Category Archives: Research & Analysis

May 29 2014
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RWJF Scholars in the News: Scandals and reforms at the VA, excluding the elderly from medical studies, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

In a Washington Post opinion piece, RWJF Scholars in Health Policy Research alumnus Colin Moore, PhD, writes that the budding scandal over patient waiting times at regional Department of Veterans’ Affairs medical centers (VA) could lead to positive reforms, if past troubles at the VA are any guide. “Throughout its history, the VA’s very public failures have shaped its development as profoundly as its successes,” Moore writes. For example, previous failures led to the adoption of the 1996 Veterans’ Health Care Eligibility Reform Act, which transformed the VA by opening more outpatient clinics and embracing new ways to track and measure health care outcomes. The recent scandal involving falsified reporting on patient waiting times could lead to another cycle of much-needed improvements, Moore writes.

“Doctors are often in the dark” when prescribing medications or procedures to older patients, because the elderly are routinely excluded from medical research, Donna Zulman, MD, MS, co-writes in an opinion piece for the New York Times. Studies have shown that 40 percent of medical research excluded individuals over the age of 65. “Clinicians consequently have to extrapolate findings about diseases as diverse as cancer, heart attacks, and mental illness from studies of younger and often healthier people, potentially putting their older patients at risk.” Older patients should be included in medical studies because age can affect the way a person’s body processes medication and other treatments, according to Zulman, an RWJF Clinical Scholars alumna.

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May 22 2014
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RWJF Scholars in the News: DNA and depression, health impact of foreclosures, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Hurricanes Katrina and Rita significantly increased the number of stillbirths in the Louisiana parishes most affected by the storms, according to a study by RWJF Health & Society Scholar Sammy Zahran, PhD. The research team concluded that 117 to 205 fetal deaths could be attributed to distress caused by the storms, the New York Times blog Well reports. “You can have two mothers with equal characteristics—age, race, and so on,” Zahran said. “[B]ut if one happens to be in a more severely destroyed area, the risk of stillbirth is higher.” The study was also covered by Daily Mail and HealthDay. Read more about Zahran’s work on the Human Capital Blog.

Genetics play an important role in whether stress makes people depressed, and in how quickly they recover, Madison.com reports. RWJF Health & Society Scholars alumnus Jason Fletcher, PhD, looked at data before and after the 9/11 attacks and correlated it with DNA information reported by survey respondents. He found that 60 percent of participants who carried a particular gene appeared to be at an increased risk for sadness after the attacks. “Overall, the evidence suggests that genetic endowments are an important source of variation in response to a stressful event, in producing some depressive symptoms in young adults,” Fletcher said. MedicalXpress also covered the study.

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May 16 2014
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New Participants in RWJF Health & Society Scholars Program to Study Determinants of Population Health

The Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program has announced the selection of 12 new scholars who will investigate how connections among biological, genetic, behavioral, social, economic, and environmental conditions impact the population’s health.

“We’re pleased to announce our newest class of Health & Society Scholars. These new scholars will continue to advance the program’s decade-long mission to answer the questions critical to guiding health policy and improving our nation’s health,” said Jo Ivey Boufford, MD, co-director with Christine Bachrach, PhD, of the national program office for the Health & Society Scholars program, and president of the New York Academy of Medicine.

The program seeks to improve the nation’s health by better understanding and acting on the determinants that can reduce population health disparities. Among many topics, the new scholars will study social factors underlying infectious disease transmission, as well as possible interventions designed to improve urban health. Previous cohorts of scholars have researched how health is influenced by civic engagement, discrimination, human happiness, work environment, public health policies, and many other societal factors.

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May 15 2014
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RWJF Scholars in the News: Budget cuts and babies’ health, nurse engineers, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

New research led by RWJF Clinical Scholar Nicole Brown, MD, MPH, suggests that children with attention deficit hyperactivity disorder (ADHD) are more likely to be from families affected by such stressors as poverty, divorce, neighborhood violence, or substance abuse, HealthDay reports. Researchers analyzed survey responses from parents of more than 65,000 children. Approximately 12 percent of the children had been diagnosed with ADHD, and their parents reported higher rates of those stressors than other respondents. “Knowledge about the prevalence and types of adverse experiences among children diagnosed with ADHD may guide efforts to address trauma in this population and improve ADHD screening, diagnostic accuracy and management," Brown said. The HealthDay article was republished in Philly.com, U.S. News & World Report, and WebMD.

RWJF Nurse Faculty Scholar Betty Bekemeier, PhD, MPH, RN, examined 11 years of data on budget cuts at 100 county health departments in Washington state and Florida in order to understand and quantify how the cuts affected children’s health, My Northwest (Washington) reports. She focused on the impact of funding reductions to such services as the Women, Infants and Children program and nutrition advice for mothers. Bekemeier found a direct correlation between budget cuts for such programs and the number of low birthweight babies. Children born with low birthweight, she notes, often have greater health care needs that may end up costing counties as much or more than the money saved by the original budget cuts.

