Category Archives: Obesity
Even Healthy Weight Adults with High Body Fat at Increased Risk of Heart Disease
Even older adults with healthy body weights can be at increased risk of cardiovascular diseases if they have high percentages of body fat, according to a new study The American Journal of Cardiology. "Just because someone has a normal BMI does not necessarily mean they are metabolically normal," said lead researcher Dr. John Batsis, a geriatrician at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. The study found that women with excess body fat (above 35 percent) were 57 percent more likely to die from heart-related causes within 11 years than were women with healthy body fat levels. Javier Salvador, MD, an endocrinologist at the University Clinic of Navarra in Pamplona, Spain, who was not involved in the study, said the findings demonstrate the limits of body mass index (BMI), which measures weight in relation to height. Read more on heart health.
‘Image Discrepancies’ of Job Roles Can Hurt Job Satisfaction, Performance and Pay
The lack of client understanding of the actual job roles of nurse practitioners and other professionals can negatively impact job satisfaction, performance and pay, according to a recent study in the Academy of Management Journal. "If people don't understand what you do, they tend to devalue what you do," study co-author Michael Pratt, a professor of management and organization at Boston College. "They don't understand why you're making all this money—'Why should I pay you all this money?' is a common question these professionals keep hearing." The study looked at “image discrepancies” in four professions—nurse practitioners, architects, litigation attorneys and certified public accountants—finding a noticeable and negative lack of understanding by clients for each. For example, many patients don’t realize that nurse practitioners can examine patients and prescribe medicine, and instead insist on seeing a doctor. "I assumed professionals would actually get over it, that there would be frustration, it would be an interpersonal problem, and that would be the extent of it," Pratt said. "I didn't think it would have such a big impact on how they did their job, how it affected their pay and how they performed. I was surprised at the depth of how this affected job performance. It's not simply annoying -- it has real impact.” Read more on mental health.
CDC Emphasizing Electronic Laboratory Reporting to Improve Public Health’s Response to Disease Outbreaks
The U.S. Centers for Disease Control and Prevention’s (CDC) emphasis on the widespread adoption of electronic laboratory reporting (ELR) has helped improve public health’s response to dangerous infections, according to data from CDC’s Morbidity and Mortality Weekly Report (MMWR). ELRs enable labs to report disease outbreak information quickly and in a usable format. The number of labs that utilize ELRs has more than doubled since 2005, and CDC has helped fund their increased use since 2010 in 57 state, local and territorial health departments. Current estimates are that about 62 percent of lab reports were received electronically. “Electronic laboratory reporting can give health officials better, more timely and complete information on emerging infections and outbreaks than they have ever received before,” said Robert Pinner, MD, associate director for surveillance, programs and informatics in CDC’s National Center for Emerging and Zoonotic Diseases. “Implementing these systems is a complex task that requires substantial investment, but ELR will provide health departments the tools they need to quickly identify and respond to disease threats and monitor disease trends now and in the future.” Read more on technology.
State AGs Urge FDA to Adopt New Regulations Covering E-cigarettes
The Attorneys General of 41 states are urging the U.S. Food and Drug Administration (FDA) to follow through on a pledge to issue regulations that would expand its oversight to include e-cigarettes. In a letter to FDA Commissioner Margaret Hamburg, they asked “the FDA to move quickly to ensure that all tobacco products are tested and regulated to ensure that companies do not continue to sell or advertise to our nation's youth.” The FDA was given authority to regulate cigarettes, cigarette tobacco and roll-your-own tobacco in 2009, as well as the authority to expand its authority after it issued new regulations. Last week a similar plea related to FDA authority was made to President Obama by the American Academy of Pediatrics and 14 other public health organizations, including the American Lung Association and American Heart Association. E-cigarettes continue to increase in sales (a projected $1.7 million in 2013) even while dropping in price. At the same time, there are no advertising restrictions for e-cigarettes. "Consumers are led to believe that e-cigarettes are a safe alternative to cigarettes, despite the fact that they are addictive, and there is no regulatory oversight ensuring the safety of the ingredients in e-cigarettes,” according to the Attorneys General’s letter. Read more on tobacco.
