Category Archives: Built Environment and Health

Jul 8 2014
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Transforming Communities to Reduce Stress and Improve Health

Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar. 

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You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.

file Brita Roy, MD, MPH, MS

Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.

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Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.

We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress. 

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Jun 12 2014
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RWJF Scholars in the News: Alzheimer’s disease, violence against women, drug 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:

Jason Karlawish, MD, participated in the design of new research that offers “an opportunity to study the future of the way we’re going to think about, talk about and live with the risks of Alzheimer’s disease,” he tells the Associated Press. The study is aimed at testing an experimental drug to see if it can protect seniors who are healthy but whose brains “harbor silent signs” of risk, such as a sticky build-up of proteins that can be a precursor to Alzheimer’s. Karlawish is an RWJF Investigator Award in Health Policy Research recipient. Read more about his work on Alzheimer’s disease here and here.

The work of RWJF Scholars in Health Policy Research alumni Ted Gayer, PhD, and Michael Greenstone, PhD, is featured in an Economist article about incorporating into federal cost-benefit analyses the global benefits of regulation to reduce carbon emissions, rather than benefits that accrue only to the United States. Agencies conduct such analyses before promulgating regulations to test whether the estimated benefits of a regulation exceed the estimated costs. Typically, estimated benefits include only those that accrue to the United States, but because global warming reaches far beyond U.S. borders, the Obama Administration’s calculations include global benefits. Greenstone was also recently cited in the New York Times.

Chris Uggen, PhD, an RWJF Investigator Award recipient, writes about the decline in the incidence of sexual violence and intimate partner violence against women since 1993 in a Pacific Standard article. Rates of sexual violence and intimate partner violence decreased from almost 10 per 1,000 in 1994 to 3.2 per 1,000 in 2012, Uggen writes. While those numbers are encouraging, “misogyny and violence against women remain enormous social problems—on our college campuses and in the larger society,” he says. Uggen’s post also appeared on Sociological Images, a Pacific Standard partner site.

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Jun 9 2014
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Seeing the Human Impact of Climate Change in Bangladesh

Sabrina McCormick, PhD, is a sociologist, filmmaker, and an associate professor of environmental and occupational health for Milken Institute School of Public Health at the George Washington University. She is an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.

Sabrina McCormick

I spent almost a month in Bangladesh producing a story starring Michael C. Hall for the last episode of the Years of Living Dangerously, a documentary series on climate change. In this blog post, I’m going to tell a story that came up in the research phase and one that highlighted, for me, what is possibly the biggest obstacle to getting anything done on this issue.

As someone who’s been studying social movements for a long time, I’ve seen that social change hinges on the tangibility of an issue and sometimes how well you can prove its existence. Yet, most scientists say climate change is invisible, that no one event can be pointed to and called an impact of climate change.

Working on the Years series highlighted this issue all the more since TV and film must show more than it tells. I was in a particularly difficult position trying to tell stories about climate change as a scientist, being bound by this adage that we can’t see it. Yet, when I went to Bangladesh, that adage stopped making sense. It’s not that my scientific mind retreated, but rather that my imagination was able to connect the dots of science in a way it couldn’t without putting science in a specific context, a place where people might already be affected.

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Apr 16 2014
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A Behind the Scenes Look at a Documentary Series on Climate Change

Sabrina McCormick, PhD, is a sociologist, filmmaker, and an associate professor of environmental and occupational health for the Milken Institute School of Public Health at the George Washington University. She is an alumna of the Robert Wood Johnson Foundation Health & Society Scholars program.

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The first episode of Years of Living Dangerously, a new documentary series exploring the human impact of climate change, aired last Sunday on Showtime. I worked on the series as associate producer and producer, but I am also a scientist who has been studying the impact of climate change on human health for almost a decade. In all that time, I’d developed a good grasp of what climate change looks like from a scientific point of view. But working on the series made me learn a lot more about what climate change looks like, not just here in the United States but worldwide.

