- Crowdsourcing the Identification of Epidemics
- The Global Early Adolescent Study: A Year in Review and Upcoming Events
- Progress on Child Survival Lags in Many Indian States
- Exploring new data sources for population statistics in low and middle-income countries
- Bill & Melinda Gates Institute
- Child and Adolescent Health Measurement Initiative (CAHMI)
- Center for Adolescent Health
- Center on the Early Life Origins of Disease
- Center for Public Health Advocacy
- Early Childhood Services Research Program
- Urban Health Institute
- WIC - The Special Supplemental Nutrition Program for Women, Infants and Children
David Bishai, MD, PhD, MPH, Professor
Is it a random uptick in death and disease or is it a trend? This question haunts disease surveillance experts in state and local health departments around the world. Death and disease incidence rates rise and fall--they seldom get systematically smaller in every single time period. How to distinguish an epidemic from random fluctuation can be quite difficult. Sounding the alarm anytime there is an uptick would produce too many false alarms. Waiting too long could delay a response that could save lives. The art of spotting epidemics can depend on the condition, the setting, and the accuracy of reporting. In many cases there is no hard and fast statistical rule or consensus on when to declare that a condition is an epidemic.
In the past 15 years every state in the US has seen mortality upticks from drug-related deaths, alcohol, and suicide. Not every state responded to their local problems with these conditions at the same time. One of the problems is that mortality data come in after a 1-2 year delay. Another basic problem addressed is that data have both signal and noise and it can be difficult to tell the difference. Epidemics have political and financial consequences so when sounding an alarm, it is important to be timely and to be right.
This month a team led by Professor David Bishai from Johns Hopkins Bloomberg School of Public Health has started a project to crowdsource the identification of mortality uptrends in the US. Called “Spot The Epidemic” the project is recruiting public health professionals to examine time trends in cause-specific death rates. The short 5-minute survey asks respondents to click on the point when they would alert local political leaders that there is a problem. The project will use the collected expert opinions to inform a machine-based rule for when to declare the start of an epidemic. The survey is anonymous and open to anyone who wants to help contribute to solving this fundamental dilemma in public health. Interested? Click on spottheepidemic.
For further information contact David Bishai.
Bob Blum, MD, PhD, MPH, Professor
The Year in Review
2018 International Conference on Family Planning
At the biennial conference, the GEAS presented Its first findings from baseline data collection In Kigali, Rwanda! Data from the study was featured in four conference presentations and one poster. In addition, the GEAS Pre-Conference event held on November 11th featured both qualitative and quantitative results, as well as panels on ethical issues with young adolescents and on gender transformative interventions taking place within the GEAS network.
Achieving Gender Equality by 2030: Putting Adolescents at the Center of the Agenda
In 2018, the GEAS also launched an initiative entitled, Achieving Gender Equality by 2030: Putting Adolescents at the Center of the Agenda. The initiative grew out of a May 2018 consultation with experts in adolescent health and gender research and advocacy, and proposes a life-course framework as central to the achievement of Sustainable Development Goal 5, which aims to achieve gender equality by 2030. The initiative was launched in Kigali at the ICFP conference, featuring a panel of experts and youth advocates. A global report launch will be held during the Women Deliver conference.
For more information about Achieving Gender Equality by 2030: Putting Adolescents at the Center of the Agenda, visit GEAS Website.
Global Early Adolescent Study Video Launch
In collaboration with Baltimore-based and youth-led Wide Angle Productions, the GEAS launched a new video that provides an overview of the longitudinal study and highlights some of the important issues and voices the GEAS hopes to amplify and address. Click here to view the video.
GEAS Country Reports
The GEAS published baseline findings from the first site of the longitudinal study in Kinshasa, DRC. Baseline reports from Shanghai, China and Cuenca, Ecuador will be published on our website this Spring.
Ethical Issues in Programming and Research with Vulnerable Young Adolescents
After conducting a survey of practitioners and researchers in the field of adolescent health, the GEAS hosted a webinar on ethical issues in research and programming with vulnerable young adolescents. Based on these results and discussions, the GEAS will co-host a meeting with collaborators and experts at WHO headquarters in Geneva to begin developing guidelines for research and practice with adolescents.
