Sammy Zahran, PhD, is a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2012 - 2014). He is assistant professor of demography in the Department of Economics at Colorado State University, assistant professor in the Department of Epidemiology in the Colorado School of Public Health, and co-director of the Center for Disaster and Risk Analysis at Colorado State University. This blog is based on his study: "Linking Source and Effect: Resuspended Soil Lead, Air Lead, and Children's Blood Lead Levels in Detroit, Michigan."

RWJF Health & Society Scholars lead the field of environmental health. This is part of a series highlighting their 2013 research.

Human Capital Blog: Tell us about your recent study, published in Environmental Science and Technology. What questions did you set out to answer? And what did you find?

Sammy Zahran: We sought to understand a mysterious statistical regularity in blood lead (Pb) data obtained from the Michigan Department of Community Health.  The dataset contained information on the dates of blood sample collection for 367,800 children (<10 years of age) in Detroit. By graphing the average monthly blood Pb levels (μg/dL) of sampled children, we found a striking seasonal pattern (see Figure 1). Child blood Pb levels behaved cyclically. Compared to the reference month of January, blood Pb levels were 11-14 percent higher in the summer months of July, August, and September.

Nicholas Stine, MD, and Dave Chokshi, MD, MSc, writing on behalf of the New York Academy of Medicine Primary Care and Population Health Working Group.

The New York Academy of Medicine is the National Program Office for the Robert Wood Johnson Foundation Health & Society Scholars program, which works to reduce population health disparities and improve the health of all Americans. The New York Academy recently conducted a survey of 17 thought leaders in primary care and population health. In the final of five blog posts, we share a synthesis of what those leaders had to say. All quotes are printed with permission.

Addressing Social Determinants of Health: Given the current state of the clinical delivery system, it may seem unrealistically burdensome to ask health care institutions to address the social determinants of health (SDH). “In this country it’s an accomplishment if you can reward value for delivery,” noted Arnold Milstein, MD, MPH, “and social determinants approaches are a step or two beyond that.”

Examples of clinical engagement in social determinants, however, can be quite impactful:

·         Lloyd Michener, MD, and Bob Lawrence, MD, described how Duke and Johns Hopkins both invested in SDH initially in order to repair or promote their public image. For example, Duke invested in some SDH programs and community partnerships in part to help repair their image in the setting of poor relationships with a minority, low-income community in Durham—though these investments have grown into more lasting partnerships. 

·         David Stevens, MD, pointed out the example of the 16th St Community Health Center in Milwaukee, where an environmental wing of the health center was created to combat lead poisoning—and then expanded over years into broader projects, such as combatting brownfields and creating green spaces for exercise.

-- Dr. Martin Luther King Jr., in a speech to the Medical Committee for Human Rights, 1966

Nalo Hamilton, PhD, RN, WHNP/ANP-BC, is an assistant professor of nursing at the University of California, Los Angeles School of Nursing; and Cheryl Woods Giscombé, PhD, RN, PMHNP-BC, is an assistant professor in the School of Nursing at the University of North Carolina at Chapel Hill.  Both are Robert Wood Johnson Foundation Nurse Faculty Scholars.

The New Year has begun and for some 2013 marks a time of celebration and progress, while for others it is a time of uncertainty and despair. As we pause to remember the rich contributions of Dr. Martin Luther King, Jr., we should also reflect on how his legacy can be used to eliminate the health care disparities that so disturbingly affect the underserved and underrepresented in our nation today.

The World Health Organization has determined that geographic locale, ethnicity, education, environmental stress, and access to a health care system are social determinants of health and health inequities. These factors are influenced by the disparate distribution of resources, wealth, and power.

In the United States:

• African Americans, Hispanic Americans, and Native Americans have rates of diabetes that far exceed those in non-Hispanic whites.
• African American women are more likely to be diagnosed with advanced stage breast cancer compared to white women and have the highest rate of mortality.
• Native Americans report more alcohol consumption and binge drinking than other racial/ethnic groups.
• Hispanic males age 20 or younger have the highest prevalence of obesity compared to non-Hispanic whites and African Americans.
• African American men and women are more likely to die of cardiovascular disease than non-Hispanic whites.
• Infant mortality occurs in African Americans 1.5 to 3 times more than in other races or ethnicities.

A member of the Navajo Nation, Lisa Palucci, MSN, RN, is a nurse consultant at the Centers for Medicare and Medicaid Services and a fellow with the Robert Wood Johnson Foundation Nursing and Health Policy Collaborative at the University of New Mexico. This post is part of the "Health Care in 2013" series.

