Context and Poverty: Mental Health

An observation about American political life that leaves me perplexed and saddened is that we, as a society, seem to ignore the influence of context on individuals. I generally consider “context” in this discussion to mean factors both internal and external to the individual over which they have no control. This observation is most readily detected in debates surrounding poverty in which some argue that the impoverished are responsible for their plight. Yet, contextual factors are strong. For instance, perhaps two children have similar medical conditions that affect school performance but only the family of child A can afford insurance. Child B may not have the same educational opportunities later due to interference from their untreated ailment. Loss of educational opportunities may, in turn, leave child B vulnerable to financial strain or extended poverty. This is an extreme hypothetical case, but we can all find less salient examples of the influence of contextual factors if we are honest about our own lives.

There exist tangled webs of relationships and befuddling patterns of causation that surround the development and maintenance of poverty. To explore this may induce headaches, but it is worth doing. Why, you might ask? If we fully reject the influence of context and instruct the impoverished to “pull themselves up by the bootstraps,” then we write them off as a loss and do not feel compelled to help. This is misguided at best and inhumane at worst. Yet, intuitively we know that contextual factors are not the only ones involved. Reality lies somewhere between these extremes. Exploration of this issue through research allows us to better understand the complex nature of poverty and to develop more effective ways of addressing this social ill. I am planning on posting multiple times regarding this issue, but I thought that I would start by examining mental health and poverty.

A social gradient in mental and physical health exists (Reiss, 2013), which means that health status depends on socioeconomic status such that the poorest citizens have the worst health. Unfortunately, this phenomenon can be observed around the world in both poor and rich nations (World Health Organization, 2014). Please see the graph below for an example of the social gradient. It shows self-reported health status by income for the state and select cities. The data in this graph come from the Massachusetts Community Health Information Profile (MassCHIP), which is managed by the Massachusetts Department of Health.

Consistent with the social gradient, research suggests that poverty-related stress increases the risk for mental illness and that severe mental illness increases the risk of experiencing poverty (DeCarlo Santiago, Kaltman, & Miranda, 2013). The former illustrates the power of the external context of poverty (e.g., increased stress, lack of social support) over the individual, and the latter underscores the impact of “internal context.” Again, I define “internal context” as an attribute of the individual over which they have no control. Moreover, this bi-directional relationship suggests a vicious cycle in which an individual could easily become trapped in poverty. This may have the strongest effect on children in poverty, as development of a mental illness as a child would likely have lifelong negative effects. What can research tell us about the social gradient in mental health in children?

Reiss (2013) reviewed studies published in either English or German that examined the relationship between low socioeconomic status (SES) and mental health issues in individuals between the ages of four and 18. Of the 55 studies reviewed, 52 found an inverse relationship between SES and mental health such that children experiencing poverty were two to three times more likely to develop mental health issues than their peers. Sadly, the review also found that the gradient was strongest in early childhood. Importantly, mental health problems were reduced by an increase in SES, suggesting that societal intervention can be beneficial to children in poverty. Thus, we can short-circuit the bi-directional relationship mentioned above.

In sum, there are complex relationships surrounding the issue of poverty in America. While we often downplay the role of context in our political debates, it is an influential force in the generation and perpetuation of poverty. Development of a mental illness is not a choice, but rather the result of an intricate set of interactions between genetic predispositions and physical and social context. The social context of poverty contributes to the development of mental illness, but mental illness itself is a contextual factor in the social condition of poverty. This bi-directional relationship can be overcome, which has strong and positive implications for efforts to raise children out of poverty.

-Jason Wright

References
DeCarlo Santiago, C., Kaltman, S., & Miranda, J. (2013). Poverty and mental health: How do low-income adults and children are in psychotherapy? Journal of Clinical Psychology: In Session, 69, 115-126. doi: 10.1002/jclp.21951

MassCHIP, Massachusetts Department of Health. (2014). Behavioral Risk Factor Surveillance System: General health status. Retrieved from http://www.mass.gov/eohhs/researcher/community-health/masschip/general-health-status.html

Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science and Medicine, 90, 24-31. doi: 10.1016/j.socscimed.2013.04.026

SOC 350 blog post – Opioid addiction

Opioid addiction

Authors: Zachary Richard & Eric Andrade, students in Professor Gloria de Sa’s SOC/ANT 350, ‘Urban Issues in Public Policy’ (learn more about their collaboration with the UI by reading this post)

Editor’s note: Zach and Eric also produced an excellent presentation which you can view here: Opioid addiction presentation – PDF.