Women Deliver 2019
The GEAS will host two events at Women Deliver 2019 In Vancouver, Canada. These sessions will be held in collaboration with Rutgers International, the Passages Project, Pathfinder International, and the Bill and Melinda Gates Foundation. The events aim to of amplify the role of adolescent engagement for the achievement of Gender Equality and highlight gender-transformative work with very young adolescents.
The GEAS looks forward to collecting baseline data in an additional three sites this year (Capetown, South Africa, Santiago, Chile and São Paulo, Brazil), and embarking on follow-up data collection across several contexts.
Stay in touch!
For further information contact Robert Blum.
Stephane Helleringer, PhD, MA, Associate Professor
High-quality data are essential to the stewardship of global health programs, particularly in low and middle-income countries (LMICs). They allow orienting resources towards pressing health issues, identifying effective interventions, and targeting programs at the groups or areas that need them the most. In most LMICs however, such data are only produced every 3-5 years, after national statistical agencies conduct large and costly surveys. In the interim, it is difficult to project basic figures such as the number of births and deaths that occur in various areas of a country. This makes planning new health and social services, or evaluating ongoing activities, particularly difficult.
Over the past two years, we have been exploring alternative data sources to measure key demographic trends in real-time. Specifically, we have been trying to mine the data that are generated continuously by mobile phone operators in LMICs. Indeed, mobile phone use has expanded at an incredible rate in most LMICs, so that even in the most remote areas, mobile coverage is available and most household own at least one phone. To bill their customers, mobile phone operators collect basic information on each call or message sent via the mobile network. This metadata includes for example the amount of time spent on the line, the ongoing and outgoing numbers, or the cell phone towers the call or message were routed through.
Various aspects of social life leave distinct “traces” in such metadata. For example, researchers have shown that poverty or unemployment spells, could be detected with high accuracy simply by looking at the call records of mobile subscribers. Since mobile networks have such high coverage in LMICs, this permits generating socio-economic statistics rapidly, and for very small areas, a significant improvement over the current state of such data in LMICs.
We recently started investigating whether data from mobile operators could also be used to count the number of births and deaths occurring in LMICs in real-time. Our hypothesis is straightforward: when a birth occurs, parents and other relatives use their mobile phone to notify others, who might then further spread the news or return calls/SMS to congratulate the new parents. In many settings, they might also use their phones to plan in-person visits or larger ceremonies such as baptisms. Such bursts of digital activity might leave distinct traces in the metadata collected by mobile operator. If we are able to characterize these traces precisely, we might also be able to count births in real time.
To test this hypothesis, together with colleagues from the International Health Department and the Flowminder Foundation (http://www.flowminder.org/), we partnered with NCell, one of the leading mobile operators in Nepal. We obtained a Discovery Award from the Provost’s office at Johns Hopkins University to conduct a survey of 500 households in southern Nepal. We purposefully selected households where a birth had recently occurred, and we found that only about a third of the births had been reported to the local registration office. We then asked consent from the household members to review their recent mobile metadata, in order to see if their calling behaviors varied notably around the time when the birth occurred.
We are currently in the data engineering phase of the project, and we hope to soon be able to better understand how the occurrence of a birth affects mobile phone use in a household. If our hypothesis holds, we might then be able to further develop a new low-cost approach to producing population statistics that does not rely on infrequent surveys and censuses.
For more information visit the research site in Nepal.
Li Liu, MBBS, PhD, MHS, Assistant Professor
India was home to 1.2 million under-five deaths in 2015, the most of any countries and one-fifth of the global total. It also saw huge disparities in under-five mortality rates across states, ranging from 10 in Goa to 73 per 1,000 livebirths in Assam.
The leading causes of deaths were preterm birth complications, pneumonia, and intrapartum related events. Collectively, they were responsible for over half of under-five deaths occurred in 2015. The cause-of-death profiles were also different across states. Among high mortality states, pneumonia and diarrhea were still important, yet in low mortality states, non-communicable causes such as preterm birth complications and congenital abnormalities were dominant.
