Socio-economic disparities in diet patterns and nutrient intake are well documented in research. People with lower incomes and less education typically have less healthful eating habits than people with higher incomes and more education. But little is known about the extent to which those disparities are driven by higher monetary costs of nutritious foods.

Now, a new study from 天美影视传媒 researchers concludes, for the first time, that socio-economic disparities in diet quality are directly affected by diet costs. The study, “Are socio-economic disparities in diet quality explained by diet costs?” is .

UW researchers have previously found that better than less nutritious diets, and that there is a . “The twist with this new study is that we’ve connected the dots that could explain why people in a lower socio- economic status have less nutritious diets,” said Pablo Monsivais, UW acting assistant professor of epidemiology.

Monsivais, with Program Manager Anju Aggarwal and UW Professor Adam Drewnowski, studied data of more than 1,300 men and women from the Seattle Obesity Study, a population-based study of food access, diet quality and health among King County, Wash. residents.

The researchers first looked at how diet cost was associated with educational attainment and household income, two indicators of socio-economic position. They used statistical methods to control for total calorie intake and other factors. The average diet cost was higher for people with higher educational attainment and higher household income. People with lower educational attainment had diet costs that were an average of $1.09 per day lower than that of persons in the highest group ($8.19 to $9.28 per day).

People with the highest educational attainment or income also enjoyed the most nutritious diets. Those in the highest income group reported diets that were on average 9.3 points higher in nutrient density than diets reported by the lowest income group (96.6 versus 87.3 percent), after controlling for dietary and demographic factors. However, after taking the cost of food into account, the difference in dietary nutrient density between the highest and lowest groups shrank to 1.4 percentage points (93.0 versus 91.6 percent). “These results tell us that cost is a major factor in explaining the differences in eating habits between people of lower and higher socioeconomic level” said Monsivais.

Monsivais said the Seattle study should be replicated on a wider, more diverse (in terms of education, income) section of Americans鈥攐r in another country. “What is the average person’s concept of nutritious food, too?” Monsivais said. “We don’t know that, and it might explain some amount of the variation we found.”

The Centers for Disease Control and Prevention’s NHANES () could also be tapped to further explore the socio-economic question, he said.

Study results provide fodder for new and different nutrition policy and interventions, which for the last several decades have been mostly premised on the idea that poor diets were due to a lack of nutrition knowledge or insufficient motivation for healthy eating. “The most universal policy change or intervention would be to rethink how we encourage the production of foods,” said the researcher. “In this country, we have a very expensive agricultural subsidy program that targets a limited range of foods that are not part of a nutritious diet. We do not support fresh produce or seafood, but instead support the production of inexpensive sugars, fat and refined grains. We need to align public health priorities with agricultural policies because it affects the largest number of people.”

In addition, Monsivais said states could be more creative with public school food programs and other nutrition efforts that impact low-income people. California has experimented with an electronic benefits transfer program (food stamps) that rewards people who buy fresh produce, which makes having a healthier diet easier and more affordable.

Food retailers and grocers could also help consumers make healthier choices, said Monsivais. When you swipe a “member” card at a local store, it could be used in a helpful and healthful way, offering up coupons for items that are nutrient-rich. “If we could overlay a health lens on top of the member cards and make recommendations that are aligned with the way consumers eat and incentives, we could make it interesting for people.”

President Barak Obama today, Jan. 21, named Dr. Michelle Williams, 天美影视传媒 (UW) professor of epidemiology and global health in the School of Public Health, as one of the nation’s outstanding mentors in science, math and engineering.

Williams, an expert in maternal and infant health, is among 11 individuals and 4 organizations selected as recipients of the prestigious Presidential Awards for Excellence in Science, Mathematics, and Engineering Mentoring. The mentors will receive their awards at a White House ceremony next week.

The Presidential Awards for Excellence in Science, Mathematics, and Engineering Mentoring, awarded by the White House each year to individuals or organizations, recognize the crucial role that mentoring plays in the academic and personal development of students studying science or engineering 鈥� particularly those who belong to groups that are underrepresented in those fields. By offering their expertise and encouragement, mentors help prepare the next generation of scientists and engineers while ensuring that tomorrow’s innovators reflect the full diversity of the United States.