Expert: People Should Get Now-available Flu Vaccine As Soon As Possible
This season’s influenza vaccine is now available and people shouldn’t hesitate to go ahead and get it, according to Stephen Russell, MD, associated professor in the general internal medicine division at the University of Alabama at Birmingham and a lead physician at the university’s Medicine Moody Clinic. This year’s vaccine protects against four types of flu viruses (as opposed to the three of previous vaccines) and comes as either a traditional shot or a nasal spray. "Contrary to some beliefs, getting the flu shot in September is a good thing and will offer protection for the entirety of the flu season," he said. The U.S. Centers for Disease Control and Prevention recommends the vaccine for people ages 6 months and older, particularly for seniors, pregnant women, caregivers and people with chronic medical conditions. "Many people will say they do not need the vaccine, as they have never had the flu before, but that is like saying you don't need to wear your seatbelt because you have never had a wreck," Russell said. "You may have been fine in the past, but that should not offer security or protection for future exposures to the flu." Read more on influenza.
Study: Losing 10 Percent of Weight Can Greatly Reduce Arthritic Knee Pain, Put Off Knee Replacement
Losing just 10 percent of their weight could go a long way toward easing the knee pain from osteoarthritis in overweight and obese people ages 55 and older, according to a new study in the Journal of the American Medical Association. That would mean better knee function, improved mobility, enhanced quality of life…and reducing the odds of needed a knee replacement. "We've had a 162 percent increase in knee replacements over the last 20 years in people 65 and over, at a cost of $5 billion a year," said lead author Stephen Messier. "From our standpoint, we think this would be at least a good way to delay knee replacements and possibly prevent some knee replacements." The study tracked 454 overweight and obese people in three groups—diet-only, exercise-only and a combination—finding that people who did the combination were the most successful at losing weight and thus reducing knee pain. "We're not talking about people getting down to ideal body weight," said Patience White, MD, the Arthritis Foundation’s vice president of public policy and advocacy. "They just have to lose 10 percent of their total weight. Someone who is 300 pounds only needs to lose 30 pounds. I think that's within reach for people." Read more on obesity.
CDC: ‘Tips From Former Smokers’ Campaign Created Spikes in Quitline Calls, Website Visits
An additional 150,000 U.S. smokers called the tobacco cessation helpline 1-800-QUIT NOW as a direct result of the U.S. Centers for Disease Control and Prevention's (CDC) 2013 “Tips From Former Smokers” campaign, which ran for 16 weeks, according to CDC’s latest Morbidity and Mortality Weekly Report. That’s an increase of about 75 percent. It also generated approximately 2.8 million visits to the campaign website, or a nearly 38-fold increase. "The TIPS campaign continues to be a huge success, saving tens of thousands of lives and millions of dollars; I wish we had the resources to run it all year long," said CDC Director Tom Frieden, MD, MPH. "Most Americans who have ever smoked have already quit, and most people who still smoke want to quit. If you smoke, quitting is the single most important thing you can do for your health – and you can succeed!" A recent study in The Lancet concluded that the campaign helped as many as 100,000 people quit smoking permanently. Read more on tobacco.
FDA, NIH Award as Much as $53M for 14 Tobacco Regulation Research Centers
The U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH) have joined together to award as much as $53 million in funding to create 14 Tobacco Centers of Regulatory Science (TCORS). The first-of-its-kind program will bring together a diverse array of scientists, public health experts, communications veterans and marketing experts to generate research to inform the regulation of tobacco products to protect public health. “While we’ve made tremendous strides in reducing the use of tobacco products in the U.S., smoking still accounts for one in five deaths each year, which is far too many,” said NIH Director Francis S. Collins, MD, PhD. “FDA/NIH partnerships like the Tobacco Centers of Regulatory Science keep us focused on reducing the burden and devastation of preventable disease caused by tobacco use.” Read more on research.
Overweight, Underweight Pregnant Women See More Complications and Longer Hospital Stays
Pregnant women who are either too thing or too heavy as measured by body-mass index (BMI) are at increased risk for complications and additional hospitalization, according to a new study in BJOG: An International Journal of Obstetrics and Gynaecology. Women with higher BMIs saw increased complications; severely obese women were three times as likely as normal weight women to have high blood pressure and gestational diabetes, as well as longer overall hospitalizations. Lower-weight women also had higher rates of additional hospitalization (8 percent) compared to normal-weight women, though not as high as the rates for overweight and obese women. The findings indicate the need to fine and implement new approaches to combating obesity. "Longer-term benefits of reducing maternal obesity will show improvements, not only in the health outcomes of mothers and their babies, but the workload and cost to current maternity services," said study co-author Fiona Denison, MD, of Queens's Medical Research Institute in Edinburgh. Read more on maternal and infant health.