Despite high burden of under-five deaths, great progress has occurred on child survival in 2000-2015 with the number of under-five deaths having declined from 2.5 million since 2000. The corresponding under-five mortality rate more than halved, dropping from 91 to 48 per 1,000 livebirths. However, during this period, regional disparities deteriorated, with the ratio between the highest regional (Northeast) under-five mortality rate and the lowest (South) increasing from 1.4 to 2.1.
For all states in India to achieve the Sustainable Development Goal 3.2 of reducing under-five mortality rate to at or below 25 and neonatal mortality rate to at or below 12 per 1,000 livebirths, 10 states need to accelerate their progress on under-five mortality and 17 states need to do so on neonatal mortality. Policy and programs are needed to particularly address preterm birth complications, vaccine preventable deaths, and geographic disparities.
Additional details can be found in the article:
National, regional, and state-level all-cause and cause-specific under-five mortality in India in 2000–15: a systematic analysis with implications for the Sustainable Development Goals. Li Liu, Yue Chu, Shefali Oza, Dan Hogan, Jamie Perin, Diego Bassani, Usha Ram, Shaza Fadel, Arvind Pandey, Neeraj Dhingra, Damodar Sahu, Pradeep Kumar, Richard Cibulskis, Brian Wahl, Anita Shet, Colin Mathers, Joy Lawn, Prabhat Jha, Rakesh Kumar, Robert E Black, and Simon Cousens. Available on The Lancet website.
An accompanying JHSPH press release is available.
In 2019, the Bill & Melinda Gates Institute for Population and Reproductive Health is celebrating our 20th anniversary — 20 years of Scholarship & Science for Social Change. Following is information about the special events and programs that will occur throughout 2019 to celebrate this milestone, and to contribute to strengthening the family planning and public health community and furthering the momentum from the 2018 International Conference on Family Planning to 2020 and beyond.
SELECTION OF THE FINAL 40 WINNERS OF 120 UNDER 40: THE NEW GENERATION OF FAMILY PLANNING LEADERS
In this final year of 120 Under 40: The New Generation of Family Planning Leaders, the last cohort of 40 outstanding young family planning champions will be chosen. Each winner will receive $1,000, as well as the opportunity to partake in high-level networking, programmatic and research opportunities and to strengthen their skills.
Nominations are now open! Nominations will close on June 11. Click here to submit a nomination.
ADVANCE FAMILY PLANNING ADVOCATES MARK 10 YEARS OF PROGRESS
The Advance Family Planning (AFP) initiative convened its annual partners meeting in Mumbai last month. Held for the first time in India, the meeting brought together more than 120 people from 13 countries to catalyze efforts and share best practices on fulfilling Family Planning 2020 commitments through evidence-based advocacy.
The meeting—hosted by local partners Jhpiego; Pathfinder International; Population Foundation of India; and the local Marie Stopes affiliate, Foundation for Reproductive Health Services India—offered a chance for AFP India’s achievements to shine, sharing lessons on how to:
- secure funds for a birth spacing initiative,
- improve the quality of tubal ligation and IUD services,
- expand the availability of comprehensive family planning counseling,
- enable youth access to sexual and reproductive health and rights information in colleges,
- and many more.
Participants highlighted their progress to improve contraceptive method mix, prepare for the Evidence for Contraceptive Options and HIV Outcomes (ECHO) study outcomes, and advance universal health coverage. See a list of feature presentations on AFP’s event page.
The meeting also marked an important event: AFP’s tenth anniversary. Partners, donors, and collaborators celebrated a decade of SMART advocacy with music, dancing, and (of course) cake.
FUTURE OF FAMILY PLANNING THOUGHT LEADERSHIP FUNDING OPPORTUNITY
The new Future of Family Planning Thought Leadership funding opportunity will help support the imagination of researchers, scholars, advocates and practitioners to advance cutting-edge ideas born out of the 2018 ICFP. In addition to a monetary award, recipients will be funded to attend the Future of Family Planning Convening (outlined below), and a special Future of Family Planning invited session at the next ICFP that will showcase their work.
