Tag Archives: poverty

This interview with Dr. Gary Evans, Elizabeth Lee Vincent Professor in the College of Human Ecology, was written for the Jacobs Foundation's BOLD initiative.

Reprinted from the Blog on Learning & Development, May 15, 2017.

Meeri Kim: Much of your work focuses on how children’s environment affects their health and well-being — in particular, the ways in which childhood poverty can lead to negative developmental outcomes. What are the components of poverty that tend to hit kids the hardest?

Gary Evans

Gary Evans: Throughout my work, I’ve tried to make the point that one of the reasons why poverty is harmful for kids is the chronic stress they experience as a result. One of the things that is unique and unfortunately quite powerful about childhood poverty is this accumulation of stressors, both physical and psychosocial. Physical stressors include housing issues, noise, crowding, and pollution. But the kids also experience psychosocial stressors like crime, family turmoil, and residential instability.

“Parts of the brain may change in children who grow up in poverty, leading to less efficient control and regulation of some cognitive and emotional processes than their wealthier peers.”

MK: How does constant exposure to such stressors impact the developing brain?

GE: The physiological response systems that are designed to handle relatively infrequent environmental stressors become overwhelmed for disadvantaged children. There is good evidence that parts of the brain linked to executive control — involved in coordinating things and keeping everything organized — are sensitive to chronic stress. Structurally as well as functionally, these regions may change in children who grow up in poverty, leading to less efficient control and regulation of some cognitive and emotional processes than their wealthier peers.

At the same time, other parts of the brain tied to automated, quick responses to stress and emergencies like the amygdala become over-developed and over-activated. So you have this bad mix of heightened emotional responses coupled with less regulation and control.

MK: Recently, you published a study on the link between childhood poverty and adult psychological well-being. What did you find?

GE: I looked at the psychological well-being of 24-year-olds in relation to their family income when they were 9 years old, finding relationships with a number of mental health and cognitive outcomes. Childhood poverty is linked to deficits in adult memory, greater psychological/physiological distress, and higher levels of aggression.

Another research interest is how motivation and helplessness differ for those who grew up in an impoverished environment. We have given both children and adults age-appropriate tasks to persist on, and we see consistently less persistence from the disadvantaged. When challenged, they’re much more likely to give up. To me, that unfortunately fits our model — if you grow up with a lot of stressors, your environment sets you up for feeling like you don’t have a sense of mastery or self-efficacy. This is a dynamic, particularly for children, that we need to look more at.

“If you grow up with a lot of stressors, your environment sets you up for feeling like you don’t have a sense of mastery or self-efficacy.”

MK: Given your findings on poverty, what kinds of policy changes could help enhance these children’s lives? Universal basic income?

GE: Various experiments have shown that when you increase the income of families in poverty, you may get better health outcomes, better parenting, and reductions in various negative outcomes. I believe any policy approach has to increase income in a way that is predictable and reliable, coupled with more available and affordable services for these families.

“Because poverty includes a convergence of multiple risk factors and stressors, it really means multiple interventions are necessary.”

Because poverty includes a convergence of multiple risk factors and stressors, it really means multiple interventions are necessary. You can’t just provide housing or job training. You really have to look across the board. A classic example is taking people off of welfare and giving them a low-income job, which is usually right around the minimum wage. However, if there is little or no childcare, the program winds up not being nearly as effective as it ought to be. Good-quality free or heavily subsidized childcare coupled with employment or job training may work better.

Reprinted from the Cornell Chronicle, December 21, 2016

By Susan Kelley

A large and growing body of research shows that poor kids grow up to have a host of physical problems as adults.

Now add psychological deficits to the list, Cornell researchers say.

Childhood poverty can cause significant psychological deficits in adulthood, according to a sweeping new study. The research, conducted by tracking participants over a 15-year period, is the first to show this damage occurs over time and in a broad range of ways.

Impoverished children in the study had more psychological distress as adults, including more antisocial conduct like aggression and bullying and more helplessness behavior, than kids from middle-income backgrounds. Poor kids also had more chronic physiological stress and more deficits in short-term spatial memory.

Gary Evans, Elizabeth Lee Vincent Professor of Human Development

“What this means is, if you’re born poor, you’re on a trajectory to have more of these kinds of psychological problems,” said Gary Evans, the author of the study and the Elizabeth Lee Vincent Professor of Human Ecology, and professor in the departments of design and environmental analysis, and human development.

