Research

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                    [post_content] => Babies may have a more complex perception of their environment than previously understood, picking up on visual and audible cues to make judgements about the people around them. Babies are also making decisions about their own actions. For example, babies who bounced rhythmically and in sync to music with a dance partner were highly likely to help that partner with small tasks, like picking up an object out of reach.

Results from a recent study indicate 21-month-old infants may be able to differentiate a bully from a leader. Francesco Margoni and colleagues assessed babies’ reactions to different scenarios involving two types of authority figure: either a respected or feared character. The respected character represented a leader, and the feared character represented a bully.

All of the infants first watched two scenes involving characters playing ball before an authority figure arrives. These scenes were used to familiarize the babies with the two types of authority. In one scene, the characters bow to a leader and hand over the ball, which the leader takes and leaves. The second scene featured the characters being hit by a bully and having their ball stolen by that bully.



Babies were then randomly assigned to two different groups, and watched test scenes in which the authority figures return. For one group, that authority figure was the leader; for the other group, the authority figure was the bully. At the beginning of these test scenes, the authority figure first commands the characters to go to bed and they obey. The authority figure leaves. Then, the babies watch two further scenarios: in one, the characters continue to obey the command to stay in bed, and in the second, the characters disobey the command and leave bed.



Given that the researchers could not ask the infants to verbally express which character they think is the bully and which is the leader, they watched the babies’ eyes. They measured how long the infants observed the obey and disobey scenarios.

Infants who watched the leader looked at the disobey scene longer than the obey scene. The researchers took this to mean the babies expected the characters to stay in bed, even after the leader left. Since the disobey scene did not match their expectations, the babies looked at it for longer than the obey scene.

The babies who watched the bully stared at obey and disobey scenes for similar amounts of time, indicating they may have considered both outcomes plausible. The babies watched the characters stay in bed, presumably out of fear of the bully returning. They watched equally as long when characters disobeyed the command, and the absent bully no longer had power over them.

According to the researchers, these results provide a basis to further explore the way infants recognize power structures in their environment. Prior research has found that babies may expect smaller characters to give into larger ones in situations of conflict, but not much was known about babies identifying different types of power. Margoni and colleagues suggest combining their findings with this previous research, to observe whether the relative sizes of authority figures influence the way infants distinguish leaders from bullies.

Feature image: Nattanon Kanchak/iStock

Images in article:"Infants distinguish between leaders and bullies, Francesco Margoni, Renée Baillargeon, and Luca Surian, PNAS September 18, 2018 115 (38) E8835-E8843; published ahead of print September 4, 2018 https://doi.org/10.1073/pnas.1801677115. Fig. 1. (detail) Schematic depiction of the character-familiarization trials in the different conditions (A–E) of experiments 1 to 3. Fig. 2. (detail) Schematic depiction of the order-familiarization and test trials in the leader condition of experiment 1. Trials in other conditions were identical, with two exceptions. First, in each condition, the character was that shown in the character-familiarization trials for that condition (Fig. 1). Second, in the bully-present condition, the character remained in the scene after giving her order.
                    [post_title] => Bullies and Leaders, According to Babies
                    [post_excerpt] => Babies may have a more complex perception of their environment than previously understood. Francesco Margoni and colleagues studied how babies differentiate a bully from a leader.
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                    [post_date] => 2019-02-04 06:00:22
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                    [post_content] => Research consistently shows that physical activity is a “magic pill” that can help ward off chronic diseases and positively impact how people feel, function, and sleep. Despite myriad benefits, only about 20 percent of Americans report sufficient physical activity. This means most people living in the United States are at unnecessary risk for chronic diseases and conditions.

