Sarah Stewart's blog
When you were out and about today, did you happen to notice that a lot of people were wearing green? That’s because today is the Green Streets Initiative’s Walk/Ride Day! On the last Friday of every month, the Green Streets Initiative asks folks to walk, ride public transportation, or bike to their destinations instead of driving a car. The goal is to reduce the number of cars on the road, thereby reducing pollution. Many businesses provide incentives for people who participate in the day. For more information about Walk/Ride Day, visit the Green Streets Initiative website at www.gogreenstreets.org.
Most days you can catch the staff here biking, walking, or taking the train to work. Personally, I’ve started biking to work almost every day, and I love the fact that I get nearly an hour of exercise everyday without event thinking about it.Here at the Regional Center, we are very supportive of the idea of active transportation, which essentially means using a mode of transportation besides a car (and that requires you to engage in at least a little physical activity). Active transportation has many potential health benefits, potentially reducing chronic disease (because more people are getting more exercise). Because there are fewer cars on the road, there are fewer accidents (and fewer injuries). And fewer cars also means cleaner air, which is great news for people with asthma and other respiratory conditions.
The Centers for Disease Control and Prevention (CDC) also supports changes in transportation policy to make it easier for people to engage in According to their 2010 Transportation Recommendations,
“Expanding the availability of, safety for, and access to a variety of transportation options and integrating health-enhancing choices into transportation policy has the potential to save lives by preventing chronic diseases, reducing and preventing motor-vehicle-related injury and deaths, improving environmental health, while stimulating economic development, and ensuring access for all people.”
The CDC sees manypotential benefits of Active Transportation (and policies that support it)– for health, for the environment, and for the economy. (See http://www.cdc.gov/transportation/ to see the CDC’s transportation policy in its entirety.)
On a last (bittersweet) note, today is also my last day here at the Regional Center. My husband and I are moving to Minnesota, where I am from. I’ll still be doing work in health promotion with the City of Minneapolis (which, incidentally, is a great city for biking!) While I am really looking forward to my move, I am also very sad to be leaving. I will miss the staff here and all of the community groups that I’ve had the chance to work with over the past couple of years. I feel privileged to have played a small part in the great work that you do, and I appreciate all that I have learned from you!
Yesterday, the New York Times published a series of commentaries from experts about underage drinking. Commentators touched on social host laws, whether these laws prevent underage drinking, and even whether or not underage drinking should be prevented at all. The commentators had really different opinions on the issues, as did the readers who wrote their own comments.
I think the scientific evidence still clearly indicates that it is best if young people do not drink alcohol, and I think this came through clearly in the New York Times piece. The commentaries that used the most scientific evidence were also the ones that were not supportive of underage drinking. There was disagreement about whether social host laws are an effective way to prevent underage drinking; however, there was general agreement that social host laws will not be sufficient. Prevention of underage drinking must follow a comprehensive, mutlifaceted approach.
Many of the other commentaries that were supportive of allowing young people to drink did not use hard evidence to back their claims. Instead, many relied on myths, the most prevalent of which was, ‘They let kids drink in Europe all the time, and they don’t have any problems.” (Not true!
Youth in the US binge drink less than youth in any other European country except for Turkey. Even
the French are grappling with underage drinking problems of their own.) Others argued that as long as kids are drinking, we might as well supervise them while they do it. (This is also a faulty argument - read the other commentaries to find out why.)
For me, the value in reading this piece was having the opportunity to ‘hear’ the opinions of people on all sides of the issue. In our work, I think we often end up preaching to the choir, and it is important to remember what people outside of the choir have to say. These also happen to be the folks that we would most like to reach.
To read the New York Times piece for yourself,click here.
Now that Memorial Day has passed, summer is here! Barbecuing season is also here, which can be more exciting for some than others. Personally, I am not a big meat eater, for a variety of reasons. That being said, I still get excited about grilling things like corn, vegetable shish kabobs, pineapple, and veggie burgers. When I say veggie burgers, I mean something that does NOT taste anything like a burger – I really dislike veggie burgers that try to be real burgers. The recipe below is a veggie burger that I like very much. It’s spicy, flavorful, healthy and satisfying - and not at all beefy. I have made these for staff lunch twice now, and my co-workers like them so much that most of them have made them at home, too. I’ve adapted the instructions to make this a relatively easy and fast recipe.
