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Wanted: Creative Research—From Any Field—Revealing What Makes Everyone In America Healthier

Jul 6, 2016, 11:00 AM, Posted by Claire Gibbons

Researchers: RWJF wants to fund your best ideas, and most rigorous study designs, to help us learn what works to promote the health of everyone in America.

A child looks through a large magnifying glass.

What does it take for Americans to lead healthier lives? Seems like a simple question, but it takes research to get answers we can act on.

Research is how we will discover what happens to resident and community health when a low-income community in Seattle—pocked with aging infrastructure and troubled, publicly subsidized housing—is transformed into one that sports mixed-income housing, new parks and services that support well-being. It’s a way we can measure the value of litigation aimed at forcing school districts in California to comply with state requirements for physical education in schools. Through research, we can pinpoint whether the presence of children in a defendant’s life influences sentencing decisions. And only through research can we further understand how criminal sentences impact the overall health and living arrangements of these children.

The Robert Wood Johnson Foundation (RWJF) is funding these and other studies through its Evidence for Action (E4A) National Program, now in its second year. We want to continue making grants through E4A, which is why we invite you to explore our Call for Proposals (CFP).

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Harvard School of Public Health Special Report: The Financial Crisis as a Public Health Crisis

Apr 30, 2014, 2:54 PM

“Five years after the Great Recession officially came to an end, the United States has yet to fully recover from the economic devastation sparked by the collapse of an $8 trillion housing bubble and the ensuing turmoil that saw global financial systems teetering on the brink of collapse. But while the economic costs of the downturn have drawn the lion’s share of attention, the damage to our bodies could end up far surpassing the damage to our bank accounts.”

Those are the opening lines of a new special report from the Harvard School of Public Health (HSPH), “Failing Economy, Failing Health: The Great Recession’s Toll on Body and Mind,” detailing how poverty and inequality resulting from the economic maelstrom pulled down so many—and what that will mean for public health in the long term.

“Health is a long-run thing, but the methods we use to analyze current data only estimate short-term effects,” says SV Subramanian, HSPH professor of population health and geography. “It may take awhile for the health impact of the Great Recession to kick in, but once it does, it could be dramatic.”

The data is strong on the links between employment and health—people who are unemployed, underemployed or laid off are less healthy and don’t live as long. 

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A 2009 study found that in the 12 months after men lost their jobs in mass layoffs, they saw their chances of dying nearly double. While over time the risk lessened it was still significant two decades later. Another study that same year found that losing a job when a business shuts its doors increases the odds of fair or poor health by 54 percent among workers with no preexisting health conditions while also increasing the risk of new health conditions by 83 percent. The stress of the situation, according to the researchers, heightens the odds of stress-related conditions such as stroke, hypertension, heart disease, arthritis, diabetes and psychiatric problems.

Yet another study, this one in 2010, found that about 4 in 10 Americans with heart disease or diabetes and 1 in 5 with cancer said the stress of the Great Recession made it more difficult to manage their illnesses.

What’s more complex is unearthing the pathways behind why this is the case. The HSPH article outlines some of the mechanisms by which unemployment affects health.

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Free the Data

Jun 27, 2013, 1:14 PM

A woman uses a laptop computer for data.

A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.

“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.

NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.

NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?

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Scholars Pose Endgame Strategies for Tobacco Use

Apr 24, 2013, 10:45 AM

file Kenneth Warner, University of Michigan School of Public Health

Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.

Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.

>>Read the articles in the tobacco endgame supplement.

Some of the strategies in the supplement include:

  • Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
  • A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
  • A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.

"What we are doing today is not enough," says Warner.  "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”

NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.

NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?

Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.

NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?

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New Research on Public Health Systems and Services: Recommended Reading

Dec 21, 2012, 1:00 PM

The new issue of Frontiers in Public Health Services and Systems Research (PHSSR), an online journal that looks at early research on issues related to public health services and delivery, focuses on quality improvement in practice-based research networks.