Candidates for the Presidential Mentoring Awards are nominated by colleagues, administrators, and students in their home institutions. The mentoring can involve students at any grade level from elementary through graduate school. In addition to being honored at the White House, recipients receive awards of $10,000 to advance their mentoring efforts.

“These individuals and organizations have gone above and beyond the call of duty to ensure that the United States remains on the cutting edge of science and engineering for years to come,” President Obama said. “Their devotion to the educational enrichment and personal growth of their students is remarkable, and these awards represent just a small token of our enormous gratitude.”

Williams is director of the UW’s Multidisciplinary International Research Training (MIRT) Program and director of the Reproductive Pediatric and Prenatal Epidemiology Training Program at the UW. She is also co-director of the Center for Prenatal Studies at Swedish Medical Center in Seattle, and an affiliate investigator at the Fred Hutchinson Cancer Research Center in Seattle.

Her major research interests and activities are women’s reproductive health and child health. Her current activities include research and teaching collaborations with epidemiologists in Peru, Ecuador, Vietnam, Thailand, Ethiopia, Zimbabwe, and the Republic of Georgia.

In 1993, Michelle developed the UW-MIRT Program, which trains students from economically and educationally disadvantaged backgrounds for research and leadership careers in public health. By identifying and implementing alliances for this global health program, Williams provides undergraduate students with life enriching and academically rigorous experiences in developing countries. At the same time, students and faculty in the MIRT Program dedicate themselves to addressing global public health problems with their partners in developing countries.

At the Center for Prenatal Studies at Swedish Medical Center, Williams co-directs a multidisciplinary research program involving clinical scholars, basic scientists and epidemiologists. Her research is on integrating genomic sciences and epidemiological research methods to identify risk factors, diagnostic markers, treatments and prevention targets for disorders that contribute to maternal and infant mortality.

Always interested in engaging young scholars in research, Williams, her collaborators, and her cadre pre- and post-doctoral fellows study groups of pregnant women to try to understand the determinants of preterm delivery, preeclampsia, gestational diabetes, and placental abruption. In her laboratory at Swedish Medical Center, Williams is working to identify unique gene expression patterns that may predict which pregnant women will go on to develop hypertension in late pregnancy (preeclampsia) or deliver prematurely. She has authored or co-authored more than 180 original research papers.

The daughter of Jamaican immigrants, Williams grew up in Queens, New York, attended public schools, and aspired to go to college on a sports scholarship.

With the encouragement of her high school teachers, Williams decided to earn her bachelor degree in genetics from Princeton University. She went on to receive a master of science degree in engineering from Tufts University, a master’s in demography and a doctor of science in epidemiology from Harvard University.

She has received the UW Brotman Award for Instructional Excellence and the Lilienfield Award from the American Public Health Association for excellence in teaching epidemiology. She gave the Spring 2010 UW School of Public Health Distinguished Faculty Lecture.

Obtaining consent for genetic studies can be an opportunity for researchers to foster respectful engagement with participants, not merely to mitigate legal risk. This shift is proposed in a policy forum appearing tomorrow, Jan. 21, in Science, the journal of the American Academy for the Advancement of Science.

The authors of the article, recommend new approaches that treat participants as true stakeholders in research, who willingly take on risks because they believe the potential benefits to society outweigh potential harms. Current practices presume that study participants don’t want to hear from researchers, or that participants find general, one-time consent acceptable. However, these practices may be contrary to participants’ preferences, according to their report.

The commentators are ethicists and medical researchers from the 天美影视传媒 (UW) and Group Health Research Institute in Seattle. They are: Susan Brown Trinidad and Stephanie M. Fullerton from the UW Department of Bioethics and Humanities, Evette J. Ludman and Eric B. Larson from Group Health Research Institute, Gail Jarvik, division head, UW Medical Genetics, and Wylie Burke, department chair, UW Bioethics and Humanities.