Applications are now open! Applications will close June 11. Click here to access the application.
ANNOUNCEMENT OF THE NEXT ICFP LOCATION AND DATE
Where in the world will the International Conference on Family Planning (ICFP) be held next? The location and date of the next ICFP will be announced in mid-2019, with the launch of the new ICFP website.
GATES INSTITUTE AT WOMEN DELIVER CONFERENCE
Stop by and see us at the Women Deliver Conference in Vancouver, June 3–6! The Gates Institute will host an exhibition booth (we’ll be in booth #503/#504), in which all Gates Institute programs (Advance Family Planning, Performance Monitoring for Action, and The Challenge Initiative) and initiatives (120 Under 40, ICFP, and Demographic Dividend) will be represented, as will be our popular photobooth!
THE FUTURE OF FAMILY PLANNING CONVENING
Building on the Beyond 2020 session at the 2018 ICFP, the Gates Institute will host The Future of Family Planning Convening, a special two-day gathering on September 12 and 13 that will bring together representatives from key family planning sectors to explore new, “business unusual,” positively disruptive ideas that could change the landscape of family planning and reproductive health in the next 10 to 15 years.
2019 GLOBAL HEALTH LEADERSHIP ACCELERATOR
The 2019 Global Health Leadership Accelerator, taking place September 16–27 in Baltimore, will engage mid-career policy-makers, program managers, advocates and academicians and impart innovative approaches to leadership, program management, policy analysis, strategic planning, communications, advocacy and organizational change.
Applications are now open! Applications are due June 10. For more details, visit the Leadership Accelerator webpage.
POWERFUL CONVERSATIONS SERIES
Held concurrently during the Leadership Accelerator, the Powerful Conversations: Leaders Transforming The World speaker series will feature dynamic conversations between two transformational leaders and will include audience Q&A. Dates and speakers to be announced.
WORLD CONTRACEPTION DAY CELEBRATION
The Gates Institute will once again host a World Contraception Day Celebration on September 26 at JHSPH, featuring fun and informative family planning-themed activities. This event is organized in partnership with JHSPH student groups, the Johns Hopkins Center for Communication Programs and other partners.
For more info about the Gates Institute’s 20th anniversary, contact email@example.com.
New Endorsements of The Challenge Initiative for Healthy Cities’ Approaches
The state governments in both Uttar Pradesh (UP) and Madyha Pradesh (MP) have officially endorsed nine of The Challenge Initiative for Healthy Cities’ (TCIHC) proven approaches that are being used to successfully implement family planning activities in 20 UP cities and eight MP cities. This means TCIHC’s approaches will now be used in all cities throughout both states (75 total in UP and 47 total in MP).Gates Institute Website
The Child and Adolescent Health Measurement Initiative, or CAHMI, has many exciting updates to share.
Recommendations Roadmap for California Proposition 64: Trauma experienced by children, youth, their families, caregivers, and communities is a perpetuating issue that requires thoughtful attention and a holistic approach to rectify successfully. California’s Proposition 64 marijuana tax revenues present a special opportunity to invest in community-based substance use education, prevention, early intervention, and treatment to address such trauma and assist community members with their healing process. Using these tax revenues to implement healing-centered and trauma-informed approaches demonstrates a proactive initiative to mitigate the effects of trauma caused by adverse childhood experiences (ACEs).
Dr. Christina Bethell, Director of the Children and Adolescent Health Measurement Initiative (CAHMI) and professor in PFRH, in partnership with a stakeholder and expert Advisory Committee and the Campaign to Counter Childhood Adversity with support from the California Endowment (April 2019) created the Recommendations Roadmap for California Proposition 64 Expenditures to present a framework, core criteria and recommendations to inform Proposition 64 decision-making processes. The framework involves the following strategies to ensure that communities and programs funded through the Prop 64 Youth Education, Prevention, Early Intervention, and Treatment Account (Prop 64 Youth Account) benefit from culturally responsive, racially just, healing-centered and trauma-informed approaches: (1) relationship and engagement-centered assessment, interventions, and healing; (2) training and Capacity Building; (3) cross-sector collaboration; (4) learning-centered innovation, measurement and evaluation. Access the full Recommendations Roadmap for California Proposition 64 Expenditures, partnerships, and details regarding upcoming forums by visiting our homepage. These efforts build on the CAHMI-led National Agenda to Address ACEs.
