Health Behavior and Health Education

Health Behavior and Health Education

On the Road

For Americans between the ages of one and 34, motor vehicle injuries are the leading cause of death. But there’s good news. Thanks to vehicle and road improvements and to safety programs, as well as two decades of collaborative work between both faculty and students at SPH and researchers at the UM Transportation Research Institute, driving the iconic American car is safer today than ever before. Jean Shope, a research professor in the Department of Health Behavior and Health Education and director of the UM Center for Injury Prevention among Youth, reports these advances:

  • In states across the country, legislative policies and law enforcement initiatives have led to a substantial drop in the percent-age of fatalities attributable to alcohol-impaired drivers;
  • Safety-belt use has increased significantly;
  • Where highway speed limits have been lowered to 55 mph, fatalities have decreased;
  • Cars have more safety features, including antilock brakes, electronic stability control, and airbags that are positioned throughout the vehicle (Shope notes, however, that seatbelts must be worn in order for airbags to be effective).

Graduated licensing programs for teen drivers—Shope’s own area of research—have also made an enormous difference. These programs exist in almost every state and have reduced crash deaths and injuries involving 16-year-old drivers by 20 to 40 percent, Shope says, “and that’s huge.” She points out that young people age and mature as they go through the gradual steps they need to complete in order to obtain full driving privileges. Some states are considering enhancing their licensing programs to get even better outcomes.

The biggest risks for teen drivers, Shope says, are night driving and teen passengers. “The higher the number of passengers, the greater the risk, especially if the passengers are young men.” Driving requires “very complex psycho-motor skills,” Shope explains. What she and her fellow researchers now want to know is “what are the extra teenage issues that make driving such a high-risk activity for them, and how can we reduce those risks further?”

When Parents Go to Jail

Eleven years ago, Shirley Cochran decided to give Christmas presents to a group of children in Flint whose mothers were in jail. That simple gesture turned into a long-term commitment when Cochran founded Motherly Intercession, a nonprofit, community-based program whose mission is to break the cycle of intergenerational incarceration and help kids cope when a parent goes to jail.

Today, Cochran and her staff not only distribute holiday gifts, they provide after-school tutoring in reading and math, monitor children’s progress in school, support caregivers by providing kids with transportation to tutoring sessions, serve biweekly dinners, and facilitate bimonthly visits to the Genesee County Jail. With input from Alison Miller, a developmental psychologist and SPH research professor, Cochran has recently started to implement a new intervention, the Strengthening Families Program (developed by Karol Kumpfer of the University of Utah), which deepens family bonds among kids, parents, and caregivers by strengthening parenting, communication, and problem-solving skills.

The needs are great, Miller says. Kids whose mothers and fathers are incarcerated are emotionally at risk, and their caregivers are often burdened by the physical, emotional, and financial stresses that come with extended—and often unexpected—child care. Miller notes that many caregivers are elderly, underresourced, and can be in frail health.

“What I like about this program is it’s very focused on building a family bond first, before you try to get in there and teach disciplinary strategies,” she says. There are separate groups for caregivers and children, but also joint sessions where caregivers and children share meals and get to practice what they’re learning. Additional sessions focus on reintegrating parents into the family unit.

Currently 38 children, from preschool to high school, are enrolled in the program, and there’s a waiting list. The overall goal is to help young children, in particular, “stay on track,” Miller says. “This is a pretty critical transition period.”

FactCheck: Children with Incarcerated Parents

  • More than one in every 100 adults in the U.S. are in jail or prison
  • On any given day, over 1.5 million children in the U.S. have a parent serving a sentence in a state or federal prison
  • 75 percent of incarcerated women in the U.S. are mothers
  • 63 percent of federal prisoners and 55 percent of state prisoners are parents of children under age 18
  • 46 percent of all imprisoned parents lived with at least one of their minor children prior to incarceration
  • The average age of children with an incarcerated parent is 8 years old
  • African-American children are 9 times more likely and Hispanic children 3 times more likely than white children to have a parent in prison

These facts come from the Annie E. Casey Foundation.