The US Department of Health and Human Services (HHS) recently updated the Physical Activity Guidelines for Americans (PAG). The PAG provides guidance on the types and amounts of physical activity that provide substantial health benefits. The principal concept of the PAG is that regular physical activity over months and years can produce long-term health benefits. Some health benefits are immediate, like lower blood pressure and improved mood, and even short episodes or small amounts of physical activity are beneficial.
Key Guidelines
The main messages of the PAG are the “key guidelines.” These highlight the amounts and types of physical activity recommended for specific population groups. The PAG also discusses doing physical activity safely. The key guidelines for youth and adults are summarized below.

School-aged children and adolescents (ages 6 through 17) should do 60 minutes or more of moderate-to-vigorous physical activity daily. Youth should include vigorous-intensity activity as well as activities that make their muscles and bones stronger at least 3 days a week. Playing tag and climbing on playground equipment are great ways to fit in all of these types of activity.

Adults should move more and sit less throughout the day. For substantial health benefits, adults should do at least 150 to 300 minutes a week of moderate-intensity aerobic physical activity like brisk walking. However, adults can reap these benefits in half the time—75 to 150 minutes a week—if they do vigorous-intensity aerobic activities like jogging. Additionally, adults should do muscle-strengthening activities of moderate or greater intensity that involve all major muscle groups on two or more days a week.
What’s New?
The updated PAG includes some new topics, reflecting the evolution of research summarized in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report. HHS included new guidance for children age 3 to 5 based on recent evidence that physical activity is associated with greater bone density and less body fat, both of which contribute to good health in later life.

The risks of sedentary behavior and their relationship with physical activity are also discussed. The first edition of the PAG specified that health benefits only accrued if physical activity was performed in at least 10-minute bouts. This requirement is removed in the second edition, making it even easier for Americans to meet the key guidelines.

The updated PAG also notes immediate benefits of physical activity in addition to the benefits of regular physical activity over months or years. Finally, the PAG includes a new chapter reporting on tested strategies to encourage physical activity.
Promoting the Physical Activity Guidelines
Realizing a shared vision of a more physically active and healthy United States will require dedication, ingenuity, skill, and commitment from many partners working across many different sectors. The scientific evidence supporting the PAG is clear. Physical activity is one of the best investments individuals and communities can make in their health and welfare. Now is the time to take action and help more individuals in the United States attain the numerous benefits of physical activity.

One way to promote the PAG is the Move Your Way campaign. The Office of Disease Prevention and Health Promotion within the US Department of Health and Human Services developed this campaign to communicate the recommendations from the PAG in plain language, promote the health benefits of meeting the recommendations, and provide tips for achieving recommended levels of exercise . Campaign resources include interactive tools, fact sheets, videos, and shareable graphics.

Health professionals and policy makers should facilitate awareness of the Physical Activity Guidelines, promote the health benefits of physical activity, and support efforts to implement programs, practices, and policies to facilitate increased physical activity that will improve the health of the U.S. population.

This post was adapted from the 2018 JAMA special communication "The Physical Activity Guidelines for Americans."

Feature image: Move Your Way logo
                    [post_title] => Physical Activity Guidelines for Americans, 2.0
                    [post_excerpt] => The second edition of the Physical Activity Guidelines for Americans has updates on sedentary behavior and key guidelines on what types and amounts of physical activity benefits health. 
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                    [post_date] => 2019-02-01 04:30:02
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                    [post_content] => “Smoking a nargile is nothing like smoking a cigarette. Cigarettes are for nervous people, competitive people, people on the run. When you smoke a nargile, you have time to think. It teaches you patience and tolerance, and gives you an appreciation of good company,” pensioner Ismet Ertep told Stephen Kinzer when interviewed for The New York Times about the pleasures of hookah smoking.

Nargile is another word for hookah. Hookahs are water pipes used to smoke certain types of tobacco. The tobacco used is commonly called shisha and comes in a wide variety of flavors, such as coconut, mango, and mint.

Hookah is several hundred years old, though there are conflicting reports of where it originated. In parts of the Middle East and Asia, smoking hookah is a social activity.

In recent years, hookah has become popular with young people in the US, as hookah bars and cafés have become more prevalent in larger cities and college towns. Hookah smoking is rising among college students who report it helps deal with stress. Many smoke simply for enjoyment with friends or at parties.

