The Crime Survey For England And Wales Criminology Essay

The Crime Survey For England And Wales Criminology Essay The National Statistician in 2011 acknowledged that the exclusion of crimes against children from the BCS estimates has been considered a major gap. As a result, in 2009 the survey was extended to include children aged between 10 and 15 (Home Office Statistical Bulletin 2010/11, p. 20). This may help in gaining further knowledge of the full extent of crime in Britain, although this process also comes with its own limitations. The children may not be entirely accurate in their accounts, or fear what may happen to them after responding. The Crime Survey for England and Wales measures the extent of crime in England and Wales by asking people whether they have experienced any crime in the past year.  The survey has measured crime in this way since 1982 and is an important source of information for the government about the extent and nature of crime in England and Wales. It also aims to enquire information regarding the location and timing of crimes, the offenders characteristics and the relationship between victims and offenders (Office for National Statistics, 2012).    A separate survey (the Scottish Crime and Justice survey) measures the extent of crime in Scotland. The survey is conducted by TNS-BMRB on behalf of the Office for National Statistics. Evidence in support of this argument comes from The Home Office (2011) which stated: the BCS offers a more dependable measure of trends in crime as it has a consistent methodology and is unaffected by changes in levels of reporting to the police, recording practice or police activityHowever, the BCS does not aim to provide an absolute count of crime in England and Wales, but to produce estimates of crimes experienced by adults aged 16 and over resident in households. (Home Office Statistical News Release: Crime in England and Wales, 2010/11). Therefore, the survey is not representative of the whole population of Britain and cannot be used to give an overview picture of crime, due to the nature of its sample. Moreover, the survey does not cover all offences such as homicide, fraud and drug offences. On the other hand, police recorded figures have a greater coverage of offences compared to those of the BCS. For example, homicide is not covered by the surveys. Sexual victimisation questions are asked in a separate form, and results are not included in the main total of crime collected by the BCS, due to their delicate nature (Home Office, 2011). Office for National Statistics, 2012): Latest figures from the Crime Survey for England and Wales (CSEW) for the year ending June 2012 show a 6 per cent decrease in overall crime against adults compared with the previous years survey. This continues the downward trend in recorded crime, seen since 2004/05. (Ref 6, the Guardian) There were 9.1m reported crimes in 2011/12, according to the Crime Survey for England and Wales, but less than half as many 3.9m were recorded by the police. (Ref 13 Home Office, 2010/11, p. 15-16) Police recorded crime has been subject to major changes in recording practice over time, making interpretation of long-term trends for this series is difficult. The BCS and recorded crime provide generally good coverage of crime committed against the public, particularly for offences involving physical harm, loss or damage to property. Recorded crime is limited to those offences which come to the attention of the police, and is affected by changes to reporting rates, recording practice and police activity. Thus for the crime types and population it covers, the BCS is the best long-term measure of crime trends. However, the BCS is limited in its coverage to crimes against those residents in households and so cannot cover all crime types (for example, homicide, crimes against businesses and other organisations and drug possession). Crime is recorded according to the victims account of events, rather than requiring criminal intent to be proven. Th e BCS asks about individuals experience of crime, irrespective of what action was subsequently taken. For police recorded crime, the victim-focused approach is enshrined in the National Crime Recording Standard (NCRS).The NCRS states that all incidents reported by a victim to the police should be recorded, if the events described amount to a crime in law and unless there is credible evidence to the contrary. The drop in crime since the mid-1990s is because of improved property and vehicle security, economic influences, social change, use of CCTV and other local crime reduction initiatives and changes in policing and the wider criminal justice system. Pg. 22: A range of non-notifiable crimes may be dealt with by the issuing of a Penalty Notice for Disorder, a Fixed Penalty Notice or prosecution at a magistrates court. Along with non-notifiable offences dealt with by the police (such as speeding), these include many offences that may be dealt with by other agencies for example, prose cutions by TV Licensing or by the DVLA for vehicle registration offences. These counts only relate to offences where action has been brought against an offender and guilt has either been ascertained in court, or the offender has admitted culpability through acceptance of a penalty notice. These crimes generally only come to light through the relevant authorities actively looking to identify offending behaviour. However, they do illustrate that, taking the broadest definition of crime, the main BCS and Recorded Crime statistics only cover a fraction of total criminal behaviour. Crime and society in Britain, Hazel Croall, 2011, p. 40: The role of victims and the public varies with the offence. Some maybe relatively invisible or the victim is totally unaware of any harm or actions regarded abnormal. For example the sexual abuse of children takes place in a private and children are often unaware that something is wrong. Some incidents such as theft at work may result in dismissal only and not involve criminal proceeding. Such incidents are therefore missed out in total crime accounted for by the police records and CSEW. Croall, 2011, Pg. 