Are Healthful Foods Too Expensive for Low-Income Americans?
This and Other Questions are Addressed in College of Health Sciences Research Projects

By Jim Raper

Do low prices for soft drinks and cookies versus higher prices for more healthful foods such as fresh tomatoes and avocados contribute to obesity among America’s poor? Is there a correlation among food prices, obesity and national food assistance programs? These and other related questions are the focus of a research project headquartered at Old Dominion University’s College of Health Sciences and funded by the National Institutes of Health (NIH).

Qi “Harry” Zhang, a health economist and assistant professor of community and environmental health, leads the research team on the $135,000 grant, which came as especially good news in the summer of 2007 for a College of Health Sciences that is striving to add a research focus to its traditional teaching focus. NIH is the nation’s largest non-defense research-and-development funding agency, and its acknowledgement of the college’s research capabilities is of major significance.

On the heels of the grant to Zhang, an agency with ties to the NIH announced an award of $50,000 to Gail Grisetti, ODU associate professor of community health professions and physical therapy. The money will support a two-day, international conference proposed by Grisetti to improve treatment strategies for adults who have lost lower limbs. Participants in the conference, scheduled for April 2008 in Hampton Roads, will include physicians, health science academics, health care professionals and prosthetics manufacturers. Potential beneficiaries are people who lose lower limbs because of diseases, accidents or military conflicts.

“You know, our college is traditionally a teaching institution,” says Zhang, “but I’d like to emphasize the new atmosphere to do good research at our college. From the dean’s office to the departments, all levels try to respect research and appreciate research activities, which make a good environment for research faculty members. Continuous support from the university, the college and the departments is necessary to keep the good trend.”

Research Grows in Health Sciences
Several factors have come together to help promote research by the college’s faculty, not the least of which was Andrew Balas’ arrival in 2004 as dean, and the completion in April 2006 of the college’s new Health Sciences Building, which is the former Technology Building renovated at a cost of $9 million.

Balas, a tireless promoter of research, was himself responsible for $10 million in externally funded community health research during the decade before he arrived at ODU. He previously was dean of the School of Public Health at Saint Louis University and Weil Distinguished Professor of Health Policy and director of the European Union Center at the University of Missouri.

The dean said that the college’s research initiative would not detract from its traditional emphasis upon teaching. “In fact, one of the main reasons we are advancing research is for the purpose of strengthening teaching,” he says. “In the case of Professor Grisetti’s conference, it will bring experts to Norfolk who will provide a tremendous learning opportunity for our students.”

The 82,000-square-foot new building more than doubles the college’s research laboratory space, and it includes, for example, the country’s only clinical facility dedicated exclusively to dental hygiene research. Says Balas, “This building energizes people. It lets us know that the university’s administration and trustees believe in the future of our college.”

Annual research expenditures at the college have grown from less than $100,000 per year in 2000 to nearly $900,000 today. During the past three years, submission of research proposals is up more than 300 percent and percentage of research awards is up almost 450 percent. Balas says momentum is building partly because of recent hires of Zhang and other faculty members who are research oriented. “But, also,” he adds, “many of our longer-serving faculty members are switching gears and becoming successful researchers with external funding.” Grisetti, whom he mentions as an example, has been at ODU since 1986. (See “Sampler of College of Health Sciences Researchers”.)

Projects Look into Major Health Care Issues
The projects of Zhang and Grisetti address two of today’s major health care issues.

Zhang’s grant, which runs for the two years ending in mid-2009 and is titled “Price Effect on Diet and Obesity Risk of Food Assistance Program Recipients,” will link data from three national surveys to study the effects of local food prices on food assistance program (FAP) participation, on FAP participants’ dietary intakes and on FAP participants’ body mass index. The work is likely to garner media attention because of its potential effect on government policy.

In hypotheses advanced by their grant proposal, Zhang and two colleagues suggest that participation in the federal food stamp program and other food assistance programs will be higher in regions where the cost of living is higher. They also believe their research will show that these FAP participants face an increased risk of obesity because the healthiest foods cost more than unhealthy foods. The long-term goal of the researchers is to identify the economic mechanisms that promote weight gain among low-income Americans.

“The proposed research is significant because identification of price effect on FAP participants’ diet and health outcomes will have important policy implications,” said Zhang, who joined the ODU faculty in 2005. “If, for example, FAP participants consume more unhealthy foods because of their lower price relative to healthy foods, the government should promote health education for FAP participants and provide subsidies to healthy foods to increase their consumption of healthy foods.”