A recent study published in the Journal of Community Health assessed college students’ attitudes and knowledge about hookah use at a large public Midwestern university.

Over half (53.8%) of the respondents reported having ever smoked hookah, and nearly 9% of respondents reported smoking hookah within the last 30 days.

Answering a series of true or false questions, over 80% of study participants believed that infections can be spread through a hookah pipe (which is commonly passed from person to person when smoked in a group setting). Indeed, since hookah pipes may not be cleaned properly, and they often are not cleaned as people in a group share, herpes and other infectious diseases can be spread from person to person.

Around 77% reported that hookah carries the same risk as smoking, but over 70% also reported, incorrectly, that it is a “safe alternative to cigarettes.” Bradley Fevrier, lead author of the study, told PHP that “although there is a consensus as to the potential health risks of hookah, there is still a lack of the fundamental understanding of these risks,” which could explain these seemingly contradictory results.

The researchers also found that respondents were less knowledgeable about other health risks of hookah. Only about half understood that smoking hookah was addictive. Hookah contains nicotine, which means it has the potential to lead to tobacco dependence.

Fevrier emphasized, “It is imperative that health educators and health professionals are educated and provided with appropriate advice to limit hookah use. Policymakers and health providers can use the results of this study to design and inform prevention messages for college students and other populations.”

Feature image: serezniy/iStock
                    [post_title] => What Do College Students Know About Hookah?
                    [post_excerpt] => Hookah smoking is rising among college students who report it helps deal with stress. However, they may be less knowledgeable about the health risks of hookah. 
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                    [post_date] => 2019-01-30 05:00:25
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                    [post_content] => Over the past year, an increasing number of novel therapies and technologies hit the market for a host of chronic medical conditions from cancer to diabetes. With these treatments came a renewed focus by the health system, the public, and the technology sector on the use of precision medicine, or personalized, highly-specific treatment, for disease management. While this has led to an exciting time in health care, we need to proceed with caution as these advances may widen racial health disparities in the United States.

As a primary care physician who provides the initial assessment and management for several chronic conditions, I am always pondering this question. My colleagues and I recently set out to investigate racial disparities in disease management on a national scale, focusing on a condition known as atrial fibrillation (AFib), or an irregular heart rhythm.

AFib raises an individual’s risk of stroke and death and is increasingly common in the US given our aging population. Research shows that Black patients with AFib have a higher risk of stroke and death than White patients, resulting from several factors connected to socioeconomic status and access to health care. We hypothesized that another possible reason for higher complication rates in Black patients with AFib is differential treatment of the condition, specifically treatment with a newer class of stroke-preventing blood thinners, called direct-acting oral anticoagulants (DOACs).
Our findings also show that socioeconomic status alone is not enough to explain the differential treatment by race we see in the use of novel treatments.

 
Our findings, recently published in JAMA Cardiology, were striking. We found that, among patients with AFib, Black individuals had a 25% lower likelihood of receiving any blood thinners. When they were prescribed blood thinners, they had a 37% lower likelihood of receiving the newer class of DOAC medications compared to White patients. These differences held true even for Black patients with health insurance, high incomes, and high levels of education.

What do our findings mean for racial disparities in the use of novel treatments? For starters, health disparities still exist despite decades of research, quality improvement, and policies intended to reduce them. Our findings also show that socioeconomic status alone is not enough to explain the differential treatment by race we see in the use of novel treatments.

Possible mechanisms that remain unexplored include patient-level factors such as trust in the health system and health literacy on decisions around novel medications. At the provider level we need to examine the role implicit bias might play when initiating conversations about novel treatments with minority patients. Lastly, at the health system level, more research needs to be done on the implications of high costs of novel treatments, across the socioeconomic spectrum.