51: victim surveys use standard classifications of crime missing out white collar and financial crimes, the CSEW is based on households omitting organisations such as businesses, hospitals, schools and care homes, omitting young teenagers and kids, respondents definitions of crime are limited by their memory and restricted to crimes which they are aware of and miss out those they cannot detect themselves, the surveys capture s ingle incidents and underestimate the full extent of repeat victimisation. Pg. 52: self-report surveys that find out how many times the population have participated in criminal activity, provide more detail about the class, age sex or race of those that have admitted to offending. They are often used with young people and therefore provide extremely valuable information about participation in crime. However respondents, particularly children, may be afraid to answer properly as they fear parents might see their answers, or others may exaggerate, hence affecting the accuracy of responses given. These surveys have been restricted to young people making it harder to question other groups of people such as senior executive about embezzlement. Pg. 60: Muir 2010 found that crime has always been and remains higher in England and Wales than in Scotland and Northern Ireland having much lower levels of crime, using a comparison of crime surveys across the UK for 2008/9 figures. Pg. 61: Moreov er, Higgins and Millard 2009 argue that Wales which is generally combined with England has lower rates for most types than England. Tierney, 2006, Pg. 34: before 1992, the BCS used to survey households randomly chosen from electoral registers, however thereafter, the Postcode Address File was used. Pg. 35: Although the BCS provides large numbers of crime incidents not present in police recorded crime figures, this only applies to certain offence categories, rather than crime in general. Pg. 38-39: victim surveys just like police recorded crimes; do not pick up all criminal offences, such as for those under 16 years. Including corporate and organised plus occupational crimes; theft from businesses (shoplifting, insurance fraud), criminal damage, or crimes without victims, plus taxation and social security fraud. Victims may be scared, embarrassed or unaware they are victims. Pg. 41: according to class conflict theories, statistics provide an insight into the class based nature of the criminal justice system, as well as being manipulated to suit the interests of the powerful plus provide indicators of the inequalit ies and biases inherent in the system itself and in a capitalist society in general. Also one must consider the links between criminal activity, police clear up rates and various community-based initiatives. Tierney, 2006, Pg. 44: changes to counting rules in 1998 mainly affected violent crime and led to some previously less serious, non-notifiable assaults being categorised as notifiable. In 2002, police had to take victims account at face value, until proven otherwise, resulting in increasing the number of offences recorded. This is a further illustration of the socially constructed nature of criminal statistics. Pg. 20: Maguire 1994 suggests crime itself is a social contrast and statistics that relate to it are socially constructed. Croall, 2011, p. 42: the higher rates of reporting property crimes, especially car thefts, result from the requirements of insurance policies. Potential crimes come to the attention of police and other law enforcement agencies by being directly encountered or reported, with the majority being reported to the police by the public (Maguire 2007). Law enforcement decisions affect all subsequent stages when a crime is encountered or reported. Not all complaints are recorded, creating a distinction between offences reported to and recorded by the police. Offences may not be recorded because they are not regarded as sufficiently serious or defined as involving no crime (Coleman and Moynihan, 1996). Croall, 2011: Changes were made in police recording procedures following the introduction of the national crime recording standards (NCRS) in 2002. These have a major impact on the reliability of official statistics, especially as recording practices in different areas and jurisdictions may vary , complicating any comparisons. They also affect overall increases and decreases and changes can create apparent crime waves. Recorded crime series were affected by new counting rules from 1998 onwards and by the NCRS from 2002 onwards. Pg. 44:.most police forces are encouraged to be cost effective and as a result successive governments have introduced diversionary schemes where offences are dealt with out of court such as on-the-spot fines. This underlines the existence of an unknowable dark figure of crime which is never recorded in the official statistics. Therefore officially recorded crimes and convicted offenders are those that have survived the process of attrition and are not representative of all who break the criminal law. Pg. 45: crimes which are more visible and take place in public are more likely to be processed than those taking place in private. For example street crimes of young people are more likely to be counted than crimes of white collar offenders which take pl ace in the offices or crimes which take place in the home, further distorting the relationships between age, gender or social class and offending. Variations in the proportions of crimes counted means that it can rarely be said with any certainty that any particular kind of crime is rising or falling, as any apparent increases or decreases could merely represent a change in the proportion of crimes reported to or recorded by the agencies. Changes in police recording practices can create crime waves or alternatively reductions in crime. On the other hand, more policing can increase crime rates, by catching more and recording more crime. Home office, stats bulletin, 2010/11, Pg. 24: Together they provide a more comprehensive picture than could be obtained from either series alone. However, neither the BCS nor police recorded crime aim to provide complete counts of