Recommendations for Advancing Payment Strategies to Address Child and Family Well-Being: Dr. Bethell, with Academy Health and the Children’s Hospital Association, have created recommendations for advancing payment strategies to address child and family well-being. This extensive and rich document discusses the limitations of our current health care system in adequately investing in the proactive promotion of positive and emotional determinants of health and the prevention and mitigation of adverse childhood experiences (ACEs). This report summarizes three priority recommendations from “The Payment Transformation to Address Social and Emotional Determinants of Health for Children”: 1) Pay to improve child and family well-being, 2) Support enhanced and personalized well-child care, and 3) Build Sustainable capacity for transformation. The full report is accessible online.
Are Our Children Flourishing? A New Publication on the Important of Family Resilience and Connection: Less than half of school-aged children in the United States are flourishing, according to a new study led by Dr. Bethell. The study also shows that children living in families with higher levels of resilience and connection are much more likely to flourish. This is true for children across all levels of household income, health status, and exposure to adverse childhood experiences (ACEs).
On May 6, 2019, Health Affairs released the publication Family Resilience and Connection Promotes Flourishing Among U.S. Children, Even Amid Adversity and suggests emphasis should be placed on programs to promote family resilience and parent-child connection. “Family resilience and connection were important for flourishing in all children, regardless of their level of adversity,” says Dr. Bethell. “Parent-child connection had a particularly strong association with child flourishing.”
Data from the combined 2016-2017 National Survey of Children’s Health (NSCH) data set were used in this study; findings were based on a nationally representative sample of over 51,000 US school aged children between the ages of 6-17 years. Children’s parents or guardians answered a series of questions about child flourishing, family resilience and connection, the child’s exposure to ACEs, household income, and whether the child had a chronic condition and special health care needs. ACEs include a range of experiences associated with trauma and toxic stress in children, like exposure to household substance abuse, serious mental illness, family and neighborhood violence and loss of a parent through death, incarceration or divorce. Parents also answered questions to assess family resilience and connection, including how families respond when facing problems, how well parents and children share ideas or talk about things that really matter, and how well parents cope with the day-to-day demands of raising children.
The study found that only 40% of U.S. school-age children were flourishing. Nearly half of children (48%) lived in families that reported the highest levels of resilience and connection. These children had over three times greater odds of flourishing, compared to the 25.5% of children living in families reporting the lowest levels of resilience and connection. A similarly strong association of resilience and connection with flourishing was found across all groups of children, regardless of their level of adversity.
Nevertheless, promoting the qualities of flourishing assessed in the study could increase the level of meaning and engagement that children have in school and in their relationships and activities. Evidence-based programs and policies to increase family resilience and connection could increase flourishing in U.S. children, even as society addresses remediable causes of childhood adversity. The authors further suggest that the success of such efforts depends on making families and children partners in the process which itself may promote flourishing among the providers of children’s health care, social, or educational services.
Writing Retreat on Healing Encounters: The CAHMI team hosted a writing retreat for staff and key experts focused on healing encounters in a medical setting. The retreat provided an opportunity for attendees to advance the written works and dissemination strategies to further opportunities to catalyze child, family, community, and practitioner and team well-being through healing relationships, structures, and policies. This retreat and associated work are funded by Robert Wood Johnson Foundation, focusing on the Culture of Health framework and creating publications to advance knowledge, data, and resources for children, youth and families.
The Data Resource Center for Child and Adolescent Health: The Data Resource Center (DRC) is a project of the CAHMI and funded by the Maternal and Child Health Bureau from the Health Resources and Services Administration. The DRC provides access to findings from the National Survey of Children’s Health (NSCH) and offers clean-coded downloadable data sets, an interactive data query, and resources for understanding the NSCH. The NSCH was redesigned in 2016 and is now administered annually. The DRC website offers the most recently available data, including the 2016, 2017, and combined 2016-2017 NSCH data. To access, visit the Data Resource Center.
