Tag: public health

Moms Know Best: These Moms Want to Share Their Solutions for Child Nutrition & Hunger with Congress

Drexel News Blog Members of Witnesses to Hunger, seen here during an exhibit of their photos on Capitol Hill in 2014 together with staff from Drexel’s Center for Hunger-Free Communities in the School of Public Health and the center’s director and public health associate professor, … Continue reading Moms Know Best: These Moms Want to Share Their Solutions for Child Nutrition & Hunger with Congress

From Soda Bans to Bike Lanes: Which “Natural Experiments” Really Reduce Obesity?

Image by Jim Henderson, CC-BY-SA 3.0

Originally posted on DrexelNow.

Banning sodas from school vending machines, building walking paths and playgrounds, adding supermarkets to food deserts and requiring nutritional labels on restaurant menus: Such changes to the environments where people live and work are among the growing number of solutions that have been proposed and attempted in efforts to stem the rising obesity epidemic with viable, population-based solutions. But which of these changes actually make an impact?

To answer that question, many public health researchers take advantage of “natural experiments”—looking at people’s calorie consumption or physical activity levels, either comparing before and after a policy or environmental change, or comparing against a similar group of people not affected by that change. But not all natural experiments are created equal.

“Rigorous science is needed to evaluate these natural or quasiexperiments,” said Amy Auchincloss, PhD, an associate professor at the Drexel University School of Public Health who was a member of a research team that authored a new study published online ahead of print in Obesity Reviews: “Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments.” The review was led by Stephanie Mayne, a doctoral student supervised by Auchincloss, and also co-authored by Yvonne Michael, ScD, an associate professor and associate dean for academic and faculty affairs in the Drexel University School of Public Health.

The Drexel team reviewed the state of the science on this topic, evaluating the results and methods of all previous such studies published in the medical literature, in particular:

  1. Which policies and built environment changes have been evaluated via natural- or quasi-experiments and what are the results from these studies?
  2. Are there issues of concern with the studies’ design, including methods of assessment?
  3. What are the limitations of these studies and areas where additional science is needed?

This is the first review that has examined the use of natural- or quasi-experiments to evaluate the efficacy of policy and built environment changes on obesity-related outcomes (body mass index, diet or physical activity).  The review included PubMed (Medline) articles published 2005–2013; 1,175 abstracts and 115 papers were reviewed and ultimately 37 studies were included in the review.

The review identified certain types of interventions that are more successful than others in improving obesity-related outcomes, and identified areas where more research is needed to draw conclusions about obesity-related outcomes:

Diet & Food Policy Changes Physical Activity Focused Changes
Changes with strong impacts were ones that improved the nutritional quality of foods:

  • Trans-fat bans
  • Sugary food and beverage availability limits
  • Higher-fat food availability limits

Changes that had smaller or no impacts in the research to date included:

  • Nutritional information requirements
  • Supermarkets built in underserved areas
Changes with stronger impacts included:

  • Active transportation infrastructure improvements
  • Changes studied after longer-term follow-up periods

More research is needed to look at physical activity effects (not just use of amenities) for built environment changes including:

  • Park improvements
  • Trails
  • Active transportation infrastructure

The researchers noted that a common shortcoming in many studies is that they only measured process outcomes such as food purchases or use of bike/transit infrastructure, rather than measuring the desired health outcomes, such as weight loss.

“Research suggests that people will use new amenities like bike shares, and limit purchases of unhealthy foods in specific contexts like schools,” said Mayne. “But it is less clear whether these changes translate into overall improvements in diet and physical activity.”

Likewise, only a few studies directly assessed impacts on BMI or weight; thus, the authors concluded that evidence is lacking on whether environmental and policy modifications are successful in maintaining healthy weight or reducing excess weight.

A key value of a natural experiment is that it can narrowly focus on the direct impact of a change in policy or infrastructure on an affected population—making natural experiments an important way to check on what kinds of public policies and investments make real-world impacts on health, and to what degree. The authors concluded that more natural experiments are needed to strengthen the evidence base about obesity-related policies and interventions. They also recommend more natural experiments to explore whether the timing of a change or repeated exposure to the changed condition enhances or reduces impacts on obesity-related outcomes.

The authors generally found stronger results in studies that had longer follow-up periods after a policy change or other intervention.

Both Auchincloss and Michael are members of the Department of Epidemiology and Biostatistics as well as principal investigators of Drexel’s Urban Health & Design team, an interdisciplinary effort to evaluate the impact of design projects on public health. The team’s work encompasses multiple research projects that are embedded within community-based design projects in Philadelphia that are believed to impact health, such as an urban greenway, community gardens and a school playground.