crime. The coverage of police recorded crime statistics is defined by the Notifiable Offence List1, which includes a broad range of offences, from murder to minor criminal damage, theft and public order offences. However, there are some, mainly less serious offences that are excluded from the recorded crime collection. These non-notifiable crimes include many incidents that might generally considered to be anti-social behaviour but that may also be crimes in law (including bye-laws) such as littering, begging and drunkenness. Other non-notifiable offences include driving under the influence of alcohol, parking offences and TV licence evasion. The survey also excludes some other offences for which it may not be possible to collect robust estimates of crime l evels (such as sexual offences). However, the BCS does capture other information about such offences. The BCS is a face-to-face victimisation survey in which people resident in households in England and Wales are asked about their experiences of crime in the 12 months prior to interview. Until recently the BCS did not cover crimes against those aged under 16, but since January 2009 interviews have been carried out with children aged 10 to 15. Experimental statistics for children are shown separately. Pg. 26: For the crime types and population it covers, the BCS provides a better reflection of the extent of household and personal crime than police recorded statistics because it includes crimes that are not reported to or recorded by the police. The BCS is also a better indicator of long-term trends because it is unaffected by changes in levels of reporting to the police or by police recording practices. Although the focus of ensuring comparability over time means that the BCS does no t include some relatively new crimes in its main crime count, such as plastic card fraud, these are asked about and presented. BCS estimates for 2010/11 are based on face-to-face interviews with 46,754 respondents. The BCS has a high response rate (76%) and the survey is weighted to adjust for possible non-response bias and to ensure the sample reflects the profile of the general population. Being based on a sample survey, BCS estimates are subject to a margin of error. Police recorded crime statistics are administrative data based on notifiable crimes that are reported to and recorded by the police in England and Wales. Unlike the BCS, recorded crime includes crime against commercial and public sector bodies, and so-called victimless crimes (such as drug possession offences). Recorded crime figures provide a good measure of trends in well-reported crimes (in particular, homicide, which is not covered by the BCS), can be used for local crime pattern analysis and are important indicators of police workload. However, there are also categories of crime whose numbers are heavily influenced by the extent to which police proactively investigate. Police recording practice is governed by the National Crime Recording Standard (NCRS). The NCRS was introduced nationally in April 2002 to ensure greater consistency and transparency of crime recording between forces, together with a victim focus where crimes reported by the public are recorded unless there is credible evidence to the contrary. Crime data are collected from police forces for each crime within the Notifiable Offence List and according to Home Office Counting Rules. Police recorded crime figures should be seen as a product of an administrative system where rules can be subject to different interpretation a nd, for some categories of crime, can reflect police workload and activity rather than underlying levels of crime. Pg. 27: While the coverage differs both in terms of offence types and population groups, property crime accounts for the majority of both BCS and recorded crime (77% and 70% respectively) with violence, including robbery, accounting for most of the remainder 23 per cent of BCS crime and 22 per cent of recorded crime. Pg. 17; the introduction of the NCRS in April 2002 considerably increased the recording of less serious violent crime by the police and figures are not directly comparable across this break in the series. Philip Schlesinger Howard Tumber, 1999, Pg. 7: new forms of crime have emerged: hard drug trafficking, terrorism and corporate fraud. Page 144: developments in police work such as computer use and forensic science, this allows for more crime to be detected. Newburn, 2012, the guardian: theft has become much more difficult.  Then there is surveillance. While the impact of CCTV is generally much less than one would imagine given how widespread it has become, it is effective in some areas and is an aid to the police and private security. There are now more police officers than there were 20 years ago. Add in  Police Community Support Officers (PCSOs) security guards and the gradual re-emergence of other jobs with a partial safety and security focus (ticket inspectors, caretakers, park keepers and the rest) and you have a substantial expansion of the eyes and ears available for crime prevention. Home Office Statistical Bulletin, 2010/11: Pg 29-30: BCS crime fell markedly between 1995 and the 2004/05 BCS. Since 2004/05 the underlying trend in BCS crime has continued to be downward, although at a slower rate and with some fluctuation in year-to-year estimates. Recorded crime fell each year until 1998/99 when the expanded coverage and changes in the Counting Rules resulted in an increase in recorded offences; this was followed by the introduction of the NCRS in April 2002, although some forces adopted NCRS practices before the standard was formally introduced. The introduction of NCRS led to a rise in recording in 2002/03 and, particularly for less serious violent crime, in following years as forces continued to improve compliance with the new standard. From 2001/02 to 2003/04 there was considerable divergence in the trends for BCS and police recorded crime, mainly associated with police recording changes (which particularly influenced violence against the person). Since 2003/0 4, despite some fluctuations, trends have been more consistent between the two series.