As the nation trudges forward in its quest to improve health care access for all Americans, I think it is essential that we continue to make progress in decreasing the health disparities and social determinant of health gaps that continue to be ignored in mainstream health policy initiatives.  Throughout the course of my PhD program at the University of New Mexico (UNM), we have had numerous opportunities to experience nursing and health policy in action by attending national conferences, meetings, and orientation programs.   To my disappointment, discussion about improving health disparities and social determinants of health are seldom a topic on the agenda.  This poses the question: Aren’t the health disparities and social determinants of health what got us to the point of an inequitable health care system in the first place?

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

The New York Times spoke with several RWJF scholars for a story about how hospitals are taking steps to avoid financial penalties from Medicare for having too many patients readmitted soon after discharge. “Just blaming the patients or saying ‘it’s destiny’ or ‘we can’t do any better’ is a premature conclusion and is likely to be wrong… I’ve got to believe we can do much, much better,” RWJF Clinical Scholars Yale site director Harlan Krumholz, MD, said. Clinical Scholars alumnus Eric Coleman, MD, MPH, and RWJF Physician Faculty Scholars alumnus Ashish Jha, MD, MPH, were also interviewed for the story.

Two other Clinical Scholars were featured in the New York Times. Alumna Leora Horwitz, MD, MHS, wrote an op-ed about the risks and benefits of electronic medical records, and RWJF/U.S. Department of Veterans Affairs Clinical Scholar Jason Lott, MD, MSHP, published a letter to the editor about the cost of robotic surgery and single-incision operations.

A program headed by RWJF Nurse Faculty Scholar Sarah L. Szanton, PhD, CRNP, is helping elderly Baltimore residents improve the safety and living standards of their homes so they can “age in place” instead of having to move to nursing homes, the Baltimore Sun reports. In addition to handyman services like installing ramps and handrails, participants are paired with occupational therapists and nurses who teach them medication management and other skills.

The New Jersey Nursing Initiative (NJNI) is making headway in recruiting, educating, and retaining nurse faculty in the state, the Philadelphia Inquirer reports. Leaders in health, business and academics testified at a state Senate committee hearing last week about NJNI’s progress in addressing the nurse faculty shortage. Read more about the hearing.

Jason M. Fletcher, PhD, MS, is an alumnus of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2010-2012) and an associate professor of health policy at Yale School of Public Health.   Fletcher was recently lead author of the study, “How Social and Genetic Factors Predict Friendship Networks,” published October 17 in the journal PNAS (Proceedings of the National Academy of Sciences). Fletcher and his colleagues found that important interactions between genetics and the social environment help determine friendship formation during high school.

For our study, we used a national survey of adolescent friendships (Add Health, or the National Longitudinal Study of Adolescent Health) to follow up on and expand a study published last year that showed that specific genes, including a dopamine receptor gene (DRD2), may determine friendships among teens.

We found the idea of a biological basis for, in our view, the very sociologically driven outcomes of friendship formation to be too narrow and to not take into account the social and geographic constraints that underlie friendship links.  So in our research we show, using the same data as the previous study, that once we take account of schools and social environments, the previous genetic story is not confirmed by our data.

Indeed, we show that some schools produce friendships that are genetically similar, and others produce friendships that are genetically dissimilar.  And specific aspects of schools, like socioeconomic inequality, appear to partially determine the types of friendships that we observe school-by-school.

By Daniel L. Howard, PhD, executive director of the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College. The Center’s mission is to provide leadership in health policy education, research and reform, while improving the health and health care of underserved communities. This post is part of a series in which RWJF scholars, fellows and alumni who are attending the American Public Health Association annual meeting reflect on the experience.

This week, I am part of a team that had the honor of being chosen to conduct a presentation on mental health in African American faith-based communities at the 140th Annual Meeting and Exposition for the American Public Health Association (APHA).  This is a significant topic for clinicians, researchers and policy-makers to consider when addressing mental health needs for African American individuals and their communities.

The Surgeon General’s Report Supplement (2001) noted that science can offer effective treatments for most disorders.  However, it noted, “Americans do not share equally in the best that science has to offer.” Numerous others researchers have concluded that publicly provided behavioral health services must be improved for ethnic minorities.

Research has consistently shown that, despite significant prevalence of mental health issues in the United States, most individuals do not seek treatment for these issues. Historically, research has shown that African Americans are even less likely to seek mental health treatment than their Caucasian counterparts. There are several reasons for this that are not exclusive to, but do include, the stigma that surrounds mental health in African American communities, the perceptions of mental health in African American communities, and the limited mental health resources available to address mental health needs in the community.

Despite the indication that the majority of mental health service needs for African Americans are unmet, there has been a strong and consistent response from the African American church to serve as the surrogate for the medical sector. Many published studies have found that African American churches have strong potential to serve as a highly effective gateway for the successful delivery of health intervention. The compatibility between health and wellness and African American churches, and particularly between mental health wellness and African American churches, can be attributed to several factors including the church’s consistent tradition of supporting its members and the inherent emphasis on the healing of psychological ills.

