Category Archives: Voices from the Field
Cindy A. Crusto, PhD, is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, an associate professor of psychology in psychiatry, Yale University School of Medicine, and a Public Voices Fellow with The OpEd Project.
Were the findings really a surprise? The recent release of the report The Burden of Stress in America commissioned by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, highlights the major role that stress plays in the health and well-being of American adults. As a researcher who studies the impact of emotional or psychological trauma on children’s health, I immediately thought about the findings in the context of trauma and the associated stress in the lives of children. That trauma can include violence in the home, school, and community.
Two decades of research has produced clear findings on this significant public health problem: Psychological trauma can have a powerful influence in the lives of children, and if not detected and addressed early, it can (and often does) have long-lasting physical and mental health effects into adulthood. Despite this strong evidence, I have encountered the sheer resistance of some advocates who work with or on behalf of vulnerable children to fully engage in this topic. Perhaps it’s because of the belief that this talk about trauma is a fad—a hot topic that will fade as soon as something “sexier” comes along.
There is also a concern that an emphasis on trauma further stigmatizes children and the cultural groups to which they belong, reinforcing existing negative stereotypes. You can understand their caution that children’s trauma histories could be used against them, that children might automatically be diagnosed with a mental health disorder, or that they would be seen as a danger to society and in need of the highest, most restrictive level of care. That care often takes children away from their families to secure facilities outside of their communities and even outside of their states.
For children, stress can come from sources inside and outside the family. It was recently documented that nearly two out of every three children in the United States have witnessed or been victims of violence in their homes, schools, or communities. That’s a staggering statistic when we consider the well-established link between children’s exposure to stress and their long-term mental and physical health outcomes.
Indeed, we know that early exposure to adverse experiences can change the way that our brains develop and function. We also know that exposure to adversity increases the likelihood that children will develop psychosocial problems, like depression, aggression, and other antisocial behaviors. There is even evidence that exposure to stressors in childhood increases the likelihood of having heart disease and cancer in adulthood!
Juliann Sebastian, PhD, RN, FAAN, is dean of the University of Nebraska Medical Center College of Nursing and president-elect of the American Association of Colleges of Nursing. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (1998-2001).
Human Capital Blog: Congratulations on your recent election as president-elect, and future president, of the American Association of Colleges of Nursing (AACN)! What is your vision for the 2014-2016 term?
Juliann Sebastian: I am honored to have been selected by the members of AACN to serve in this role for an organization that is pivotal to the future of baccalaureate and higher degree nursing education. I support the president and the board in advancing our shared vision of excellence in nursing education, research, and practice.
I look forward to working with the entire board to address issues of concern to AACN’s member schools. Because AACN’s membership encompasses large/small, public/private institutions, we have the special advantage of incorporating diverse voices into shaping the organization’s vision. I am enthusiastic about deepening my opportunity to support the vision AACN has identified for itself and the profession.
- AACN’s own vision is: “By 2020, as a driving force for quality health care, AACN will leverage member schools in meeting the demand for innovation and leadership in nursing education, research and practice.”
- AACN’s vision statement for the profession is: “By 2020, highly educated and diverse nursing professionals will lead the delivery of quality health care and the generation of new knowledge to improve health and the delivery of care services.”
Linda Charmaraman is a research scientist at the Wellesley Centers for Women at Wellesley College and a former National Institute of Child Health and Human Development postdoctoral scholar. She is a Robert Wood Johnson Foundation (RWJF) New Connections grantee, examining the potential of social media networks to promote resiliency in vulnerable populations.
If you were stressed out and wanted to vent to your friends about it, how would you let them know? Would you pick up the phone and talk, or text? Would you set up time to grab coffee or go for a brisk walk? Or would you post to Facebook why your day just couldn’t get any worse?
As I logged into the recent RWJF/NPR/Harvard School of Public Health-sponsored Stress in America discussion, I identified with the panelists who were dispelling stereotypes about “highly stressed” individuals being high-level executives or those at the top of the ladder. Instead of finding work-related stress as a top concern, as is often played out in the media and popular culture, the researchers were finding that individuals with health concerns, people with disabilities, and low-income individuals were experiencing the highest levels of stress. The panelists talked about the importance of qualities like resiliency and the ability to turn multiple, competing stressors into productive challenges to overcome, and the integral role of communities in shaping, buffering, and/or exacerbating stress.
Gabriel R. Sanchez, PhD, is an associate professor of political science at the University of New Mexico (UNM), executive director of the Robert Wood Johnson Foundation (RWJF) Center for Health Policy at UNM, and director of research for Latino Decisions. Yajaira Johnson-Esparza is a PhD Candidate in the UNM department of psychology and an RWJF Fellow at the University.
A recent survey conducted by RWJF, NPR, and the Harvard School of Public Health focused our attention on the burdens that stress poses for Americans. We want to focus our attention in this blog post on factors that may be leading to stress among the Latino population. Although the experience of stress is very common, the experience and burden of stress is not uniform across people in the United States.
One of the main findings that emerged from the recent RWJF/NPR/Harvard survey was the strong role of health problems in stress in the United States, with 27 percent of respondents noting that illness or disease was a major source of stress over the past year. In addition to the direct impact of being sick, the financial burdens associated with needing medical care can generate a lot of stress. We have found support for this finding in some of our own work at the UNM RWJF Center for Health Policy. For example, a recent survey we helped produce found that 28 percent of Latino adults indicated that because of medical bills, they have been unable to pay for basic necessities like food, housing, or heat, with 40 percent indicating they have had trouble paying their other bills. The financial stress associated with illness can have a devastating impact on Latinos.
