In 2012, a new campus was constructed for the Buckingham K-5 public school in rural Dillwyn, Va., replacing the original middle and high school buildings that had stood since 1954 and 1962.
The Charlottesville, Va., architectural firm VMDO Inc., which constructed the campus, says the sites were transformed into a modern learning campus with the aim of addressing the growing concerns of student health and wellbeing. New facilities include a teaching kitchen; innovative food and nutritional displays; an open servery to promote demonstration cooking; a food lab; a small group learning lounge; scratch bakery; dehydrating food composter; ample natural daylight; flexible seating arrangements; and outdoor student gardens.
The firm took advantage of the school’s natural setting surrounding a pine and oak forest and wove them into the design and construction to showcase the “active landscape.” The school’s project committee and design team worked collaboratively to create a total learning environment in order to support learning both inside and outside the traditional classroom. Each grade level enjoys age-appropriate outdoor gardens and play terraces, which encourage children to re-connect and spend time in their natural surroundings. Inside the schools, in addition to core classrooms, each grade level has small group learning spaces that transform pathways into child-centric “learning streets” that have soft seating and fun colors that communicate both collaborative and shared learning experiences.
To study the impact of the healthy design features, VMDO teamed with Matthew Trowbridge, MD, MPH, an associate professor at the University of Virginia School of Medicine, with a special interest in the impact of the built environment on public health to study how health-promoting educational design strategies can support active communities and reduce incidence rates of childhood obesity.
NewPublicHealth recently spoke with Trowbridge about the project.
NewPublicHealth: How did the project come about?
Matthew Trowbridge: Through a collaboration between me and Terry Huang, who was a program officer at the National Institute of Child Health and Human Development and a leader in that institute’s childhood obesity research portfolio. [Editor’s note: He is now a Professor and Chair of the Department of Health Promotion, Social & Behavioral Health University of Nebraska Medical Center College of Public Health.] Back in 2007, Terry had been thinking about how architecture, and particularly school architecture, could be utilized as a tool for obesity prevention. The thinking behind that is that schools have always been a particularly interesting environment for child health very broadly, but also obesity prevention in particular, partly because children spend so much time at school and because the school day provides an important opportunity to help children develop healthy lifelong attitudes and behaviors.
One of the insights that Terry had was that while public health had done a lot to develop programming for school-based obesity prevention, the actual school building itself had really not been looked at in terms of opportunities to help make school-based obesity prevention programs work most effectively. In 2007, Terry actually wrote a journal article outlining ideas for ways in which architecture could be used to augment school-based childhood obesity prevention programs that was published in one of the top obesity journals. When I met Terry at NIH, we realized we both shared an interest in moving beyond studying the association between built environment and health toward real world translation. In other words, providing tangible tools and guidelines to foster collaboration between public health and the design community to bring these ideas into action.
Ukraine Crash Kills Scores of AIDS Researchers
Malaysian Flight 17, believed to have been shot down by a missile over Ukraine yesterday, included dozens of AIDs researchers headed to Melbourne for AIDS 2014, the annual international gathering of AIDS researchers. Global Health Now, a daily newsletter produced by the Johns Hopkins Bloomberg School of Public Health, interviewed Prof. Richard Boyd, director of the Monash Immunology and Stem Cell Laboratories in Melbourne, who said, "There were some serious HIV leaders on that plane. This will have ramifications globally because whenever you lose a leader in any field, it has an impact. That knowledge is irreplaceable.” Read more on HIV.
First Chikungunya Case Acquired in the United States reported in Florida
The first locally acquired case of Chikungunya was reported in Florida this week in a man who had not recently traveled outside the United States. The U.S. Centers for Disease Control and Prevention (CDC) is working with the Florida Department of Health to investigate how the patient contracted the virus and will also monitor for additional locally acquired U.S. cases of the virus.
“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” said Roger Nasci, PhD, chief of CDC’s Arboviral Diseases Branch. Chikungunya virus is transmitted to people by two species of mosquitoes, Aedes aegypti and Aedes albopictus. Both species are found in the southeastern United States and limited parts of the southwest; Aedes albopictus is also found further north up the East Coast, through the Mid-Atlantic States and is also found in the lower Midwest.
The CDC has asked state health departments to report cases of chikungunya to help track the virus in the United States. Local transmission occurs when a mosquito bites someone who is infected with the virus and then bites another person. People infected with chikungunya virus typically develop fever and joint pain. Other symptoms can include muscle aches, headaches, joint swelling or rash. Read more on infectious diseases.
HHS Releases Health Insurance Information for Immigrant Families
The U.S. Department of Health and Human Services (HHS) recently released information clarifying health insurance coverage options for immigrant families, including:
- In order to buy private health insurance through the Marketplace, individuals must be U.S. citizens or be lawfully present in the United States.