Duquesne University is pioneering the nation’s first dual degree in nursing and biomedical engineering this fall, according to the Tribune-Review (Pittsburgh). Mary Ellen Glasgow, PhD, RN, ACNS-BC, dean and professor of the Duquesne University School of Nursing, said the dual major will provide engineers with hands-on clinical experience in patient care that will give them a better perspective on the practical applications of solutions to health care problems. “We aren’t going to be putting out millions of nurse engineers,” Glasgow, an RWJF Executive Nurse Fellow, said, predicting that nurse engineers will help pioneer advances and efficiencies in health care through their direct experience with patient care.

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May 1 2014
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RWJF Scholars in the News: Worldwide diabetes epidemic, covering birth control services, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

“[D]iabetes has become a full-blown epidemic in India, China, and throughout many emerging economies,” writes Kasia Lipska, MD, an RWJF Clinical Scholars program alumna, in a New York Times opinion piece. Lipska details her experience treating patients in India, explaining that the country’s recent economic transition has created a “perfect storm of commerce, lifestyle, and genetics” that has led to a rapid growth in diabetes cases. She highlights how costly the disease is to manage, as well as the shortcomings of India’s health care infrastructure, warning that, without reforms, India will have to provide chronic care for more than 100 million diabetics in a few decades.

RWJF Scholars in Health Policy Research alumnus Michael Greenstone, PhD, co-authored an op-ed piece in the Los Angeles Times that praises a recent appellate court decision to uphold the U.S. Environmental Protection Agency’s mercury standards. The court’s majority ruled that the EPA had factored in costs when deciding how stringent the regulation should be, and that the monetized environmental benefits of the rule outweighed the costs, Greenstone writes.

A majority of Americans—69 percent—support the Affordable Care Act requirement that health insurance plans pay for birth control, according to a survey by Michelle Moniz, MD, a Clinical Scholar. The survey included more than 2,000 respondents, NBC News reports. The U.S. Supreme Court is expected to rule by June in a case in which two for-profit corporations assert that paying for insurance coverage of certain forms of birth control conflicts with the companies’ religious beliefs. Moniz’s survey was also covered by MSNBC and Newsweek, among other outlets.

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Apr 24 2014
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RWJF Scholars in the News: Markers for PTSD, inexcusable morbidity, nurse education, cigarette marketing, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Neuroscientists at Harvard University studying trauma and the adolescent brain have identified markers that might help predict susceptibility to post-traumatic stress syndrome (PTSD), New England Public Radio (NEPR) reports. Kate McLaughlin, PhD, an RWJF Health & Society Scholars alumna, and colleagues were studying young people who’d been through serious adversity when the Boston Marathon bombing occurred. They surveyed some study participants who had already had brain scans about how much media coverage of the tragedy they’d watched and how they reacted emotionally, learning that children with certain neurobiological markers or previous trauma were more likely to report symptoms of PTSD. “The more that we can understand the neurobiological markers as well as the psychological and social markers ... the better able we’ll be to deliver early and effective interventions to prevent the onset of mental health problems,” she tells NEPR. Listen here.

“People think about asthma and think we must have a handle on it in the United States, but the grim reality is that most patients’ asthma in this country is uncontrolled,” David Van Sickle, PhD, MA, an RWJF Health & Society Scholars alumnus tells Nonprofit Quarterly in an interview. Van Sickle points to little progress in reducing asthma-related hospitalizations, and what he describes as “inexcusable morbidity” from the condition.  

RWJF Executive Nurse Fellows alumna Jane Kirschling, RN, PhD, FAAN, is featured in Nurse.com on the importance of nurse education. “We’re the largest single group of health care providers in the United States, and we’re there 24-7, 365 days a year for the care that’s provided,” Kirschling said. “That’s in hospitals, community settings and long-term care settings. So, we have to make that commitment as a discipline and as professional nurses to continue to expand our knowledge and our critical thinking skills, and we do that through advancing nursing education.”

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Apr 22 2014
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Tracking the Affordable Care Act with the RAND Health Reform Opinion Study

Katherine Grace Carman, PhD, is an economist at the nonprofit, nonpartisan RAND Corporation and an alumna of the Robert Wood Johnson Foundation (RWJF) Scholars in Health Policy Research program.

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Since September 2013, the RAND Health Reform Opinion Study (HROS) has been collecting data about both public opinion regarding the Affordable Care Act (ACA) and insurance enrollment among respondents of the RAND American Life Panel.

The HROS uses panel data to track changes in public opinion regarding the ACA and insurance coverage.  We survey the same respondents each month. This allows us to observe not only aggregate changes, but also individual respondents changing their opinion or insurance coverage over time. Respondents are split into four groups and one group is surveyed each week. This allows us to present updated information on a weekly basis, while not burdening survey respondents.