This documentary television series consists of nine episodes featuring star correspondents as they meet experts and visit ordinary people who have lived through extreme weather events triggered by climate change. James Cameron, Jerry Weintraub, and Arnold Schwarzenegger served as executive producers of the series, along with former 60 Minutes producers Joel Bach and David Gelber. I worked with Matt Damon on an upcoming segment about heat waves and with Michael C. Hall on another story focusing on Bangladesh, a nation already vulnerable to extreme weather.

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Nov 19 2013
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Childhood Lead Exposure: Piling Disadvantage onto Some of the Country’s Most Vulnerable Kids

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.

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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.

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Sep 9 2013
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Community Linkages Increase Access to Diabetes Prevention Education

Robin Whittemore, PhD, APRN, FAAN, is an associate professor at Yale School of Nursing. Whittemore has received national and international recognition for her work in behavioral interventions for type 1 and type 2 diabetes. One focus of her work has been to examine ways to improve access to health programs for vulnerable high-risk populations. She is the primary investigator on a study funded by the RWJF Interdisciplinary Nursing Quality Research Initiative to prevent diabetes among at-risk adults in public housing. This post originally appeared on the U.S. Department of Health and Human Services’ National Partnership for Action blog.

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Minority adults are at a disproportionate risk for developing type 2 diabetes, a challenging illness to manage that is a leading cause of morbidity and mortality in the U.S. Evidence indicates that lifestyle change programs, which incorporate healthy eating, physical activity and modest weight loss, can prevent or delay the development of type 2 diabetes. Yet, access to diabetes prevention programs is limited, particularly among minority and low-income adults.

To help address the issues with access to diabetes prevention programs, we designed a study to link existing community resources—public housing communities and a homecare agency— to minority and low-income adults at-risk for type 2 diabetes. Public housing communities provide housing at reduced rental costs for families of low socioeconomic status. We chose this setting because these communities often have the space and personnel to support a community-based program. The homecare agency consists of nurses who monitor and implement healthcare in a home environment, and are trusted health professionals in public housing communities.

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Jul 18 2013
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Human Capital News Roundup: Interpreters at pediatric appointments, air pollution’s effect on life expectancy, fast food restaurants near schools, 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:

The majority of pediatricians use bilingual family members instead of professional interpreters to communicate with patients with limited understanding of English, according to a study led by RWJF Clinical Scholars alumna Lisa DeCamp, MD. Family members may make errors or withhold sensitive or painful information, DeCamp told Reuters. Two other Clinical Scholars alumnae, who were not involved in the study, also spoke to Reuters about the findings: Lisa Diamond, MD, MPH, and Darcy Thompson, MD, MPH.

Nearly 500 million people living north of the Huai River in Northern China will lose an estimated 2.5 billion life years—or five years each, on average—because of air pollution from widespread coal burning, the Washington Post reports. The data come from a new study co-authored by RWJF Scholars in Health Policy Research alumni Michael Greenstone, PhD, and Avraham Ebenstein, PhD. Greenstone tells the Washington Post he was “surprised by the magnitude of the effect.”

A study led by RWJF Health & Society Scholars alumna Magdalena Cerdá, PhD, MPH, finds New York City saw a sevenfold increase in opioid overdoses from 1990 to 2006, Pain Medicine News reports. The trend has largely been driven by White individuals who live in areas with “high income inequality but lower than average rates of poverty.”

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Jul 15 2013
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RWJF Fellow Named White House "Champion of Change"

Laura Anderko, an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows (ENF) program (2005-2008), received a prestigious honor from the White House last week for her work to protect health in a changing climate.

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The Robert and Kathleen Scanlon Endowed Chair in Values Based Health Care at the School of Nursing & Health Studies at Georgetown University, Anderko was named a “Champion of Change” by the White House. On July 9, she and 10 other “champions” who work at the intersection of the climate and public health attended an event with top government officials to discuss their work.