The authors point to recent national events that have increased attention on the use of biological samples in research: The Immortal Life of Henrietta Lacks, a best-selling book on the origins of the HeLa cell line; a lawsuit over the Texas Department of Health Services supplying newborn screening blood samples for research; and the settlement of the Havasupai tribe’s lawsuit against the Arizona Board of Regents for unauthorized use of biospecimens. Claims of harm in these and other cases have included breach of privacy, stigmatization, and attacks against cultural beliefs. Settlements have included financial payments, research restrictions, and sample destruction. In some cases, plaintiffs simply wanted to be asked permission.

Increased scrutiny of research practices is coming at a time when advances in genomic science depend on collecting massive amounts of data for analysis, the authors observed. To obtain large numbers of samples, improve the reliability of findings, and achieve greater efficiency, genome scientists around the world have begun pooling biospecimens and data from previous studies. The Science commentary notes that current U.S. federal policies or laws regarding human subjects’ protection or privacy of health information do not apply to studies using only coded samples and data. At the same time, other federal policies mandate data sharing and strongly encourage researchers to deposit their study data in public repositories such as the database of Genotypes and Phenotypes (dbGaP), a public access resource maintained by the National Institutes of Health.

The authors added that many disease-specific and general-purpose biorepositories have attracted many participants who have signed blanket informed consents for a broad range of potential purposes. Although a U.S. survey showed that more than 90 percent of respondents would be willing to have their samples and health data placed in a research biobank, their views on blanket consents were divided: 48 percent preferred one-time blanket consent, and 42 percent wanted the chance to re-consent for each new use of their data. Policy disagreement continues, the authors said. Some policy advisors want stronger regulations, but other s believe an opt-out model is better. In an opt-out, consent for research use of clinical samples (with personal identifiers removed) is presumed unless denied.

What’s missing from research policy and practice, in many cases, is knowledge and consideration of participants’ viewpoints and values, and participants’ desire to be notified and to give permission for sharing of their data for other studies. Recent research at Group Health Cooperative, a non-profit Seattle health system, had offered insight into study participant views. Group Health patients enrolled in the Adult Changes in Thought (ACT) study, a long running joint UW and Group Health project on brain aging, were asked if their ACT data could be submitted to the database of Genotypes and Phenotypes (dbGaP). Telephone interviews with a sample of those who granted such permission showed that while they were willing to have their information used in this way, this didn’t mean that they had no interest in learning how and by whom the data might be used.

“What was really important to participants in the cases we mention,” said Susan Brown Trinidad, research scientist in the , “wasn’t solely driven by the desire for control, or the chance to say no to certain kinds of studies. Rather, participants viewed being asked as an important demonstration of the researchers’ respect and appreciation.”

When contact with research volunteers is feasible and practical, then the extra work to re-engage them for re-use of data can be a valuable investment in science.

“Our experience with the ACT study,” said Dr. Eric B. Larson, executive director of , “showed informing subjects and seeking additional consent was worthwhile. Every time we share information and involve research subjects, we build on the trusting relationship that ultimately improves our research 鈥� and the value our research has for participants, the scientific community, and the public. Through trusting relationships, research can inform patient care, while patient participation keeps informing research.”

UW bioethicist, physician, and genetic researcher Wylie Burke has served for many years as a national advisor on the legal, ethical and social implications of genomic research.

“The good news here,” she said, “is that participants are interested in research and feel themselves to have an investment in the studies in which they are involved. It’s up to the research establishment — scientists, policy makers and institutional review boards — to respond appropriately.”

About UW Medicine

UW Medicine trains health professionals and medical scientists, conducts research to improve health and prevent disease, and provides primary and specialty care to patients throughout Seattle/King County and the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. UW Medicine includes Harborview Medical Center, UW Medical Center, Northwest Hospital & Medical Center, UW Neighborhood Clinics, UW School of Medicine, UW Physicians, and Airlift Northwest. UW Medicine also shares in the ownership and governance of the Seattle Cancer Care Alliance with Seattle Children’s Hospital and Fred Hutchinson Cancer Research Center and shares in ownership of Children’s University Medical Group with Seattle Children’s Hospital.

UW Medicine has major academic and service affiliations with Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, the Veteran’s Affairs Puget Sound Health Care System in Seattle, and the VA Hospital in Boise. The UW School of Medicine has been ranked No. 1 in the nation in primary-care training for the past 17 years by US News & World Report and is the top public institution for receipt of biomedical research funding from the National Institutes of Health and second among all institutions for NIH funding, public and private.