- People who recently gained U.S. citizenship or had a change in their immigration status may qualify for a Special Enrollment Period.
- Many immigrant families are of “mixed status,” with members having different immigration and citizenship statuses. Mixed status families can apply for a tax credit or lower out-of-pocket costs for private insurance for their dependent family members who are eligible for coverage in the Marketplace or for Medicaid and CHIP coverage. Family members who aren't applying for health coverage for themselves won't be asked if they have eligible immigration status.
- Federal and state Marketplaces and state Medicaid and CHIP agencies can’t require people to provide information about the citizenship or immigration status of any family or household members who aren’t applying for coverage.
- States can’t deny benefits because a family or household member who isn't applying hasn’t provided his or her citizenship or immigration status.
- Information provided to the Marketplace won’t be used for immigration enforcement purposes.
- If a person is not eligible for Marketplace coverage or can't afford a health plan, they can get low-cost health care at a nearby community health center. Community health centers provide primary health care services to all residents, including immigrant families, in the health center’s service area.
Read more on the Affordable Care Act.
Building a Culture of Health means building a society where getting healthy and staying healthy is a fundamental and guiding social value that helps define American culture...and it’s a mission that communities across the country are eagerly taking on. They include the six communities honored by this year’s Culture of Health prizes from the Robert Wood Johnson Foundation (RWJF), who are coming together today and tomorrow at RWJF’s Princeton, N.J. campus to celebrate their efforts and share the lessons learned. Picked from more than 250 submissions, these six communities are leading some of the nation’s most innovative public health efforts.
The RWJF Culture of Health Prize was launched to further the work of the County Healthy Rankings & Roadmaps program, which aims to educate the public and policy makers on the multiple factors that influence community health—such as education, economic conditions and the physical environment—and to provide solutions that will improve community health. The prizes honor communities that place a high priority on health and bring partners together to drive local change.
Study: Common Asthma Treatment Suppresses Growth in Children
A common treatment for asthma may suppress growth in children, according to a new review of two studies that was published in The Cochrane Library journal. The studies included 45 trials on corticosteroid drugs, which are delivered via inhalers to both children and adults with asthma and generally used as first-line treatments for persistent asthma. "The evidence... suggests that children treated daily with inhaled corticosteroids may grow approximately half a centimeter less during the first year of treatment," said Linjie Zhang at the Federal University of Rio Grande in Brazil, according to Reuters. "But this effect is less pronounced in subsequent years, is not cumulative, and seems minor compared to the known benefits of the drugs for controlling asthma." The World Health Organization estimates that there are approximately 235 million people living with asthma. Read more on pediatrics.
Study: Busiest ERs Often Provide the Best Care
People with life-threatening emergencies have better odds of survival when treated at busier emergency departments, according to a new study in the Annals of Emergency Medicine. The study found that patients admitted to a hospital after an emergency had a 10 percent lower chance of dying in the hospital if they initially went to one of the nation's busiest emergency departments; that people with sepsis had a 26 percent lower death rate at the busiest emergency centers; and that lung failure patients had a 22 percent lower death rate. The researchers behind the study estimate that if all emergency patients received the level of care provided by the busiest emergency departments then approximately 24,000 fewer people would die each year. "It's too early to say that based on these results, patients and first responders should change their decision about which hospital to choose in an emergency," said Keith Kocher, MD, MPH, the lead author of the new study and a University of Michigan Health System emergency physician, in a release. "But the bottom line is that emergency departments and hospitals perform differently, there really are differences in care and they matter." Read more on health disparities.
HHS: $11M Toward Integrating HIV Services into Primary Care
As part of the ongoing National HIV/AIDS Strategy, the U.S. Department of Health and Human Services is making $11 million available for the integration of HIV services into primary care services in Florida, Massachusetts, Maryland and New York. The funds will go toward innovative partnerships between health centers and those states’ health departments. They are part of Partnerships for Care: Health Departments and Health Centers Collaborating to Improve HIV Health Outcomes, a multi-agency project that includes the U.S. Centers for Disease Control and Prevention and the Health Resources and Services Administration. Read more on HIV/AIDS.
More than half of youths in the United States have access to parks or playground areas; recreation centers; boys’ and girls’ clubs; and walking paths or sidewalks in their neighborhoods, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC), State Indicator Report on Physical Activity, 2014.
While that information might conjure up images of newly built, dedicated playgrounds, the reality is different...and less expensive. Thousands of communities have created physical activity opportunities by developing shared use agreements with schools to allow the use of facilities after school hours and on weekends.
In 2011, for example, the nonprofit Partners for Active Living (PAL), in Spartanburg, S.C., met with the city’s Parks and Recreation Department and learned that while the city did have access to defunct school facilities, it had no shared use agreements that would let PAL use school facilities for exercise. With help from a board member (who was also a member of the city council) and online resources for shared use agreements, PAL was able to move the concept forward by showing that:
- Under South Carolina law, school districts and third parties would be protected under the recreational user statute.