Higher Education Linked to Better Obesity Rates for Women in Poorer Areas
Higher education is a key factor that helps protect women in economically disadvantaged areas from obesity, according to a new study in the American Journal of Health Promotion. “It is possible that education is a marker of an individual’s access to health information, capacity to assimilate health-related messages, and ability to retain knowledge-related assets, such as nutrition knowledge,” wrote the study’s authors. Previous studies have shown that women living in area with fewer economic resources have higher body mass index (BMI) than other women. The results indicate that both low education and personal income should be addressed by obesity prevention initiatives. Read more on obesity.
Regular Exercise May Help Decrease Depression
Increases in exercise may be linked to decreases in depression, according to a new review of existing research by The Cochrane Library. The researchers found people with depression who also exercised saw a “moderate” reduction in their symptoms when compared to people who did instead used relaxation techniques or received no treatment. Antidepressant medications and psychotherapy are the most common treatments for depression, which affects about 10 percent of Americans, according to the U.S. Centers for Disease Control and Prevention. More research is needed to better understand the relationship between exercise and depression symptoms. Still, Madhukar Trivedi, MD, a professor of psychiatry at the UT Southwestern Medical Center in Dallas, who was not a part of the study, said one of the keys is making sure patients stick with the exercise regimen. "Once people are prescribed exercise or they choose exercise, the big challenge is to make the exercise real," he said. "If the recommendation from the treating clinician is that you should be exercising with some frequency and intensity…it's important that the patient follow that regimen week after week.” Read more on mental health.
Predominantly Black Nursing Homes Deliver Lower Levels of Care, Perform Worse Financially
Nursing homes that are predominantly populated by black residents deliver overall poorer care and are less successful financially than homes with few or not minority residents, according to a new study in Health Services Research. The study looked at issues such as the ratio of nursing staff to patients, success in preventing pressure ulcers, help with walking, help with getting out of bed, prevention of urinary tract infections, the incidence of medication errors and citations by governmental agencies. However, the study noted that black and white patients living in the same facilities received equal treatments, meaning the disparity is not due to any biases of health care workers. One factor leading to the disparity could be the fact that older black Americans are more likely to rely on Medicaid, which means lower reimbursement rates. Still, Latarsha Chisholm, assistant professor at the University of Central Florida and study author, believes something more must be at play. "It isn't only the financial performance [of nursing homes] that affects performance," she said. "There has to be something else affecting quality. I want to understand what management practices promote improved care in nursing homes with high proportions of minorities that don't have disparities in care.” Read more on health disparities.
Study: 60 Percent of Uterine Cancer Cases are Preventable
Approximately 60 percent of U.S. uterine cancer cases are preventable thorough regular physical activity and maintaining a healthy weight, according to a new study from the American Institute for Cancer Research (AICR) and World Cancer Research Fund International. That comes out to nearly 30,000 cases per year; endometrial cancer is the most common cancer of the female reproductive system, ahead of both ovarian cancer and cervical cancer. "Body fat can produce hormones that promote cancer development," said Alice Bender, nutrition communications manager for AICR. "We also know that body fat is linked to chronic inflammation, which produces an environment that encourages cancer development." The study also found various dietary choices that influence cancer risk because of the way they influence hormones such as estrogen and insulin. For example, drinking one cup of coffee a day can reduce the risk of endometrial cancer by 7 percent, while eating sugary items and processed grains can increase it. Read more on cancer.
Overweight, Obese People More Likely to Suffer from Migraines
Migraines can now be added to the long list of medical conditions more likely in people who are overweight or obese, according to a new study in the journal Neurology. Researchers found the painful, often-debilitating headaches were twice as common for obese people as they were for people of normal weight. As many as 15 percent of people suffer from episodic migraines and approximately 32 percent of people with the migraines were obese. "This suggests patients and doctors need to be aware that obesity is associated with an increased risk of episodic migraine and not wait until a patient has chronic migraine to address healthy lifestyle choices, such as diet and exercise, and to choose medications that impact weight with care," said lead researcher Lee Peterlin, MD, from the Johns Hopkins University School of Medicine, according to Reuters. While further research is needed to determine causation, the study results do provide yet one more reason to make healthy lifestyle changes. Read more on obesity.