Why? In a word, stress.

“With poverty, you’re exposed to lots of stress. Everybody has stress, but low-income families, low-income children, have a lot more of it,” Evans said. “And the parents are also under a lot of stress. So for kids, there is a cumulative risk exposure.”

Evans, a child psychologist who specializes in the effects of stress on children, is the author of “Childhood poverty and adult psychological well-being,” published Dec. 12 in the Proceedings of the National Academic of Sciences (PNAS).

The findings are important because kids who grow up in poverty are likely to stay impoverished as adults, Evans said. For example, there’s a 40 percent chance that a son’s income will be the same as his father’s income. That’s because the United States has the least social mobility of any wealthy Western democracy, he said.

“People walk around with this idea in their head that if you work hard, play by the rules, you can get ahead,” Evans said. “And that’s just a myth. It’s just not true.”

In his study, Evans tested 341 participants, all white, at ages 9, 13, 17 and 24.

Short-term spatial memory was tested by asking adult study participants to repeat increasingly complex sequences of lights and sounds by pressing four colored pads in the correct order – similar to the “Simon” game. The adults who grew up in poverty had a diminished ability to recall the sequences, compared to those who did not.

“This is an important result because the ability to retain information in short-term memory is fundamental to a host of basic cognitive skills, including language and achievement,” Evans wrote.

Although the participants were assessed on this measure only when they were adults, this test had the strongest association with childhood poverty of the four measures.

Helplessnesswas assessed by asking the participants to solve an impossible puzzle. Adults who grew up in poverty gave up 8 percent quicker than those who weren’t poor as kids. Previous research has shown chronic exposure to uncontrollable stressors – such as family turmoil and substandard housing – tends to induce helplessness.

Mental healthwas measured with a well-validated, standardized index of mental health with statements including “I argue a lot” and “I am too impatient.” Adults who grew up in poverty were more likely to agree with those questions than adults from a middle-income background.

Chronic physiological stress was tested by measuring the participants’ blood pressure, stress hormones and body mass index. Adults who grew up in poverty had a higher level of chronic physical stress throughout childhood and into adulthood.

The study has two implications, Evans said. First, early intervention to prevent these problems is more efficient and more likely to work.

“If you don’t intervene early, it’s going to be really difficult and is going to cost a lot to intervene later,” he said.

Second, increasing poor families’ incomes is the most efficient way to reduce a child’s exposure to poverty and, in turn, their risk of developing psychological problems. Evans supports the creation of a safety net, similar to Social Security’s supplemental income for the elderly and disabled. If a family is poor and has children, the federal government should provide them with supplementary income sufficient to participate in society, he said.

“It’s not true you can’t do anything about poverty. It’s just whether there’s the political will, and are people willing to reframe the problem, instead of blaming the person who is poor and – even more preposterous – blaming their children,” he said.

“This is a societal issue, and if we decide to reallocate resources like we did with the elderly and Social Security, we could change the kind of data this study is showing,” he said.

“Could we get rid of poverty? Probably not,” Evans said. “But I think we could change it dramatically.”

The research was supported by the W.T. Grant Foundation, the John D. and Catherine T. MacArthur Foundation and the National Institute for Minority Health and Health Disparities.

By Sharon Tregaskis
Reprinted from Cornell Chronicle, May 15, 2015
urie460

A half century ago, Cornell developmental psychologist Urie Bronfenbrenner gave Congressional testimony that eventually led to the creation of the Head Start program.

 

Testifying before Congress in 1964, Cornell developmental psychologist Urie Bronfenbrenner urged lawmakers to fight “poverty where it hits first and most damagingly – in early childhood.”

Intrigued by his work, Lady Bird Johnson invited Bronfenbrenner to tea at the White House, where he shared his findings on early childhood programs he had observed abroad. In January 1965, as part of President Lyndon Johnson’s War on Poverty, Sargent Shriver empaneled 13 experts – including Bronfenbrenner – to develop a federally funded preschool program for the nation’s poorest children.

In May 1965, federal Head Start was born, announced in a Rose Garden speech by Johnson. “Five- and six-year-old children are inheritors of poverty’s curse and not its creators,” the president said. “Unless we act, these children will pass it on to the next generation, like a family birthmark.”