The Johns Hopkins Center for Adolescent Health (CAH) has received funding from the Centers for Disease Control and Prevention as a Prevention Research Center for the 2019-2024 grant cycle. The new cycle begins September 30, 2019, extending CAH’s tenure as a Prevention Research Center, which began in 1993. CAH’s mission is to assist urban youth in becoming healthy and productive adults by contributing to improved youth population health, elimination of youth health disparities, and achievement of health equity for young people.
The CDC PRC program funds academic institutions to conduct core research projects targeting underserved populations with a prevention focus. Our core research project for the new cycle will identify and disseminate strategies for promoting economic stability for low-income youth, a key social determinant of health across the life course. Grads2Careers—an initiative launched by Baltimore’s Promise, the Mayor’s Office of Employment Development, and Baltimore City Public Schools—provides free job training and a path to employment for Baltimore City graduating seniors not headed to college. Our core research project will assess how a variety of health factors are related to youth participation in Grads2Careers and to longer-term youth employment and health outcomes. This project will build on a process evaluation of Grads2Careers that CAH researchers are currently conducting through a contract with Baltimore’s Promise to aid in refining program implementation.
Other exciting developments at CAH are underway. In the past year, we have undergone a leadership transition with Tamar Mendelson taking on the role of Director, and we began a strategic planning process to refine our mission and vision, identify priorities for advancing adolescent health, and prepare for the new CDC cycle. We now have an active Youth Advisory Board that meets biweekly to advise CAH and have invited new Community Advisory Board members to join the Board. We recently held a dinner to bring together the YAB, CAB, and core CAH team for the first time, reflect on the Center’s history using a “journey scroll,” and refine our plans for the next phase in CAH’s journey. We will consolidate these plans at a summer retreat with facilitation from our strategic planning advisors, Geri Peak, Mindelyn Anderson, and their Mirror Gems Consulting Services team.
Over the past months, we also convened a meeting of faculty studying adolescent health across Hopkins to explore potential collaborations and joint initiatives and will be meeting with a smaller group to move that conversation forward. We continue to build synergies with the Bloomberg American Heath Initiative in the area of public health strategies for preventing youth disconnection. We recently received several pilot grants through the Bloomberg Initiative to advance key areas of our work, including adolescent food insecurity, trainings for youth-serving organizations, and a toolkit for creating and sustaining youth advisory boards. CAH and the Bloomberg Initiative are hosting an event at Hopkins this fall along with the U.S. Surgeon General’s Office on career pathways for opportunity youth.
CAH welcomes collaboration and connection. Please feel free to reach out to Tamar Mendelson.
CAH’s Community Advisory Board Member Joni Holifield Launches #ThrivingThursdays
Joni Holified has started a new program, #ThrivingThursdays, for 20 adolescents to provide them with mentorship and enrichment with support from Bloomberg Philanthropies and CAH. At the group’s first meeting, the young people created vision boards about their goals and aspirations. CAH’s Community Engagement Director Katrina Brooks said, “More and more, we need to identify safe spaces for young people. It’s important the Center is a safe space where adolescents come into contact with caring adults.”
Photo of the CAH Team
Back row from left: Lauren Burns, Morgan Prioleau, Kristin Mmari, Philip Leaf
Front row from left: Beth Marshall, Terri Powell, Sushma Chapagain, Renee Johnson, Tamar Mendelson, Katrina Brooks, Ann Herbert
New NIH Grant
Dr. Xiaobin Wang and her team received a new NIH R01 grant titled “Inter-generational Link of Cardio-Metabolic Risk: Integrate Multi-OMICs with Birth Cohort”. This project aims to elucidate epigenetic pathways underlying inter-generational cardio-metabolic risk in the Boston Birth Cohort.