– See more at: http://drexel.edu/now/archive/2015/March/Which-Natural-Experiments-Reduce-Obesity

Drexel Program Helping Violence Victims to Expand Across Philadelphia Hospitals

A memorial for victims who died in incidents of violence in Philadelphia. Photo: Tony Fischer, CC BY 2.0

Originally posted on DrexelNow.

As the epidemic of community violence swells in U.S. cities, one promising place for intervention and prevention of future violence is the emergency departments of hospitals. More than 25 hospitals nationwide have adopted a public health approach to helping victims of violence with programs that aim to prevent future violent injuries, not just treat them.

In Philadelphia, that public health approach is about to reach a much larger public: Healing Hurt People, a trauma-informed hospital-based violence intervention program developed at Drexel University, is expanding its reach at an unprecedented city-wide level. Efforts are underway to offer the program soon at Temple University Hospital in North Philadelphia, with further expansion planned for Einstein Medical Center Philadelphia and the Hospital of the University of Pennsylvania later in 2015-2016. The program currently operates in partnership with the emergency departments of Hahnemann University Hospital and St. Christopher’s Hospital for Children.

“No other city has expanded hospital-based violence intervention in this way,” said Ted Corbin, MD, an associate professor in Drexel’s College of Medicine and School of Public Health and director of Healing Hurt People. “What’s especially valuable about Healing Hurt People is that our approach to violence intervention is trauma-informed, meaning the program is built on principles recognizing how traumatic stress and past exposure to violence affect clients and their needs.”

Healing Hurt People, a program of Drexel’s Center for Nonviolence and Social Justice in the School of Public Health and College of Medicine, has previously been replicated at two hospitals in Chicago and one in Portland, Oregon, with a second Portland site under development.

“Research has shown that more than 60 percent of young people who are victims of violence show symptoms of PTSD at a diagnosable level after their injuries, and many more experience symptoms of hyperarousal,” said John A. Rich, MD, a professor in Drexel’s School of Public Health and co-director of the Center for Nonviolence and Social Justice. “We see that people who live with chronic traumatic stress in an unsafe environment are more likely to seek safety by resorting to carrying a weapon and in some cases retaliating, or to self-medicate with drugs—all behaviors that put them at continued risk and perpetuate the cycle of violence.”

Intervention programs like Healing Hurt People offer services to victims at a critical moment when their thoughts may turn to retaliation or to changing their lives. The programs’ case management services and behavioral health interventions offer clients a personalized path to safety from future violence, including access to health care and education.

The emphasis on trauma-informed care in Healing Hurt People has engendered its support from Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). The department provides funding for trauma specific behavioral health, case management and other components of Healing Hurt People at its existing Philadelphia sites; DBHIDS is now funding the expansion to other city hospitals. The department’s commissioner, Arthur Evans, PhD, has publicly stated a goal of making Philadelphia the most trauma-informed city in the nation.

“We think Healing Hurt People is a terrific model,” said Evans, “and represents a tremendous opportunity to engage people in care without those individuals having to reach out for the crucial services they need. We’re very pleased that HHP is expanding its reach to help more young people in Philadelphia.”

In the program expansion process already underway, Drexel’s Healing Hurt People program staff are currently working with academic and health-care partners at Temple, including training and hiring staff and initiating enrollment in a rigorous research program to evaluate the program’s effectiveness. Hospital and affiliated academic leaders of the Healing Hurt People sites from Drexel, Temple, Einstein and Penn have already formed a “learning community” so they can share the process of planning and implementing Healing Hurt People across the city.

The research program to evaluate Healing Hurt People during its expansion across Philadelphia is funded by the Annie E. Casey Foundation and the Stoneleigh Foundation and aims to measure the effectiveness of the program’s trauma-informed services on clients’ mental health outcomes. Previous research studies on the effectiveness of hospital-based violence intervention programs, including a limited number of randomized controlled trials, have demonstrated their success in preventing violent reinjury and involvement with the criminal justice system, among other outcomes. A recent simulation study led by members of Drexel’s Center for Nonviolence and Social Justice also demonstrated that such programs are likely to save money, compared to nonintervention. However, the primary aim of these programs is typically not research, but service to clients to address critical community needs in violence prevention.

“Temple is no stranger to developing and maintaining programs that serve to reduce the incidence of gun fatalities in Philadelphia, and we are proud to be a part of this program,” said Marla Davis Bellamy, JD, co-principal investigator of the Healing Hurt People replication at Temple. “The expansion of Healing Hurt People to Temple University Hospital will provide our Emergency Department an opportunity to provide patients with behavioral health support to help them deal with traumatic stress given their overexposure to violence. The goal of this collaboration is to provide the residents of our surrounding neighborhoods with the tools necessary to prevent future violence as well as to improve the overall health of our community.” Kathleen Reeves, MD, is also a co-principal investigator of the Healing Hurt People replication at Temple.