In its first summer, the six-week program reached 500,000 youngsters; in the 50 years since, it has provided 32 million infants, toddlers and preschoolers with health, educational and family support services. On May 18, the National Head Start Association will mark the milestone by planting rose bushes at programs nationwide and celebrating with members of Congress.

Among Head Start’s architects, Bronfenbrenner stood out for his dynamic systems theory of human development – which became synonymous with the field of human ecology and inspired the renaming of Cornell’s College of Human Ecology in 1969. A champion of field-based observations in children’s homes, schools and neighborhoods, Bronfenbrenner upended the conventions of mid-20th century developmental psychology, which had taken a decontextualized, sterilized approach.

For Bronfenbrenner, it wasn’t enough to look narrowly at children. To understand the effect of a mother’s employment on a child’s development, for example, he urged investigators to consider the child’s age, the quality of daycare in the mother’s absence, her attitude toward her work, the family’s race and income level and the father’s employment status and attitude toward his partner’s work and family duties.

On the Cornell faculty from 1948 until his death in 2005, Bronfenbrenner formulated a theory of human development that reflects not only individual personalities and potential, but also the dynamic interplay among members of the family, the family’s place in their neighborhood and community, that community’s place and the pervasive influence of macrosystem factors, including social policy, the legal system and economic trends.

“He wanted us to include the real-world messiness that we were intent on excluding, because at that time we thought of it as methodological noise,” said longtime collaborator Stephen Ceci, the Helen L. Carr Professor of Developmental Psychology.

As the extended family of the 19th century gave way to increasingly fractured variants, Bronfenbrenner campaigned for policies to bolster and sustain the family as society’s most vital building block through programs like Head Start; minimum income programs for impoverished families; paid leave for new parents and flexible work hours for those with older children; affordable, high-quality childcare; gun control; and universal health care.

“Urie was a grand theorist whose theories were reflected in the comprehensive nature of Head Start, in the recognition of the need to support families and enrich the educational experiences of children and take care of children’s emotional and physical well-being,” says Jeanette Valentine, Ph.D ’76, co-author of “Head Start: A Legacy of the War on Poverty.”

A proponent for the power of family ties to help children reach their full potential, Bronfenbrenner saw Head Start as a buffer against the stress experienced by impoverished parents. Day care would allow parents to spend more time with their children, forming the passionate attachments he saw as a cornerstone of lifelong success.

“Every kid,” Bronfenbrenner frequently declared, “needs at least one adult who is crazy about him.”

Adapted from a spring 2015 issue of Human Ecology magazine by freelance writer Sharon Tragaskis.

By Karene Booker
Reprinted from Cornell Chronicle, June 19, 2014

Gary Evans

Evans

By age 2, poor children have gained more weight than those who are better off. But after age 2, neighborhood poverty, not family poverty, puts the pounds on, finds a new study, published in the Journal of Applied Developmental Psychology (35:3).

About one-third of America’s children are overweight or obese, but rates are highest among poor and minority children. The study identifies for the first time the effects of neighborhood-level poverty, family poverty and ethnicity on children’s weight, shedding new light on the origins of adult health disparities, the authors say.

“The effects of neighborhood poverty on children’s weight may be just as important as the effects of family poverty,” says Cornell’s Gary W. Evans, the Elizabeth Lee Vincent Professor of Human Ecology, who co-authored the study with Pamela Klebanov, Princeton University, and Jeanne Brooks-Gunn, Columbia University.

“Children and families are embedded in neighborhoods; poor neighborhoods differ structurally from wealthier neighborhoods, with fewer safe and natural places to play and exercise, fewer supermarkets and more fast food,” Evans explains.

For their study, the researchers analyzed demographic factors and changes in body mass index (BMI) from ages 2 to 6 1/2 for nearly 1,000 children born with low birth weight. In typically developing children, BMI increases during the first year, then declines to a low point before increasing again in what is called adiposity rebound, usually between the ages of 5 and 7. Children who rapidly gain weight early in their first year or who have an early rebound are at risk for obesity throughout life.

Because they tend to gain weight more rapidly over their first two years to “catch up” with normal birth weight infants, low birth weight infants face higher risks for obesity, but being poor, a minority or living in poor neighborhoods adds to their disadvantage, the authors say.