 

Recent Opioid Discussion & Trends

Opioid abuse and overdoses have become central topics of discussion both locally and nationally in recent months. The heroin related death of actor Philip Seymour Hoffman stoked these discussions and brought them to the forefront of public discourse via media coverage and public officials. Vermont Governor Peter Shumlin dedicated nearly his entire state of the state address back in January to discussing the heroin / opioid problem in his state. Massachusetts Governor Deval Patrick declared a “public health emergency” in Massachusetts in March resultant of heroin /opioid abuse in the commonwealth. Attorney General Eric Holder even weighed in to the discussion earlier this year calling it an “urgent public health crisis.”

Here in Massachusetts Governor Patrick has implemented a policy to make Narcan, a drug used to reverse the effects of opioid overdoses, available to police officers and first responders to combat opioid overdoses; which are believed to be increasingly resultant of the incorporation of fentanyl in opioids, primarily heroin. Governor Patrick recently even tried to ban ‘Zohydro’ in the commonwealth; a new FDA approved prescription opioid. Federal courts quickly rejected the ban and overturned it; much to the dismay of Governor Patrick. Zohydro sparked a firestorm amid already opioid weary politicians and citizens both in Massachusetts and beyond. Locally Mayor William Flanagan of Fall River (one of the most opioid afflicted cities in Massachusetts) beseeched President Obama to weigh in and speak on behalf of those trying to ban Zohydro. This discussion has landed on the national stage where senators have also expressed concern over the new potent opioid which some have called, “heroin in a capsule.” According to the National Institute on Drug Abuse “Prescription opioid pain medications such as Oxycontin and Vicodin can have effects similar to heroin when taken in doses or in ways other than prescribed, and research now suggests that abuse of these drugs may actually open the door to heroin abuse.” With the rising prevalence of prescription opioids in the U.S one can infer that this is having a substantial effect on opioid abuse and is a leading cause of addiction.

Statistically speaking Massachusetts has, overall, seen in increase in opioid related overdoses over the past decade. “The rate of unintentional opioid-related overdose deaths, which includes deaths related to heroin, reached levels in 2012 previously unseen in Massachusetts. The rate of 10.1 deaths per 100,000 residents for 2012 (the most recent full year of data available) was the highest ever for unintentional opioid overdoses and represents a 90% increase from the rate of 5.3 deaths per 100,000 residents in 2000. In 2012, 668 Massachusetts residents died from unintentional opioid overdoses, a ten percent increase over the previous year. While data are still preliminary, unintentional overdose deaths for the first six months of 2013 point to even higher numbers than 2012.” (Mass.gov) Nationally the figure is up as well.

According to the National Institute on Drug Abuse’s National Survey on Drug Use and Health (NSDUH), “in 2012 about 669,000 Americans reported using heroin in the past year,a number that has been on the rise since 2007. This trend appears to be driven largely by young adults aged 18–25 among whom there have been the greatest increases. The number of people using heroin for the first time is unacceptably high, with 156,000 people starting heroin use in 2012, nearly double the number of people in 2006 (90,000).” The report goes on to state that “Heroin use no longer predominates solely in urban areas.” This information correlates with Massachusetts data which states that “In addition to the burden in major cities, many smaller communities saw increases” in opioid abuse and overdoes between 2003 and 2012, according to the most recent information from the Massachusetts Department of Public Health.

As far as New Bedford and Fall River are concerned opioid overdoses haven’t changed too much. Though yearly fluctuation does occur, fatal overdoses in these cities are continuously higher than others in Massachusetts. Due to its much larger population, Boston had the most opioid overdoses each year between 2000 and 2012. However it is quite clear that opioid abuse is particularly high in the South Coast due to the fact that New Bedford and Fall River literally alternate between 2nd to 4th place for opioid overdoses each year, despite the fact that these cities are currently the 6th and 10th most populated cities in Massachusetts, respectively. (2010 census data) In 2012 New Bedford had the second most opioid overdoses in Massachusetts with 25. New Bedford also came in second in the years 2010 and 2008. In 2011 Fall River was tied for second with Lowell with 25. It was also in second in 2009. These numbers have remained largely similar in the South Coast since the year 2003 (Mass.gov statistics, refer to table 1) Another telling fact is that according to the Herald News, which cites the Massachusetts Prescription Monitoring Program, 72% of prescriptions given to Fall River residents were opioid based, while in New Bedford that number is 70%. Both cities are well above the Massachusetts prescription rate of 40%. It is clear that opioid abuse is a serious and sustained problem in the South Coast.