UW Medicine’s 2,000 faculty physicians and nearly 5,000 volunteer and part-time faculty include four Nobel Laureates, 32 members of the National Academy of Sciences, and 33 members of the Institute of Medicine. For more information about UW Medicine, visit http://www.uwmedicine.org/.

About Group Health Research Institute

Founded in 1947, Group Health Cooperative is a Seattle-based, consumer-governed, non-profit health care system. Group Health Res

On January 18, 2011, the chief executive officers of UW Medicine and Valley Medical Center (VMC) announced the signing of a non-binding Letter of Intent to explore a strategic alliance in which Valley Medical Center, Public Hospital District #1 of King County, would join UW Medicine. UW Medicine currently includes: Harborview Medical Center, UW Medical Center, Northwest Hospital & Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine and Airlift Northwest. With the signing of the non-binding Letter of Intent, our organizations will begin in-depth due diligence, discussion with respective boards, communication with key stakeholders, and preparation of a strategic alliance agreement for approval by the Governing Boards of both organizations. The work is expected to be completed by May 31, 2011.

Valley Medical Center and UW Medicine are exploring a strategic alliance to increase access to additional healthcare services for South King County residents, align best practice models, expand clinical, teaching and research programs, and position both organizations for future healthcare reform opportunities, such as the creation of an Accountable Care Organization (ACO).

The exploration of a strategic alliance between UW Medicine and Valley Medical Center provides exciting opportunities to explore what can be accomplished in the future through combining efforts on important initiatives to benefit patients and the community.

“UW Medicine and Valley Medical Center share a commitment to providing outstanding clinical care with an emphasis on patient safety and service,” said Dr. Paul Ramsey, CEO of UW Medicine and dean of the UW School of Medicine. “A strategic alliance would support our mission of improving the health of the public and would enhance our ability to provide national leadership for healthcare reform.”

“A formal collaboration with UW Medicine can provide enormous opportunities for VMC to further our ability to provide even more comprehensive care to the residents of our hospital district,” said Rich Roodman, CEO of Valley Medical Center. “With this strategic alliance, we would be able to give our local community access to additional clinical services as well as additional depth of sub-specialization through the expertise of one of the top medical organizations in the United States,” Roodman said. “VMC brings strong community support, a personalized and innovative patient-care environment, and a history of superior clinical outcomes and technical innovation. Combining these features with the excellence of UW Medicine’s clinical, teaching and research programs would certainly be a benefit to the residents of South King County.”

About UW Medicine

UW Medicine trains health professionals and medical scientists, conducts research to improve health and prevent disease, and provides primary and specialty care to patients throughout Seattle/King County and the WWAMI (Washington, Wyoming, Alaska, Montana and Idaho) region. UW Medicine includes Harborview Medical Center, UW Medical Center, Northwest Hospital & Medical Center, UW Neighborhood Clinics, UW School of Medicine, UW Physicians, and Airlift Northwest. UW Medicine also shares in the ownership and governance of the Seattle Cancer Care Alliance with Seattle Children’s Hospital and Fred Hutchinson Cancer Research Center and shares in ownership of Children’s University Medical Group with Seattle Children’s Hospital.

UW Medicine has major academic and service affiliations with Seattle Children’s Hospital, Fred Hutchinson Cancer Research Center, the Veteran’s Affairs Puget Sound Health Care System in Seattle, and the VA Hospital in Boise. The UW School of Medicine has been ranked #1 in the nation in primary-care training for the past 17 years by US News & World Report and is the top public institution for receipt of biomedical research funding from the National Institutes of Health and second among all institutions for NIH funding, public and private. UW Medicine’s 2,000 faculty physicians and nearly 5,000 volunteer and part-time faculty include four Nobel Laureates, 32 members of the National Academy of Sciences, and 33 members of the Institute of Medicine. For more information about UW Medicine, visit .

