Inquiring Minds By David Brooks and Kristen Grieco Illustrations by Jim Paillot

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Art Nouveau
Kids learn more than drawing with tablet PCs

Parents who have to erase toddlers' scribbles off the walls of their house know that kids love to draw. Ongoing research has found this applies even when the "pen and paper" are digital—tablet computers, for example—a finding that could give preschool teachers a new tool in the classroom.

"We found that kids created at least as much detail, if not more, in their drawings on a tablet as from traditional media," says Leslie Couse, associate professor of education and coordinator of the graduate Early Childhood Program. Even when children encountered glitches on their tablet computers—and what computer user doesn't encounter glitches?—they charged ahead. "Over time, the number of technical incidents increased—the kids got more sophisticated in their uses—but there was not an increase in frustration. They persisted, and took it to new levels," she says.

After being handed a tablet PC in 2006 during the Faculty Instructional Technology Summer Institute, Couse became intrigued with the possibility of using stylus-controlled computers in early education, since a keyboard or computer mouse can be a major obstacle for young children. She and Dora Chen, assistant professor of family studies and associate director of the UNH Child Study and Development Center, set up a "learning center" at the center, featuring two tablet PCs. Using interviews, assessment tools like the "draw-a-man test" and videotaped sessions, they oversaw children's interaction with the tablets to see how feasible they were in a real-world classroom.

Not only did the kids not destroy the computers, Chen says the kids found unexpected benefits , such as the fact that the tablet could erase better than a pencil—no smudges!—and had colors like a marker. "Pencil erasing is a big thing—it leaves a mark and is actually pretty frustrating. Tablet makes it easy; they loved it," she says.

Loving something and learning from it aren't always the same thing, of course, but Couse and Chen say their study of 41 children over a period of time found few drawbacks, aside from cost. The excitement of new technology provided more than enough motivation to overcome any distraction, while the added complexity was a bonus at least as often as a drawback, because kids enjoyed showing each other how to make the tablet work. "Particularly for young children, when you put computers as a learning center, there's an increase in language, in social interaction. Put two (computers) side by side, it's a good way to build children's language skills," Couse says.

This research, to be published later this year in Journal of Research on Technology in Education, has drawn accolades. Couse and Chen were awarded the 2008 Technology Leadership Award by the National Association of Early Childhood Teacher Educators and received the National Technology Leadership Initiative Fellowship at the Society for Information Technology in Teacher Education Conference. But they say it's only a start: While the believe they have demonstrated that tablets can play a useful role in early education, the next level of research will involve determining specifics ways teachers can use tablets.

"We would never suggest that it replaces traditional things that happen in early childhood or preschool classrooms, but it is one more tool for teachers to be able to use to motivate children in the learning process—a tool for teaching them skills," says Couse.

Cost Surgery
Collecting data on health pricing may lead to reform

Want an outpatient mammogram in New Hampshire? You and your insurer should prepare to spend between $243 and $550, depending on which facility you use. An office visit of moderate complexity for a middle-aged person? That's somewhere from $124 to $276. How about an outpatient kidney stone removal? Prepare to spend from $5,300 to $13,000.

Those numbers come from one of the most innovative health-care initiatives in recent years, born of work by UNH as well as the state governments of New Hampshire and Maine. It's a data-driven analysis of medical costs that in three-plus years of operation it has not only opened eyes about hospital's wide variation of charges for similar practices, and also provided a valuable tool for researchers looking to help the health-care debate.

Patrick Miller, a research professor with the New Hampshire Institute for Health Policy and Practice, points to a recent Patient Migration Study based on data compiled from insurance companies as part of the database. "That's one of the things it holds great promise for: We can very quickly get a sense of what's being spent in different parts of the state today, who's spending it, where it's being spent. That can certainly lead to health-care reform," he said.

Like much academic research, the migration study created new questions even as it provided answers. For example, it found that Coos County loses roughly 70 percent of its health care market to facilities further south, often in Plymouth. Whether that's good because it creates economies of scale or bad because it puts health-care out of geographic reach is a topic for debate, but the debate couldn't happen without the data to drive it.