This issue’s commentary, from the journal’s editor, Glen Mays, PhD, MPH, is about a series of studies sponsored by the Robert Wood Johnson Foundation that  look at how public health decision-makers are responding to accreditation, quality improvement, and public reporting initiatives during  ongoing fiscal problems. Mays is co-principal Investigator of the National Coordinating Center on PHSSR, Director of the Public Health Practice-Based Research Networks and the F. Douglas Scutchfield Endowed Professor at the University of Kentucky College of Public Health. Mays says that, overall, the current evidence shows that “these initiatives represent promising strategies for strengthening evidence-based decision-making and expanding the delivery of evidence-tested programs and policies in local public health settings.” 

Mays  adds that continued comparative research and evaluation activities are needed to provide more definitive evidence about which combination of strategies work best, for which population groups, in which community and organizational settings, and why.

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LawAtlas: Exploring Public Health Laws and Policies that Work to Improve Public Health

Nov 6, 2012, 11:56 AM

Public Health Law Research, a national program of the Robert Wood Johnson Foundation housed at the Temple University Beasley School of Law, released a comprehensive online portal called LawAtlas that allows users to explore variation in laws across U.S. states and over time. Having more information about state laws, and their effect on health over time, is a critical step toward understanding what works to improve health. LawAtlas offers:

  • Interactive Law Maps to show how certain laws differ by state and how they have changed over time.
  • Policy Surveillance Reports to summarize the state of various public health laws across the country
  • Data that public health law researchers can work with to expand upon existing research

NewPublicHealth caught up with Damika Webb, JD, Law Fellow at the Center for Health Law Policy and Practice at Temple University, at last week’s APHA Annual Meeting to chat about LawAtlas and how it can be used to better understand why policy surveillance is critical, and what we can learn from a program like LawAtlas.

NewPublicHealth: Why is it important to conduct research to know whether particular laws and policies are working to improve public health?

Damika Webb: By measuring the dimensions of a law, you can figure out which components of the law are having a positive or negative effect on health outcomes.

NPH: Why is it important to track how public health laws and policies differ from state to state?

 

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AcademyHealth Annual Research Meeting

Jun 27, 2012, 2:09 PM, Posted by NewPublicHealth

We’ll never know if it was the spirited discussions or Tropical Storm Debby, which is pummeling northern and central Florida, that kept most of the 2,000-plus attendees at this year’s AcademyHealth Annual Research Meeting—this year in Orlando—indoors and packed into the sessions and the exhibit hall at just about every minute of the meeting this year. Public Health was a featured topic, according to AcademyHealth president and CEO Lisa Simpson, and a session on the IOM report on the integration of public health and primary care, led by the committee chair, Paul Wallace, MD, was a featured, and well-attended, session as well.

Not surprisingly, many public health officials made their way into a ballroom very early Tuesday morning to hear three health law scholars, Sara Rosenbaum of the George Washington University, Timothy Jost of Washington and Lee and Mark Hall of Wake Forest, talk about the issues likely contemplated by the Supreme Court Justices as they considered the cases brought against the Affordable Care Act. Critical for public health were the discussion points aired just before the session ended, concerned with continued state and federal budget cuts including cuts to the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services, which could impact public health service delivery now underway, as well as implementation of the Affordable Care Act, if it is upheld.

Health disparities were also a focus of several sessions, as well as the topic that won the student poster award of the conference. Stephen Vance, a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine, won the best student poster award for his work with Aida Lugo-Somolinos, MD, of the medical school, on clinical trial enrollment barriers faced by the Hispanic population in North Carolina. Vance’s research found that the barriers identified by the Hispanic participants in the study differ from those expected by clinical investigators.

The study provided a questionnaire for physicians on their perceptions of why more members of the Hispanic community don’t enroll in clinical trials, and also collected patient questionnaires on trial participation from close to 400 members of the Hispanic community.