Anderko, PhD, RN, said in an interview that she was “honored, thrilled, and surprised” to receive the recognition and added that the honor will help raise awareness of the health implications of climate change. My hope, she said, is that this award helps this issue gain “more prominence in the minds of society, not just in America, but globally.”

The ENF program had a “huge impact” on my career, she added. It allowed me to “really immerse myself in environmental health” and taught me to “think big and consider unusual and unlikely partners”—a theme she addressed during the July 9 event at the White House.

“Champions of Change” are recognized by the White House for their work in a wide range of fields. The program was created as an opportunity for the administration to recognize American individuals, businesses and organizations that are “doing extraordinary things to empower and inspire members of their communities.”

“Laura Anderko is making strong efforts to change her community’s ways on treating the environment and is leading the way on climate and health,” a White House release stated.

Learn more about Champions of Change here.

Aug 30 2012
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Framing Public Health Issues

This Q&A originally appeared on the RWJF New Public Health Blog. Read more about Nisbet’s research.

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Environmental issues are consistently a topic of hot debate. A new study reveals that how we talk about these issues could have a big impact on whether people feel compelled to act on them. According to new research led by two awardees of the Robert Wood Johnson Foundation Investigator Awards in Health Policy Research, Matthew C. Nisbet, PhD, MS, and Edward W. Maibach, PhD, MPH, talking about the environmental consequences of climate change may not convince the unconvinced—while talking about the public health consequences might have a better chance.

As the American University and George Mason University professors write in a newly published study in the journal Climatic Change Letters, “Results show that across audience segments, the public health focus was the most likely to elicit emotional reactions consistent with support for climate change mitigation and adaptation.”  The study was co-authored with Teresa Myers and Anthony Leiserowitz.

We caught up with Matthew Nisbet to get his take on the latest findings, and how the public health field can do a better job of framing issues in a way that motivates action.

New Public Health: What is message framing?

Matthew Nisbet: When you frame something as a communicator or as a journalist or as an expert, what you do is you emphasize one dimension of a complex issue over another, calling attention to certain considerations and certain arguments more so than other arguments. In the process, what you do is you communicate why an issue may or may not be a problem, who or what is responsible for that problem and then what should be done. One of the common misunderstandings about framing is that there can be something such as unframed information. Every act of communication, whether intentional or not, involves some type of framing.

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Jan 5 2012
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Housing, Neighborhoods and Health Disparities

As we head into 2012, the Human Capital Blog asked Robert Wood Johnson Foundation (RWJF) staff, program directors, scholars and grantees to share their New Year’s resolutions for our health care system, and what they think should be the priorities for action in the New Year. This post is by Corina Graif, PhD, RWJF Health & Society Scholar at the University of Michigan, Ann Arbor.

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In the New Year I hope that our thinking about housing policy will more systematically incorporate the expanding evidence and relevance of housing conditions for population health and health care policy. Many aspects of internal housing conditions are known to affect health. For instance, heating, ventilation, mold and lead are linked to cardiovascular health, excess mortality, asthma, disability, intellectual functioning, ADHD [Attention Deficit Hyperactivity Disorder] and delinquent behavior.

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We are also learning more and more about the health relevance of various characteristics of the physical environment surrounding one’s residence. For example noise, spatial proximity to vegetation, to grocery shops and to highways, and other sources of air pollution are linked to cardiovascular, mental health, obesity, asthma and allergic effects. Limited but important evidence also exists on the health implications of the socio-spatial context of housing. For instance, fear of crime, crowding, neighborhood disadvantage, social exclusion, and residents’ social exchange are linked to cardiovascular and mental health, obesity, diabetes and low birth weight.

In my dissertation work and related projects, I ask questions about the spatial context of neighborhood effects to investigate how the urban geography of inequality and cumulative spatial disadvantage shape the health and well-being of the inner-city poor. I analyze residential mobility data from the Moving to Opportunity Experiment in Los Angeles, New York, Boston, Baltimore, and Chicago together with data from PHDCN [Project on Human Development in Chicago Neighborhoods], and a large collection of data based on Census and other administrative records over several years.

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