How is 1984 terrifying? Essay

This brings in the relationships between Winston and Oi Brien. At first, they seem to have taken to each other, but in the end we find out that Oi Brien double-crossed Winston and that he couldni t trust someone he thought was his friend. The party did not want people to trust or have feelings for one another. A perfect example is, in the ministry of love, where a chinless man dropped a piece of bread for a starving fellow inmate. The man (who dropped the bread) was immediately punished, by being beaten until he bled. A normal person, in the ‘starving inmatei s positioni would have felt indebted to the man, as he was punished for trying to feed him, but moments after guards came in to take the inmate who was given the bread immediately betrayed the man who gave him the bread. Telling the guards to take him (chinless) to room 101 instead. This would have surely pleased Big Brother, as the eradication of friendship would be the partyi s main goal. When the request was not replied, the man pleaded that they rather slit throat of his wife and all his children than send him to room 101. This man was betraying his own family members. This would have pleased Big Brother. People came to the conclusion that one could not trust anybody in fear that they would report them to the thought police, where one would be vaporised. This was true when dealing with peoplei s families. In the ministry of love when Winston meets Parson who tells him how his daughter betrayed him when she heard him talking of overthrowing the party in his sleep. Other families were destroyed by the loss of respect between parents and children. People were refusing to obey their parents, as Big Brother encouraged them to do. The relationships between lovers were also controlled by the party, as they annihilate all the pleasures and desires of having sex and even promote artificial insemination. The party did not like sex as when two people share the experience they begin to love each other. The party then begins to put negative thought behind the idea of sex. This is illustrated during the two minutes that Winston describes Julia as â€Å"sexless†. During the relationship, Julia and Winston have to meet in secret. When they meet in secret from directions passed to each other on a note, so the prying eyes of the Telescreen do not catch them. This is particularly scary as nowadays, love is seen as a beautiful thing, not a secret affair. The last and final terrifying aspect of â€Å"nineteen eighty-four†, is the idea of all the power that Big Brother holds. Big Brother is a dictator with so much power that he is able to make people love him and fear him all at the same time. He controls them. The most dangerous thing about it is that Orwell does not really tell us whether or not Big Brother exists as he is Hitler, Stalin and Lenin all rolled into one, this time unstoppable, making it more real to readers as these are real people. Orwell believed that there would be a communist leader that would practise capitalism and still rule. This is exactly what Big Brother did. Orwell blends the terrifying aspects that the people experienced of communism and capitalism in his portrayal of Big brotheri s totalitarianism. Orwell describes the situation of the people in great detail when he wrote the description of the lives led by the people. Although the conditions were very poor, The party convinced people conditions fourty years ago, conditions were worse and that Big Brother was improving things. ‘Day and night, the Telescreen bruised peoplei s ears with news and information of how [people] were better off than people fourty years ago. i Because of all this propaganda making Big Brother seem like a God, Big Brother was able to scare people into hating the people that were a threat to the party. People like Goldstein. This was the reason of the two minutes hate. The two-minute hate was another example of the lack of individuality. Every party member was forced to take part. During the two minutes hate, people were watched for signs of â€Å"Unorthodox behaviour. † In the event, Winston sees Julia. He then has fantasies about her. These fantasies, although full of hateful thoughts, illustrate the passion he feels for her, but the fact that he thinks of being with her in these horrible scenarios, shows the way that Big Brother is able to control feelings. What I mean is when one person lusts after another, they have fantasies of being together in a place they would describe as paradise. They do not want to rape them in horrific scenes. The amount of passion he feels for Julia makes him want to be with her, but because he cani t, he has built up anger and hatred inside him. The picture of Goldstein shown in these two minutes, conjures up hate for the people. This is important, as people like Goldstein and his followers, the proles, were the biggest threat to the party. The people saw the proles as outcasts and propaganda made the people hate them. This is similar to the propaganda Hitler used against the Jews in the late 1930i s, so the people are able to relate. It was easy for Big Brother to make the people do this, as the people could not remember what life was like without a ruler (like Big Brother) to tell them what to do. Big Brother eliminated the past by destroying records and rewrote it. People, especially party members could not have memories. They were completely under Big Brotheri s control. In conclusion there are many terrifying aspects, but none more terrifying than the other is. Each is terrifying in iti s own way and all point to the fact that most of these things did, could have, and could still happen. Orwell realised this and that inspired him to write an ‘account of the futurei which is what â€Å"nineteen eighty-four† was to him and others living in 1949. Although terrifying now, these things would have been more terrifying in 1949, because, the things Orwell described had happened to them in some form. For example, the threats of labour camps, them being told that the Jews (Goldstein) were the enemy, capitalist dictatorship. So this book would have been the terrifying reality to the people of that time. At the time this novel was written, the Russian revolution and World War II was the reality and these things were happening in Russia. So in answer to the question, this novel would have been much more terrifying in 1949, because to them this book was real life.