Anger, Irritability May Be Signs of More Severe, Chronic Depression
Irritability and anger may indicate more complex, chronic and severe forms of major depression, according to a new study in JAMA Psychiatry. Symptoms of irritability and anger during a major depressive episode (MDE) appear to be clinical markers for a significantly more complex, chronic, and severe form of major depressive disorder, a new study indicates. Researchers found that people with MDEs who also exhibit anger and irritability were more likely to have increased severity of their depression, longer bouts of depression, lower impulse control and a more chronic long term course of illness. The findings indicate that people who exhibit these behaviors need closer clinical monitoring that "should include specific strategies to address anger management issues, as well as the frequently associated problems of comorbid anxiety disorder, substance abuse disorder, poor impulse control, and psychosocial impairment when these are present." Read more on mental health.
CDC’s ‘Tips From Former Smokers’ Campaign Helped 200,000 Quit
The U.S. Centers for Disease Control and Prevention’s (CDC) three-month “Tips From Former Smokers” national ad campaign helped more than 200,000 Americans quit smoking immediately, with an estimated 100,000 expected to quit permanently, according to a new CDC study in The Lancet. About 1.6 million smokers attempted to quit because of the campaign, which featured powerful—and real—stories of former smokers living with smoking-related diseases and disabilities, which encouraging people to call the toll-free 1-800-QUIT-NOW. The results far exceeded CDC’s initial goals. “Quitting can be hard and I congratulate and celebrate with former smokers—this is the most important step you can take to a longer, healthier life,” said CDC Director Tom Frieden, MD, MPH. “I encourage anyone who tried to quit to keep trying—it may take several attempts to succeed.’’ Read more on tobacco.
White House Honors ‘Champions of Change’ in Public Health, Prevention
The White House this week is honoring eight “Champions of Change” in the world of prevention and public health. The weekly event is meant to highlight and honor Americans who “are doing extraordinary things in their communities to out-innovate, out-educate, and out-build the rest of the world.” This week focuses on people who are working in the field of public health on everything from childhood obesity to reducing health disparities to fighting healthcare-acquired infections. “These leaders are taking innovative approaches to improve the health of people in their communities—and showing real results,” said Jeffrey Levi, PhD, executive director of Trust for America’s Health. “Prevention is one of the most common-sense ways we can save lives and reduce healthcare costs, and the efforts of these champions show how to put prevention to work in effective ways.” Read more on faces of public health.
Small Changes to Kids’ Routines Can Reduce Childhood Obesity
Small changes in the home environment, such as limiting the time spent in front of the television and increasing the time spent sleeping, can help reduce childhood obesity, according to a new study in the journal Pediatrics. The simple routine changes led to a slower rate of weight gain in children ages 2 to 5 (the children obviously still gaining weight overall because they were growing). After six months on the new routine, participants saw their body mass index (BMI) drop, for a healthier rate of weight gain. About 17 percent of U.S. youth are obese, with lower-income kids at highest risk, according to the U.S. Centers for Disease Control and Prevention. Thomas Robinson, MD, a professor of pediatrics and medicine at Stanford University and Lucile Packard Children's Hospital at Stanford, who was not involved in the study, said the findings were significant for the fight against childhood obesity. "These behaviors and BMI have not been easy to change in a world where junk food and screen time are so heavily marketed, and families are dealing with tremendous financial and social challenges," he said. "I think it is exciting to see studies like this one showing positive results." Read more on obesity.
Last week the Public Health Accreditation Board (PHAB) awarded five-year national accreditation status to five public health departments, bringing the number of health departments now accredited to 19 since the credential was launched two years ago. Hundreds more health departments are currently preparing to apply for accreditation, which includes a peer-reviewed assessment process to ensure it meets or exceeds a set of public health quality standards and measures. Among the newly accredited is the Chicago Department of Public Health.
"This is an important achievement and recognition that highlights the city of Chicago’s ongoing commitment to health and wellness on the part of all of our residents,” said Chicago Mayor Rahm Emanuel in a statement issued by PHAB. "We are focused on policies that will help all Chicagoans and their families enjoy the highest quality of life, [and w]e will continue to strive to make Chicago one of the healthiest cities in the world."