Co-investigators with Zhang on the FAP obesity project are Dr. Youfa Wang, a physician and assistant professor of human nutrition at Johns Hopkins’ Bloomberg School of Public Health whose research focus is childhood eating behaviors and obesity, and Harold Pollack, associate professor and faculty chair of the Center for Health Administration Studies at the University of Chicago whose research focus is poverty and public health policy. Zhang, who has researched socioeconomic disparities and prevalence of obesity in the United States, has collaborated on other projects with Dr. Wang.

Soda Pop is Cheaper in the South
Zhang conducted a related pilot study with research support from the U.S. Department of Agriculture’s Economic Research Service and Southern Rural Development Center at Mississippi State University. The pilot study found that the cost of food—including many popular unhealthy foods—is generally less in the South. Coca-Cola, according to the research, costs 7 percent less by average in the South than in the country as a whole.

The preliminary work in the South indicates that lower costs of living do promote unhealthy weight gain. “This suggests that the cost of living could be an important factor that affects low-income populations’ food choices and other health behaviors that affect body weight,” the proposal to NIH asserts.

Conference Targets Lower-Limb Amputees
Grisetti’s funding from the Agency for Healthcare Research and Quality allows her to plan a conference to meet a growing healthcare problem created in part by the leg injuries sustained by soldiers in Iraq or Afghanistan. “We will have discussions regarding soldiers returning from conflicts and have experts on hand who have extensive experience in the area,” she says. “We have no reason to believe that an amputee who is otherwise healthy should remain in a wheelchair. Representatives from the Walter Reed Medical Center will present efforts of the military to return wounded soldiers who have lost a limb to full function.”

Her idea is to invite interdisciplinary conferees involved in the three principal phases of care for adults with lower-limb amputations: the pre-surgical phase, the pre-prosthetic phase and the prosthetic/rehabilitation phase. “I am seeking out the health care professionals who represent the best available in their specific disciplines,” she says. The conference format will emphasize how the phases are interrelated. “Selection of a specific surgical technique will impact options for selection of a prosthetic device; selection of a specific prosthesis will impact options for the physical therapy plan of care,” she wrote in the grant proposal. “Such interdependence suggests the importance of collaborative patient-centered practice.”

Collaborative Treatment and Therapies for Patients with Limb Loss
Treatment of lower-limb amputees lacks the collaboration that can deliver the latest and most appropriate surgical techniques, prosthetic technologies and physical therapies, Grisetti believes. Better practices are required because the need is so great, she adds. “Diabetes-related amputations are projected to increase and amputations resulting from military conflicts will contribute to the number of individuals in this group. The amputation of a lower limb produces a significant loss of functional ability and challenges the patient to redefine his or her role in the family and the community.

“These challenges are particularly unique for the young, and typically healthy, military soldier. This population brings unique challenges that require re-evaluation of existing treatment approaches and determination of functional outcome measures specific for this population.”

Sampler of College of Health Sciences Researchers
Holly Gaff, assistant professor of community and environmental health, studies the dynamics and control of infectious diseases using mathematical modeling and computer simulation. She has an NIH-funded career development award to develop a spatially explicit mathematical model of a tick-borne disease. Joined faculty in 2007.

Steven Morrison, endowed professor of physical therapy and director of the School of Physical Therapy’s research laboratory, has research interests in motor control and biomechanics. One focus is the effect of factors such as disease and aging on human balance control during posture and walking. Joined faculty in 2007.

Patricia Hentosh, professor of medical laboratory and radiation sciences, does proteomics research related to cancer cells, including studies of complex protein interactions designed to allow earlier detection and more effective treatment of lung tumors. Joined faculty in 2006.

Gianluca DeLeo, assistant professor of medical laboratory and radiation sciences, is involved in research related to health and biomedical informatics and virtual reality. Joined faculty in 2006.

H. Anna Jeng, assistant professor of community and environmental health, studies genetic and environmental contamination, as well as environmental justice and health disparity. Joined faculty in 2004.

Richardean Benjamin, associate professor and chair of the School of Nursing, does research in behavorial and mental health problems of children and adolescents and in outcomes of health care for the elderly. Joined faculty in 1989.

Martha Walker, associate professor and chair of the School of Physical Therapy, does biomedical studies in motion analysis and investigates factors affecting outcomes for inpatient rehabilitation facilities. Joined faculty in 1986.

Michele Darby, University Professor and eminent scholar of dental hygiene, has a broad-ranging research background focusing on topics such as workplace issues facing hygienists, dental-plaque-induced gingival disease and patient anxiety. Joined faculty in 1974.