Sarah Burgard, PhD, MS, MA, is an alumna of the RWJF Health & Society Scholars program, and an associate professor of sociology and epidemiology and research associate professor at the Population Studies Center at the University of Michigan. Burgard recently co-authored a study that finds perceived job insecurity is linked with significantly higher odds of fair or poor self-reported health, symptoms of depression, and anxiety attacks.

Human Capital Blog: What got you interested in researching the working lives and health outcomes of adults? Was there anything in particular that sparked your curiosity about job insecurity?

Sarah Burgard: I was interested in the excellent research being done by health disparities researchers that focused on socioeconomic position and its strong and persistent relationship with health. My dissertation looked at race and socioeconomic position and how they shaped children's health in different societies. When I started looking at the lives of adults in wealthy economies and focusing on health disparities in these groups, it struck me that most scholars were focused on education and income as stratifying factors, but not looking deeply at what connected them: paid employment.

Careers characterized by stimulating and satisfying work versus dangerous, monotonous or insecure work are of considerable interest in their own right to sociologists of stratification, but they could also be important for understanding divergence in health, as considerable research in occupational psychology and epidemiology has suggested. Many of the projects I've done have been aimed at bringing together the strong work in each of these fields to build even stronger explanations of the way work (or lack of work) influence health. I've been interested in less explored aspects of work, such as perceptions of job insecurity among those still employed, and in taking better account of the multitude of psychosocial aspects of work that affect individuals at a given point in time and the ways these could change over the career.

Natasha Dow Schüll, PhD, MA, is a cultural anthropologist and associate professor at the Massachusetts Institute of Technology's Program in Science, Technology and Society. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2003-2005). Her recent book, Addiction by Design: Machine Gambling in Las Vegas, examines the ways that the gambling industry has designed gambling machines that encourage addiction.

Human Capital Blog: In your book, you describe how electronic gambling machines—the modern equivalent of slot machines—are designed in such a way that they encourage addiction. Tell us about that, please.

Natasha Dow Schüll: If you have never actually been in a Las Vegas casino and your idea of it comes from a James Bond movie, you'd be surprised by what you'd find. Of course they still have card games and roulette wheels, but most of the money casinos make is from electronic gambling machines, which are amazingly sophisticated versions of the classic three-reel slot machine. Every aspect of their design—the hardware, the software, the math, even the seating components—is carefully designed to keep players at the machine, playing game after game. Play is simple and amazingly fast—it takes only three to four seconds per spin. The machines are programmed so gamblers win every now and then, and they give audiovisual feedback to encourage them to continue. They induce players to gamble quickly and repeatedly, developing a sort of rhythmic flow that can sweep them away. Gamblers talk about getting into a "zone" where everything but the game just drops out of their awareness. After a while, they crave the zone itself, so it stops being about beating the machine and becomes instead about staying on the machine for as long as they can so they can be in that zone. They're addicted, and they develop all the behaviors of an addict as a result.

My point is that it's no accident; the machines are designed to drive the kinds of behavior—playing faster, longer, and more intensively—that turns gamblers into addicts.

Cleopatra M. Abdou, PhD, is an assistant professor of gerontology at the University of Southern California, and an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program. This post is part of a series on the RWJF Health & Society Scholars program, running in conjunction with the program’s tenth anniversary.  The RWJF Health & Society Scholars program is designed to build the nation’s capacity for research, leadership and policy change to address the multiple determinants of population health.

Gerontology, the study of aging, is a diverse field that integrates the biological, social-behavioral, and health sciences, as well as public policy. This means that gerontological research addresses a vast range of questions. One type of question asked by gerontologists, including myself, has to do with intergenerational processes. My own research investigates the intergenerational transmission of culture, social identities, conceptions of stress and success, and, ultimately, health. For example, how do our notions of, and relationships to, family affect our health at critical points in the lifespan? More specifically, how do familial roles and responsibilities, such as marrying, reproducing, and caring for grandchildren, correlate with life satisfaction and longevity?

My four siblings and I are the first American-born generation in our family. Our parents came to the United States from Egypt in 1969, and I am strongly identified as both an American and an Egyptian. Anyone who has complex or competing identities knows that it’s a mixed bag—a blessing and a curse. Recently, as I boarded a plane in Cairo to return to the United States, I found myself sobbing with what I think was a kind of homesickness. As happy as I was to return to my immediate family and orderly life in The States, I mourned leaving the land of my parents and all of our parents before them, especially during this important time in Egypt’s history.