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Spring 2009
Volume VII, Issue 1

JHN Spring 2009 Cover

Johns Hopkins University School of Nursing | News and Events | News |



Bench to Bedside
The Latest in Nursing Research

Money Worries Take a Toll on Older Women's Health

Lady worrying image from istockphoto.comIt has been said that every day, at every age, we do one of two things. We either build health or produce disease in ourselves. A host of genetic, biological, social, psychological, and environmental stressors affect mind and body daily. We know, for example, that socioeconomic status, race, and ethnicity have an effect on our health and wellness across a lifetime. Poverty, homelessness, and disability, too, take a toll on wellness and longevity, as do behavioral issues such as anxiety, stress, and depression.

A growing body of research suggests that late-life disability, illness, and premature mortality are the result of how an individual's body adjusts to those stresses and the cumulative effect of a lifetime of adjusting to those stressors. And, in the face of the most significant economic crisis since the Great Depression, a new stressor has been added: financial strain. In fact, according to assistant professor Sarah L. Szanton, PhD, RN, and professor and Associate Dean for Research Jerilyn K. Allen, ScD, RN, FAAN, worries about finances may outstrip socioeconomic status, ethnicity, or disability as a predictor of premature death among older women.

Reporting in the Journal of Gerontology: Social Sciences, Szanton and Allen found that, without regard to race, age, education, absolute income, insurance status, and illness, older women expressing greater levels of financial stress are 60 percent more likely to die within five years than their less-financially stressed counterparts. Their longitudinal analysis of 728 women between 70 and 79 years of age also found the impact of financial stress on the likelihood of death within five years among older African-American women to be 2.5 times higher than among similarly economically stressed older Caucasian women.

Moreover, the perception of financial strain, particularly among African-American women, may be a better predictor of mortality than actual income because, in contrast to the latter, the former focuses directly on financial adequacy. The authors caution, however, that other factors-neighborhood effects, historical health disadvantages in African Americans, etc.-may explain or contribute to the racial differences in mortality among the older women in the study. Nonetheless, the findings lead Szanton to conclude that, "Money worries can be a significant social determinant of ill health and even death in later life. If we can help address the sources of the financial strain for older adults, such as the monthly costs of multiple medications and health care, we may be able to help reduce the toll economics takes on life and health, particularly among African-American women."

In the Online Hunt for Health Information, Nurses Can Guide the Way

The Internet is changing how people of all ages gather knowledge-including knowledge about health and wellness. On an average day, as many as eight million Americans surf the world wide web for health information for themselves, family, or friends.

Laptop The majority of surfers, according to the Pew Internet and American Life Project, don't head to a health-specific site. Rather, two-thirds actually begin with a general search engine, such as Google@, Yahoo@, or They simply enter the name of a health problem or symptom-from heart disease, cancer, and poison ivy to shortness of breath, tender breasts, and hives-and press the enter key. What appears on their screens is the first page of a long list of web entries of varying medical and scientific soundness or usefulness to a lay reader. And when it comes to getting accurate information about heart health, that's where problems can start and where nurses can be of significant help, according to Associate Professor Cheryl R. Dennison, PhD, RN, ANP, FAHA. 

Writing with a colleague in the Journal of Cardiovascular Nursing, Dennison asserts that since nurses spend the greatest amount of time with patients, they can readily point patients toward the most accurate, current, and relevant disease-specific websites. Dennison notes, "We need to arm ourselves with the knowledge of key websites and web resources to share with both patients and their families. And we need to help educate them about what to look for and watch out for when surfing for health information on their own."

In the area of cardio-vascular disease, for example, websites such as those of the National Institutes of Health, the American Heart Association and the American College of Cardiology have developed patient education pages providing a broad range of accurate, medically-current information. "By stepping up to the plate to help families and patients get the accurate, online health information they need," Dennison observes, "nurses can help patients prevent some problems and can assure early identification and treatment of others."   -Teddi Fine

Nurses can both steer patients to the best health websites and also educate patients about what to look for when surfing for health information in general. For example, patients should:

  • Identify the site's sponsor. That can say a lot about the site's credibility. If it has a web address ending in ".gov", it is a government site, which lends credibility. An educational institution, such as a medical school, will have a ".edu" address end; professional organizations' sites end in ".org."
  • Avoid potentially biased information. Check if the site is sponsored by a for-profit organization. Such a site may be more focused on promoting a particular product or program than on providing patient information.
  • Look for the author's name. If an individual, look for that person's credentials in the specific health field. If an organization, ensure it is a credible organization in the field.
  • Are sources cited and credible? Does the site state where data come from? Are they credible sources, such as the CDC or a major health organization? Are the data the same as are found on other sites?
  • Is the site up to date? Check when the site was last updated. If the information is old or an answer to the question can't be found, move on.
  • Don't trust online diagnoses. If a site says it provides online diagnosis, click away quickly.
  • When in doubt, ask your nurse or other health professional.

Additional advice and information you can provide to patients on how to find and evaluate health information on the internet is available online from:

  • The National Library of Medicine (English and Spanish) (
  • The Medical Library Association (
  • A User's Guide to Finding and Evaluating Health Information on the Web (  
  • Top Ten Most Useful Consumer Health Web Sites (

Take My Breath Away: Asthma and Urban Violence

Asthma, the leading chronic illness among children and youth in the United States, is a growing problem of increasing concern to health professionals and families alike. It ranks among the top three causes of hospitalization for those younger than 15 and can contribute to lower levels of school attendance, physical activity, and fitness. Disproportionately higher rates of asthma are found among children living in urban settings, children of color, and children in families with limited economic resources.

Asthma image from istockphoto.comWhile not preventable, asthma can be controlled not only through the regular use of medication but also by avoiding potential triggers in the environment, like tobacco smoke, chemicals, mold, small animals, and some household chemicals. Avoiding these triggers is not always easy or, at times, even possible for urban families of limited income. And faculty members Joan E. Kub, PhD, APHN, BC and Arlene Butz, ScD, PNP, collaborating with colleagues at the Johns Hopkins University School of Medicine and the University of Maryland School of Pharmacy, have found an ominous environmental factor that may have an adverse effect on a child's asthma management. That factor is community violence.

Separately, violence and asthma pose risks for urban youth; together, they represent a considerable public health threat. African-American youngsters are twice as likely to die from asthma than their white counterparts, and homicide is the leading cause of death among these youth. Countless other youth and their families witness or fear neighborhood violence. Reporting in the Journal of Community Health, Kub and her colleagues describe their study of 231 urban-dwelling caregivers and their children with moderate, persistent asthma to examine family exposure to community violence, perceptions of feeling safe, and their children's asthma symptoms and treatments. Families with greater exposure to community violence reported more asthma symptoms for their children than families with less exposure to violence. Further, children who saw violence were less likely to participate in primary care asthma follow-up and management after an emergency department visit, though the reasons are not clearly understood.

Kub and Butz observe, "By finding ways to reduce environmental barriers to regular asthma care, we can help improve the quality of life and breath for urban young people with asthma and their families. Because we are at the front door of community health care, nurses are in an ideal position to help promote better preventive care." Their study's findings suggest that when tailoring asthma treatment and education, health care providers should include an assessment of potential violence exposure and tailor recommended care protocols accordingly.

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