Whether we like it or not, society is moving towards an age of precision medicine, and the desire by patients, and providers, to be treated and to treat with the latest, most advanced therapies is a valid one. How prepared we are as a health care system to address these desires and to ensure equity remains to be seen. We hope the findings of this study serve as a reminder to take a pause when a new therapy comes out and ask: who is most likely to benefit from this treatment and how can we ensure that it is distributed fairly?

Feature image: Popfossa, AF, LAD, LBBB, used under CC BY-NC 2.0
                    [post_title] => Race and Novel Prescription Drugs
                    [post_excerpt] => Research by Essien and colleagues found that Black patients with atrial fibrillation were less likely to receive the newer class of DOAC blood thinner medications than White patients. 
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                    [post_date] => 2019-01-29 07:00:03
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                    [post_content] => Trichomoniasis is the most common curable sexually transmitted infection, but diagnosis can easily be missed by a health care practitioner. The Trichomonas vaginalis parasite infects 3.7 million people in the United States every year. Its symptoms are not always evident, however. Only 30% of infected individuals have discernible symptoms like itching and irritation of and around genitalia, painful or uncomfortable urination, and unusual changes in the color or smell of discharge.

Trichomoniasis is generally easy to treat with oral antibiotics, but it can reoccur through reinfection. The only way to completely prevent trichomoniasis is to fully abstain from all forms of sex. Condoms do not guarantee protection, but consistent and correct use is helpful in avoiding infection.

A March 2018 study by Eshan Patel and colleagues aimed to better understand the burden of trichomoniasis in the US. They note that public health professionals have not done much to bring more attention to the infection, and that clinicians are not required to report it to state health departments. Although anyone can be infected by Trichomonas vaginalis, screening guidelines set by the Centers for Disease Control and Prevention only clearly advise that women living with HIV get checked.
Left untreated, trichomoniasis can increase one’s chance of acquiring HIV during unsafe sex, or lead to premature births by infected mothers.

 
The researchers used information from the 2013-2014 National Health and Nutrition Examination Survey and accompanying laboratory urine tests to assess the impact of trichomoniasis in the US, and to learn if infection varies by sex, race, and income. They found that about 1.2% of the US population was infected between 2013 and 2014; more women than men were diagnosed.

The most drastic differences, however, were seen between racial and ethnic groups. Almost 7% of Black people in the US were infected, compared to only 0.4% among all other racial and ethnic groups combined. More specifically, 4.2% of Black men and 8.9% of Black women had trichomoniasis.

Low income was also associated with the infection; close to 4% of people with an income below the federal poverty line were infected between 2013 and 2014, compared to 0.6% among those with an income at or above the poverty line. Further, those with at least a high school education had fewer cases of infection than those who did not.

Based on their results, the researchers call for greater public health awareness of trichomoniasis, and suggest routine screening by clinicians for all individuals in communities most affected by the infection. Screening can involve a non-invasive urine test, but testing for trichomoniasis usually includes a sample of discharge. Monitoring the response to treatment more diligently may become increasingly important given a recent finding that a single dose of antibiotics may not be enough to cure trichomoniasis.

Left untreated, trichomoniasis can increase one’s chance of acquiring HIV during unsafe sex, or lead to premature births by infected mothers.

Feature image: Scanning electron micrograph of the parasitic protozoan Trichomonas vaginalis, the cause of sexually transmitted vaginitis. This pear-shaped organism is 15-20 microns in length and equipped with whip-like organs called flagella (bottom), which enable it to move around.  Magnification x7000 at 10x8 inch size. Photo: Moredun Animal Health Ltd/Science Photo Library
                    [post_title] => Sex and Another Silent Infection
                    [post_excerpt] => Trichomoniasis is the most common curable sexually transmitted infection, but diagnosis can easily be missed by a health care practitioner. Only 30% of infected individuals have discernible symptoms. 
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                    [post_date] => 2019-01-28 06:30:14
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                    [post_content] => In both public health and law enforcement, assisting people with mental illness remains a challenging priority. Police officers may not have adequate training, cities may not have sufficient mental health services and outreach, and mental health professionals may not collaborate with law enforcement professionals to assist people experiencing a mental health crisis.