Note: this recipe makes about 14 burgers, which is a lot. I can eat about one and a half before I’m stuffed – you might want to scale down the recipe. (I’ve also had luck freezing the burgers.)
Black Bean Burgers (Bon Appetit, August 2004)
4 green onions, roots removed
2 cloves garlic
Scant 1 cup cilantro leaves (stems removed)
3 15 oz. cans black beans (about 4 cups), drained
2 large eggs
3 cups bread crumbs, divided
1 cup chopped red pepper
2 teaspoons chili powder
1 teaspoon ground cumin
Scant 1/2 teaspoon cayenne pepper (more if you like things spicy)
1 teaspoon salt
½ teaspoon ground black pepper
½ teaspoon onion powder
4 tablespoons vegetable oil
Sour cream
Salsa
Avocado slices
Pulse green onions, garlic, and cilantro in a food processor or blender until minced. Add 2 cups black beans and eggs, and puree. Transfer to a large bowl. Stir in remaining beans, 1 ¼ cups bread crumbs, and next 7 ingredients (red pepper through onion powder). Shape the mixture into patties. (I make mine about 1/3 cup each, which makes about 14 patties). Coat patties with remaining bread crumbs.
To cook – option 1: Heat 2 tablespoons of oil in a large skillet. Add 1/2 of the patties and cook until browned (about 4 minutes per side). Repeat with remaining oil and patties.
To cook – option 2: Brush the grates of a heated grill with oil. Grill the patties until browned, about 3 minutes per side.
Top cooked patties with avocado slices, sour cream, salsa, or whatever else you think would be good.
Yesterday, we hosted a workshop called "Creative Ways to Present Data". The workshop began with a presentation by Dr. K. 'Vish' Viswanath from the Harvard School of Public Health about effective communication of risk and science. In the second part of the workshop, we focused on the process of how to choose the best method of presenting data. I had the pleasure of facilitating the second part of the workshop with Rahul Bhargava, a consultant who has lots of experience developing creative data visualizations. We were very lucky to have both Dr. Vish and Rahul present!
If you missed the workshop but are interested in seeing the materials, we've made them available in our training archive. Click here to download the materials (you'll have to scroll to the bottom of the page).
In last week’s Morbidity and Mortality Weekly Reports (a journal put out by the Centers for Disease Control and Prevention), there was an interesting ‘Quick Stats’ article that caught my attention. The following chart was published in the issue:
QuickStats: Percentage of Adults Aged ≥18 Years Who Looked Up Health Information on the Internet, by Age Group and Sex--- National Health Interview Survey, United States, January--September 2009
Source: MMWR, April 23, 2010 / 59(15);461
The data tells us that about ½ of adults are getting health information online – and about ½ are not. Not surprisingly, there are differences based on age; however, the differences were not as large as I expected. I was surprised that less than half of 18-24-year-olds use the internet to look up health information, and that there is no significant difference between 18-24-year-olds and 45-64-year-olds. The low number might have something to do with the relative health of young adults – maybe they are not looking up health information as much because they, on average, are healthier. Still, most of them are NOT using the internet find health information, which means that some caution is warranted in using the internet to deliver health messages to this age group. This doesn’t meant that we CAN’T use the internet, but if we do use the internet, we probably have to get creative – for example, how can we reach them in the places they are already visiting online?
I think that the real ‘moral of the story’ here is that when designing health campaigns, we should never, ever assume anything about our target audience. We need to ask them lots of questions before we design campaigns, and we always need to pilot test our materials. We need to meet people where they are at – whether this is in cyberspace or elsewhere.
The upcoming May issue of the journal Pediatrics will include a new policy statement by the American Academy of Pediatrics regarding the problem of youth alcohol use. Importantly, the policy statement also outlines the role of pediatricians in preventing alcohol use among their patients and in their communities. This is welcome news for those of us working to engage whole communities (including health care providers) in our prevention efforts!