Uncommon Article Gives You the Facts on Summary and Response Essay Samples That Only a Few People Know Exist

Uncommon Article Gives You the Facts on Summary and Response Essay Samples That Only a Few People Know Exist Put simply, you've got to analyze the chosen topic. No matter the topic on which you're writing, all important responses follow the exact same format. Following your analysis, put forward your opinion on the subject. Start with the review of the topic. A summary grid is a helpful tool for helping students to pull main ideas from a text before organizing them in a bit of writing. A literature review is done so as to clarify the regions of prior research of the issue you've currently undertaken. Check with your instructor to identify what publishing information is essential and where it ought to be placed. A really nice and well-paid job is actually challenging to find without excellent academic grades. Even though the pros and cons could possibly be equal, the dilemma of how to reduce the proportion of greenhouse gasses might never be solved. People who have an inc lination to eat junk foods need to be made accountable for their wellbeing, not by restricting what food they eat but by enabling them to cover their medical care expenses. Obesity is among the most discussed health issues in today's world. As a consequence the state expects that water sports increase. The statement also assumes that in the event the state cleans up the river, the usage of the river for water sports will certainly increase. Obtain a high degree of mastery on the topic that you're likely to write about. If getting a fantastic academic grade is your aim, you're in the proper spot! The Nuiances of Summary and Response Essay Samples Be both concise and informative to find an unsurpassed outcome! You should discover the last objectives of each text and the mutual features if you own a set of those. First off, an introduction is utilised to establish your primary argument about the work analyzed. Though the response may start to deal with the assigned task, it del ivers no development. Facts, Fiction and Summary and Response Essay Samples Even if a text uses a conventional structure, it's still worthwhile to consider whether there was space for improvement. Try to remember, your view is the thing that dictates a response paper. An outline is a distinct item of paper, which functions as a plan for you. Within the analysis, your reply to the text also needs to be presented. The Dirty Truth on Summary and Response Essay Samples Try to remember, the readers are accustomed to the book you may be speaking about. Summarize the material so that he gets a general sense of all key aspects of the original work. Next, a succinct review of the work is presented so the reader, who's perhaps not acquainted with the text, will understand what the text is all about. Consequently, you should offer your reader a background overview of what the article you're responding to talks about. It isn't possible that after reading, you have no emotions or impressions. When you begin expressing your emotions to the author's work, remember that you're a personality. The body of your response should earn a claim about a part of the text which you find interesting and worthy of discussion. The previous one, describing feelings, which is regarded as the very best approach to deal with the feelings, is placing your feeling into words in a moderate way. The New Fuss About Summary and Response Essay Samples This way you are able to secure the best grades for the very best summary response essays. The experienced essay helpers are working for quite a while within this area and therefore can write a supreme high quality essay without plagiarism at an affordable price. Critical essays aren't that popular among teachers and professors, therefore, some students find it difficult to comprehend how to compose a crucial essay. Before writing the essay, it's important to select an intriguing topic. Now you are aware of how to compose a response essay! Although this essay seems to be carefully organized, it doesn't comply with the directions for the assigned task. How to compose a response essay. The Basics of Summary and Response Essay Samples Each paragraph within the body of this perceptive essay identifies and examines an unstated assumption that is essential to the argument. Unlike the summary, it's composed of YOUR opinions in regard to the article being summarized. When you check at two sentences, the outcome isn't acceptable for the cause. Communication differences between women and men. In conclusion, the statement isn't logical since there are a few errors in it. This statement appears like logical, but there are a number of erroneous sentences in it which isn't logical. Also, you don't need to be too long with the sentences. It can be broken by sentence, paragraph, or section, based on the duration of the text. Whatever They Told You About Summary and Response Essay Samples Is Dead Wrong...And Here's Why The statement assumes that everybody in Mason City enjoys some form of recreational activity, which might not be necessarily accurate. What's interesting to you and others, select some study region that's well worth reviewing. The solution to this question takes a survey to figure out the reasons our residents use or don't use the river. Herbie Steinmark's parents should have prayed. Choosing Good Summary and Response Essay Samples Where there's no true care, there's no meaning. You should criticize the job. It is preferable to use short ones, but you should be precise and clear. As it is really less difficult to write about something when you recognize practically everything on it.

Does Adherence Predict Weight Loss An Examination of an IDEA - Free Essay Example

