Category Archives: Children (0-5 years)
Sheryl Magzamen, PhD, MPH, is an assistant professor in the College of Veterinary Medicine and Biomedical Sciences at Colorado State University and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2007-2009). She recently published two studies exploring the link between early childhood lead exposure and behavioral and academic outcomes in Environmental Research and the Annals of Epidemiology. She discusses both below.
Human Capital Blog: What are the main findings of your study on childhood lead exposure and discipline?
Sheryl Magzamen: We found that children who had moderate but elevated exposure lead in early childhood were more than two times as likely as unexposed children to be suspended from school, and that’s controlling for race, socioeconomic status, and other covariates. We’re particularly concerned about this because of what it means for barriers to school success and achievement due to behavioral issues.
We are also concerned about the fact that there‘s a strong possibility, based on animal models, that neurological effects of lead exposure predispose children to an array of disruptive or anti-social behavior in schools. The environmental exposures that children have prior to going to school have been largely ignored in debates about quality public education.
It’s made of glass, and it glows and changes colors—but it’s not a crystal ball. It’s an “orb” and it’s poised to revolutionize the way providers assess and treat pain in premature infants.
Martin Schiavenato, PhD, RN, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar, has invented a revolutionary tool to assess pain in premature infants and potentially protect them from its negative developmental effects.
The glass orb translates behavioral and physiological signs of pain in infants—such as body gestures and physiological signals like heart rate metrics—into a “real time” visual display of pain levels. It changes color depending on the subject’s pain levels, giving clinicians readouts on infant pain.
Sammy Zahran, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2012 - 2014). He is assistant professor of demography in the Department of Economics at Colorado State University, assistant professor in the Department of Epidemiology in the Colorado School of Public Health, and co-director of the Center for Disaster and Risk Analysis at Colorado State University. This blog is based on his study: "Linking Source and Effect: Resuspended Soil Lead, Air Lead, and Children's Blood Lead Levels in Detroit, Michigan."
RWJF Health & Society Scholars lead the field of environmental health. This is part of a series highlighting their 2013 research.
Human Capital Blog: Tell us about your recent study, published in Environmental Science and Technology. What questions did you set out to answer? And what did you find?
Sammy Zahran: We sought to understand a mysterious statistical regularity in blood lead (Pb) data obtained from the Michigan Department of Community Health. The dataset contained information on the dates of blood sample collection for 367,800 children (<10 years of age) in Detroit. By graphing the average monthly blood Pb levels (μg/dL) of sampled children, we found a striking seasonal pattern (see Figure 1). Child blood Pb levels behaved cyclically. Compared to the reference month of January, blood Pb levels were 11-14 percent higher in the summer months of July, August, and September.
February is National Children’s Dental Health Month, so the Human Capital Blog reached out to John Gusha, DMD, PC, a 2003 Robert Wood Johnson Foundation (RWJF) Community Health Leader, to learn more about children’s oral health. As project director of the Central Massachusetts Oral Health Initiative, Gusha mobilized dozens of dental societies and non-profit groups to provide dental care for low-income residents of Worcester County. Although funding for the Oral Health Initiative has ended, many of the programs Gusha helped create are still in place.
Human Capital Blog: What spurred the Central Massachusetts Oral Health Initiative? What made you aware of this need for oral health care in your community?
John Gusha: There was a special legislative report in 2000 that described disparities in access to oral health care for low-income populations. It raised a lot of questions about what we could be doing in the community and in the dental society to address these gaps. We got funding from the Health Foundation of Central Massachusetts, which also saw this as a critical need for our area, to launch the initiative.
HCB: Tell us about the school-based programs you put in place.
Gusha: The decay rate in Worcester County schools was very high—more than one-third of the students had active decay in their mouths. It was especially prominent in schools with high numbers of free and reduced price lunches, where students came from low-income families that are more likely to be using Medicaid. These students didn’t have access to care and weren’t getting the preventive services they needed.
We started a school-based program that is now in place in more than 30 Worcester County schools. Dental hygiene students from a local community college provide fluoride varnishes, cleanings and other preventive services to students, and the University of Massachusetts’ Ronald McDonald “Care Mobile” visits schools to offer the same services. Community health centers also participate in these programs by adding dental to their school-based health centers. In the past you could go to schools and provide services, but Medicaid rules didn’t allow you to get reimbursed. We were able to help get those rules changed so the program could become sustainable.
HCB: You also had a role in creating a dental residency program and training primary care providers to screen for oral health needs.