Evans and colleagues found that the low birth weight toddlers from poor families already had higher BMIs than their wealthier counterparts by age 2, at which point the harmful effects of living in an impoverished neighborhood took over. The children in poor and near poor neighborhoods reached adiposity rebound more quickly, and their BMIs increased more rapidly compared to children from non-poor neighborhoods.

The team also found that African-American toddlers displayed an earlier adiposity rebound and greater subsequent BMI increases over time compared to Anglo-American toddlers. Hispanic-American children, on the other hand, had an atypical pattern in which their BMI increased steadily from birth, without exhibiting a decrease and rebound.

“Health disparities emerge early and shape lifelong health,” Evans says.

“Interventions need to address both the fundamental risk factors for pediatric obesity, such as poverty, chaotic living conditions and low parental education, as well as the mechanisms that appear to convey these risks, such as restricted access to healthy food, few safe and natural places to play, too much fast food, child food marketing and high levels of chronic stress, he concludes.

The study, “Poverty, ethnicity and risk of obesity among low birth weight infants,” was supported in part by the Stanford Center for Poverty and Inequality.

Karene Booker is an extension support specialist in the Department of Human Development.

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Gary Evans
The Paper

In U.S. counties where personal incomes cluster on opposite sides of the rich and poor spectrum, children appear to endure more neglect and abuse, according to new research by John Eckenrode and colleagues reported in Reuters, February 11th. Using statistical methods to gauge income inequality, the team found a steep rise in the rate of child maltreatment with rising inequality. The relationship held after researchers adjusted for poverty itself, and other factors such as the racial and ethnic makeup of regions, education levels and the number of people receiving public assistance income. Read more.

By H. Roger Segelken
Reprinted from Cornell Chronicle, February 11, 2014

Eckenrode

Eckenrode

In the aftermath of the Great Recession and the increased attention to the widening income gap, concern over the impact of inequality on children and families has risen. According to a nationwide study by Cornell researchers, the list of bad outcomes associated with income inequality now includes child abuse and neglect.

The income inequality-child maltreatment study, covering all 3,142 U.S. counties from 2005 to 2009, is said to be the most comprehensive of its kind and the first to link higher risk of child maltreatment to localities where the gap between rich and poor is greatest.

“More equal societies, states and communities have fewer health and social problems than less equal ones – that much was known. Our study extends the list of unfavorable child outcomes associated with income inequality to include child abuse and neglect,” said John Eckenrode, professor of human development and director of the Bronfenbrenner Center for Translational Research in the College of Human Ecology.

Results of the nationwide study were published in the Feb. 10 online edition of the journal Pediatrics as “Income Inequality and Child Maltreatment in the United States.” In addition to Eckenrode, who directs the National Data Archive of Child Abuse and Neglect, other report authors include Elliott Smith, Margaret McCarthy and Michael Dineen, researchers in Cornell’s Bronfenbrenner Center for Translational Research.

Nearly 3 million children younger than 18 years of age are abused physically, sexually or emotionally or are physically neglected each year in the United States, the Cornell researchers noted. That is about 4 percent of the youth population.

“We have known for some time that poverty is one of the strongest precursors of child abuse and neglect,” Eckenrode said. “In this paper we were also interested in areas with wide variations in income – think of counties encompassing affluent suburbs and impoverished inner cities – and in the U.S. there is quite a lot of variation in inequality from county to county and state to state.”

The damage inflicted on children by maltreatment doesn’t stop when kids graduate – if they do – from school, the Cornell researchers observed. “Child maltreatment is a toxic stressor in the lives of children that may result in childhood mortality and morbidities and have lifelong effects on leading causes of death in adults,” they wrote. “This is in addition to long-term effects on mental health, substance use, risky sexual behavior and criminal behavior ... increased rates of unemployment, poverty and Medicaid use in adulthood.” Eckenrode noted that “reducing poverty and inequality would be the single most effective way to prevent maltreatment of children, but in addition there are proven programs that work to support parents and children and help to reduce the chances of abuse and neglect – clearly a multifaceted strategy is needed.”

Support for the study came from the Children’s Bureau, Administration for Children and Families, a division of the U.S. Department of Health and Human Services.