- The South Carolina Tort Claims Act imposes the same liabilities and protections both during and after the school day.
- The school district may be liable for negligent supervision of a student only if a duty is executed in a grossly negligent manner.
After about a year of discussions with parents, activists, policymakers, school officials and others, agreements were worked out in 2012 for school soccer fields, basketball courts, trails, playgrounds and football fields to remain open to the community on weekends and from 9 a.m. to 6 p.m. on non-school days and after school until 6 p.m. on school days, with supervision by the Parks and Recreation Department to deal with damage, vandalism and other concerns. The agreement is automatically renewed every five years unless amended. To promote the continued usage of school playgrounds, the department will offer regularly scheduled programming at each site and PAL will be tracking usage.
Proposed Tobacco Merger Could Boost Smoking Rates
The proposed merger of the Reynolds American and Lorillard tobacco companies announced earlier this week could result in increased smoking rates, according to the Campaign for Tobacco-Free Kids. “This proposed merger is clearly driven by steep smoking declines in the U.S.,” said Matthew L. Myers, president of Tobacco-Free Kids. Myers said cigarette sales fell by 37.1 percent from 2000 to 2013, with the largest decline in 2009, when a 62 cent per-pack increase in the federal cigarette tax was implemented. “Reynolds and Lorillard no doubt hope the economic and political power of a merged company will help them slow or reverse these trends. Elected officials and regulators must be equally aggressive in working to accelerate progress in reducing smoking and other tobacco use.” Read more on tobacco.
Health Education Program Also Reduces Youth Dating Violence
A health education program designed to delay sexual behavior and promote healthy data relationships also significantly reduces dating violence behaviors among minority youth, according to a new study in the American Journal of Public Health. Researchers at the University of Texas Health Science Center at Houston (UTHealth) analyzed 766 students in 10 middle schools in a large, urban school district in southeast Texas, where 44 percent were African American and 42 percent were Hispanic. They looked at four areas—physical victimization, emotional victimization, physical perpetration and emotional perpetration—finding that the It’s Your Game...Keep it Real program reduced all but physical dating violence, which comprised the smallest portion of the program; a revised program with a heavier emphasis on this area is currently being tested in schools. The U.S. Centers for Disease Control and Prevention estimates that 10 percent of high school youth are victims of physical dating violence (with ethnic-minority students at increased risk), with other studies indicating that as many as 20 percent are victims of emotional dating violence. Read more on violence.
CDC Report Finds High Rates of Youth Fruit, Vegetable Consumption
Approximately 77.1 percent of U.S. youth ages 2-19 years consume fruit on any given day and 92 percent consume vegetables, according to a recent NCHS Data Brief from the U.S. Centers for Disease Control and Prevention. However, the rate drops as youth age, while at the same time the amount of fruits and vegetables they eat should be increasing. The report used data from the National Health and Nutrition Examination Survey, 2009–2010. The focused report looked only at whether the foods were consumed, and now how much was consumed. Read more on nutrition.
This week, the National Prevention, Health Promotion, and Public Health Council (National Prevention Council) submitted its annual status report to the President and designated Congressional committees describing national progress in meeting specific prevention, health promotion and public health goals defined in the National Prevention Strategy first released three years ago. The National Prevention Strategy is required under the Patient Protection and Affordable Care Act and has the overarching goal of increasing the number of Americans who are healthy at every stage of life.
The goal of the annual report is to show how cabinet-level agencies are working across the federal government to incorporate health in diverse sectors—such as housing, transportation and education—to advance the National Prevention Strategy and influence the health of individuals, families and communities. The status report also highlights how private- and public-sector partners across the country are advancing the National Prevention Strategy in organizations ranging from health care systems to national foundations.
Federal agency highlights for the past twelve months include:
- Continued support for smoke-free housing by the U.S. Department of Health and Human Services
- Smoking cessation initiatives by the U.S. Department of Defense for its troops and their families
- Pedestrian safety promotion efforts from the U.S. Department of Transportation
- School-based healthy food initiatives from the U.S. Department of Education
The report also includes status updates from several partner organization promoting health and wellness, including the American Public Health Association; the Henry Ford Health System; the Delaware Department of Health and Social Services; and the Robert Wood Johnson Foundation. The health promotion efforts of these organizations over the last year includes the fifth annual release of the County Health Rankings, which shows how health is influenced by where we live, learn, work and play.
Read interviews and listen to podcasts with federal agency leaders about the National Prevention Strategy on NewPublicHealth.