Sample details Pages: 3 Words: 865 Downloads: 10 Date added: 2019/08/16 Category Health Essay Level High school Tags: Weight Loss Essay Did you like this example? What is knee osteoarthritis (OA)? Knee osteoarthritis is a disease characterized by deterioration and inflammation of the knee joint.6 Knee OA can be identified with radiographic evidence or by symptomology. The Kellgren-Lawrence (KL) grading scheme is the radiographic reference standard for defining knee OA.6 The severity of osteoarthritis is determined by the presence of osteophytes on the knee joint, joint space narrowing, sclerosis of the subchondral bone, and deformity of the femoral head.7 Scoring of the KL grading scheme ranges from 0 to 4. Minimal, but definitive, knee OA is defined by the presence of an osteophyte, equating to a KL grade of 2 or higher.6,7,10 Symptomatic knee OA is characterized by radiographic evidence of OA accompanied by pain, aching, or stiffness in the affected joint. Don’t waste time! Our writers will create an original "Does Adherence Predict Weight Loss An Examination of an IDEA" essay for you Create order Pain occurring on most days of a recent month is representative of symptomatic knee OA.2,6,8 Epidemiology of knee OA Data from the 2011-2012 National Health Interview Survey (NHIS) indicates that 15.1 million United States (U.S.) adults have symptomatic knee OA. An additional 8.6 million adults are classified with KL grade 3 or 4 advanced symptomatic knee OA.1 The prevalence of knee OA has dramatically increased in the past one hundred years. Wallace et al. compared the prevalence of knee OA among American adults from the early industrial and postindustrial periods. The prevalence of knee OA (16%, 95% CI: 14-19%) was 2.6 times higher among the postindustrial sample (95% CI: 2.1-3.4) compared to the early industrial sample (6%, 95% CI: 5-7%). 10 Prevalence data for knee OA differs across studies depending on the definition of osteoarthritis. Studies using the radiographic definition of osteoarthritis trend towards higher prevalence as compared to the symptomatic definition.4,11,12 In the Framingham Osteoarthritis study, 27.4% of adults over sixty-three had radiographic knee OA. However, only 7% of adults within this sample had symptomatic OA.9,13 Similarly, the prevalence of radiographic knee OA was almost 10% higher than the prevalence of symptomatic knee OA among middle-age adults in the Johnston County OA Project (27.8% vs. 16.7%).9,11 The population being studied can also impact estimates of knee osteoarthritis. Whereas two studies found that non-Hispanic whites had the highest rates of knee OA, other articles reported highest rates in African Americans.1,9,11,13 Age and sex also influence the prevalence of knee OA. Osteoarthritis is a chronic disease whose prevalence increases across the lifespan. The prevalence of knee OA increases from 1-2% in adults 25-44 years old to 14% in adults over 65 years.1,9,13 According to Murphy et al., the overall lifetime risk of developing symptomatic knee OA by age 85 is 44.7%.2 Across age groups, females are more likely to have knee OA and have more severe knee OA when compared to men. Women over 50 years old were 1.68 (RR 95% CI 1.37-2.07) times more likely than men over 50 years old to have knee OA.5 Furthermore, diagnosed knee OA in women over 55 years old was more severe than knee OA in men of the same age range (standardized mean difference 0.20, 95% CI 0.11-0.28).14 Healthcare Burden Knee osteoarthritis places a large strain on a countrys economy. U.S. adults spend roughly 28 years living with symptomatic knee OA.15 Treatment for knee OA comes in various forms and at various price points. The minimum treatment strategy consisting of a physician visit, physical therapy, knee braces, and medications costs $684 annually.15 Many adults will spend years using medications and non-surgical treatments before seeking advanced care. The standard care treatment for end-stage knee OA is total knee arthroplasty (TKA).16 The TKA is widespread due to its life expectancy and relative safety. In 2010, 658,000 knee arthroplasties were performed, with 92% of surgeries being TKAs.16 Direct and indirect medical costs associated with knee OA create a large burden on the individual and on society. As of 2013, a primary TKA cost $20,293 in the United States.15 Individuals undergoing revision TKA spend an average of $49,360 and 5 days in the hospital.16 On a larger scale, the hospital charges associated with revision knee arthroplasties accounts for nearly $2.7 billion in U.S. healthcare spending.16 From a national viewpoint, the U.S. spends $139.8 billion dollars annually (95% CI 83.7-195.9) on direct costs attributable to knee OA.17 Indirectly, the disability associated with knee OA impacts workplace productivity. The U.S. loses nearly $164 billion each year (95% CI, 85.2-242.3) in earnings attributable to arthritis. Between direct medical costs and productivity loses, arthritis accounts for $303.5 billion in healthcare spending.17 Risk Factors for Knee Osteoarthritis Predisposing factors for knee OA are divided into systemic risk factors and local risk factors. Systemic risk factors include age, gender, race/ethnicity, and genetics. Age is one of the strongest systemic risk factors for knee OA due to loss of muscular strength, thinning of articular cartilage, and oxidative damage to the knee joint.6 Local risk factors for knee OA include previous injury, physical activity, and obesity. The risk of developing knee OA increases by 183% (RR 2.83, 95% CI 1.91-4.19) in adults who have suffered a previous knee injury when compared to adults who have not had a previous injury.5 Roughly 5% of cases of knee OA could be avoided if knee injuries could be prevented in adults.5 The relationship between knee OA, physical activity, and overweight/obesity is more complicated. Adults engaging in at least four hours per day of heavy physical activity were significantly more likely to have radiographic knee OA when compared to adults engaging in no heavy physical activity (OR 7.0, 95% CI 2.4-20, p0.001).18 Further analysis of the influence of weight status revealed the highest risk of developing radiographic knee OA was in obese adults engaging in heavy physical activity (OR 13.0, 95% CI 3.3-51) .18 Although frequent and heavy physical activity may be associated with knee OA, a sedentary lifestyle and subsequent weight gain may also elevate the risk for developing knee OA. Overweight and obesity is a strong predictor of knee OA in adults. Being overweight or becoming overweight as an adult increases the lifetime risk of developing symptomatic knee OA by nearly 30%.2 The literature often uses the World Health Organizations (WHO) classification of overweight and obesity, which defines overweight as a body mass index (BMI) of †°? 