Related Information

By H. Roger Segelken
Reprinted from Cornell Chronicle, October 30, 2013

Evans

Evans

The chronic stress of childhood poverty can trigger physical changes that have lifelong psychological effects, a study of adult brains has shown.

“Some of the anxiety disorders, depression, post traumatic stress disorders, impulsive aggression and substance abuse we’re seeing in adults might be traced to a stressful childhood,” says Cornell’s Gary W. Evans, the Elizabeth Lee Vincent Professor of Human Ecology.

The environmental and developmental psychologist joined researchers from three other universities to publish findings in the journal Proceedings of the National Academy of Sciences as “Effects of childhood poverty and chronic stress on regulatory brain function in adulthood.” The 15-year study confirms something Evans has long suspected: “Early experiences of poverty become embedded in the brain. Exposure to chronic stress in early childhood – when the amygdala and prefrontal cortex are rapidly developing – produces lasting neurological changes,” he says.

The longitudinal study followed 49 rural 9-year-olds for 15 years – checking in at ages 9, 13, 17 and 24. “Even if the 24-year-olds had escaped poverty and were making a comfortable living,” Evans says, “functional magnetic resonance imaging scans of two parts of the brain that process emotion, the prefrontal cortex and the amygdala, revealed neural patterns for emotion regulatory dysfunction.

“Chronic stresses of childhood poverty may make it harder to regulate your emotions and this remains whether or not you are upwardly mobile as an adult,” he adds.

The report by researchers at the University of Michigan, University of Denver, University of Illinois at Chicago and Cornell said “… children living in poverty are more likely to be exposed to chronic multiple stressors, including violence, family turmoil, separation from family members and substandard living environments.”

Pilyoung Kim, M.A. ’07, Ph.D. ’09, assistant professor in the Department of Psychology at the University of Denver, is the lead author on the paper. Support for the long-term study came from the National Institutes of Health, William T. Grant Foundation, John D. and Catherine T. MacArthur Foundation and the Robert Wood Johnson Foundation.

Reprinted from the Cornell Chronicle, July 3, 2013

Evans

Evans

Children from low-income families tend to do worse at school than their financially better-off peers. Poor planning skills, which can emerge as early as kindergarten and continue through high school, is one reason for the income-achievement gap, reports a new Cornell study of a large ethnically and socioeconomically diverse group of children from across the United States.

The study, "The role of planning skills in the income-achievement gap," is published in the July/August issue of the journal Child Development (84:4).

“Low-income children appear to have more difficulty accomplishing planning tasks efficiently, and this, in turn, partially explains the income-achievement gap,” says Gary Evans, the Elizabeth Lee Vincent Professor of Human Ecology at Cornell, senior author of the study with Stephen Crook ’10, M.A. ’11. “Efforts to enhance the academic performance of low-income children need to consider multiple aspects of their development, including the ability to plan in a goal-oriented manner.”

The study, which was based on Crook’s master’s thesis, used data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development, which looked at almost 1,500 children from 10 geographic sites across the United States.

Planning skills were assessed when the children were in third grade, through the widely used Tower of Hanoi game. The game starts with a stack of rings placed on a rod so that the biggest ring is at the bottom, and the smallest is on the top. Using two other rods and moving only one ring at a time without ever placing a wider ring on a smaller ring, the children have to recreate the original stack on one of the two spare rods.

The study found that the children’s performance in fifth grade could be explained, in part, by how they did on the third-grade planning task, even when taking IQ into consideration. Using income as well as math and reading scores, the study also found that the lower the household income during infancy, the worse the children’s performance on reading and math in fifth grade – replicating the well-known gap between income and achievement.

The researchers suggest several reasons why poverty may interfere with the development of good planning skills. Individuals living in low-income homes experience greater chaos in their daily lives, including more moves, school changes, family turmoil, and crowded and noisy environments, and fewer structured routines and rituals. In addition, low-income parents may be less successful at planning because of their own stress levels.

Researchers believe the group of skills called executive function, which includes planning skills, can be strengthened through interventions. Such interventions are being developed and tested for children as young as the preschool years.

The study was funded by the W.T. Grant Foundation and the John D. and Catherine T. MacArthur Foundation Network on Socioeconomic Status and Health.

By Karene Booker
Reprinted from Cornell Chronicle, February 20, 2013

Evans

Evans

Low-income children may be overweight in part because they have less access to open green space where they can play and exercise, reports a Cornell study of obesity in Europe published in Social Science and Medicine (December 2012; Vol. 75).