For the last two decades, the Lincoln Police Department (LPD) has partnered with the Mental Health Association of Nebraska to improve police training, expand community mental health services, and enhance collaboration between police officers and mental health workers. The culmination of this partnership is the REAL program, which stands for Respond, Empower, Advocate, and Listen. The REAL program is different from other mental health assistance programs. It is free, voluntary, and non-clinical assistance is provided entirely by individuals who have lived experience with mental illness.
Within 24-48 hours, a peer specialist will contact the individual and offer assistance.

 
It works like this: After an LPD officer finishes assisting a person in crisis, the officer may send an email to the REAL program about that individual’s background and the incident. Within 24-48 hours, a peer specialist will contact the individual and offer assistance. Peer specialists do not diagnose, recommend medications or doctors, or attempt to institutionalize the people they are assisting. Instead, they help people with mental illness identify needs and challenges that may have precipitated their crisis.

These issues may or may not be directly mental health-related. For instance, a person may experience a mental health crisis because of anxiety over a lost job or inability to pay bills.  Peer specialists listen and help them develop their own solutions and strategies. Peer specialists may help an individual find mental health professionals, locate stable housing, arrange contact with a substance abuse counselor, and/or secure long-term employment. As the name of the program indicates, peer specialists respond to people after a crisis, empower them by helping them develop long-term mental health plans, advocate for them when attempting to secure resources, and listen to their needs, wants, and frustrations rather than coerce them into decisions.
The Mental Health Association of Nebraska peer specialists and LPD investigators often meet and collaborate to develop solutions for people who use police, mental health, and hospital services at very high rates.

 
The Mental Health Association of Nebraska peer specialists and LPD investigators often meet and collaborate to develop solutions for people who use police, mental health, and hospital services at very high rates. The goal is to identify why someone is using services so frequently, develop a plan, and then present that plan in an encouraging, non-threatening manner.

In 2017, LPD conducted a three year evaluation of the impact of the REAL program, examining three outcomes: Did the REAL program reduce 1) arrests, 2) mental health calls for service, and 3) the odds of being taken into protective custody for individuals referred to the program (compared to those not referred)?  LPD analyzed these outcomes twelve, twenty-four, and thirty-six months after the mental health crisis.

First, the disappointing news: LPD found no difference in arrest rates between referred and non-referred people with mental illness. Notably, however, LPD’s study found that those referred generated fewer mental health calls for service and were less likely to be taken into emergency protective custody twenty-four and thirty-six months after a crisis. In addition, the REAL program was especially effective for people with lengthy histories of contact with police officers during a mental health crisis. Further analyses suggested that it took between twelve and twenty-four months to develop stable, long-term mental health plans for individuals in the REAL program.

There are three key takeaways from LPD’s work with the REAL program. First, it is critical that law enforcement agencies collaborate with mental health workers and advocates to assist people with mental illness. Second, it may take over a year before individuals reap the benefits of a post-crisis assistance program. Third, jurisdictions truly committed to aiding their most vulnerable citizens must consistently fund collaborative mental health response programs. The other option—already in full force—is to simply continue spending money cycling and recycling people living with mental illness through jails, hospitals, homeless shelters, and other costly, ineffective alternatives.

Feature image courtesy of the author and the Lincoln Police Department
                    [post_title] => Keeping it REAL
                    [post_excerpt] => The Lincoln Police Department partners with the Mental Health Association of Nebraska on the REAL program to improve police training and expand community mental health services. 
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                    [post_date] => 2019-01-25 05:00:32
                    [post_date_gmt] => 2019-01-25 10:00:32
                    [post_content] => We all ask health-related questions. What kind of exercise should I be doing at my age? What should I eat and how much? My doctor told me that I have high blood pressure, what should I do? Should my partner change his or her medication to manage their diabetes better? We need health information throughout the life course, but health information is particularly important during middle and later life—when good health can no longer be taken for granted.