From Criminal Justice to Public Health

Unquestionably the topic of opioid abuse has been at the forefront of much discussion. Whether or not there is a full-fledged epidemic, as is claimed by many, remains to be seen – as data for 2014 and the second half of 2013 is not yet available. However, one may agree that irrespective of the semantics of whether or not opioid abuse constitutes an epidemic something should be done to alleviate and resolve this problem. Opioid abuse is a serious and troubling affliction that should most certainly be addressed and discussed by lawmakers, media outlets, and the public at large. We must also, and most importantly, adjust our understanding of drug addiction and remove it from the realm of criminal justice; shifting it to the jurisdiction of public health where it rightfully belongs. Persecution has arguably gotten us nowhere. Let us heal and not condemn. Also we should critically examine the role of the pharmaceutical industry in potentially stoking this surge in opioid abuse and overdoses. As a society we should begin the debate as to whether or not the benefits of prescription opioids outweigh the costs.

 

Table 1. Cities/Towns with Over 7 Unintentional Opioid Overdose Deaths in 2012, MA Residents

opioid1Source: Registry of Vital Records and Statistics, MDPH

Figure 1. Rate of Unintentional Opioid Overdose Deaths, MA Residents, 2000-2013

opioid2

Source: Registry of Vital Records and Statistics, MDPH

 

Figure 2. Number of Unintentional Opioid Overdose Deaths, MA Residents, 2000-2013

opioid3Source: Registry of Vital Records and Statistics, MDPH

 

 

September project update

New developments this month include a new graduate assistant, new (and renewed) collaborations with UMass Dartmouth faculty and their students, and even a new project to announce. Read on:

1) SouthCoast health planning dashboard

If you haven’t noticed, 2013 is the year of public health for the Urban Initiative. This is an exciting direction for us, and not only because health is so closely connected to every other urban issue we study, particularly in cities like New Bedford and Fall River. We’re also excited to have the opportunity to work with group of individuals and organizations that collaborate genuinely and effectively to promote better health outcomes for SouthCoast residents. And as we know, collaboration matters!

Our newest health-related project will be to work with a great team of regional health organizations (headed up by the indefatigable Dave Weed of Partners for a Healthier Community) to develop an information-sharing tool that will build the capacity of our region when it comes to understanding and acting upon health needs and opportunities. The main feature of the site will be a tool that allows partner organizations to share local health data and resources in a timely and interactive way, serving as a “dashboard” to guide decision-making. Stay tuned for more updates and let us know if you’re interested in learning more about joining this project!

2) Taunton HOPE VI evaluation

This month has us drafting our first annual report on the progress of the Taunton Housing Authority’s HOPE VI project, which will include data related to the city, the neighborhood, and the original residents of the former Fairfax Gardens housing development.

3) LifeWork evaluation

The Women’s Fund has just enrolled the first cohort of participants in its pilot program, LifeWork. Over the next few months, the Urban Initiative will work with LifeWork program staff to collect baseline data on participants so that we can establish a baseline against which to measure individual and collective progress toward the program’s goals of advancing educational attainment, improving employment status and earnings, and helping women on a path to financial self-sufficiency.

4) College access

We’re currently working with our team of high school interns to finalize their report on findings related to college access in the SouthCoast, and we’ll soon be announcing a report release event.

5) SouthCoast Hospitals Community Needs Assessment

We’ve been working with our colleagues of the UMass Dartmouth Center for Policy Analysis to develop the community needs assessment for the SouthCoast Hospitals system. The assessment includes data on health status and social determinants of health for the region spanning Swansea to Wareham.

6) NB Line

We’re currently working on reporting our findings from the second year of evaluating the NB Line, a shuttle system being piloted in downtown New Bedford by the city’s National Park.