25 – †°Ã‚ ¤ 29.9 kg/m2 and obese as a BMI †°? 30 kg/m2.19 Evidence suggests there is a curvilinear relationship between BMI and risk of knee OA. One meta-analysis quantified the pooled risk of developing knee OA as a factor of increasing BMI across twelve studies. Having a BMI of 25 kg/m2 is associated with a 59% (RR 1.59, 95% CI 1.34-1.81) increased likelihood of developing knee OA.20 A second study found ones likelihood of developing knee OA to rise by 35% (RR 1.35, 95% CI 1.18-1.53) for each 5 kg/m2 increase in BMI.21 Disease progression and severity are also affected by weight status. A prospective study of 354 adults found overweight individuals to be 9.1 (95% CI, 2.6-32.2) times more likely to develop K/L grade 1+ knee OA within 5 years. Additionally, being overweight increased the likelihood of progressing to moderate knee OA (K/L grade 2+) within 5 years by 18.3 times (95% CI, 5.1-65.1).22 In addition to disease progression, weight status affects an individuals symptoms. Being overweight or obese is associated with a 2.66 (95% CI, 2.03-3.48) times higher risk of being diagnosed with symptomatic knee OA.23 Overweight (OR 1.69, 95% CI 1.36-2.11) and obese (OR 2.58, 95% CI 1.74-3.58) individuals are also more likely to experience persistent knee pain than normal weight adults.23 Treatment Recommendations for Knee OA Weight Loss Although being overweight or obese increases the likelihood of developing knee OA, weight reduction can improve clinical and functional outcomes. The Osteoarthritis Research International (OARSI) guidelines committee recommends weight loss as a core management strategy for overweight and obese patients with knee OA (strength of recommendation 96%, 95% CI 92-100).24 Weight loss has been shown to have positive effects on pain, joint stiffness, and disability in adults with knee OA. A meta-analysis of four randomized controlled trials (RCTs) reported a small improvement in knee pain resulting from weight loss (ES = 0.20, 95% CI 0-0.39). The literature supports a dose-response relationship between the amount of weight lost and reductions in knee pain. An intensive 18-month diet and exercise intervention found significantly lower self-reported pain scores with at least 10% (3.71, 95% CI 3.09-4.34) and 20% (2.79, 95% CI 1.87-3.71) weight loss when compared to 5% weight loss (4.46, 95% CI 3 .81-5.11, p = 0.006).25 Knee joint stiffness is also alleviated by weight loss in overweight adults with knee OA. The results of two RCTs support a small decrease in joint stiffness as a result of weight loss (ES = 0.36, 95% CI -0.08, 0.80).24 Reductions joint stiffness associated with weight loss may also be related to improvements in physical function. A meta-analysis of three RCTs found an average weight loss of 6.1kg (95% CI 4.7-7.6kg) was associated with a small improvement (ES = 0.23, 95% CI 0.04-0.42) in self-reported disability.26 The relationship between weight loss and increases in physical function is also supported by objective measures. Overweight adults with knee OA who lost an average of 5.2kg (95% CI 0.85-9.55) demonstrated significant improvements in both six-minute walk distance (?† from baseline = 61.61m, 95% CI 35.90-87.32) and stair climb time (?† from baseline = -2.54s, 95% CI -4.13, -0.95).27 Exercise Weight loss should not be considered independently of physical activity. The OARSI group recommends regular aerobic activity and resistance training as an adjuvant treatment for knee OA.24 Engaging in regular aerobic activity can serve as a non-pharmacologic pain reliever for individuals with knee OA. A meta-analysis of 13 RCTs on aerobic activity has shown support for a moderate improvement in pain (ES = 0.52, 95% CI 0.34-0.70).24 Aerobic activity can also improve physical function in people with knee OA. Individuals with knee OA who take part in aerobic activity experience moderate improvements in self-reported disability (ES = 0.46, 95% CI 0.25-0.67).24 Muscle strengthening has also been identified as a core recommendation for the management of knee OA. Small reductions in pain (ES = 0.32, 95% CI 0.23-0.42) and self-reported disability (ES = 0.32, 95% CI 0.23-0.41) have been reported with quadriceps training.24 Combined Weight Loss Plus Exercise Interventions Multiple studies have examined the relationship between weight loss and clinical outcomes in overweight adults with knee OA. The Arthritis, Diet, and Activity Promotion Trial (ADAPT) was an 18-month RCT comparing standard care to dietary weight loss, exercise, or combined diet plus exercise on physical function, pain, and mobility. Individuals in the diet plus exercise group lost the largest amount of body weight (mean 5.20kg, 95% CI 0.85-9.55), followed by those in the diet only group (mean 4.61kg, 95% CI 0.38-8.84) when assessed at 18-month follow-up.27 Physical function, pain, and mobility were significantly improved for individuals in the diet plus exercise group after 18 months. Weight loss of 5% baseline body weight was associated with a 24% reduction (95% CI 2.63-8.83) in physical function scores and a 30% reduction in pain scores. Additionally, mobility improved as noted by increased 6-minute walk distance (477.76  ± 13.12m, p Whereas a weight loss goal of 5% was established for the ADAPT study, the Intensive Diet and Exercise for Arthritis (IDEA) study had a weight loss goal of at least 10% body weight.28 IDEA was an 18-month RCT that compared the effects of dietary weight loss, exercise, or diet plus exercise on clinical outcomes. Participants in the diet plus exercise group lost an average 10.6 kg (95% CI -14.1, -7.1) compared to an average 1.8 kg (95% CI, -5.7-1.8) loss in the exercise only group.28 Although IDEA participants in the diet plus exercise group had a higher percentage of body weight loss, a similar trend was reported for physical function, pain, and mobility scores after 18 months. Physical function scores decreased by nearly 42% (?