– See more at: http://drexel.edu/now/archive/2015/February/Philadelphia-Hospital-Violence-Intervention/

A Natural Match: Drexel Research Team Connects Urban Design to Public Health

Originally posted on DrexelNow.

As inner-city school kids climb and swing at a state-of-the-art playground with a rain garden and trees, will their surroundings make a difference in their health and social well-being? At urban community gardens nearby, will the fresh produce and a greener view help local residents breathe easier?

Such questions, connecting urban design and natural systems with public health, are the focus of a new convergence of research and community engagement efforts at Drexel. A new team of faculty from the School of Public Health and Westphal College of Media Arts & Design is bringing together research on these interdisciplinary questions within community-based projects in West Philadelphia—some of which are already underway, and some that have yet to begin.

These efforts to study design and health will now be better linked and better equipped to succeed. In December, the American Institute of Architects (AIA) selected Drexel’s Urban Design & Health team as one of 11 inaugural members of the AIA Design & Health Research Consortium. The consortium will support member research on how design affects public health through workshops and discussion forums. It will provide members a platform to share ideas, such as resources for measuring and assessing the built or natural environment and results of related studies, with like-minded researchers and practitioners from across the country.

The Drexel researchers’ central hypothesis is that aspects of natural systems can be woven into existing urban systems to create healthier populations through design. The team is placing a special emphasis on measuring that idea in community settings in the Mantua neighborhood, where Drexel has already committed a number of efforts toward being the most civically engaged university in the nation.

The Drexel team’s research plan focuses on assessing the public health impact of design projects in neighborhoods near the University’s campus where community members face high rates of poverty and health disparities. These projects include:

  • A clean, sustainable and safe playground to be built at the Morton McMichael Elementary School in Mantua in summer 2015, including terraced gardens, trees and a rain garden to provide green space, shade and seating in addition to serving as an in-depth water management system.
  • Southwest Philadelphia Greenway, a 1.5 mile urban greenway built in 2013 in the center of a low-income, high-crime African-American area designed to connect residents to recreational facilities as well as provide a critical link in the larger regional and national trail networks that make up the “East Coast Greenway.”
  • Three community gardening initiatives developed in Mantua as part of a multiyear process aimed at creating long-term university-neighborhood partnerships that expand health and wellness opportunities in the community, including community gardens at Drexel’s Dornsife Center for Neighborhood Partnerships, where most of the harvested produce is donated to community members; at Backyard Beds, a project still under development, in which a group of Drexel students committed to urban farming and sustainability are building vegetable gardens in neighborhood residents’ backyards; and the Mantua Urban Peace Garden, managed by neighborhood residents along with Drexel and the Pennsylvania Horticultural Society, following a classic community garden model.
  • A proposed revitalization project for park at 34th and Brandywine Streets in Mantua. The team aims to collaboratively create a new vision for the park and invite residents to directly contribute to the park’s physical structure. The project will include community involvement in terms of art making, place making and design.

“There has been a growing collaborative effort between faculty in the School of Public Health and in Westphal College’s Department of Architecture & Interiors, including projects such as the Mantua Presbyterian Apartments, a low-income senior housing complex where Drexel students designed an urban garden, ” said Yvonne Michael, ScD, an associate professor in the School of Public Health and one of the principal investigators of the new team. “We saw the AIA consortium as an opportunity to better link the schools together. Now that we’ve been accepted as a consortium member, we are beginning to develop a framework for developing joint research and educational projects.”

The group aims to generate data that is useful to city residents and policy makers in understanding and addressing the causes of urban health problems and health inequalities—and to translate their new knowledge into effective practice and policy to promote health in communities. At the same time, they will train undergraduate and graduate students, as well as community members and external partners, in design and health issues.

“Working in an interdisciplinary capacity with Public Health faculty and students in the pre and post occupancy phases of the McMichael STEAM Schoolyard is just one of many future projects where we hope to better understand and quantify health impacts in the built environment,” said Debra Ruben, an associate professor and director of interior design programs in the Westphal College of Media Arts & Design. “Design and public health has always had a strong connection and the consortium is a perfect way to foster this type of collaboration, underscoring the important role that the built environment plays in the health and well-being of the community.”

Principal investigators on this team are, from the School of Public Health: Yvonne L. Michael, ScD,  Amy Auchincloss, PhD, Amy Carroll-Scott, PhD, and the school’s dean Ana Diez Roux, MD, PhD; and from the Westphal College of Media Arts & Design: Debra Ruben, Diana Nicholas, Jon P. Coddington, Harris Steinberg and Eugenia Victoria Ellis, PhD of the College of Engineering and Westphal College.