The policy report begins by reviewing the problem of youth and adolescent substance use:
- Drinking at an early age increases lifetime risk of developing alcohol dependence
- Alcohol use by youth is associated with sexual risk taking, academic problems, other substance use, and deviant behavior
- Alcohol is a major contributor to the leading cause of death of youth (car crashes)
- Compared to adult drinkers, youth drinkers are much more likely to binge drink
- Emerging research suggest that adolescent alcohol use interferes with brain development and can impede an adolescent’s ability to make decisions, even when s/he is not under the influence
The report then describes risk factors associated with youth alcohol use. Finally, the report highlights the role that pediatricians should play in prevention of alcohol use, offering 16 recommendations for pediatricians. Some of the recommendations include:
- Increase knowledge of teen alcohol and other substance use
- Screen regularly for alcohol use and abuse
- Discuss the hazards of alcohol with patients and strongly advise against alcohol use
- Talk to parents about their role in preventing alcohol use
- Serve as a resource and support for school and other community alcohol programs (such as local substance abuse prevention coalitions!)
To see all 16 recommendations and to read the rest of the report, click here.
Citation: American Academy of Pediatrics Committee on Substance Use. (2010). Policy statement - Alcohol use by youth and adolescents: A pediatric concern. Pediatrics 125(5), 1078-1087.
This week for journal club, we read about a study that explored what happens when unhealthy foods are taxed or healthy foods are subsidized - does this influence what foods people buy? According to the study, the answer is yes, and in very interesting ways. It turns out that if you tax unhealthy food, people are much less likely to buy it, and will use their savings to buy healthy food. In a similar vein, if you subsidize healthy food (and therefore lower the cost for the consumer) people are more likely to buy it. However, in this study, consumers used their savings on healthy food to buy more junk food, potentially increasing caloric intake beyond pre-intervention levels - certainly and unintended and unwanted side effect!
The study comes with some caveats. First, the sample only included mothers, so it cannot be generalized. Second, it was conducted in a lab setting, in a simulated grocery store, so we cannot be certain how this would play out in a real world setting. Still, the study is interesting. It also provides a good reminder that it is essential to couple interventions with strong evaluations, including pilot testing, and that we must be on the lookout for unintended results.
For more information about the study, see: http://www.grist.org/article/study-suggests-junk-food-taxes-may-beat-healthy-food-subsidies/.
Yesterday, Charlene and I were able to attend the Blue Hills Community Health Alliance (CHNA 20) winter event. It's always a pleasure to attend events like these - to be able to meet people from around the community, and hear about the work they are doing.
We also learned about a great resource, Massachusetts 211. Donna Jackson, the Community Outreach Coordinator from Massachusetts 211, spoke about the service, which is a way to connect people to the health and human resources they need. By dialing 2-1-1 from any phone in Massachusetts, people are connected to a trained operator, who will help them find the resources they need. Interpretation in over 100 languages is also available. The database of services is also available online at www.mass211.org. Organizations can check online to make sure they are listed as a resource, and to ensure that their information is correct and up-to-date. Folks at the meeting were excited about this resource, both as a way to connect people to services, and as a way to let people know about the services they offer.
If you are not already linked into your local CHNA (Community Health Network Area), I would encourage you to find out about how to get involved. CHNAs provide great professional development and networking opportunities, and often have funding opportunities as well. To find out more about CHNAs, and to learn about the 5 CHNAs in the Metrowest region, see http://healthier-communities.org/info/chna.
And when I say fresh, I mean really fresh. Stacy, Emily and I have all joined a CSF, or a Community Supported Fishery. CSFs are based on the concept of Community Supported Agriculture, where people ‘subscribe’ to a farm, and receive fruits and veggies directly from that farm. In a CSA, you ‘subscribe’, but instead of fresh, local vegetables, you get fresh fish and shrimp from local fishermen.
There are some definite benefits to belonging to a CSF. It’s relatively inexpensive, and it supports the local economy. In fact, the fishermen who are part of the CSF get a higher price for their catch than they would at market. The fishermen also don’t have to go in search of a specific kind of fish, which means they can fish whichever waters are safest – making their job much safer. The fish don’t have to travel very far, making it a really ‘green’ option. This also means your fish is likely to have been caught the same day that you get it, so it’s really tasty. And we know that fish can be a great part of a healthy diet.
