Crime and violence in U.S. inner cities has a profound impact on public health. The question is how best to combat it. According to recent studies, one answer could be as simple as assigning more police officers to foot patrols in crime hotspots.

With funding in part from the Robert Wood Johnson Foundation’s Public Health Law Research program, researchers from Temple University worked with the Philadelphia Police Department to conduct a study on the impact of police foot patrols on inner city crime. Findings published in Criminology in 2011 found foot patrols helped reduce violent crime — at least temporarily — by 23 percent in high-crime areas of the city. A recent follow-up study in Policing and Society revealed a qualitative look at how the participating officers developed extensive local knowledge and formed community relationships — both of which contributed to the cuts in crime.

These and other results demonstrate the need to involve officers on foot patrol in the development of violence prevention strategies, according to researchers.

>> Read more about the study.

Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks. 

NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?

Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.

So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.

NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?

Municipal mixed-use zoning is a public health strategy to create more walkable neighborhoods by creating integrated, un-siloed access to daily activities—such as going grocery shopping and traveling to school and work. A recent study in a special issue of the Journal of Health, Politics, Policy and Law funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation, evaluated municipal zoning ordinances in 22 California cities to see whether the ordinances improved walkability in those communities. NewPublicHealth spoke with the study’s two authors, Sue Thomas, PhD, senior research scientist at the Pacific Institute for Research and Evaluation-Santa Cruz (PIRE) and Carol Cannon, PhD, formerly with PIRE and current associate research scientist at the CDM Group, Inc, a consulting firm in Bethesda, Md.

>>Read the full study.

NewPublicHealth: What was the scope of your study? 

Carol Cannon: We looked at ordinances that create municipal mixed use zoning, and whether these laws seem to have an impact on the potential for walking to destinations. 

NPH: In what ways were the study and findings innovative?

The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently announced eight new grant recipients that will receive funding to conduct health impact assessments (HIAs). The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy.

“Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.”

By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States.

Funding for some of the new proposals was also provided by the Blue Cross and Blue Shield of Minnesota Foundation and The California Endowment.

Some of the new HIAs that have received funding include:

• Partners for a Healthier Community, Inc. will undertake an HIA to inform decisions about a proposed casino in western Massachusetts. Decision-makers—including the state gaming commission, local government officials, and voters—will consider siting options as well as licensing, regulation, design and development of the casino. The HIA will examine health risks that might be linked to gambling—including substance abuse, mental health, and injury—and potential health benefits related to employment opportunity, access to health insurance, and community revenues. 
• The University of Texas at El Paso, will conduct an HIA on the impacts of proposed water and sanitation improvement projects on the town of Vinton, Texas. Vinton primarily relies on failing septic tanks and cesspools for wastewater removal and domestic wells with poor water quality. Poor water and sanitation are associated with gastrointestinal illnesses and other serious health conditions such as hepatitis, dysentery, and dehydration. Improved systems could not only improve public health but also support economic development and long-term sustainability of local businesses and industry. 
• An HIA by the Kentucky Environmental Foundation, in collaboration with the Purchase District Health Department, will examine the potential health benefits and risks of the retrofit or retirement of the Shawnee coal plant in Paducah, KY, operated by the Tennessee Valley Authority. The HIA will analyze environmental health concerns associated with air and water pollution from the plant and the effects of its closure on the community including employment, individual income, and revenue for local services important to health.

NewPublicHealth recently spoke with two of the researchers conducting the Shawnee coal plant HIA, Elizabeth Crowe, executive director of the Kentucky Environmental Foundation, and Deborah Payne, energy and health coordinator for the Foundation.

NewPublicHealth: What is the scope of the HIA you’re conducting? 

The U.S. Food and Drug Administration (FDA) has announced that it will investigate the safety of caffeine in food products, especially the effects of caffeine on children and teens. The FDA’s announcement comes as an increasing number of food companies have introduced food products that contain caffeine—including gum, jelly beans, hot sauce, marshmallows and Cracker Jacks.

Caffeine can be addictive, and can lead to high blood pressure and insomnia, according to the American Academy of Pediatrics (AAP). AAP discourages the use of caffeine by kids and teens. Caffeine levels vary in the new foods on the market. According to the FDA, a caffeinated version of Wrigley’s gum contains as much caffeine as four ounces of coffee, per piece. The new caffeinated gum packs each contain eight pieces of gum.

While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.

In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.

“This problem requires a public health solution since [preventing childhood] lead exposure…involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.

NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.

NewPublicHealth: What did your study find?

Did you know that consumers are supposed to call a three-digit number, 811, before starting any digging on residential property? Many would-be diggers don’t, which is why the U.S. Department of Transportation’s Pipeline and Hazardous Materials Safety Administration (PHMSA) began an 811 public education campaign last month.

PHMSA has good reason for getting the word out. Striking buried lines is a leading cause of pipeline-related death and injury and can lead to service outages in whole neighborhoods. Over the last 20 years, property damage costs were over $500 million nationwide from such strikes.

PHMSA estimated that three out of ten households will begin residential construction or renovation projects this spring. A call to 811, which connects would-be diggers to a local utility’s call center, a few days before planned digging generates a visit from a local representative who will mark the approximate location of nearby underground lines, pipes and cables, so workers can dig safely.

 “We want 811 to become as well-known as 911, because digging without getting your utilities marked is not only dangerous, it can also cut off services to an entire neighborhood and cost you money[in fines],” said PHMSA Administrator Cynthia Quarterman.

Since 811 debuted six years ago, serious pipeline incidents from unsafe digging have decreased by more than 45 percent, according to PHMSA.