– See more at: http://drexel.edu/now/archive/2015/February/Urban-Health-Design-Research/

Children’s Hunger Born From Mothers’ Trauma

Originally posted on DrexelNow.

The roots of children’s hunger today may stretch back, in part, to the past childhood trauma of their caregivers. Evidence amassed over the past two decades has demonstrated that stress and deprivation during childhood have lifelong consequences on health, as well as school and job performance. A new small-scale study from Drexel University now suggests a strong relationship between exposure to adverse childhood experiences (ACEs) and household food insecurity among mothers of young children.

“This is brutal stuff,” said Mariana Chilton, PhD, an associate professor and director of the Center for Hunger-Free Communities in the Drexel University School of Public Health, who was lead author of the study now published in the journal Public Health Nutrition. “The causes and realities of hunger and poverty are complicated and difficult to unravel. We are seeing one component of them is that, for many people, experiences of hunger have trauma and adversity at their core.”

This Childhood Stress study, led by Chilton with several Drexel graduates in the School of Public Health, used both quantitative and qualitative methods to gather information about 31 Philadelphia mothers’ experience with deprivation, abuse, violence and neglect, as well as their experiences with hunger, education and employment and more.

The findings, Chilton and colleagues say, show that trauma and chronic stress are a largely overlooked part of the picture of why one in five American households with young children live with food insecurity. They say it indicates a greater need for public assistance programs to provide support for families’ emotional needs in addition to their material needs.

While the team’s quantitative surveys were small in number, the results still point clearly to a value in considering adverse childhood experiences as a contributor to food insecurity. Higher scores on the adverse childhood experiences survey, for instance, were significantly associated with the severity of participants’ household food insecurity.

In interviews, the study participants relayed their perceptions of how emotional and physical abuse in childhood affected their lives, including physical health, school performance and ability to maintain employment—all factors directly linked to household income and ability to afford enough healthy food for their own children.

“If a person always says you’re nothing; you’re nothing. Then for a while I used to think I’m not anything,” said 22-year-old Tamira (a pseudonym), a study participant who experienced abandonment by her mother at age five, then abuse and rape by members of her caregiver family at age six, and was emotionally and physically abused by her grandmother who took her in at the age of seven. Tamira experienced homelessness in her teens after her grandmother kicked her out, but eventually still graduated from high school. In her interview she described a connection between her childhood struggles with physical and emotional abuse and her ability to provide for her young daughter today: “So maybe that’s how I don’t have a job, because I’m thinking I’m nothing. I’m not ever going to have a job. I’m not going to be [anything], like my grandma said. […] Because I can’t find a job I cannot feed my daughter. How am I supposed to? I cannot buy her what she needs.”

Other study participants described experiences of physical neglect, household drug abuse, exposure to violence at home and in their communities and other adverse experiences in childhood. Many said they felt these experiences affected their lifelong abilities to succeed—although many simultaneously expressed strong feelings of resilience and hope to change the story for their own young children.

“This study has been difficult for us, because examining the relationship between food insecurity and adverse experiences in childhood may simply add more stigma to families already stigmatized and blamed for the hardships that they face,” said Molly Knowles, a Drexel MPH graduate, research coordinator at the center, and a co-author of the study. “It’s important to be clear that childhood adversity is one factor interrelated with many others, including low wages, insufficiently and inequitably funded education systems, racism and discrimination, lack of safe and affordable housing and an inadequate safety net.”

The researchers recommend that those working to address poverty and hunger in children should include emotional health of parents and caregivers in a more comprehensive approach to policy and services. Such an approach should include ensuring parents and caregivers have safe places to live, access to behavioral health support and opportunities to develop positive social relationships. They also recommend providing public assistance programs that recognize widespread exposure to trauma and violence, offering additional support to participants with behavioral health barriers to employment, and implementing programs in ways that avoid re-traumatization.

For more information about the study, see the following resources:

– See more at: http://drexel.edu/now/archive/2015/February/Child-Hunger-Trauma-Study/

Hospitals Helping Violence Victims Could Save Millions

Originally posted on DrexelNow.

At more than 25 hospitals across the U.S., health care professionals have embraced a public health approach to their work—taking action to prevent violent injuries, not just treat them. In programs known as hospital-based violence intervention programs (HVIPs), teams of medical professionals, social workers and researchers step in at a critical moment in a patient’s life—the period following a violent injury such as a gunshot or stab wound—with case management, counseling and other services that help these victims break free from the cycle of violence.

As these programs have grown, up from about six programs in 2009, reports of their successes have accrued. There is evidence that HVIPs prevent violent reinjury and perpetration, reduce aggressive behaviors and improve employment, education and healthcare utilization among program participants.