- Hong, X., Liang, L., Sun, Q., Keet, C., Tsai, HJ., Ji, Y., Wang, G., Ji, H., Clish, C., Pearson, C., Wang, Y., Wood, R., Hu, B.F., Wang, X. Maternal Triacylglycerol Signature and Offspring Risk of Food Allergy: Effect modification by timing of solid food introduction, Hong X, Liang L, Sun Q, Keet C, Tsai HJ, Ji Y, Wang G, Ji H, Clish C, Pearson C, Wang Y, Wood R, Hu FB, Wang X. Maternal Triacylglycerol Signature and Offspring Risk of Food Allergy. J Allergy Clin Immunol. 2019 Apr 17. pii: S0091-6749(19)30522-6. doi: 10.1016/j.jaci.2019.03.033. [Epub ahead of print] PMID: 31004614 JACI is the number 1 journal in the field of allergy and immunology
- Wang G, Liu X, Bartell TR, Pearson C, Cheng TL, Wang X. Vitamin D trajectories from birth to early childhood and elevated systolic blood pressure during childhood and adolescence. Hypertension (in press). Hypertension is the number 1 journal in the field of hypertension
- Chen T, Hughes ME, Wang H, Wang G, Hong X, Liu Li, Ji Y, Pearson C, Li S, Hao L, Wang X. Prenatal, Perinatal, Early Childhood Factors Associated with Childhood Obstructive Sleep Apnea: Role of Cord and Early Childhood Plasma Leptin. J Pediatrics (in press)
- Azuine*, E.R. Ji*, Y., Chang, H.Y., Kim, Y., Ji, H., DiBari, J., Hong, X., Wang, G., Singh, K.G. Pearson, C., Zuckerman, B., Surkan, J.P., Wang, X. Prenatal Risk Factors, Peri- and Post-natal Outcomes associated with Maternal Opioids Exposure in a U.S. Urban Low-Income Multi-Ethnic Population. JAMA Network Open (in press) *co-first authors
For further information, please contact Xiaobin Wang.Center Website
On April 23, the Center for Public Health Advocacy hosted Mark Suzman as the keynote speaker in the latest Distinguished Speaker Series event. Mark Suzman is the Chief Strategy Officer and President of Global Policy and Advocacy for the Bill and Melinda Gates Foundation. Mr. Suzman’s talk was titled, “The Future of Advocacy: Working Together for Global Good”. During his remarks, Mr. Suzman spoke about the role of advocacy in highlighting global progress in health and development, as well as the importance of setting ambitious goals. The Distinguished Speaker Series event was open to JHU faculty, staff, and students, with over 100 individuals in attendance.
Mark Suzman leads the Bill and Melinda Gates Foundation's efforts to build strategic relationships with governments, private philanthropists, and other key partners to increase awareness, action, and resources devoted to Foundation programs in both the U.S. and abroad. Additionally, he oversees the Foundation's regional offices and strategic presence in Europe and China, as well as grant portfolios supporting cross-cutting policy research, advocacy, communications, and select country-level delivery efforts. As Chief Strategy Officer, he also manages foundation-wide learning initiatives and critical strategic trade-offs across all the Foundation’s work.
A recording of the full event is available here.
Developing a toolkit to support use of communication strategies
Home visiting programs provide education, support and community service referrals to vulnerable expectant mothers and families with very young children. There has been tremendous federal investment in the scale up of home visiting programs over the past 10 years through the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Although various models of home visiting are considered evidence–based, home visiting program impacts are still much too often modest and inconsistent.
The Home Visiting Applied Research Collaborative (HARC), a project of the Early Childhood Services Research Team, is seeking to strengthen and broaden the impact of home visiting by focusing on an theorized active ingredient of home visiting: communication between home visitors and families.
Home visitor communication with families has two aspects: communication around task-focused elements and communication around social-emotional elements.
- Task-focused elements include the “What” that is talked about. What information is conveyed to families? What activities do home visitors and families do together? Examples might include information on parenting practices, mental health, child development, or service referrals.
- Social-Emotional elements include the “How” of talking about the “What.” How do home visitors connect with families? How do they listen to families and open up families to what they have to say?
HARC has developed a toolkit of eleven communication strategies around responsive partnership building, an important part of the social-emotional element of communication. If home visitors cannot respond sensitively to the needs of families, reach agreement on tasks and goals and create collaborative decision-making processes, then families are not likely to feel supported in their efforts and the task-focused elements are likely to be less successful.