Today, health information is readily available from a wide array of sources such as newspapers, books, magazines, internet, television, etc. Many people also get health information from health professionals, family, and friends. This wonderful variety of health information sources helps you make more optimal health and medical decisions, right?

The problem is that not all available health information is scientifically supported and accurately presented. Also, not everyone knows how or where to locate, evaluate, and understand available information.

Health literacy—“the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”—is an essential skill for successfully finding health information. Basic skills such as literacy and numeracy are the foundation for health literacy. Aging is known to be related to lower literacy and numeracy proficiency in general. Only about one in ten American adults have proficient literacy and numeracy skills. To better understand the relationships between literacy, numeracy, and health information seeking among Americans age 45 and older, we analyzed data from the 2012/2014 Program for International Assessment of Adult Competencies, which provides nationally representative data on literacy and numeracy. We found that literacy and numeracy are differentially related to the use of information sources.
Aging is known to be related to lower literacy and numeracy proficiency in general. Only about one in ten American adults have proficient literacy and numeracy skills.

 
People with poorer literacy use health professionals and the internet as health information sources less often than those with proficient literacy. Literacy is important in learning new medical terms, reading instructions for medical treatment, and handling large amounts of text information online. People with poorer literacy skills may face health information disadvantages because they have a hard time reading text-based health information (e.g., books, internet) and communicating with health professionals.

People with poor numeracy skills use books, newspapers, magazines, and TV as health information sources more often than those with proficient numeracy skills. We can find diverse health information including commercial health products and public health information from government agencies. Questionable health products are routinely advertised in “health” magazines and TV commercials. Numeracy skills are necessary for evaluating the risks and benefits of health-related decisions.

Simply put, people with proficient literacy and numeracy skills have access to more health information sources such as health professionals and the internet. They also tend to evaluate risks and benefits based on multiple sources more accurately. Accurate and up-to-date information is critical to improving population health, but, at the same time, health information disparities may exacerbate existing health disparities. Policymakers, community leaders, educators, and other public health stakeholders need to be aware of the importance of basic skills. Improving literacy and numeracy enables middle-aged and older people to seek accurate health information and empowers them to engage in learning activities for many other purposes.

The author would like to thank the co-authors of the original research study: Anthony Bardo (University of Kentucky), Darren Liu (Des Moines University), and Phyllis Cummins (Miami University). 

Feature image: Aaron Hall, Doesn't matter which doctor, used under CC BY-SA 2.0
                    [post_title] => Making Sense of Health Information
                    [post_excerpt] => Health literacy is necessary to make sense of the wide array of health information that is available today, especially for middle-aged and older people. 
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                    [post_date] => 2019-01-22 06:30:11
                    [post_date_gmt] => 2019-01-22 11:30:11
                    [post_content] => Although we might have an image of farmworkers as sun-beaten men, nearly one-third (28%) of farmworkers are women. In addition to the well-known dangers of this farm work—pesticides, heat, injuries from machinery—women farmworkers face particular challenges including sexual harassment, assault, and violations of their reproductive rights, Most American farmworkers are Latinos, and Latino women may have particular stresses and mental health concerns.

Researchers from the Wake Forest School of Medicine compared the mental health of Latina farmworker immigrants in North Carolina to other Latina immigrant laborers. This study was part of a community-based participatory research collaboration with the NC Farmworkers Project that started in 2000. Community-based participatory research focuses on making community members “full and equal partners in all phases of the research process.”

In this study, female farmworkers reported greater stress and anxiety than women working outside the agricultural sector. The authors provided several reasons for these findings. First, the manual labor of farming is hazardous work; second, these jobs are seasonal, and employment is sporadic; third, working hours are long. Fourth, the farm industry has high rates of sexual harassment. The problem is so pervasive within the agricultural sector that the National Farm Worker Ministry has developed an online resource to provide women farmworkers with information they can use to advocate for their rights. And, in August, the TIME’S UP Legal Defense Fund announced that it will provide support to the Alianza Nacional de Campesinas to educate farmworkers about sexual harassment and their legal rights.