Researchers at Drexel University have now published the first study to systematically look at the economic outcomes of hospital-based violence intervention. They demonstrate that, in addition to transforming victims’ lives, these programs may indeed save a significant amount of money compared to non-intervention, in various sectors including health care and criminal justice. They report in the February issue of the American Journal of Preventive Medicine that an HVIP serving 90 clients could result in costs savings from tens of thousands of dollars and up to about $4 million in a five-year period.

“This is the first systematic economic evaluation of a hospital-based violence intervention program, and it’s done in a way that can be replicated as new evidence emerges about the programs’ impacts across different sectors,” said Jonathan Purtle, DrPH, an assistant professor at the Drexel University School of Public Health who was lead author of the simulation study.

Attaching dollars and cents to HVIPs—and knowing which sectors of society are likely to see the financial benefit—is important because many HVIPs lack a sustainable funding source. Most programs currently rely on a patchwork of funders that may include some use of insurance billing for eligible services, such as behavioral counseling; private foundation grant or institutional funding; or local government funding.

Demonstrating that HVIPs are a source of long-term cost savings for the health care system or for the criminal justice system, or both, helps make the case that investing in HVIPs pays off.

Purtle’s study drew on the research literature about violent reinjury, violent perpetration, and estimates of the rates at which HVIPs prevent these outcomes. He compared the costs of outcomes likely to be experienced by a hypothetical group of 90 individuals who received HVIP services (plus the costs of providing HVIP services to the 90 clients, $350,000 per year) to the costs of the outcomes likely to be experienced by a similar group of 90 individuals who did not receive HVIP services. Various models of the simulation included costs to the health care system, such as costs of treating the individuals who are reinjured and/or treating their victims if those individuals go on to perpetrate violence against others; those health care costs plus costs to the criminal justice system to prosecute and incarcerate individuals who become perpetrators; and the preceding costs in addition to societal costs of lost productivity.

In all models of the simulation, HVIPs produced cost savings over five years. The most conservative simulation, including only the future health care costs of those among the 90 individuals who may experience violent reinjury, showed health care savings of $82,765. The most comprehensive model, including lost productivity costs, showed a societal cost savings of over $4 million to serve 90 clients.

Purtle noted that lost productivity costs, while common in economic analyses, may be somewhat unrealistically high because they assume all individuals in the model are employed. Conversely, beyond the economic analysis there are still social benefits of HVIPs that aren’t easily quantifiable: “Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented,” Purtle said.

A Closer Look: Healing Hurt People in Philadelphia and the Benefits of Hospital-Based Violence Intervention

“The research literature has poetically referred to the time after a traumatic injury as the ‘golden hour’,” said Ted Corbin, MD, an associate professor in Drexel’s College of Medicine and School of Public Health, and a co-author of the study with Purtle. That first hour after a major injury is a medically critical time to address physical symptoms such as blood loss and brain injury.

Soon thereafter, Corbin said, is also a critical, vulnerable moment when patients who were victims of interpersonal violence may direct their thoughts toward retaliation, or toward turning their lives around.

Corbin directs Healing Hurt People, the hospital-based violence intervention program in Philadelphia, based in Drexel’s interdisciplinary Center for Nonviolence and Social Justice, of which he, Purtle and all of the study’s co-authors are part. Healing Hurt People serves a population of pediatric and young adult clients in two inner-city hospitals, who are largely marginalized, underresourced and socially disenfranchised. It operates based on a framework that is trauma-informed—meaning that the program is designed on principles recognizing how traumatic stress and adversity associated with past exposure to violence affect clients and their needs.

“Our efforts are to connect with that person, gain their trust and work to connect them with services,” Corbin said. The majority of patients approached by the program’s caseworkers, either during their time in the hospital or soon after, are interested in enrolling as clients. Many use the assistance of case managers to enroll in health insurance and connect to a primary care doctor for the first time as adults, get an ID card, connect with court advocacy and compensation services for victims, access school services or otherwise pursue positive changes in their lives to avoid future involvement with violence.

The Healing Hurt People program receives financial backing for trauma-informed case management services from the City of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services. Many of the behavioral health counseling services within the program are billed to insurance when appropriate.

“There are many aspects of society where people can take steps to address trauma and step in to contribute to reducing violence,” Corbin said. “Those of us in medicine have an opportunity to do something through hospital-based violence intervention, but it’s just one slice of the pie.”

– See more at: http://drexel.edu/now/archive/2015/January/Hospital-Violence-Intervention-Cost-Benefits/

Report Shows Challenges for Working Families in Transition Off of Public Benefits

Originally posted on DrexelNow.