Latinos in the United States also face unique stressors from other Americans due to their language use, nativity, and experiences with discrimination. Being followed in a store, being denied employment or housing, and being told that you do not speak English well can all lead to stress for Latinos.
More specifically, the current political climate surrounding immigration politics and policy has led to an increase in discrimination directed toward Latinos, and consequently stress levels. Our Center has been tracking immigration laws passed at the state level over time; we have found a significant increase in passage of punitive laws during the economic recession, with more than 200 immigration laws being passed in 2009 alone. A June 2011 impreMedia/Latino Decisions (LD) poll reveals that Latino voters are conscious of this tense landscape, as 76 percent of respondents believe that an anti-Hispanic and anti-immigrant environment exists today.
Audrey Dorélien, PhD, is a 2012-2014 Robert Wood Johnson Foundation (RWJF) Health & Society Scholar studying demography, infectious diseases, and maternal and child health.
Reoccurring outbreaks of measles and other vaccine-preventable diseases are a major killer of children, particularly in sub-Saharan Africa. In 2012, more than 226,000 cases of measles were reported worldwide, with a little less than half of those in Africa. For the World Health Organization to meet its global measles eradication goal and implement more effective supplemental vaccination programs, public health officials will need a better understanding of the mechanism driving seasonal and episodic outbreaks.
Infectious disease ecologists have demonstrated the importance of human demography, and in particular the influence of the birth rate on the dynamics of acute childhood immunizing (ACI) diseases. For instance in London, in the few years prior to 1950, the city experienced annual measles epidemics, but the dynamics changed to biennial epidemics as a result of a decline in the birth rate between 1950 and 1968. How can the birth rate influence disease outbreaks? An outbreak can only occur when the fraction of the susceptible population exceeds a critical threshold. In the case of ACI disease, the majority of the susceptible population are young children; therefore the birth rate influences the rate at which the pool of susceptibles is replenished.
Keely Muscatell, PhD, is a social neuroscientist and psychoneuroimmunologist. She is a post-doctoral scholar in the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program at the University of California (UC), San Francisco and UC, Berkeley.
Results from the recent NPR/RWJF/Harvard School of Public Health poll suggesting that Americans are living under high levels of stress probably don’t surprise anyone. In a way, I’ve been taking an informal version of this poll for the last six years, since when I tell people I meet on airplanes or at local bars that I study stress and health, I am unfailingly met with knowing glances and stories about stressors people are facing in their lives. Given that stress is pervasive (and problematic) in modern life, lots of current research in psychology and neuroscience is focused on understanding exactly how stress can get “into our brains” and “under our skin” to make us sick.
When we think of illness, one of the first things that comes to mind is the immune system, with its lymph nodes, white blood cells, and antibodies hanging around to help us fight off infections and heal our injuries. An especially important component of the immune system involves inflammation. If you’ve ever gotten a paper cut, you’ve probably noticed that the area of skin around the cut tends to turn red and warm up shortly after the injury. This happens because proteins called “pro-inflammatory cytokines” swim through your blood stream to the site of the wound, where they call out to other immune cells to come to the area and help heal the cut. In the short term, this is a good thing; those little cytokines are a key part of healing. But if inflammation becomes widespread throughout the body, cytokines can lead to depression and even physical diseases, like arthritis and heart disease.
A. Janet Tomiyama, PhD, an alumna of the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program (2009-2011), is assistant professor of psychology and director of the Dieting, Stress, and Health (DiSH) Lab at the University of California, Los Angeles. She was recently named the 2013 recipient of the Early Career Investigator Award from the Society of Behavioral Medicine. Her favorite comfort food: potato chips.
What’s your favorite comfort food? Ice cream, pizza, chocolate—everyone’s got a preference, whether they’re from Los Angeles, London, Sao Paolo, or Tokyo. Stress eating is as universal as eating itself; indeed, even Cervantes in his 1605 classic Don Quixote addressed the practice with the line, “All sorrows are less with bread.” Humans seem to reach for food as a way to soothe negative emotions, and that food is often high-fat, high-sugar, and high-calorie. That’s why comfort eating is often blamed as one reason stress is bad for health—because stress causes us to find comfort in a dozen cookies.
If you’re like me, you’ll be surprised but delighted to know it’s not just humans that engage in comfort eating! Eating high-fat, sugary foods in response to stress is a behavior that we see in non-human species like rodents and primates. Under chronic stress conditions, for example, rats will shift their food intake away from standard food pellets to the rodent version of “comfort food” (researchers often use Crisco mixed with sugar).
Even more amazing: it works. These comfort-eating rats showed dampened biological stress reactivity in a stress system called the Hypothalamic-Pituitary-Adrenal (HPA) axis. Sustained over-activity of the HPA axis is associated with poor health, and these studies suggest that comfort eating is playing an important role in managing an organism’s stress levels.
Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar.
You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.
Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.
Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.
We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress.
Arthur Kellermann, MD, MPH, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is professor and dean of the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD. He is co-author of the new RAND report, “Redirecting Innovation in U.S. Health Care: Options to Decrease Spending and Increase Value.” Here, he shares recommendations for a brave new world of medical technology.
Americans take justifiable pride in our capacity for innovation. From putting the first men on the moon to developing the Internet, we lead the world in developing innovative technologies. Health care is no exception. The United States holds more Nobel prizes in medicine than any other nation.
Novel drugs, biologics, diagnostics, and medical devices have transformed American health care, but not always for the better.
Some innovations have made a big difference. Combination antiretroviral therapy changed HIV infection from a death sentence to a treatable, chronic disease. Before an effective vaccine was developed, Hemophilus Influenze type b, a bacterial disease, was a major cause of death and mental disability in young children. Today, it is virtually eradicated here and in Western Europe.