About Valley Medical Center

Valley Medical Center (VMC) is a 303-bed acute care hospital and clinic network committed to providing safe, quality, compassionate care for more than 63 years. The oldest and largest public district hospital in the State of Washington, VMC proudly serves over 400,000 residents in South King County. Dedicated to patient safety and improving the overall health of the community, VMC is a thriving medical center that focuses resources on major disease areas and specialties, including: emergency and trauma care, joint replacement, neuroscience, childbirth and Level III neonatal ICU, surgical services, critical care, cancer services, breast health, sleep medicine, diabetes education and much more. Through Valley Medical Group, a network of primary care clinics serve as a medical home for care management, urgent care clinics provide a safety net of after-hours care and walk-in consult and treatment, and over a dozen specialty clinics provide convenient access throughout the district.

As the largest nonprofit healthcare provider between Seattle and Tacoma, Valley Medical Center is South King County’s only disaster recovery facility and offers advanced emergency care in our Level III Trauma Center. VMC’s joint replacement program was proudly rated #1 in Washington by HealthGrades for 2009 and 2010. Ranked Top 10 in the Nation as a Best Place to Work in Healthcare for 2009 and 2010, Valley Medical Center attracts world class clinicians through state-of-the- art facilities and technology, award-winning teamwork and an atmosphere of medical excellence. For more information, visit us at .

Elementary school students who participated in a three-month anti-bullying program in Seattle schools showed a 72 percent decrease in malicious gossip.

The study, led by the 天美影视传媒, is the first to show that the widely-used Steps to Respect bullying prevention program can curb children’s gossip, an element of playground culture often seen as harmless but capable of causing real harm.

“Gossip is an element of bullying, and it can lead to physical bullying,” said Karin Frey, a UW research associate professor of educational psychology. “Kids will tell you that gossip is just as painful as physical bullying.”

But teachers tend to not view gossip as a significant form of bullying, Frey said. Since gossip can lead to physical bullying, she and her collaborators investigated whether the program would help suppress teasing, name-calling, rumor-spreading and other ostracizing chitchat.

The study, published in the winter issue of School Psychology Review, showed that having supportive friends and not choosing retaliation when victimized by malicious gossip helped participants in the program avoid further victimization.

Researchers used Palm Pilots to electronically record second-by-second observations of 610 students in grades 3-6 at six elementary schools in the Seattle area. Researchers recorded each child’s behavior on the playground for five minutes once a week for 10 weeks in the fall and 10 weeks in the spring.

“Gossip is surprisingly visible, because you have to have more than one person, and it can last awhile,” said Frey, who led development of the Steps to Respect program in 2000. “Is the cootie girl in your class?” and “Did you hear Dan cheated?” are two examples of children’s gossip Frey and her co-authors mention in their paper.

Not all gossip is strictly behind the back, though. The researchers also found that sometimes gossips will huddle together and clearly talk about a victim. “Without speaking loudly enough that others will know what they are saying, they’ll point and look at the person they’re gossiping about,” Frey said.

After observers heard gossip on the playground in the fall, the anti-bullying program began in half of the 36 classrooms. During three months, teachers taught Steps to Respect lesson plans that encouraged empathy, taught assertiveness and emphasized that bullying is not a social norm.

In a questionnaire for students, the researchers measured two factors that influence bullying: beliefs about fighting back against bullies and having supportive friends.

When students’ playground gossip was observed in the spring, children in the Steps to Respect classrooms had 234 fewer instances of gossip per class of 25, or a 72 percent decrease in gossip among students who had gossiped before participating in the anti-bullying program.

“Gossip is still there, but it’s better,” Frey said. “That’s going to make a difference in the life of a child.”

Kids may mistakenly subscribe to the “don’t get mad, get even,” philosophy. But since victims who retaliate often end up bullied even more, Steps to Respect teaches kids to not fight back. Frey and her co-authors found that gossip victims in the fall who went through Steps to Respect in the winter were less likely to believe in retaliation as a response to bullying, and more likely to avoid being a victim of gossip in the spring.

Having supportive friends also helped gossip victims. “Maybe friends use their assertiveness skills and say, 鈥楥ome on, let’s go,'” Frey said.