In the world's richest nations, growing up poor is linked to an increased risk of childhood obesity, putting disadvantaged children at higher risk for a lifetime of obesity and a host of diseases such as heart disease and diabetes later in life. One reason for this association may be inequities in access to green space, which, in turn, affect children's level of physical activity, the study found.

This is the first study to test the full model of the relationships among income, green space, physical activity and body mass index (BMI), the authors said.

The team analyzed data from a survey of European housing and health status that included 1,184 children, from 6 to 18 years of age, in eight European cities. The survey collected information on income, child body weight, height and physical activity, and observer ratings of open green space.

The researchers found that lower income children were more likely to live in neighborhoods with less open green space and that this correlated with reduced physical activity and higher BMI.

"Although our study suggests that children's differential access to space for outdoor physical activity plays some role in the prevalence of obesity, this is a very complex problem with multiple causes," said lead author Gary Evans, the Elizabeth Lee Vincent Professor of Human Ecology in the Departments of Design and Environmental Analysis and of Human Development in Cornell's College of Human Ecology.

"It is important to take an ecological perspective in thinking about the challenge of childhood obesity," he added. "The environment, personality, culture, stress, family history and economics likely all play an important role."

"Given mounting evidence that adult obesity is rooted in child biology and experience, it behooves us to better understand who, where and how people and their surroundings coalesce to influence the probability of being overweight," he said.

Evans conducted the study with McKenzie Jones-Rounds, Ph.D. '12; Goran Belojevic, Fulbright scholar and professor of medicine at the University of Belgrade; and Francoise Vermeylen, statistical consultant in the College of Human Ecology.

The research was made possible by the Fulbright Scholar Program and by the Large Analysis and Review of European Housing and Health Status (LARES), conducted by the World Health Organization.

Karene Booker is an extension support specialist in the Department of Human Development.

By Karene Booker
Reprinted from Cornell Chronicle, August 6, 2012
 
Evans

Evans

Such behavior problems in adolescence as aggression and delinquency are linked to chronic stress in early childhood, which interferes with children's development of self-control, reports a Cornell study published online in April in Developmental Psychology. 

To better understand the well-documented link between poverty and poor outcomes for children, the researchers analyzed data on risk factors, maternal responsiveness and child characteristics in 265 adolescents and their parents. 

The longitudinal study found that early exposure to the multiple risks linked with poverty -- such as poor living conditions, separation from family, single parenting and violence -- negatively affects children's self-regulatory abilities, critical skills needed to plan and control attention and behavior toward one's goals. These risks compromised children's self-regulation directly as well as indirectly when mothers could not provide sensitive, nurturing care. 

Lower self-regulation is, in turn, linked to more "externalizing" problems in adolescents, such as aggression and delinquency. "Internalizing" problems, such as depression and anxiety, were not similarly affected. 

"Our research examines the additive effects of multiple stressor exposures, rather than the typical focus on single variables such as divorce, abuse or housing," said Gary W. Evans, the Elizabeth Lee Vincent Professor of Human Ecology in Cornell's College of Human Ecology. He conducted the study with lead author Stacey N. Doan, Ph.D. '10, assistant professor of psychology at Boston University, and Thomas Fuller-Rowell, Ph.D. '10, a Robert Wood Johnson postdoctoral fellow at the University of Wisconsin-Madison. 

"One of the things that chronic stress seems to do in children is damage the body's ability to regulate the physiological response system for handling environmental demands with consequences for physical and mental health," Evans said. "By teasing apart two major subtypes of psychological well-being, internalizing and externalizing, we have shown that their predictors operate differentially." 

In other words, internalizing and externalizing problems may have different causes and be influenced by different factors. Temperament may be more predictive of internalizing problems, while environmental risk factors are more associated with externalizing problems, the authors say. 

"Overall, our results suggest that while it may not always possible to increase income or reduce all risk factors, by improving parenting skills or child self-regulation abilities we may be able to ameliorate some of the effects of poverty on children's mental health," Doan said. 

This research was funded by the W.T. Grant Foundation, the John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health, and the Robert Wood Johnson Foundation Health and Society Scholars Program. 

Karene Booker is an extension support specialist in the Department of Human Development.