NewPublicHealth recently spoke with Bechara Choucair, MD, MS, Commissioner of the Chicago Department of Public Health, about the value of accreditation for improving the health of the community—and about how this effort supports Healthy Chicago, the city’s public health agenda.
>>Read more about Healthy Chicago in a previous NewPublicHealth Q&A with Choucair.
NewPublicHealth: You’re one of the first public health departments to be accredited. How did that happen so quickly?
Bechara Choucair: When we released Healthy Chicago in 2011, one of the strategies we identified was to obtain accreditation. We wanted to be the first big city to earn the credential. It took us 18 months and we are excited that we are the first big city to be accredited and the first in Illinois. And one of the added bonuses of accreditation is a sense of pride. It says a lot to our staff, residents and our mayor.
NPH: A community health assessment is required as part of the accreditation application. What did Chicago’s community health assessments entail?
Chemicals in Plastic Food Containers Could be Adding to Childhood Obesity Problem
Unhealthy foods kept in plastic food wraps and containers may be even more unhealthy for kids because of the chemicals in the plastic, according to two new studies in the journal Pediatrics. The studies linked phthalates to increased insulin resistance in children and bisphenol A (BPA) with high body-mass index (BMI). Leonardo Trasande, MD, an associate professor of pediatrics and environmental medicine at the NYU School of Medicine and author of the phthalates study, said certain chemicals can affect how the body reacts to glucose influence the release of insulin. "There is increasing concern that environmental chemicals might be independent contributors to childhood diseases related to the obesity epidemic," he said. "Our research adds to these growing concerns." He recommends against using certain types of plastic containers and against microwaving any plastic containers. He also says parents should wash plastic containers by hand instead of putting them in the dishwasher, and should throw them out when they’ve been damaged. Hugh Taylor, MD, chair of the Yale School of Medicine's department of obstetrics, gynecology and reproductive sciences, said that while the two studies "point out the vulnerability of children to environmental chemicals,” parents should also be working to move their kids’ diets to healthier and natural food. Read more on obesity.
CDC: As Many as 300,000 Infected with Lyme Disease Annually
The actual number of U.S. cases of Lyme disease is as much as ten times higher than the reported figure, according to the U.S. Centers for Disease Control and Prevention (CDC). Three ongoing CDC studies put the number of cases of the tick-borne illness at around 300,000 annually. This major difference between reported and actual cases emphasizes the need for greater and more diverse prevention efforts. Traditional preventive measures at the personal level include wearing repellent, checking for ticks daily, showering soon after being outdoors and alerting a doctor if you get a fever or rash. “We know people can prevent tick bites through steps like using repellents and tick checks. Although these measures are effective, they aren’t fail-proof and people don’t always use them,” said Lyle R. Petersen, MD, MPH, director of CDC’s Division of Vector-Borne Diseases. “We need to move to a broader approach to tick reduction, involving entire communities, to combat this public health problem.” Read more on infectious disease.
Study Links Kids’ Trouble Sleeping, Poor School Performance
Trouble sleeping is tied to trouble in the classroom for kids, according to a new study in the journal Sleep Medicine. Researchers analyzed kids age seven to 10 in Sao Paulo, Brazil schools, finding that 13 percent with difficulty sleeping were failing Portuguese, compared to 9 percent for kids who did not have sleep problems. They also found that 25 percent of kids with trouble sleeping were failing math, compared to eight percent for kids who have no trouble sleeping. U.S. experts estimate that approximately 25 percent of U.S. kids have trouble sleeping, either due to sleep disorders such as insomnia and nightmares, or from other factors such as erratic bedtime hours and anxiety. While noting that the study was "far from perfect," Carl Bazil, MD, a neurologist and director of the division of epilepsy and sleep at New York Presbyterian/Columbia University Medical Center in New York City, said “It's a first step in emphasizing that sleep in children is something that's important, not only to prevent them from being sleepy but to make sure that they learn. I think this study will help raise awareness that sleep is particularly important in children." Read more on pediatrics.