Health Literacy, Teens, and Type 2 Diabetes

As recently as a decade ago, clinicians and researchers mostly referred to type 2 diabetes as adult-onset diabetes. With the rise in childhood obesity in the U.S., however, more and more young people are developing the disease. Nationwide, some 3,700 young Americans between the ages of nine and 18 are diagnosed with type 2 diabetes every year. African Americans and Hispanics are especially vulnerable, and because these groups also have disproportionate rates of lower health literacy—meaning the ability to obtain, process, and use health-related information—that risk is compounded. Information about diet, exercise, health care, and personal risk is critical to preventing and/or delaying the onset of type 2 diabetes, says SPH Assistant Professor Melissa Valerio. But if people have trouble accessing and understanding health-related information, their health may suffer.

Through a feasibility study involving at-risk Hispanic and African-American teens in Detroit, Valerio and a team of community partners are examining the impact of functional health literacy in diabetes prevention. Both individuals and society stand to benefit from the elimination of health disparities in chronic illness. “If we’re able to promote the prevention or delay of type 2 diabetes in a large portion of the population, we’ll see both lower health care costs and a healthier, more productive work force.”

child dancingIn photo: Together with her mother, Diana Rodríguez, this young girl is taking part in an exercise class led by a promotora, or community health worker, at a church in Brownsville, Texas. For weights, they’re using plastic bottles filled with water. Several SPH students helped provide the classes during a week-long spring-break immersion trip to the South Texas Rio Grande Valley area. Obesity and type 2 diabetes are serious problems in the border region, and this intervention is designed to help lower the incidence of both through the promotion of exercise.

From Boys to Men

Cleo Caldwell has spent years working to help African-American teens navigate the tricky waters from childhood into adulthood. She’s especially interested in the health and well-being of African-American boys, who disproportionately grow up in single-parent households, she notes, and often lack meaningful relationships with their biological fathers.

In fact, says Caldwell, an associate professor of health behavior and health education, if young African-American men are to avoid problem behaviors—including early sexual encounters, substance abuse, poor academic achievement, and violence—it’s critical they have strong bonds with their fathers. So in partnership with the Flint, Michigan, community, Caldwell and a team of SPH researchers have developed an intervention called the Fathers and Sons Project, which is designed to strengthen the bonds between non-resident African-American dads and their eight-to-12-year-old sons by improving communication, deepening cultural awareness, and increasing healthy behaviors.

Results from the intervention have been so positive that the Centers for Disease Control and Prevention, which funded the project, lists Fathers and Sons as a “promising intervention program” on its website, and Caldwell and her colleagues are now planning to replicate the program in New Haven, Connecticut; Baltimore, Maryland; Saginaw, Michigan; and New York City.

Caldwell has long understood that the family “is a vital social context for understanding the health and well-being of adolescents,” she says, and her research therefore focuses on identifying both risk and protective factors within diverse family environments. In separate studies, she is examining discrimination and psychological well-being among African-American and Caribbean black adolescents and depression rates among adolescent African-American mothers and fathers—rates she says are “concerning.” Preliminary research suggests that the prenatal relationship between adolescent fathers and maternal grandmothers is an important link to fathers’ postpartum mental health.

Adults Matter

When kids get into trouble, fingers point. But when they stay out of trouble, who’s responsible? For the past 12 years, Marc Zimmerman and his research team in the Prevention Research Center of Michigan have been seeking to answer that question by studying what’s known as “adolescent resiliency”—the ability of young people to overcome the negative effects of risks. Zimmerman, who chairs the SPH Department of Health Behavior and Health Education, says two factors are key.