Compiling that data hasn't been easy, even as Maine and New Hampshire have put their government authority behind the requirement that insurance payout records be made available. But in the four years since its birth from the Maine Healthcare Information Center, the two-state system has accumulated "many, many terabytes of data" out of insurance payout records, says Miller (a terabyte is roughly equivalent 1,000 Encyclopedia Brittanicas). "The backend processing is fairly straightforward," said Miller. That part is done by OnPoint Health Data of Augusta, Maine, under contract. "The front-end processing and analytics, that's difficult. Good data analysts and statisticians are extremely hard to find, and understanding health-care data can be a special challenge."

The relatively straightforward task from the database has been the creation of online medical cost-comparison tools, called HealthCost (www.nhhealthcost.org) that allow patients and employers to comparison shop for prices - something that policy-makers hope will force hospitals to hold down expenses. Using this monstrous database for detailed academic-level research into the way our patchwork health-care system works will be harder.

Making such research possible is why UNH hosts the Regional All Payer Healthcare Information Council, a collection of researchers, policy makers and health-care officials who want to make it easier to find and fix health-care database inefficiencies. Their work is unexciting—harmonizing data collection rules and integrating Medicaid information are high on the to-do list—but is drawing a lot of interest. "I hear from folks from academic institutions, policy think tanks, industry; I recently got a call from a University of Pennsylvania researcher asking for how to get access to data," said Miller.

Not as eye-catching as exposing cost differences between hospitals, but in the long run, it might do more than headline-grabbing genomics or technology updates to improve America's health care.

Rural Mural
A survey reveals four distinct rural categories

Rural America: rolling hills, cows grazing on green grass, farmers making their living off the land. For the 50 million people living in small towns and rural communities, these stereotypes are outdated. (In fact, 94 percent of them make their living at something other than farming.) That's why researchers at the Carsey Institute are redefining rural.

"These places are changing along with the rest of America," says sociology professor Larry Hamilton. "America is no longer a nation of small farms. The changes that are so obvious and heavily publicized in cities are paralleled in places that we might have pictured as unspoiled areas."

"Place Matters: Challenges and Opportunities in Four Rural Americas," is the result of the Carsey Institute's survey of nearly 8,000 residents in 19 rural counties across the country during 2007. Researchers drew from a wide variety of areas in their survey, from picturesque mountain towns to poverty-stricken spots with failing infrastructures. Each was labeled with the "rural" classification, but the differences among them were stark.

"Rural America isn't one thing," says Chris Colocousis '03G, a UNH doctoral candidate and one of the study's authors. "It's a diverse set of places that are dealing with issues that are specific to each type of place."

In the amenity-rich Rocky Mountains, postcard-worthy landscapes draw an influx of newcomers, growing the population 71 percent over 15 years. The survey found high employment rates, low poverty levels, and residents who were cognizant of environmental issues and largely in favor of conservation laws to protect the natural landscapes that had attracted them to the area.

Conversely, the declining resource-dependent areas of the Midwest and chronically poor counties of the South face a population drain. In the Midwest, the young adult population has shrunk by half, and the rural blue-collar middle class faces a challenge as industries like mining and timber are depleted and manufacturing jobs are increasingly outsourced. Chronically poor areas, where 27 percent of the population lives in poverty, tend to take a dim view on the environmental rules that restrict development, and are evenly split over their preference to conserve resources or to use them in creating new jobs.

A fourth, hybrid area emerged in the study: the amenity-decline areas of the Northwest and Northeast. These areas, long dominated by industries like paper and pulp, are looking to other amenities to create jobs as natural resources wane.

"To me, the amenity-decline areas are the most interesting," says Colocousis. "They've historically been dependent on natural resources and are transitioning to something else. It represents a whole new relationship between their communities and their environments."

The Place Matters report was the first in a series of four surveys of rural America—and the most large-scale. Subsequent surveys have focused on smaller rural areas to delve deeper into the issues that surfaced in the report. In 2008, researchers surveyed upper-peninsula Michigan and last year they examined rural areas along coastal Maine. In the final stage, set to begin this year, researchers will survey rural Americans in coastal Washington. These studies are designed to establish the differences between rural areas and to give policymakers a sense of what the issues present in each of them are. One thing that began to jump out at researchers is how much the environmental issues they were examining had become politicized. The pattern appeared in a recent survey of coastal Maine residents, and will be studied further in the upcoming survey of coastal Washington state.

"We're seeing a shift in America," Hamilton says. "Back in the 1970s, issues like environmental protection were bipartisan. In [recent surveys], there has developed a partisan division even on local issues. It could have an unfortunate effect on efforts to solve local problems." ~