The physician responses showed that they viewed language and transportation as the key barriers. But the patient responses showed other concerns including worries about what participating might cost them, concern about missed work time and a lack of understanding about the potential benefits of trial participation, including access to health care. The researchers say the following should be considered as a means to enroll more members of Hispanic communities in trials:

  • Provide information about studies to health care providers in areas with large Hispanic populations
  • In large cities, create partnerships with Hispanic advocacy groups
  • Communicate that trial participation is not necessarily costly and may take no more time than a regular doctor’s appointment
  • Include a person fluent in Spanish on the research team

“Before this study, I would have thought that transportation and language were the key barriers,” says Vance. “It’s really a lack of understanding of what a clinical research project entails.”

“Perhaps as clinicians, we’re asking the wrong questions,” says Vance, who is on track to get an MBA as well as his MD degree, and plans to go into health management. “This study focuses on the Hispanic community, but should push us to look at the reasons why other groups are underrepresented in trials.”

This commentary originally appeared on the RWJF New Public Health blog.

Public Health Law Research Program Annual Meeting: Q&A With Scott Burris

Jan 18, 2012, 2:55 PM, Posted by NewPublicHealth

Public Health Law Research (PHLR), a Robert Wood Johnson Foundation program at Temple University, recently held its annual meeting in New Orleans. The theme of this year’s meeting, the first such conferences open to non-grantees of the program, was "Public Health Law Targets of Opportunities." The conference offered an opportunity to highlight research about how law can be used to improve population health. 

NewPublicHealth spoke with Scott Burris, JD, director of the Public Health Law Research program.

NewPublicHealth: What’s key about this year’s conference?

Scott Burris: This is a transitional conference for us. We have been planting the orchard for the last two and a half years since we started the program. Now we are starting lot get some fruit. Our grantees are reporting on their results. And we’re getting as many paying people coming to the conference as we have new grantees coming to the conference.

NPH: Needle exchange is a key topic at the conference this year. Why is that?

 

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NewPublicHealth Interview: Susan Dentzer, Editor-In-Chief of Health Affairs

May 10, 2011, 5:23 PM, Posted by NewPublicHealth

The May issue of Health Affairs features the journal’s first issue about environmental health concerns. NewPublicHealth spoke with Health Affairs Editor-In-Chief Susan Dentzer about the issue.

NPH: One of the articles in the May issue is by Aaron Wernham, director of the Health Impact Project, on conducting health impact assessments when making environmental and land-use decisions. Why is that important?

Susan Dentzer: It’s often, if not always, the case that in almost every jurisdiction--before you build a major highway or other major projects, you have to do a very systematic assessment about the overall impact on the environment. So, obviously what should take place is--in addition to that-- is to find out what is going to be the impact on health. For example, what if you build a major highway and it happens to go by a school?

Other studies in the issue draw on information that we already are well-aware of, which is that if you have particulates in the atmosphere, or other forms of air-pollution through auto exhaust, that’s going to have an impact on the kids in the school. So, using the health impact assessment tool before any major [environmental] project seems a good place to start in terms of understanding what the impact is going to be on health. The assessment lets you get health into the mix of the decision-making process and you can weigh the pros and cons and the trade-offs of any kind of community-level initiative.

NPH: Three of the articles focused on environmental factors that have been shown to impact children’s health. Can you tell us about some of the findings?

Susan Dentzer: Absolutely. We've known for some time now that exposures that children undergo can have a bigger impact on children than they do on adults. For a few reasons. One is, just by virtue of the concentration of these things in the atmosphere or and children’s’ body weight --proportionately, these things have a bigger impact. Plus, we know from the way children develop that there are these windows of exposure as children’s’ bodies are changing very, very rapidly. Cells are multiplying, brain cells are growing in infancy and toddler-hood. All of those things create vulnerability so that any kind of toxic substance that may not be so toxic to adults will be potentially much more toxic to children. And we know this, for example, from lead exposure, which unequivocally caused a decline in brain function in many children. Several IQ points or more for children who have been exposed to lead are lost.