The researchers note that older Latina farmworkers, who are less likely to have young children at home, reported lower levels of stress than younger Latina farmworkers. For some, the low wages of the agricultural sector and other characteristics of this work can exacerbate stress related to balancing work with family responsibilities.

The care of Latina farmworkers should involve attention to the specific mental health needs of this group as well as the physical problems, as these women have far higher rates of anxiety and depressive than other segments of the American female population.

Feature image: Joseph Sorrentino/iStock
                    [post_title] => Stress and Anxiety in Latina Farmworkers
                    [post_excerpt] => Latina farmworker immigrants in North Carolina reported greater stress and anxiety than Latina immigrant laborers working outside the agricultural sector. 
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                    [post_date] => 2019-01-18 05:00:50
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                    [post_content] => Repeated traumatic experiences in childhood can have a strong, lasting impact on a person’s future health, behavior, and success. As the number of these experiences increases, the risk of harm related to physical and mental health, academic and professional performance, and early substance use in adulthood can also increase. Forms of trauma include child abuse, neglect, grief, loss, separation from family, and placement in welfare, among other stressors. Complex trauma occurs when these experiences start early in childhood and accumulate. Within child welfare systems, the likelihood of anxiety and depression is higher among children with complex trauma.

In April of 2018, two fatal cases of child abuse in Maine brought attention to how things can go incredibly wrong when a state’s welfare system fails to identify dangerous maltreatment situations. Approaching child welfare with a practice that helps monitor, address, and overcome trauma has potential to improve how child abuse and neglect are tackled on a system and state level. Trauma-informed initiatives also equip case-workers with tools to manage responses to their own trauma that might result from being exposed to their clients’ experiences.

The Massachusetts Child Trauma Project ran from 2011 to 2016, with a goal of using trauma-informed practice to help children with complex trauma under the care of the state’s welfare program. It emphasized increased training for caseworkers to employ protocols and guidelines for trauma-informed approaches so that clients can be more actively referred to evidence-based treatment options.
Physical abuse was 12% less likely in the intervention group of children who received care from programs using trauma-informed practice, compared to children who did not receive trauma-informed care.

 
Beth Barto and colleagues conducted a study to assess the impact of the Massachusetts project on cases of child maltreatment, as well as successful placement of foster children in stable and permanent families. The researchers compared experiences of children served by welfare offices that did not employ the project’s protocols to children served by offices that did, with the expectation that trauma-informed care would result in better outcomes.

The study’s results aligned with the researchers’ hypothesis that children whose caseworkers followed the Massachusetts Child Trauma Project’s protocol saw better outcomes overall. Physical abuse was 12% less likely in the intervention group of children who received care from programs using trauma-informed practice, compared to children who did not receive trauma-informed care. Neglect was 14% less likely among children in the intervention group. In terms of permanency of placement of children in the welfare system, those who received trauma-informed care were 21% more likely to be adopted than those served by programs without trauma-informed protocol. Compared to long-term foster care, children who are successfully adopted experience more stability and have improved mental health.

The researchers emphasize that policy makers consider investing in trauma-sensitivity training for state welfare programs. They also suggest that collaborations between mental health and child welfare services, as well as changes in their practices to incorporate more trauma-informed approaches, may lead to improved coordination of care for children and better health, academic performance, and life success.