There was one thing I did not fully anticipate or understand when I joined. The first week, I rode the T to Harvard Square (my pick-up location) with a cooler in hand, and left with a WHOLE COD in my cooler. After joining the CSF, my husband and I have had to become proficient at filleting both cod and flounder. We’ve also learned how to de-head, de-roe and de-shell a whole pile of northern shrimp (which are delicious, but really small and delicate). At first this made me a bit queasy, but by the time I had filleted my fifth flounder, I was actually quite proud of myself. I think there’s something to be said for really understanding – and coming to terms with - where your food comes from. I’m posting pictures of the cod and flounder, and might post some of the shrimp when I get a chance.
Sadly, the current season for our CSF ends in a couple of weeks. The next season will not begin until May, and I hope to join again then. For more information about CSFs in the area, including Cape Ann Fresh Catch, the CSF we joined, visit http://namanet.org/csf/.
The last time I made lunch for the RCHC staff, I managed to cook a meal that contained NINE different kinds of vegetables. (OK, so I’m counting the onions and garlic here, but there were definitely lots veggies in this meal.) And, despite the potential for veggie overload, it tasted great!
We ate mushroom soup and bean dip served with cut veggies and bread. I especially liked the bean dip. It had a really fresh flavor, and it was a nice change of pace from hummus. Here are the recipes I used – enjoy!
Mushroom Bisque, adapted slightly from the Moosewood Cookbook by Molly Katzen
2 medium potatoes, peeled and diced
1 1/2 cups water
1 1/2 tbsp butter or olive oil
2 cups onion, chopped
1 stalk celery, minced
1 ½ - 2 pounds mushrooms ( I used 2 lbs. and I combined 4 kinds of mushrooms - lots of button and cremini, and a few oyster and shitake thrown in for flavor.)
1 1/2 tsp salt
2 cloves garlic, minced
1/4 tsp thyme (I used dried)
3 tbsp dry sherry (could substitute chicken or vegetable stock)
2 tsp soy sauce
Black pepper, to taste
1 cup milk or soy milk (optional - I used light cream)
Boil the potatoes in the (1.5 cups) of water until tender (about 10 minutes, depending on how small you cut the potatoes). Allow to cool a bit, and then puree the potatoes in their cooking water with an immersion blender, a food processor or a blender.
Heat butter in large saucepan over medium heat and sauté the onions and celery for five minutes (until the onion is tender but not brown).
Add mushrooms, salt, garlic, and thyme, cover, and simmer, stirring occasionally, for 10 minutes.
Turn off the heat add the sherry (or broth), soy sauce, and pepper. Use an immersion blender, a food processor, or a blender to puree with milk (or cream, if using).
Add the potato puree to the mushroom puree and heat the soup until very hot. Taste, adjust salt and pepper, and serve.
The recipe suggests that you top the soup with croutons and scallions or chives, but I didn’t bother, and it was delicious without. The soup can easily be reheated, and it freezes well, so make a bunch while you’re at it!
Ostuni Chickpea Dip, adapted slightly from the Big Flavor Cookbook by Steven Raichlen
1 1/2 c. cooked chickpeas (or 1 15 oz. can. I used a 15 oz. can of cannellini beans)
1 tomato, peeled (with juices)*
2 cloves garlic, minced (or to taste)
2 oz. feta cheese
1 1/2 tablespoons lemon juice
1 tablespoon extra virgin olive oil
salt and pepper to taste
1-3 tablespoons of water or broth (optional - I used it, and my dip was a bit runny)
In a blender or a food processor, puree the chickpeas (or beans), tomato, garlic and feta until smooth. Blend in the lemon juice and olive oil. Add salt and pepper to taste, and blend again. If the dip seems too thick, add the water or broth (I wouldn't recommend it). Serve with bread, crackers, crostini, and/or cut vegetables. I also suspect this would also be a tasty sandwich spread.