Getting a better job or more hours at work should be a boon to low-income individuals who are trying to lift themselves and their families out of poverty. But sometimes, instead, their families suffer more just when they should begin to thrive.

“Earning more income should always be a positive step forward, but for too many families a modest increase in income, especially when those increases are often temporary, does not make up for benefits that are lost as a result of the increase,” said Mariana Chilton, PhD, an associate professor and director of the Center for Hunger-Free Communities in the Drexel University School of Public Health and principal investigator of the Philadelphia site of Children’s HealthWatch, a multi-site research program investigating the impact of public policies and programs on the health of young children seen in hospitals, emergency rooms, and primary care clinics. “When incomes are unstable, benefits help families stay stable. A loss of benefits can have drastic impacts on a family, limiting their ability to purchase food and other basic necessities, and forcing families to return to benefit programs they were working so hard to leave.”

That cliff effect—losing benefits in the transition out of poverty—is the focus of a new policy report released today by Drexel’s Center for Hunger-Free Communities and Children’s HealthWatch based on Children’s HealthWatch data collected in Philadelphia from 2005 through 2013.

The analysis found that families who experienced a reduction of food stamp benefits (officially known as the Supplemental Nutrition Assistance Program, or SNAP) due to an increase in income were more likely to be food insecure or marginally food secure, than were families who received a consistent level of SNAP benefits.

The report was presented at a Shared Prosperity roundtable hosted by the City of Philadelphia’s Mayor’s Office of Community Empowerment and Opportunity (CEO) in support of Shared Prosperity Philadelphia, the city’s plan to fight poverty. Monthly roundtables bring together researchers, service providers and consumers, funders, and others to deepen knowledge and form more effective partnerships to address critical poverty issues.

The report indicates that losing or having a reduction of SNAP benefits due to income growth was associated with other sacrifices in the family’s health and health care, beyond access to food. Families whose SNAP benefits were reduced were more likely to include a family member who was forced to forgo health care due to cost. In households who lost SNAP benefits completely due to increased income, young children were twice as likely to have foregone needed health care due to cost and more likely to live in a household that made trade-offs between paying for other basic living expenses (food, rent or housing) to pay for health care.

These trade-offs and the fear of faring worse after benefit loss when earning higher wages are familiar for many people who live in poverty, including participants in the Witnesses to Hunger program in the Center for Hunger-Free Communities. Participant Imani Sullivan, for example, has described her first-hand experience with this struggle: “I was on my way to my job when my food stamps were cut off,” she said. “They had called me to work there overtime for one day and I thought to myself, ‘Well, if I go down here this one day, are they going to cut my food stamps off?’ I really didn’t know what to do. I don’t think it’s fair for us to get reprimanded for doing something positive.”

To help families in Philadelphia and nationwide have a clear and effective path out of poverty and into economic independence, the authors of the new policy report recommend three major types of solutions:

  • Reducing barriers to employment for families of young children by implementing measures such as mandatory paid sick leave and increased access to affordable childcare.
  • Providing wages that allow families to achieve self-sufficiency without need for benefit programs. (Currently, many working families rely on SNAP because they do not earn enough from working to make ends meet.)
  • Developing processes for work support programs to help families move and stay off of benefit programs, e.g. by creating a more gradual decline in benefits.

The authors recommend developing creative solutions across local, state and federal policies.

“We are proud to partner with the Center for Hunger-Free Communities to support families as they increase their earned income,” said Eva Gladstein, Executive Director of CEO.  “We look forward to working with Dr. Chilton and partners at all levels of government to bring much needed relief to working families across Philadelphia.”

– See more at: http://drexel.edu/now/archive/2014/December/Working-Families-SNAP-Benefits-Report/

Study Maps How City Neighborhoods Affect Diabetes Risk

Originally posted on DrexelNow.

As the linked epidemics of obesity and diabetes continue to escalate, a staggering one in five U.S. adults is projected to have diabetes by 2050.

Ground zero for identifying ways to slow and stop that rise is Philadelphia, which has the highest diabetes rate among the nation’s largest cities. For public health researchers at Drexel University, it is also a prime location to learn how neighborhood and community-level factors — not just individual factors like diet, exercise and education— influence people’s risk.

A new Drexel study published this month in the journal Advances in Preventive Medicine adds new insight into the role of the physical and social environment on the risk of diabetes, zip code by zip code throughout the city. The researchers report that age-adjusted prevalence of diabetes in adults aged 18 and older in the city increased significantly between 2002 and 2010. Having diabetes is a strong risk factor for heart disease, even more so in minorities. Living in a disadvantaged neighborhood may play a critical role in a person’s risk of the disease, accounting for about 12 percent of the difference in risk between otherwise-similar groups.