†_18month = -10.3, p 0.001), pain scores decreased by 45% (?†_18month = -3.0, p = 0.02), and 6-minute walk distance increased by 15% (?†_18month = 70, p 0.001).28 Rather than analyzing the impact of weight loss on clinical and functional outcomes, one study analyzed whether weight loss could prevent the onset of knee pain in overweight adults with diabetes. White and colleagues randomized participants to one of two treatment conditions: 1) intensive lifestyle intervention focusing on aerobic activity and weight loss, or 2) diabetes education and support comparison group. Individuals randomized to the intensive exercise and weight loss program were 15% (RR = 0.85, 95% CI 0.74-0.98) less likely to develop knee pain within 1-year when compared to individuals in the comparison group.29 Participants who met the 7% weight loss target were 37% (RR = 0.63, 95% CI 0.46-0.88) and 38% (RR = 0.62, 95% CI 0.47-0.83) less likely to develop knee pain within 1 and 4 years, respectively.29 Collectively, these three studies strengthen the conclusion that the combination of dietary weight loss and exercise is associated with positive clinical outcomes. Predictors of Weight Loss Due to the strong evidence of the benefits of weight loss in overweight adults with knee OA, researchers have sought to identify predictors of weight loss. Predictors of weight loss can be grouped as individual factors or factors pertaining to the intervention. Internal Factors Self-Efficacy Self-efficacy is the belief in ones ability to accomplish a specific task or goal.30 Within the weight loss literature, self-efficacy can divided into exercise self-efficacy and dietary self-efficacy. Having a high exercise self-efficacy at baseline was associated with achieving the 7% weight loss target among adult participants involved in the Diabetes Prevention Program (DPP).31 Among overweight adult women, both exercise self-efficacy (r = -0.32, p Depressive Symptoms An individuals general affect can influence their willingness to engage in behaviors that may lead to weight loss. Pre-treatment depressive symptoms may influence weight loss if the individuals negative affect stems from unhappiness with their current weight status. Among obese adults, lower levels of baseline depressive symptoms are associated with weight loss success after 1 year.34 Additionally, baseline depression scores among overweight, older veterans with knee OA were predictive of weight loss after a 6 month intervention.35 It should be noted, however, that both studies used inventories measuring depressive symptoms rather than identifying individuals with clinical depression. Participants who are clinically depressed are often excluded from weight loss studies because they may be taking medications that impact their ability to lose weight.36 Programmatic Features Social Support The social aspect of participation in a research study may be a contributing treatment-related factor for weight loss. Individuals who participated in a group-based commercial weight loss program lost more weight than individuals who participated in one-on-one dietary counseling sessions (-4.3  ± 6.1 kg vs. -1.3  ± 6.1 kg, p Attendance The relationship between attendance at a diet or exercise intervention and weight loss is intuitive for the general population. As a result, studies have sought to find evidence to support this conclusion. Among overweight adults receiving a modified version of the Diabetes Prevention Program (DPP), attendance at counseling sessions was a significant predictor of weight loss ( = -0.609, p = 0.003).33 Evidence from a RCT comparing self-help to a commercially based weight reduction program for adults found higher self-reported attendance at sessions was significantly associated with weight loss after 1 and 2 years (p Adherence Definition of Adherence To date, there is no consensus on the operational definition of adherence. In simplistic terms, adherence is defined as a percentage of the number of sessions completed divided by the total number of sessions offered.27,28,40 However, more complex definitions of adherence necessitate the need to first answer the question: adherence to what? Exercise adherence can be defined by attendance rates and by goal achievement. Two community-based RCTs in overweight adults with knee OA have used on-line attendance logs to track exercise adherence.27,28 Among adult participants in the Healthy Weights Initiative, meeting the goal for exercise frequency, intensity, or duration was the criteria for exercise adherence.41 Adherence to a dietary intervention depends on the behavior being measured. Multiple studies have used attendance rates to define adherence to a diet class.27,28,41 Other studies have defined adherence by the frequency of food tracking over a specific period of time. Jacobs and colleagues defined adherence as logging a meal within its specified time frame, but also separated from a consecutive record by at least 30 minutes.40 A separate study expanded the time constraint of an adherent period to no longer than 4 days between consecutive food logs.42 Aside from defining adherence by attendance rates frequency of food tracking, adherence may also be defined as an individuals agreement to the prescribed dietary intervention. One study defined dietary adherence as the percentage of discrepancy between ones actual daily kilocalorie loss divided by their expected daily kilocalorie loss.43 The definition of adherence is often driven by the way that adherence is measured.