7) Faculty/student collaborations

This semester, we’ve been asked to identify community-based research projects for students in Professor Sarah Cosgrove’s Urban Economics course as well as students in Professor Gloria de Sa’s Sociology course. We got a lot of great ideas from our community partners for projects that will build students’ skills, help them apply their coursework, and develop a better understanding of needs and opportunities in Fall River and New Bedford. We look forward to updating you on the projects these students have chosen to take on!

Grant opportunities: child obesity, environmental initiatives

1) Active Schools Acceleration Project (ASAP) seeks applicants from K-12 schools combating child obesity

ASAP, an initiative of ChildObesity180,  will award $1,000 grants to one thousand schools to implement one of three ASAP signature programs: 100 Mile Club (students are challenged to walk 100 miles over the course of one school year), BOKS (a 12-week program to engage students in physical activity before the school day), or Just Move (a classroom-based exercise program that integrates academics). Application deadline is April 22; to learn more or apply, click here.

2) Ray C. Anderson Foundation environmental grants program

Through its Gray Notes Grants program, the foundation will award grants of $2,000-$25,000 for projects related to: environmental conservation, preservation, education, and restoration; urban agriculture; clean water/air; and grassroots efforts aimed at promoting collaboration and engagement. Grants are awarded on a rolling basis. To learn more, click here.

Youth running grants

If you haven’t visited the SouthCoast Urban Indicators Project yet, do so now! You’re missing out on some really rich data about Fall River and New Bedford, such as the fact that 17.4% of Fall River kids and 19.2% of New Bedford kids are classified as obese (the statewide rate is 16.3%).

Two grant opportunities we just learned about could help SouthCoast organizations bring those numbers down:

1) ING Run for Something Better initiative

“The ING Run for Something Better program will provide a minimum of fifty grants of up to $2,500 each for schools to establish a running program or expand an existing one. The first $1,000 will be awarded to winning schools upon notification of the grant, while the second installment will be distributed upon conclusion of the program and evidence of a culminating running event, receipt of PACER data, and other required post-evaluation materials.

Awards are available for programs serving boys and girls in grades K-8 . Schools must design an eight-week program that runs before, during-, and/or afterschool and that is offered (to the best of the school’s ability) to all students in eligible grades at least twice a week, with a culminating event completed by December 31, 2013. In addition, the program must have a commitment of at least twenty-five students in grades 4 through 8 and must supply PACER data results to NASPE. Any school districts currently involved with ING Run for Something Better or that already participate in an ING U.S.-sponsored culminating event are not eligible to apply.”

2) Saucony Run for Good Foundation

“The foundation awards between ten and twenty grants a year for programs that encourage active and healthy lifestyles in children. To be eligible for a grant, organizations must have 501(c)(3) tax-exempt status, operate a program that serves youth age 18 or under, and be able to demonstrate positive impact on the lives of program participants through their increased participation in running. Grant recipients will be announced two months after the application deadlines (in February and in August).”

Grant opportunities: youth nutrition/fitness, creative placemaking, and literacy

1) General Mills Foundation’s Champions for Health Kids Program – Deadline: December 3

The program will award fifty grants of $10,000 to community-based groups such as health departments, government agencies, schools, and Native American Tribes that develop creative ways to help youth adopt a balanced diet and physically active lifestyle.

To ensure that the nutrition information in the proposed program is accurate and is scientifically based, a registered dietitian must either be directly involved or serve as an advisor to the program. Learn more by clicking this link.

2) NEA accepting proposals for its ‘Our Town’ creative placemaking program – Deadline: January 14

The program seeks to invest in creative and innovative projects in which communities, together with their arts and design organizations and artists, seek to improve their quality of life; encourage greater creative activity; foster stronger community identity and a sense of place; and revitalize economic development. Projects may include arts engagement, cultural planning, and design activities.

All Our Town applications must reflect a partnership that will provide leadership for the project. These partnerships must involve two primary partners — a nonprofit organization and a local government entity. One of the two primary partners must be a cultural (arts or design) organization. Awards will range from $25,000 to $200,000. View the full RFP.

3) Big Read accepting grant applications for community-wide reading programs

Community organizations participating in the Big Read develop and produce reading programs that encourage reading and participation by diverse local audiences. These programs include activities such as author readings, book discussions, art exhibits, lectures, film series, music or dance events, theatrical performances, panel discussions, and other events and activities related to the community’s chosen book or poet. Activities must focus on a book or poet from the Big Read Library. Previous grantees must select a different reading choice from their previous programming.