RWJF Analysis of ACA Effects Finds No Increase in New Patient Visits
A new report, ACAView, from the Robert Wood Johnson Foundation (RWJF) and athenahealth, finds that in the first five months of 2014 there was no increase in new patient visits, when compared to the same time last year. The ACAView initiative was created to measure the impact of the Affordable Care Act (ACA) on providers, patients and physicians from 2014 through 2016. The report focuses on the provider perspective, showcasing how the ACA affects the practice patterns and economics of physicians and other care team members around the country. Potential reasons for the lack of an increase in visits include the newly insured being unfamiliar with the health care system, or even the winter weather. Read more on the Affordable Care Act.
Study: Nickel in an iPad Linked to Boy’s Allergic Skin Reaction
An ever-increasing reliance on consumer electronics may also mean rarer allergies are becoming more common, according to researchers who linked an 11-year-old boy’s allergic skin reaction to the nickel found in a first-generation Apple iPad. The study was published in the journal Pediatrics. Previous studies have linked the nickel in computers, smartphones and other electronics to allergic reactions; other common sources of nickel include ear piercings, clothing fasteners and dental work. “With the increasing prevalence of nickel allergy in the pediatric population, it is important for clinicians to continue to consider metallic-appearing electronics and personal effects as potential sources of nickel exposure,” according to the study. Read more on pediatrics.
Study: Changing Generic Pill Color, Shape Can Decrease Prescription Adherence
In addition to known considerations such as side effects and cost, the change in the appearance of prescription medications may also lead some people to stop taking their prescriptions, according to a new study in the Annals of Internal Medicine. In a study of more than 11,000 patients, researchers determined that a change in pill color would increase the odds that a patient would stop taking their heart medication by 34 percent, while a change in pill shape would increase the chances by 66 percent. This adds another wrinkle to the series problem of medication adherence; the American Heart Association estimates that three out of four Americans do not take their medication as directed. Read more on prescription drugs.
Earlier this year, when a federal task force convened to look at how to help Detroit pull out of bankruptcy and regain resident and business confidence, one of the first recommendations was to assess the many blighted areas of the city—typically created when residents leave an area in droves, or when a business moves out of a building and isn’t replaced by another—and begin restoring them for residential, business or green space use.
Blight matters. Beyond making a city ugly, abandoned areas become a haven for trash, toxic elements, drug sales and prostitution. In Dorchester, outside Boston, a space sold by the city for a parking lot was left vacant for years and became a trash dump with mounds of cigarettes, and cars and tires—all leaching toxins.
A growing number of communities are starting to clean up those lots. In Baltimore, flight from the city has left close to a million homes and apartment buildings vacant over the last few decades, leaving in their place empty, dirty spaces that invite crime and trash. Bon Secours Community Works—the foundation of the Bon Secours Health System with hospitals in Baltimore and other cities—supports initiatives aimed at creating stable housing, including a program called Clean and Green, which is a part of Bon Secours' Housing and Neighborhood Revitalization Department.
Clean and Green is a landscaping training program that has transformed more than 85 vacant lots into green spaces, and has also begun to initiate community arts projects such as large public murals and community gardens. The program is designed to teach green job development skills, as well as provide free cleanup and beautification services to Baltimore neighborhoods.
Each program team is hired for six months of on-the-job training in green landscaping, during which they learn how to use landscaping and gardening tools and then go out into the field to clean lots, plant trees, pick up trash and do weeding. As part of their training, each individual gives at least three presentations about some aspect of green landscaping that they’ve learned, further preparing them for job interviews and jobs in the field. Each summer, youth employees also join the Clean and Green team for six weeks, working alongside the adults to learn about green landscaping and giving back to a community.
The public comment period for rules regulating the sale and use of e-cigarettes proposed in April by the U.S. Food and Drug Administration (FDA) ends on August 8, after which the agency is expected to release final rules governing the products. Experts say the timing is critical because sales of the products—which weren’t even on the market a decade ago—are heating up, with revenues approaching $1 billion a year, according to Forbes Magazine.
Last week, Health Affairs and the Robert Wood Johnson Foundation (RWJF) released a health policy brief about e-cigarettes that sets out key issues concerning the products and provides important background, particularly for people poised to comment on the FDA’s proposed rules.
Among the issues the policy brief addresses are e-cigarette safety; whether the devices ought to be regulated as a medical (smoking cessation) device or as a cigarette; and whether e-cigarettes pose a risk as a “gateway” drug to tobacco products. It notes that the FDA is currently funding close to 40 studies on e-cigarettes.
The issue is especially critical because sales to kids and teens are increasing, and there is still insufficient information on whether the vapor emitted by the devices pose a cancer risk. A 2013 study of 40,000 middle and high school students around the country by researchers at UC San Francisco found that e-cigarette use in that group doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.
Read the policy brief from Health Affairs and RWJF.
>>Bonus Link: Read a NewPublicHealth post on initiatives by major cities to regulate the sale and use of e-cigarettes.