Gusha: We wanted to better integrate dentistry into medicine. The University of Massachusetts was the administrator of our program, and the team there developed a dental residency program at the medical school. The University had no classes in oral health before this. The local hospitals were in desperate need of professionals with this kind of training, particularly in emergency rooms. The Medicaid population was presenting there frequently for treatment because they had nowhere else to go, and people with other issues like cardiac problems or cancer needed clearance on their oral health in order to proceed with treatment.
The residency program is still in place at our two local community health centers, and it’s grown now to include education for other disciplines.
In May, the U.S. Department of Housing and Urban Development (HUD) awarded a multi-year grant to an asthma prevention and treatment program run by 2008 Robert Wood Johnson Foundation Community Health Leader Ray Lopez of New York City. Lopez is the director of environmental health services at the Little Sisters of the Assumption Family Health Service in New York’s East Harlem. The grant award is shared with the New York Academy of Medicine.
Ray Lopez: Our mission is to serve children in East Harlem by helping their families treat and prevent asthma incidents. Asthma rates are unusually high in New York City in general, and the problem’s even more acute in Harlem, the South Bronx and Central Brooklyn where there are all kinds of environmental factors in children’s homes. We’re focused on children in public housing, where there are a number of problems. A lot of the apartments have mold that has grown as a result of leaks, and they’ve also got a lot of cockroaches, and mice, which all contribute as well. What we do, and what this grant will help us do a lot more broadly, is to get treatment for the kids, but also to go into their apartments and get to work on reducing the environmental factors. Sometimes that means identifying moisture sources and safely cleaning the mold. Sometimes it means pressing the city’s housing authority to do major work. Sometimes it involves teaching the adults in the family about the safe use of pesticides and cleaning products. For each family we visit, we work with them to create an individualized service plan, and then we focus on remediating the asthma triggers.
Teaching is a major part of this, too, and the plan is to teach by showing and doing. Families are enrolled with us for a year, and by end of year, we hope they will have accumulated skills to manage these problems on their own in the long-term. It’s a three-year project, in all: two-plus years working with the families, and then a final phase that consists of data analysis and policy initiatives led by the New York Academy of Medicine.
HCB: And then what’s the plan with the data and the analysis?
Lopez: The plan is to build the business case for this kind of intervention, and then to persuade insurance companies and providers that it’s worth the investment to them to spend a little money up front to prevent asthma incidents, rather than paying for them in the emergency room.
On April 27, 2011, Robert Wood Johnson Foundation Ladder to Leadership: Developing the Next Generation of Community Health Leaders program graduate (2009-10) Beth Albright Johns, M.P.H., assistant vice president for Early Childhood Initiatives and Education and the Success by 6 program at the United Way of Central Alabama, watched as much of her hometown was destroyed by tornadoes. While helping her friends, neighbors and colleagues in any way that she could, Johns also focused on her primary role, finding ways to protect the emotional health of the children affected by the tornado.
On April 27, 2011, the largest outbreak of tornadoes in the history of our country hit the southeastern United States and my home state of Alabama. Living in my part of Alabama, I am used to severe weather, but the 27th felt different. The day started with a sense of foreboding, but given our weather history, worrying about it was out of character. In our community, a warning of severe weather generally means watching experienced meteorologist, James Spann, roll up his sleeves and get down to business to help us prepare. So that April day, we tuned in only to watch Spann struggle to maintain his composure as the tornado destroyed Tuscaloosa. I became more and more alarmed as I watched it devastate the communities of friends, colleagues and other neighborhoods where I work and tear through my hometown of Birmingham. Numbing disbelief set in as Spann said, “Oh my God, take cover…it’s out of control.”
The next day, April 28th, the community sprung into action. Our boardroom became the statewide 2-1-1 help line headquarters. Calls poured in from people asking for assistance or asking: “What can I do to help out?” Over 13,000 citizens registered through Hands On Birmingham and 2-1-1 to assist with the clean up and recovery. Pallets of clothes, water, generators and people from all over the country arrived to help. While trying to help others, my co-workers were also searching for loved ones and focusing on our job—protecting the mental health of children affected by the storms.
We immediately went to work with local agencies to advocate for mental health assessments for post-traumatic stress disorder among the kids.
February's RWJF Clinical Scholars Health Policy Podcast Focuses on Philadelphia's Fight Against Childhood Obesity
In this month’s RWJF Clinical Scholars Health Policy Podcast former RWJF Clinical Scholar Donald Schwarz, M.D., M.B.A., (University of Pennsylvania, 1985-1987), Philadelphia Health Commissioner and Deputy Mayor for Health and Opportunity, discusses his work combating the childhood obesity epidemic in Philadelphia, touching on that effort’s controversial soda tax. In his conversation with podcast series host, Matthew Press, M.D., Schwarz also talks about the impact of health care reform at the city health level, and the learning curve required to transition from a career in academia to government service.