Feature image: tom_t.photography, Lost Teddy? used under CC BY-NC-ND 2.0
                    [post_title] => Reducing the Harms of Childhood Trauma
                    [post_excerpt] => A study on the Massachusetts Child Trauma Project showed trauma-informed care of children in the state’s welfare program resulted in less physical abuse, neglect, and better adoption placement. 
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                    [post_date] => 2019-01-17 07:00:07
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                    [post_content] => The last federal minimum wage increase occurred in 2009 raising the hourly minimum compensation to $7.25. One lesser known fact is that the hourly rate does not automatically adjust for inflation, thereby eroding the purchasing power of individuals who earn it. As a result of federal inaction and rising costs of living, several states and municipalities have elected to raise the minimum wage above the federal level. Twenty-two states and the District of Columbia plan to increase, the wage floor in 2019. Some states already have. For example, in New York City the minimum wage increased for large employers from $13 to $15 an hour on January 1, 2019.

The current debate on the benefits of raising the minimum wage rarely acknowledges that individuals of all ages are compensated at the lowest required amount. This reality contrasts starkly with the common perception that only temporary employees and high school students are paid at this rate. Over 2.2 million employees earn wages at or below the minimum wage. Forty-six percent of earners are older than 25 and 19% are older than 45, highlighting that the minimum wage permeates all facets of the working population.
Forty-six percent of earners are older than 25 and 19% are older than 45, highlighting that the minimum wage permeates all facets of the working population.

 
Opponents of minimum wage increases point to rising labor costs that could reduce employment, though little consensus exists on whether such effects materialize beyond teen employment. Proponents argue that increasing salaries will have wide ranging benefits, such as improved diet and enabling workers to address delayed health care needs; however, little evidence exists to support such claims. I recently conducted a study with my colleague, Elena Andreyeva, to explore the effect of state-level minimum wage increases on a broad set of health and dietary outcomes between 1993 and 2015 among individuals most likely affected by changes to the minimum wage: 21 to 64 year olds attached to the labor force with no more than a high-school degree.

We evaluated the impacts of minimum wage increases on health care access, self-reported health, and health behaviors (alcohol consumption, smoking, weight, fruit and vegetable intake). We found that a $1 increase in the minimum wage reduced daily fruit and vegetable consumption and increased the likelihood of obesity. This implies an increase in unhealthy food consumption, possibly connected to purchasing more meals at restaurants. These impacts were largest among individuals who were high-school graduates, married, and between the ages of 30 and 65.
We found that a $1 increase in the minimum wage reduced daily fruit and vegetable consumption and increased the likelihood of obesity.

 
Higher minimum wages were associated with fewer days reported with health-related limitations. We did not detect large overall impacts on health care access or self-reported health. Instead, the benefits of minimum wage increases were concentrated among subsamples. The reduction in reported days with health-related limitations was strongest among non-White, middle-aged (30-39), and married individuals. Married, White respondents and those with a high school degree were more likely to have visited a doctor for an annual check-up. Young adults (age 21-29), women, unmarried individuals, and those with a high school degree reported fewer days with mental health problems, possibly indicating that easing immediate monetary concerns may improve mental health in the long-term.
We did not detect large overall impacts on health care access or self-reported health. Instead, the benefits of minimum wage increases were concentrated among subsamples.

 
Our findings are broadly in line with previous research showing that the minimum wage seems to have little overall effect on self-reported health and that the impact is concentrated among specific socio-demographic groups. General policy recommendations need to take into account that specific groups, especially the younger population and singles, seem to benefit quite substantially from the current increases in the minimum wage.

Increasing the minimum wage may be especially beneficial in states and occupations at the bottom of the wage distribution with few benefits (such as health insurance). Increasing the minimum wage too much can have repercussions for fringe benefits and overall welfare. If minimum wage policy affects the salary of occupations higher up the wage distribution then this can lead employers to eliminate health insurance benefits to offset the increase in salary.

Given the value of health insurance, a general policy guideline should be to implement minimum wage increases among those at the bottom of the wage distribution who predominately do not receive health insurance benefits.

Feature image: MarianVejcik/iStock
                    [post_title] => Your Hourly Wage Affects Your Weight?
                    [post_excerpt] => Ukert and colleagues explored the effect of state-level minimum wage increases on health and diet among individuals most likely affected by changes to the minimum wage. 
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