One of the most notable findings of our study has been the increase in insurance coverage between September 2013 and March 2014, with an estimated net gain of 9.3 million in the number insured. The margin of error for this estimate is 3.5 million. The newly insured have gained access to insurance through a variety of insurance types, with the largest gains through employer-sponsored insurance (ESI). One might expect larger gains through Medicaid or the exchanges than through ESI. While our data do not allow us to tease out the causes of this gain in ESI, some possible explanations include: greater take-up of previously offered benefits, an improved economy leading more people to hold jobs (or have family members with jobs) that offer ESI, or an increase in employers offering ESI. These results on insurance coverage transitions have been discussed widely in the media, so here we want to bring your attention to some of the other findings of the HROS.

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Apr 18 2014
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New on the RWJF Website

Two stories on the Robert Wood Johnson Foundation (RWJF) website report on new research by RWJF scholars.

An Incentive for Healthier Living: RWJF Scholars Find a Stronger Link Between Obesity and Kidney Disease

Vanessa Grubbs, MD, MPH, and Kirsten Bibbins-Domingo, MD, PhD, both alumnae of the Harold Amos Medical Faculty Development Program (AMFDP), have discovered that obesity appears to be a driver of diminished kidney function, independent of a number of common kidney conditions. This suggests that overweight patients could face kidney troubles even if they avoid hypertension, diabetes, or other such conditions. The researchers also found that the standard measure used to gauge kidney function might miss early signals of deterioration that a more sensitive test can detect. This suggests that clinicians could identify emerging problems in otherwise asymptomatic patients, and help steer them toward healthier habits early in life.

Reducing Adolescents’ Risky Behaviors

New studies from RWJF scholars seek early markers for substance abuse, explore young adult sleep patterns, and gather data on health care providers’ counseling. RWJF Health & Society Scholar Julie Maslowsky, PhD, and colleagues found that mental health problems in eighth graders are a likely marker for subsequent substance abuse issues. In a separate study, Maslowsky’s research team studied the sleep patterns of more than 15,000 teens, because getting too little or too much sleep is related to a number of mental and physical health problems, including depression and anxiety. The same story reports on a survey by Aletha Akers, MD, MPH, an AMFDP alumna, examining the counseling health care providers give to parents of adolescent patients. The topics parents most frequently recalled discussing were the ones least associated with adolescent morbidity.

Apr 17 2014
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RWJF Scholars in the News: Education levels and bone fractures, nursing research, hospital choice, and more.

Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:

Social class may have a significant bearing on the likelihood that middle-aged African American and Asian women will suffer bone fractures, a new study suggests. Co-author Rebecca Thurston, PhD, an RWJF Health & Society Scholars alumna, found that current income level or ability to pay for care is not associated with bone-fracture risk. However, educational levels among minorities, which the authors note are tightly associated with socioeconomic status, are directly related. This suggests that socioeconomic status over the entire course of a woman’s life is more relevant to bone health than current income status, Health Canal reports.

The Richmond Times Dispatch reports on the importance and value of nursing research. Nursing “really looks at the whole person. So we consider the physiological issues in terms of health problems, as well as psychological components, which is a big part of any health problem,” Jacquelyn Campbell, PhD, RN, FAAN, director of the RWJF Nurse Faculty Scholars program, tells the Dispatch. “We also are very concerned with vulnerable populations, ending health inequalities. Some of our nurse scientists, including some of the Nurse Faculty Scholars, are actually doing physiological research in the lab, but they are very concerned with how that translates to the bedside and to the community.” 

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Apr 15 2014
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Media Exposure and Acute Stress Following the Boston Marathon Bombings

E. Alison Holman, PhD, FNP, is an associate professor in nursing science at the University of California, Irvine and a Robert Wood Johnson Foundation Nurse Faculty Scholar.

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A year ago today, on April 15, 2013, in the first major terror attack on U.S. soil since September 11, 2001, Dzhokhar and Tamerlan Tsarnaev planted two pressure cooker bombs near the finish line of the Boston Marathon. Three people died and more than 260 were injured. For a week authorities searched for the perpetrators, shootouts occurred, and Boston was locked down. As reporters and spectators filmed the mayhem, graphic images were shown repeatedly in both traditional and social media around the world. Like the September 11, 2001 (9/11) terrorist attacks, the population of the United States was the terrorists’ intended psychological target. Yet most research on reactions to such events focuses on individuals directly affected, leaving the public health consequences for populations living outside the immediate community largely unexplored.

Tens of thousands of individuals directly witnessed 9/11, but millions more viewed the attacks and their aftermath via the media. In our three-year study following 9/11, my colleagues and I found that people who watched more than one hour of daily 9/11-related TV in the week following the attacks experienced increases in post-traumatic stress (PTS) symptoms (e.g., flashbacks, feeling on edge and hyper vigilant, and avoidance of trauma reminders) and physical ailments over the next three years (Silver, Holman et al., 2013).

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