Frey said that bystanders are really important in decreasing gossip and bullying, but many times bystanders feel uncomfortable and don’t know what to do. Bystanders’ silence can give a lot of power to bullies, but if bystanders speak up, the bullying stops.

“Stand up straight, look the bully in the eye, and say 鈥榢nock it off,'” Frey said. Friends who encourage victims to retaliate, on the other hand, may inadvertently set victims up for continued bullying, she said.

Co-authors of the paper are Sabina Low, assistant professor of psychology at Wichita State University, and Callie Brockman, graduate student in clinical psychology at Wichita State University.

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For more information, contact Frey at 206-367-8409 or karinf@uw.edu.

Learn more about the anti-bullying program Steps to Respect: http://www.cfchildren.org/

Many people in the U.S. have multiple common chronic diseases such as diabetes and heart disease, which complicates health care needs. When depression coexists with diabetes, heart disease, or both, health outcomes are often less favorable.

In a randomized controlled trial, testing a primary care intervention called , nurses worked with patients and health teams to manage care for depression and physical disease together, using evidence-based guidelines. The result for patients: less depression, and better control of blood sugar, blood pressure and cholesterol and improved quality of life.

Researchers at the 天美影视传媒 (UW) and published their findings in the December 30, 2010 New England Journal of Medicine.

“Depressed patients with multiple uncontrolled chronic diseases are at high risk of heart attack, stroke and other complications,” said Dr. , a UW professor of psychiatry and behavioral sciences and an affiliate investigator at Group Health Research Institute. “We are excited about finding a new way to help patients control these chronic diseases, including depression. Then they can get back to enjoying what makes their lives worth living,” he said.

Depression is common in patients with diabetes and heart disease, and it has been linked to worse self-management and more complications and deaths. Depression can make people feel helpless and hopeless about managing other chronic diseases. In turn, coping with chronic disease can worsen depression. This tangle of health problems can feel overwhelming鈥攆or patients, their families and their health care providers.

To explore possible solutions, the trial focused on 214 patients who were randomly assigned to either standard care or the TEAMcare intervention. In the TEAMcare intervention, a nurse care manager coached each patient, monitored disease control and depression, and worked with the patient’s primary care doctors to make changes in medications and lifestyle when treatment goals were not reached. Working together, the nurse and patient set realistic step-by-step goals: reductions in depression and blood sugar, pressure and cholesterol levels. Patients assigned to the standard care arm of the study did not receive the nurses’ coaching and monitoring services.

To reach these goals, the nurse regularly monitored the patient’s mental and physical health. Based on guidelines that promoted incremental improvements, the care team offered recommendations to the patient’s primary care doctor to consider changes to the dose or type of medication used for managing blood pressure, blood sugar, lipids or depression. This process is called “treating to target.”

Katon said that the “treating to target” approach helped boost patients’ confidence as goals were accomplished. “It reverses what happens when they set overly ambitious goals they don’t reach, which discourages them, their families, and health care providers.”

At one year鈥攃ompared with the standard care control group鈥攑atients with the TEAMcare intervention were significantly less depressed and also had improved levels of blood glucose, low-density lipoprotein (LDL) cholesterol, and systolic blood pressure. These differences are clinically significant, particularly if achieved in large numbers of patients, Katon said.

“Each of these four disease control measures has been linked to higher risks of complications and deaths from diabetes and heart disease,” he added.

The researchers have not yet completed their analysis of possible cost savings from the intervention, but they estimated that the two-year TEAMcare intervention cost $1,224 per patient, on average. This is for patients whose medical care costs health care systems approximately $10,000 per year, said Katon.

TEAMcare intervention patients reported enhanced quality of life and satisfaction with care for depression and either diabetes, heart disease or both. Patients were more likely to have timely adjustment of glucose levels, high blood pressure, cholesterol and antidepressant medications.

“TEAMcare is a truly patient-centered approach that enhances a primary care team to deliver optimal care for both physical and mental health in a seamless manner,” said co-author , MD, MPH, Group Health family physician and an affiliate investigator at Group Health Research Institute. “It recognizes there can be no health without mental health.”

This trial is the culmination of more than 25 years of collaboration between the UW and Group Health to improve care for patients with chronic diseases including depression in everyday primary care settings.