TFAH: U.S. Adult Obesity Rates Relatively Level, But Still Extremely High
Though adult obesity rates are level in all states except Arkansas, the rates are still far too high, according to F as in Fat: How Obesity Threatens America's Future 2013, a new report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation. The plateau comes after mostly 30 years of rising rates. No state had higher than a 15 percent obesity rate in 1980; today every state is about 20 percent and 13 states have rates higher than 30 percent. “While stable rates of adult obesity may signal prevention efforts are starting to yield some results, the rates remain extremely high,” said Jeffrey Levi, PhD, executive director of TFAH. “Even if the nation holds steady at the current rates, Baby Boomers—who are aging into obesity-related illnesses—and the rapidly rising numbers of extremely obese Americans are already translating into a cost crisis for the healthcare system and Medicare. In order to decrease obesity and related costs, we must ensure that policies at every level support healthy choices, and we must focus investments on prevention.” Read more on obesity.
Soda Consumption Tied to Higher Aggressive Behavior in Kids
Soda consumption is tied to higher aggressive behavior in kids, according to a new study in The Journal of Pediatrics. Study authors cautioned that the increase may not be apparent in individuals and the study does not show causation. However, previous studies have demonstrated a link between soda consumption and violent behavior. The researchers analyzed data of mothers’ assessment of their children’s aggressiveness, including acts such as destroying their belongings or the belongings of others. On an aggression scale of 0-100, kids who drank no soda scored an average of 56, kids who drank one scored 57, who drank two scored 58, who drank three scored 59 and who drank at least four scored 62. Janet Fischel, director of developmental and behavioral pediatrics in the department of pediatrics at Stony Brook University School of Medicine in New York, who was not involved in the study, believes it represents a strong first step. "I think it's really important and a giant first step in gathering an evidence base for what's becoming a very widespread dietary habit. I think that's really important.” Read more on pediatrics.
People with Insomnia Need Regular Exercise, Not a Quick Trip to the Gym
It takes time for exercise to help cure insomnia, so people shouldn’t expect one trip to the gym to do the trick, according to a new study in the Journal of Clinical Sleep Medicine. "The message here is that exercise is not a quick fix, which I don't really think is discouraging at all," said study author Kelly Baron, director of the Behavioral Sleep Medicine Program with the Feinberg School of Medicine at Northwestern University in Chicago. "Our previous work found that exercise over a 16-week period is very effective in promoting sleep, on par with any kind of medication. But like with weight loss or any sort of behavioral change, it doesn't happen immediately. You have to measure progress over months, not day-to-day." Baron said it is important for people with insomnia to make exercise a part of their routine, planning ahead and being sure to make it a regular endeavor. She also noted that a poor night of sleep makes it less likely for someone to exercise the next day, further emphasizing the need for routine. Approximately 14 percent of the population experiences chronic insomnia. Read more on physical activity.
Almost everything touches public health. From understanding care options to access to nutritious food to being able to breathe clean air—it all works together to prevent disease and promote healthy living. That includes the types of available transportation.
>>View NewPublicHealth’s infographic exploring the role of transportation in the health of our communities, “Better Transportation Options = Healthier Lives.”
The Transportation Research Board Subcommittee on Health and Transportation (H+T) was formed in the Summer of 2011 to provide a variety of disciplines the opportunity to share and compare transportation-related health research in an academic environment. It’s a place where engineers, public health professionals, planners, epidemiologists, advocates and others can identify, advance and publish research that advances our understanding of transportation infrastructure and policies affect public health. [Editor’s Note: Read NewPublicHealth’s coverage of last year’s Transportation Research Board conference.]
The H+T Subcommittee’s areas of interest and study include sustainable and active transportation modes (e.g., walking, biking, transit); mobility and accessibility; safety; transportation-related air pollution and noise impacts; and social cohesion and other social, physical and mental health impacts.
State and local government across the country are already utilizing engineering and design solutions to improve public health in their communities, according to The Network for Public Health Law, which provides information and technical assistance on issues related to public health and is funded by the Robert Wood Johnson Foundation.
“In Massachusetts and Minnesota, transportation officials are exploring infrastructures that allow for ‘active transportation’—like walking and bicycling—which can help prevent weight gain and lower the risks of obesity, diabetes and heart disease. In Washington and California, programs are incorporating transit-oriented development strategies to improve environmental health and access to healthy foods.”
>>Read more on how transportation can impact health.