This toolkit describes the communication strategies, features a video library of clips from actual home visits that demonstrate each strategy; provides guidance on using role-plays to practice communication strategies; and provides rubrics and self-assessments to help home visitors track their progress.
HARC has launched a community of learning with twelve home visiting programs to pilot this toolkit in their practice over Summer 2019. Each program nominated a supervisor and two home visitors to take part. As part of the community of learning, the participants will submit three videos of their own home visits, review their home visits with other home visitors and reflect on and practice effective communication strategies to be used with families.
HARC received a tremendous amount of interest in this opportunity. The twelve programs that were selected represent seven states and six home visiting program models. The twelve programs convened in Chicago at the Erikson Institute in early May for a kick-off meeting (see picture). The participants enthusiastically participated in discussion, role-plays and sharing of their own home visiting videos in small groups of their peers. The programs will take part in three virtual meetings over the summer. HARC looks forward to sharing results and a final toolkit when the project wraps up.
This project is supported with funding from the HRSA’s Maternal and Child Health Bureau and the Heising-Simons Foundation.
For more information on the Early Childhood Services Research Team, please visit our webpage.
The Urban Health Institute’s (UHI) Spring Newsletter is officially out!
Over the past eight months, the UHI has welcomed a new cohort of Fellows to their Bunting Neighborhood Leadership Program, joined nationally recognized author, Antero Pietila, on his book tour by hosting a book dialogue for “The Ghosts of Johns Hopkins”, sat down with some of Baltimore’s top women leaders for a panel discussion, funded new community-university partnerships, and more!
You can read about all of this and more in their spring newsletter, which can be found here.
Johns Hopkins WIC Program awarded $10 million five-year renewal grant by the Maryland Department of Health
The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a federally funded program that provides healthy supplemental foods, nutrition and breastfeeding counseling, and referrals for pregnant women, new mothers, infants and children under age five. Numerous studies have shown that pregnant women who participate in WIC have longer gestations and a reduced risk of delivering an infant born at a low birth weight, prematurely or requiring care in the Neonatal Intensive Care Unit. Additionally, childhood WIC participation is associated with numerous positive health and cognitive outcomes when compared to children eligible but not participating in WIC. Children receiving WIC benefits are more likely to receive regular preventative health care, such as well-child check-ups, immunizations and routine dental care
The prototype for the National WIC Program was designed and piloted at the Johns Hopkins University Bloomberg School of Public Health and adopted nationally by Congress in 1974.The School currently operates the Johns Hopkins WIC Program, directed by David Paige, MD, MPH. Johns Hopkins WIC promotes the health and nutritional well-being of low-income pregnant, postpartum and breastfeeding women, infants and children under five years of age living in Baltimore through practice, research and community engagement. Johns Hopkins WIC provides services for over 10,000 participants and operates in numerous clinic sites, Head Start Centers, shelters for the homeless and domestically abused women and children, and other community locations in Baltimore.
Johns Hopkins Participant Research Innovation Laboratory for Enhancing WIC Services (HPRIL)
HPRIL is a partnership between the Johns Hopkins University Bloomberg School of Public Health and the Food and Nutrition Service (FNS) of the U.S. Department of Agriculture (USDA), The Innovation Laboratory was established to address the problem of declining child retention in the WIC Program. Although over 75% of eligible infants currently participate in WIC, at age 1 that number starts to decline and continues declining with each birthday. Just over 25% of eligible 4-year-olds currently participate in the program.
HPRIL will test the impact of innovative management, clinical, and retail tools designed to improve services, on long-term family engagement with the WIC program by competitively funding and supporting local WIC Agency projects in communities across the country. These projects will focus specifically on using WIC’s participant information databases to help identify children at risk for not returning to the program, identify service gaps, and evaluate the impact of selected innovative tools on retention. Collectively, the goal is to effectively demonstrate how local agencies can use existing WIC data collection and monitoring tools to target and monitor child retention efforts, a practice that could be scaled nationally.