One is the presence of adults. Whether it’s support from a parent or some other caring adult, or simply the existence of an adult role model, kids benefit from “natural mentors”—adults with whom they feel a natural connection and whose advice, guidance, and support they seek out. Even high school seniors do better in school and avoid problem behaviors, like drug use, when they have an adult mentor in their lives. “It’s true that peers have influence, but that doesn’t mean parents don’t,” Zimmerman says. “It just means they have to share more. But their adolescent is still paying attention to them.”

A second important factor is involvement in extracurricular activities. Young people who participate in sports, clubs, youth programs, church events, and the like tend to avoid trouble in school and with the law. Part of the reason for that, Zimmerman notes, is again the presence of caring adults. “So it comes back to the question of what sort of world are we making for our children? Adults make the world that their kids live in—we play a role in their lives. If kids are having problems, part of the responsibility is on us. We can create structures, opportunities, programs, and relationships to help kids develop healthy behaviors and achieve positive developmental outcomes.”

Teens, Jobs, and Risky Sex

If teens work too many hours in the wrong environment, it can be dangerous for their sexual health, because it may foster conditions that lead them to older sex partners. This is just one of the key findings in a recent UM study of youth on what predicts the age of sex partners. SPH Assistant Research Professor Jose Bauermeister, one of the study’s authors, says the age difference of sex partners is important, because a larger age difference is associated with riskier sexual behavior and STDs, including HIV.

The study also found that a youth’s self-esteem and alcohol use play a role in the age difference between sex partners. Overall, the research shows that teenagers who work part-time benefit in almost all areas over those who don’t have jobs—but those benefits come with caveats.

Working too many hours in an adult atmosphere without adequate supervision can lead to exposure to adults and eventually sexual activity with older partners, especially for young girls, Bauermeister says. “It’s OK to let kids work, but we want to make sure they are spending time in an environment where it’s safe to work. Parents must ask the right questions and make sure it’s a safe place for their children.”

High self-esteem and low use of alcohol offset the negative effects of working too many hours, Bauermeister notes. Those factors also protect youths overall from engaging in riskier sexual behavior. —by Laura Bailey

Kids and Food Allergies

Fully six percent of kids in the U.S. have life-threatening food allergies, and those numbers are growing. In fact, says SPH researcher and pediatric allergist Harvey Leo, as recently as 20 years ago, food-allergic children were something of a rarity. Leo is working with colleagues in the UM Center for Managing Chronic Disease to understand why the numbers are rising and what parents and communities can do to help keep kids safe.

Through the UM’s eight childcare centers and other local childcare centers, he and his research team are working to devise a systematic approach to the care of allergic children in childcare settings, so that food-allergic kids are safe but not socially or developmentally isolated, and staff members feel more secure in their knowledge about food allergies and treatment plans.

Leo hopes the approach they develop can serve as a model for other childcare programs. He’s especially concerned about the impact of food allergies on children in socioeconomically disadvantaged communities, and he hopes to see this research translate into programs to improve their health.

Childhood Asthma

Asthma afflicts nearly seven million children in the U.S., many of them in low-income urban settings, where particulate matter is often dense and access to health care can be problematic. Asthma is a major cause of childhood disability and can severely constrain a child’s ability to learn, play, and even sleep. “It’s also life-threatening,” says SPH Associate Professor Edith Parker, who has been studying the disease since 1998. “And it shouldn’t be, if it’s managed properly.”

With SPH faculty members Tom Robins, Stuart Batterman, Barbara Israel, and Bhramar Mukherjee, pediatric pulmonologist Toby Lewis of the UM Medical School, and community partners in Detroit, Parker is part of a team called Community Action Against Asthma, which for the past 12 years has been studying both indoor and outdoor environmental triggers of asthma. The team has also been developing and testing interventions to reduce those triggers and improve asthma-related health.

Current projects include a Detroit-based intervention designed to test the capacity of air filters, both with and without air conditioners, to reduce indoor environmental triggers for asthma; a study of the extent to which viral interactions with particulate matter exacerbate childhood asthma; and two studies of roadway pollution and asthma, including one funded by the U.S. Environmental Protection Agency.