So, what a number of studies in our new issue do is take that knowledge forward and say, for example, what is the cost of this exposure to children? One of the studies suggests that the health care related costs alone of chemical and other toxic exposures to children is about $77 billion dollars annually. That’s about 3 ½ percentage points of U.S. health care costs. Now, that’s not 100 percent, but we could all acknowledge we’d rather have that money to spend on other things, like keeping children healthier. And, if you just put that up against say, what we spend on the Children’s Health Insurance Program, which isn’t by any means the only way we help to cover kids in America, it greatly exceeds our annual expenditure on children’s health insurance alone.

So, in a crazy way, we’re exposing kids to a lot of things that are harmful to them and then spending a lot of money on the other side fixing them up. And a classic case of this is asthma. We know that lots of asthma in children now is caused by exposures to pollutants, second-hand smoke, those kinds of things. So, we in effect-make these children sick and then we pay to get them healthier or to stabilize their disease.

NPH: The studies about children and environmental exposures were posted on your web site last week. Have you already received comments?

Susan Dentzer: Certainly from academics. For one thing, everybody notes that we do have this sort of crazily siloed health and health care, and even policy related to health and environment in this country, where the environmental science people have known for some time that these threats and exposures are real. They’ve kind of been, frankly, ignored by others who are so busy focusing on other things--like finding a way to produce high quality health care for children with asthma. So, what people have said to us is great. Now, we’re going to help break down these silos so that we can understand what the effects are of these exposures and actually incorporate that into the health care that we deliver to children and families. For example, one of the pieces in our issue has a so-called navigation guide which is really a very elaborate way of helping the health care community understand the evolving science on the environmental health side and be able to make explicit recommendations to people about what they should do to protect their health.

When you are looking at something like environmental science, frankly we’re not going to do a whole lot of randomized controlled trials and randomize children into camps of some who are exposed and camps of children who are not exposed and then decide what the exposure is. That’s unethical. So, what we have to do is a very, very different kind of science. But, getting the clinical community to understand how that’s done is a challenge. So this navigation guide basically says, here’s how you can walk through the environmental health science and use that to decide what recommendations should be made to patients and incorporate these into, not only guidelines for clinicians about what to do, but also, how they communicate these risks to patients and explain to patients what steps there are available so they can avoid these exposures when possible.

 

This commentary originally appeared on the RWJF New Public Health blog.

NIH to Survey Functional Changes in the Elderly

Apr 26, 2011, 6:26 PM

new survey by the National Institute on Aging will look at how aging affects the daily lives of older U.S. adults. Beginning in May, the National Health and Aging Trends Study (NHATS) will begin inviting about 9,000 Medicare beneficiaries, age 65 and older, to participate in the long-term study.

"Many factors affect an older person’s ability to function effectively and live independently," says NIA Director Richard J. Hodes, M.D. "NHATS is designed to help us understand the contributions of these factors to trends in the prevalence, onset and recovery from functional limitations."

Many people experience difficulty caring for themselves as they get older, according to the NIA. This can be seen in their increased need for help with daily activities such as walking, dressing and getting into/out of bed — issues that affect whether a person can live on their own. The survey will measure participants’ abilities to perform these activities. It will also ask about what assistance they may need, such as changes in living arrangements or health care needs.

"Inability to live independently will add to costs for long-term care and nursing home stays, and reduce well-being among older people,” says Richard Suzman, Ph.D., director of NIA’s Division of Behavioral and Social Research, which is funding the NHATS study. “This poses additional challenges for the aging of the baby boom. It’s critical to track the trend and understand its dynamics.”

Study participants will be interviewed in person in 2011 for baseline information, then once a year going forward. Researchers will also conduct physical performance tests.

The survey will be led by Judith Kasper, Ph.D. a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. A companion survey will be sent to family members and friends who assist the study participants.

This commentary originally appeared on the RWJF New Public Health blog.