News Brief: The 2019 APHA Meeting in Philadelphia

Study: Housing Insecurity Linked to Adverse Birth Outcomes, Including Low Birth Weight and Preterm Birth

Infants born to women living in large U.S. cities who were homeless or faced eviction were nearly twice as likely to experience adverse outcomes such as low birth weight and preterm birth than infants born to mothers with stable housing, according to new research from Johns Hopkins Bloomberg School of Public Health.

The findings highlight the potential impact of housing instability on maternal and infant health as the U.S. experiences an affordable housing crisis.

Kathryn M. Leifheit, MSPH, a PhD candidate in the Bloomberg School’s Department of Epidemiology, presented the findings at American Public Health Association (APHA) meeting in Philadelphia on Tuesday, November 5.

For their analysis, the researchers used data from the Fragile Families and Child Wellbeing Study, a cohort of children born to low-income families in large U.S. cities from 1998-2000. Mothers completed baseline interviews, and medical records data were abstracted for a subset. The study defines adverse birth outcomes as low birth weight—less than 2,500 grams, or 5.5 pounds—and/or preterm birth, before 37 weeks.

The study population included 3,621 mother-infant dyads. Among these, 58 mothers (1.6 percent) experienced severe housing insecurity during pregnancy. Forty percent of the housing- insecure mothers had low birth weight or preterm babies, compared to 15 percent among women who were more stably housed. Even after accounting for socioeconomic differences between the two groups of women, the researchers continued to see nearly double the prevalence of adverse birth outcomes among women with severe housing insecurity. 

“We think birth outcomes are very sensitive to the kind of extreme maternal stress that comes with the hardship of housing insecurity,” says Leifheit. “To promote healthy births, policymakers might consider increasing the availability of affordable housing through voucher programs and public housing. There’s also a role for tenant protections such as rent control laws and right to counsel in eviction cases.”

Leifheit notes that focusing on births that occurred 20 years ago should have no bearing on the relationship between housing insecurity and adverse birth outcomes. “Given the current housing affordability crisis and the growing proportion of U.S. families experiencing housing insecurity, the question is more relevant now than ever,” says Leifheit.

The data will also allow Leifheit and colleagues to study the impact of housing insecurity over the lifespan. She plans to follow children exposed to housing insecurity in utero into childhood and adolescence, with the hope of better understanding how cycles of housing insecurity affect children’s developmental trajectories.

“Severe housing insecurity in pregnancy: Association with adverse birth outcomes in a cohort of urban mothers and infants” was conducted by Kathryn Leifheit, Gabriel Schwartz, Craig Pollack, Maureen Black, Kathryn Edin, Keri Althoff, and Jacky M. Jennings.

A Community Takes a Bite Out of Climate Change through Meatless Monday Food Action

Six months after participating in a Meatless Monday campaign to raise awareness about turning food choices into climate-change action, more than two-thirds of respondents reported being more committed to going meatless one day of the week, according to new research led by Johns Hopkins Bloomberg School of Public Health.

The findings are part of a study of a Meatless Monday campaign involving households in Bedford, New York, that was part of the town’s larger climate change initiative, Bedford 2020. Becky Ramsing, MPH, RDN, senior program officer at the Johns Hopkins Center for a Livable Future at the Bloomberg School of Public Health, presented the findings at the APHA meeting in Philadelphia on Tuesday, November 5.

Meatless Monday is a global campaign that encourages people to eat less meat for their health and for the environment. The Center for a Livable has served as a science advisor to the campaign since its beginning in 2003.

In 2010, the town of Bedford, New York, launched a community-wide effort to reduce greenhouse gas emissions 20 percent by 2020. To further the town’s climate goals, Bedford 2020 partnered with Meatless Monday and Johns Hopkins Center for a Livable Future to launch and evaluate Meatless Mondays with Bedford 2020 in their community. The campaign ran for 12 weeks from February 5 through April 23, 2018, with 320 Bedford households pledging to give up meat one day a week.  

For their study, the researchers surveyed participating households at the start of 12 weeks and at the end. They also conducted a follow-up survey six months later.