Philadelphia is often referred to as comprising a patchwork of neighborhoods. As a result of this city-wide patchwork, “people who live in the same general area have huge variations in socioeconomic environment,” said Longjian Liu, MD, PhD, an associate professor and interim chair of the Department of Environmental and Occupational Health in Drexel’s School of Public Health. Liu was lead author of the new study. This report was coauthored by Ana E. Núñez, MD, a professor and associate dean for urban health equity, education and research in Drexel’s College of Medicine. “Philadelphia also has the worst health status among 67 counties in Pennsylvania.”

The communities people live in contribute to wellness or illness. To evaluate the health impact of disadvantaged urban communities, Liu and Núñez developed an indicator of people’s physical and social environment (PSE) based on their answers to certain questions on a large region-wide health survey. These questions asked about the availability of healthy food, use of local recreational facilities, helpfulness of neighbors and other factors, in addition to poverty level. The survey also asked more than 17,000 participants who lived in 46 Philadelphia zip codes about personal factors that affected their risk of diabetes. These questions included whether they were overweight or obese, their physical activity, fruit and vegetable intake, age, sex, race/ethnicity and smoking status.

Liu and Núñez found that scores for the physical and social environment varied widely across neighborhoods. The neighborhoods with worse PSE statuses had a higher prevalence of diabetes. In areas where residents had higher rates of overweight and obesity or lower education attendance, there were also higher rates of diabetes. Between the survey periods in 2002 and 2010, the number of neighborhoods with higher rates of diabetes increased substantially.

Using statistical models, the researchers determined that about 12 percent of the risk of diabetes correlated with neighborhood PSE factors when adjusted for respondents’ age and sex — meaning they would expect diabetes rates to drop by 12 percent if the neighborhood environment were improved. Another nearly 12 percent of risk correlated with education when adjusted for respondents’ age and sex. Excess weight (overweight or obese) and race/ethnicity still remained larger contributors to the odds of diabetes.

“Too often, we focus exclusively on the individual in solving the problem. Here we found that we also need to focus on the healthiness of the community if we want to improve overall health and ultimately decrease health care costs” Núñez said.

“We want to stop the epidemic of diabetes and eliminate health disparities in communities,” Liu said. He noted that although the risk of diabetes develops from an interaction between genes, lifestyle and environmental factors, the disease can be largely prevented by influencing its modifiable risk factors. To do so, we need to critically look at health policies that reduce risk at a larger community level. Working towards improving the health quality of an entire neighborhood or city shows promise in helping to reduce the risk of disease.

– See more at: http://drexel.edu/now/archive/2014/November/City-Diabetes-Map-Study/

From Big-Data Injury Prevention to Mapping Travel for Prenatal Care: Drexel Public Health Research at APHA 2014

Originally posted on DrexelNow.

Researchers from Drexel University in Philadelphia this week presented research on a wide range of public health topics emphasizing urban health challenges, geographic methods in public health, community resilience and more, at the 142nd annual meeting and exposition of the American Public Health Association in New Orleans.

A few selected highlights among the dozens of posters and presentations by faculty, staff and students from the Drexel University School of Public Health include:

What Makes Communities Resilient in Times of Adversity?

Psychologists have long studied what makes individuals resilient, but when groups and entire communities of people together face disaster, violence, or other disadvantages, how do they survive and thrive together? Amy Carroll-Scott, PhD, an assistant professor in the Drexel University School of Public Health, organized moderated a session encompassing multiple presentations on Monday, Nov. 17, “Understanding and Building Resilience for Healthier Communities. The session kicked off with her own systematic, cross-disciplinary literature review of community resilience. Carroll-Scott’s research examines the conditions and characteristics of neighborhoods to better understand community-level health disparities and community-driven efforts to address them.

Another Drexel team also presented work at this session, “Understanding How to Support and Build Resilience within Community Leaders,” based on a project done in partnership with a community organization in Southwest Philadelphia to help community leaders in high-crime, high-poverty neighborhoods. “Many times people in these community leadership roles can burn out without proper support and tools,” said Nicole Vaughn, PhD, an assistant professor at Drexel and co-leader of this project. Vaughn, along with Crystal Wyatt (a community research coordinator at Drexel) and Carey Davis, D.Min (co-leader of this project and director of CityLights Network) met with a small group of community leaders to understand the stressors associated with being the “go to” people for neighbors in crisis. They worked with these leaders to develop a plan to adapt the Sanctuary Model® for communities. The Sanctuary Model®, developed by project co-leader Sandra Bloom, MD, an associate professor at Drexel, is an evidence-based model for organizations to operate using trauma-informed approaches. “Many of these leaders wanted more in-depth training in the Sanctuary Model ®and more opportunities for connecting, debriefing and self-care,” Vaughn said. “All of these identified needs are important if you’re shouldering the weight of the community’s issues.”

