
•
•
site-specific focus, especially with intact work crews:
discuss prior workplace hazards, problems,
and the solutions developed
•
promote crew approaches to specific
problems on-site
Training principles:
•
front-line worker control is essential where hazards
are present
•
promote good communication, cooperation, and preplanning between workers and front-line supervisors
•
safety is a skill
•
integrate safety with production as the performance
standard, i.e. safety and productivity are interdependent in the work organization and processes
•
subject-matter experts (including veteran workers)
identify hazards and develop plans to reduce risk
Training principles - 2:
•
hazard recognition:
• is not simply identifying existing problems in the
work environment
• includes anticipating incipient problems that may
be likely to develop
• once identified, hazards can be prioritized for
elimination or mitigation, with an emphasis on
reducing risk
•
crew-based solutions promote:
• improved safe-work practices
• reduction in variability on critical tasks
• improved safety climate
References:
Altman, I., Rogoff, B., (1987). World views in psychology: Trait, interactional, organismic, and
transactional perspectives. In: D. Stokols and I. Altman, (Eds.). Handbook of environmental
psychology. v.1. New York: John Wiley and Sons.
Angell, M. (1997). The ethics of clinical research in the third world. New England Journal of
Medicine. v.337, no.12. (September 18, 1997.) pp.847-849.
Baron, S., Estill, C.F., Steege, A., and Lalich, N., (Eds.) (2001). Simple solutions: Ergonomics for
farm workers. National Institute for Occupational Safety and Health, Cincinnati, Ohio. DHHS
(NIOSH) Publication No. 2001-111.
Campbell, D.T. (1984). Can we be scientific in applied social science? In: Conner, R.F.,
Altman, D.G., and Jackson, C. (Eds.). Evaluation studies: Review Annual. v.9, 1984. Beverley
Hills, Sage Publications, pp. 26-48.)
Campbell, D.T., & Stanley, J. (1966). Experimental and quasi-experimental designs for
research. Boston: Houghton Mifflin Co.
Cole, H.P. (1997). Stories to live by: A narrative approach to health behavior research and injury
prevention. In: Gochman, D.S., ed. Handbook of health behavior research IV: Relevance for
professionals and issues for the future. New York, NY: Plenum Press., pp. 325-349.
Cole, H.P., Lehtola, C.J., Thomas, S.R., and Hadley, M. (2005). No way to meet a neighbor,
2ed. Simulation exercise. Available at: http://nasdonline.org/document/1014/9/d000997/thekentucky-community-partners-for-healthy-farming-rops-project.html.
References - 2
Cole, H.P., Lehtola, C.J., Thomas, S.R., and Hadley, M. (2000). Facts about tractor/motor vehicle
collisions. Available at: http://nasdonline.org/static_content/documents/1014/TMVC%20doc.pdf.
Cook, T.D., and Campbell, D.T. (1979). Quasi-experimentation: Design and analysis issues for
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Thank you
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