The program is accepting applications from nonprofit organizations to develop reading programs between September 2013 and June 2014. Organizations selected to participate receive a grant, educational and promotional materials, and access to online training resources and opportunities. Approximately seventy-five organizations will be selected from communities of varying size in the U.S. Awards range from $2,500-20,000. Learn more here.

Grant opportunity for communities addressing public health

The Robert Wood Johnson Foundation is accepting proposals through May 2 for its Roadmaps to Health Community Grants Program. Up to 20 applicants will receive awards of up to $200,000; awards must have 100 percent matching support (50 percent can be in-kind).

Grants will help communities work to address social and economic issues affecting health outcomes, which could include education, financial self-sufficiency, public safety, and family social support. Grantees should represent cross-sector collaborations, and community members should be involved in all planning processes. Learn more at the RWJ Foundation website and by joining one of their upcoming webinars.

NDPC conference recap: The most effective dropout prevention program you’ve never heard of

1. The most effective dropout prevention program you’ve never heard of.

Communities In Schools (CIS) of North Carolina was a co-sponsor of the conference, and I attended a presentation by their national office first thing Monday morning. I was so glad I did, because this program is not just contributing to improved outcomes for high-risk populations of kids so prevalent in urban school districts, but CIS is also using rigorous evaluation processes that give them statistics like this:

  • 98% of students identified as potential dropouts stayed in school
  • 87% of students graduated on time
  • 82% of students reduced high-risk behaviors

How does CIS obtain these results (which, it should be noted, were measured and reported on by an independent evaluator, making them particularly noteworthy)? They provide an in-school linkage between students and supportive services that address the barriers to education faced by high-risk students, emphasizing the fact that the decision to dropout is not just a function of academic performance. Each CIS partner school has a site coordinator whose job is to make these connections between student needs and services that are or can be provided by the community (these might include healthcare, mental health services, family counseling, or mentoring). While this function is technically in the realm of guidance counselors, the need–particularly in urban communities–is so significant, and counselors rarely have time to work proactively to bring community partners and their services together under one roof.

So why haven’t you heard of it? CIS has no state offices in New England; it’s closest local affiliate is in New York City. And while bringing this program to Massachusetts would require resources, the philosophy is already being espoused by Governor Patrick’s Gateway Cities Education Agenda. This agenda calls for $3.6 million to be spent on creating Student Support Councils at urban schools and hiring Student Support Counselors whose functions seem to resemble those of CIS site coordinators. Based on the evidence of CIS’s success, this is definitely a step in the right direction, but effective implementation will doubtlessly hold the key to replicating CIS’s impact on dropout prevention.

What’s your walk score?

Go to www.walkscore.com and enter your address. How does your neighborhood do? My New Bedford neighborhood gets a 55:  “somewhat walkable,” which is based on the proximity of my house to restaurants, groceries, coffee, bars, libraries, parks, etc.

So sure, this is a fun tool to use–particularly if you’re house-hunting–but why does it matter? According to a study by CEOs for Cities, a one-point increase in a Walk Score can translate to as much as an additional $3,000 of property value. This subsequently benefits homeowners and a municipality’s property tax base.

But at the same time, accessible amenities are increasingly in high demand among the creative class that cities are desperate to court (thanks to Richard Florida’s work). It turns out that there’s a house in Brooklyn’s Cobble Hill neighborhood that shares the street address of my own. Their walk score? Ninety-four. “A walker’s paradise.”

And then there’s the health benefit. Walkable neighborhoods promote the reduction of carbon emissions and thus particulates that contribute to things like asthma. Quite obviously, they encourage people to walk more, reducing obesity and its related ailments (a University of Utah study found that an average man living in a walkable neighborhood weighs about 10 lbs less than peers in a less walkable community).

So what US cities are leading the charge in walkability? Unsurprisingly, San Francisco leads the pack, and New York, Boston, Chicago, and Portland find themselves on the list. But what’s a numerically un-walkable city like New Bedford (score: 65) or Fall River (score: 62) to do? Promoting neighborhood-based small business corridors has a huge impact, according to a study done by UC-Irvine. The key is that these businesses must not only support the needs of the neighborhood, the researchers say, but they must also draw from the outside to sustain the businesses’ viability. Read more in this Atlantic Cities article, or check out the published study here.