Among the survey findings in the six-month follow-up survey:

• Over half (56.7 percent) of the respondents reported eating less meat compared to before the 12-week Bedford Meatless Monday campaign.
• Over 70 percent of participants reported they practice a meatless day every Monday (32.7 percent) or at least once a week (39.8 percent).
• Nearly 70 percent stated it was easy or very easy to cut back on eating meat at least once a week.
• Over two-thirds (68 percent) of respondents reported being more committed to going meatless on one day of the week.

The survey also found that the biggest challenge to reducing meat consumption one day a week was friend and family preferences for and/or eating habits around meat.

Across all three surveys, health was the most prominent reason given for reducing meat consumption for the highest proportion of individuals. In the survey taken at the end of the 12-week campaign, climate change mitigation, environment, energy saving, and water conservation increased as reasons for reducing meat consumption, while health decreased as a reason. In the six-month follow-up survey, climate and environment lessened slightly as reasons for reducing meat consumption but remained higher than at the start of the 12-week campaign.

The authors note that Bedford, New York, has a higher education and income level than the average U.S. community. “As a result, the results skew toward higher awareness and smaller levels of behavior change because they were already eating less meat,” says Ramsing. “At the same time, the findings can help us understand which strategies may be most effective in building community awareness and action around food and climate.”

This research was supported by the Columbus Foundation.

“A Community Takes a Bite out of Climate Change through Food Action” was conducted Becky Ramsing, Madison Friel, and Ellen Calves.

Self-Assessment Tool Can Provide Insights to Community-Based Organizations

Community-based organizations working on the front lines of public health could benefit from a self-assessment tool that gauges participants’ perceived synergy and leadership, according to new research from Johns Hopkins Bloomberg School of Public Health.

Taylor D. Parnham, MPH, senior research program coordinator in the Bloomberg School’s Department of Health, Behavior, and Society, presented the findings at APHA’s meeting in Philadelphia on Tuesday, November 5.

For their study, the researchers assessed collaborative partnership and satisfaction among stakeholders in a community advisory board overseeing a community-based youth violence prevention program in an urban setting. The researchers used a 37-item Partnership Self-Assessment Tool to determine satisfaction as a function of synergy, leadership, and benefits of participation among members. The tool was administered to participants via an email-invitation online survey.

The researchers used advisory board meeting minutes to provide examples on how synergy, leadership, and benefits to participation were described over the course of one year of meetings. The board included 34 members from eight types of organizations: 29 percent schools, 26 percent nonprofits, 24 percent public health representatives, 9 percent universities, and 12 percent representing a mix individuals and other city agencies. 

The researchers found that for each unit increase of positive perception of synergy and leadership, there was an increase in satisfaction among participants. Synergy, leadership, and satisfaction were each measured using survey questions, with response options from one to five, that asked participants how well they thought the advisory group worked together. The responses were then scored, with higher scores reflecting lower synergy, leadership, and satisfaction. 

Participant satisfaction is critical to ongoing success of any organization, and is especially important for community organizations and coalitions that often bring together many different groups and operate on an ad hoc basis.

“Not surprisingly, we found that the extent to which the group of individuals gets along and collaborates—as well as the benefits that occur as a result of being a member—and time invested in the committee mattered to their ultimate satisfaction with these experiences,” says Parnham. “In other words, people will be more likely to continue to be a part of a committee and be satisfied in their participation if they receive some benefit from participation. Our findings highlight the importance of satisfaction as a function of participation.”

Parnham notes that other organizations can benefit from regular assessment. “It is a good idea to evaluate member satisfaction annually to help tailor the focus of committee work and structure,” says Parnham. “Whether the evaluation is the form of a survey, open discussion, or both, it is important to understand how things are going in an effort to contribute to the overall sustainability of the group.”

The research was supported by the Centers for Disease Control and Prevention for the delivery and evaluation of the Youth Violence and Teen Dating Violence program (Grant 6NH28CE002393-02). The results of this study do not reflect the interests or conclusions of the CDC. 

“Evaluating participant satisfaction with an advisory committee for a community-based youth violence prevention program” was conducted by Taylor Parnham, Vanya Jones, Andrea Cimino, Carey Borkoski, Aisha Burgess and Jacquelyn Campbell.

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Media contacts for the Johns Hopkins Bloomberg School of Public Health: Barbara Benham at 410-614-6029 or bbenham1@jhu.edu and Robin Scullin at 410-955-7619 or rsculli1@jhu.edu.