For anyone who has ever had a mammogram, reminded someone to have a mammogram or sported anything pink for breast cancer awareness month, the New York Times has a thought-provoking article well worth reading. The author battled breast cancer twice and raises the interesting and controversial question of whether the uber-awareness campaign about breast cancer led to more mammograms than were necessary. The author argues that mammograms can result in early treatment—which comes with its own risks—but ultimately doesn’t save many lives. Studies cited show many women died despite early detection and many others, who underwent years of treatment for breast cancer, might never have been bothered by their breast tumors at all.  

The article arrives on the heels of a study in the journal Cancer that found that the proportion of women undergoing screening for breast cancer every year did not change after the U.S. Preventive Services Task Force advised that there was not enough evidence to support routine mammograms for women in their 40s.

Otis Brawley, chief medical officer of the American Cancer Society, weighed in on the Times article on the ACS Press room Blog and agreed that it is recommended reading: “This is a powerful and important article, one I believe every breast cancer advocate, and frankly even advocates for prostate and other cancers, should read,” wrote Brawley. “ It lays out the challenge that lies before us in reducing death and suffering from breast cancer, while demonstrating the challenge that we in public health face in how to accurately and truthfully administer information.”

>>Read the article.

Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. In this Idea Gallery, Bryan Samuels, Commissioner of the Administration on Children, Youth and Families, provides his perspective on how communities and organizations and families can work together to keep children safe, in honor of Child Abuse Prevention Month.

Nancy Barrand, Senior Adviser for Program Development at the Robert Wood Johnson Foundation (RWJF), also weighed in to provide some context for Commissioner Samuels' post:

Few events are more traumatic for children than being removed from their families and entered into the foster care system. In 2010, the Robert Wood Johnson Foundation funded the Corporation for Supportive Housing to develop and implement a pilot program in New York City that uses supportive housing to offer stability to families with children who are at risk of recurring involvement in the child welfare system. The New York pilot initiative, called Keeping Families Together (KFT), showed positive results in keeping and reuniting children with their families in a safe, stable environment. A 2011 evaluation indicates that the KFT pilot generated a 91 percent housing retention rate among participating families. By the end of the evaluation, 61 percent of the child welfare cases open at the time of placement in supportive housing had been closed, and there were fewer repeat incidents of child maltreatment.

Now, RWJF has partnered with the U.S. Department of Health and Human Services, Administration on Children Youth and Families and three private foundations – the Annie E. Casey Foundation, Casey Family Programs, and the Edna McConnell Clark Foundation – to jointly fund a $35.5 million initiative to further test how supportive housing can help stabilize highly vulnerable families. The national replication effort will be evaluated and we’re anxious to see whether, again, secure and affordable housing, when paired with the right services for struggling families, can reduce instances of child abuse and neglect.  The long-term gains in health and well-being, and costs saved, could be tremendous.

Commissioner Bryan Samuels on Child Abuse Prevention

Throughout the month of April, we turn our attention to the prevention of child abuse and neglect, celebrating those efforts in neighborhoods, faith communities, and schools that keep children safe and help families thrive. Whether formal or informal, these efforts involve wrapping caregivers and children in supports that reduce risk factors for maltreatment and promote protective factors, by decreasing stress, boosting parenting skills, and helping parents manage substance abuse or mental health issues.

Last year, more than 675,000 U.S. children were victims of maltreatment. These children are more likely than their peers to have emotional and behavioral problems, struggles in school, and difficulty forming and maintaining relationships. The effects of abuse and neglect can be pernicious and lifelong.

In recent years, we’ve come a long way in learning what it takes to help children who have experienced abuse and neglect heal and recover. We have interventions that help put families back together after maltreatment has occurred. But preventing abuse and neglect in the first place by giving families the support they need, when they need it, yields the best outcomes.

In recent years many bacteria have become resistant to drugs that commonly vanquished them, depleting a natural resource—antibiotics—that has saved millions of lives around the globe. Using these drugs only when necessary, and using the right drug for the right infection will help ensure that the medications are available and effective when they’re needed.

>>Watch a new, three-minute animated video that tells the story of how antibiotic-resistant “superbug” bacteria have become a serious public health threat that affects everyone. The video frames the problem uniquely: We must treat antibiotics as a natural resource that can be depleted with overuse, just like water, trees, and other resources on which we all depend. The video lays out specific steps that everyone – including doctors, hospitals, and consumers – can take to tackle the problem.

Extending the Cure (ETC), a project of the Center for Disease Dynamics, Economics & Policy based in Washington, D.C., and New Delhi, released the Superbugs video this week, along with a new report on trends in antibiotic resistance.

Last year, the organization also released research showing that certain types of bacteria responsible for causing urinary tract infections (UTIs) are becoming more difficult to treat with current antibiotics. ETC released the research via its online ResistanceMap, an online tool created to track changes in antibiotic drug use and resistance. A new, added feature of the ResistanceMap is ETC’s Drug Resistance Index, a way for non-experts to track changes in antibiotic effectiveness.

This research was funded by the Robert Wood Johnson Foundation. Urinary tract infections account for about 8.6 million visits to health care providers each year, according to the Centers for Disease Control and Prevention. More than half of U.S. women will get a UTI in their lifetime.

“Without proper antibiotic treatment, UTIs can turn into bloodstream infections, which are much more serious and can be life-threatening,” said Ramanan Laxminarayan, director of Extending the Cure (ETC). “These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective,” says Laxminarayan. 

Read a previous NewPublicHealth interview with Ramanan Laxminarayan about ETC’s research and Drug Resistance Index.