Additional panelists discussed the state of community resilience in public health, including the RAND Corporation’s Community Resilience Project, lessons learned from New Orleans-based efforts to build community resilience post-Katrina and grassroots community resilience teams focusing on reducing gun violence in New Haven, Ct. “This session at APHA will highlight important efforts in our field that draw from and strengthen community assets in order to overcome threats to residents’ health and well being,” said Carroll-Scott in advance of the session.

How Many Buses Must a Low-Income Mother Take to Get Prenatal Care?

Travel to care is a recognized challenge for low-income pregnant women seeking prenatal care. “As a nurse, I try to make sense of what the data may mean based on my experiences caring for real pregnant women in Philadelphia,” said Joan Bloch, PhD, an associate professor in Drexel’s College of Nursing and Health Professions and School of Public Health. “If a mother arrives 15 or 20 minutes late because of delays or the hassle of traveling by bus with young children in tow to all the locations for prenatal care services, she often won’t be seen.” So in her research aiming to reduce health disparities in preterm birth – which is associated with a stunning two-fold racial disparity in infant mortality – Bloch and her collaborators combined large-scale geographical map data with a case-vignette method she calls “ground truthing.” Bloch’s poster, “More than Just Bus Fare: Critical Theory and GIS to Deconstruct Prenatal Care Travel among Low-income Urban Mothers,” discusses this simulated case quantifying the challenges facing a low-income pregnant woman in a Philadelphia neighborhood with high preterm birth rates: She would need to make 25 visits to different facilities to get prenatal care, traveling nearly 180 miles and spending more than 19 hours—in just getting to care. Bloch said this type of approach is important to understand specifically what factors can be changed to shift health disparities in preterm births.

How Can We Link Big Data Sets to Provide Public Health Insight?

Combining large-scale data sets can help public health researchers unlock insights into questions unavailable in other ways. For Jennifer Taylor, PhD, an associate professor in Drexel’s School of Public Health, to learn what types of occupational injuries and illnesses are causing harm to firefighters and other emergency responders, answers lie in the linkage among employee rosters, worker’s compensation databases and hospitalization databases. But researchers like Taylor need the ability to match up an individual record in one database to another with certainty. “Often people don’t have the luxury of unique identifiers such as Social Security numbers because they are sensitive personally-identifying information,” Taylor said. At APHA, Taylor and Michael LeVasseur, a data manager on Taylor’s research project team and a doctoral candidate in epidemiology at Drexel, presented a roundtable for work comparing methods of linking data sets. Knowing which methods are most effective and accurate when connecting data sets that may be incomplete or contain some errors, is increasingly important as the reliance on big data in public health research grows. “By linking big data sets together, we get even bigger data, and that tells a more comprehensive and complete worker injury story,” Taylor said.

What Happens When EMTs Experience Assault by Patients?

A recent Drexel MPH graduate working with Taylor, Brittany Barnes, showed a poster for work done at a much smaller and more personal scale, “Expecting the unexpected: Assaults to EMTs/Paramedics,” including in-depth information gathered through interviews and focus groups with these emergency responders. “Most people have no idea that this happens,” Taylor said, and statistics show calls for medical service are increasing at 30 percent annually. When Barnes and Taylor spoke with paramedics in Philadelphia, most de-emphasized the physical injuries they sustained. Instead, “they wanted to talk about the psychological effect of being called to someone’s house and getting beat up,” Taylor said. “That’s not expected, and the impact stays with a person. We’re concerned about what this means for paramedics as their work is already quite high-stress, and now they are dealing with combative patients as well.”

Do Food Stamps Stave Off Harmful Effects of Diabetes?

For people with Type II diabetes, a healthy diet is part of the best medicine to maintain health and stave off complications. But a consistent healthy diet and consistent medical care can both be unaffordable for low-income individuals who live with food insecurity. Darryl Brown, PhD, an assistant professor in Drexel’s School of Public Health, investigated the health care expenditures and outcomes among low-income individuals with diabetes who received federal public assistance to better afford food, and benefit-eligible low-income individuals who did not receive the assistance. Brown and Drexel collaborator and associate professor Mariana Chilton, PhD, report in their poster that the group who received benefits from the Supplemental Nutrition Assistance Program (SNAP, commonly known as food stamps) had better diabetes outcomes and used more health care services for diabetes-associated health issues than the group who did not receive SNAP – despite the latter group being older and sicker. “The SNAP-eligible group who were older and sicker should be using more health care,” Brown said. “That they don’t suggests there’s an access issue, and SNAP benefits are supporting access to care.”

– See more at: http://drexel.edu/now/archive/2014/November/APHA-Public-Health-Research/