Kaiser Permanente to Examine Role of Environmental Factors in Childhood Obesity

Kaiser Permanente's new study will focus on in utero exposures to endocrine-disrupting chemicals.

Kaiser Permanente (No. 1 on the DiversityInc Top 50 Companies list) researchers have received a major new grant from the National Institutes of Health to study how exposures to environmental chemicals during pregnancy may influence the risk of obesity and neurodevelopmental disorders in children.


Twenty percent of U.S. children are now considered obese and 15 percent have developmental impairments in physical, learning, language, or behavior areas, according to the Centers for Disease Control and Prevention.

"This research will explore how in-womb exposure to chemicals in the environment affects normal growth and development by changing the metabolism of glucose and thyroid hormones, both of which regulate infant growth and neurodevelopment," said Assiamira Ferrara, MD, PhD, principal investigator of the new study and associate director of women's and children's health at the Kaiser Permanente Northern California Division of Research.

The new Kaiser Permanente study is part of the Environmental Influences on Child Health Outcomes research program, known as ECHO. It will use existing research study cohort populations around the nation to investigate how exposure to a range of environmental factors in early development — from conception through early childhood — influences the health of children and adolescents. The proposed seven-year study will launch with $3.25 million in initial NIH funding over the first two years, with an estimated total cost of $24 million. The ECHO program encompasses a total of $144 million in NIH grants.

"Every baby should have the best opportunity to remain healthy and thrive throughout childhood," said NIH Director Francis S. Collins, MD, PhD. "ECHO will help us better understand the factors that contribute to optimal health in children."

Kaiser Permanente investigators will focus on in utero exposures to endocrine-disrupting chemicals — including perfluoroalkyl substances (or PFAs), polybrominated ethers (PBDEs), and organophosphate flame retardants (OPFRs) — which are found in many common household and personal products, plastics and furniture.

"Several of these types of chemicals are persistent in the environment and can be measured in human tissue such as blood and urine," said Lisa A. Croen, PhD, co-principal investigator and director of Kaiser Permanente's Autism Research Program.

Researchers will ask women who participated in two existing Kaiser Permanente pregnancy cohorts — the Pregnancy and Environment Lifestyle Study (funded by the National Institute of Environmental Health Sciences and led by Dr. Ferrara) and the Kaiser Permanente Research Bank Pregnancy Cohort (funded by Kaiser Permanente and led by Croen) — to join the study, along with their young children.

"The new study would not have been possible without years of previous groundwork at the Division of Research and the resources of the Kaiser Permanente Research Bank, as well as the support of clinicians throughout Kaiser Permanente in Northern California," said Tracy A. Lieu, MD, MPH, director of the Division of Research.

Dr. Ferrara noted that this research could lead to policy changes to protect children from environmental exposures in the future. "Since the use of environmental chemicals is potentially modifiable, results from the study may help to inform national environmental and public health agencies regarding policies to further regulate the production of these chemicals and inform the public regarding the restriction of their use," she said.

Concerned about increasing levels of potentially harmful chemicals in the environment, Kaiser Permanente earlier this year advanced its longstanding environmental-stewardship commitment by announcing new and ambitious goals for the year 2025 that include, among other things, aiming to increase its purchase of products and materials that meet environmental standards to 50 percent.

Co-investigators of the study include Stacey Alexeeff, PhD, Lyndsay Ammon Avalos, PhD, MPH, Monique M. Hedderson, PhDLawrence H. Kushi, ScD, and Charles P. Quesenberry, PhD, of the Kaiser Permanente Division of Research.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 550-plus staff is working on more than 250 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org or follow @KPDOR.

Kaiser Permanente: It's Men's Health Month

A look at the top health threats that face men, prevention tips and how to get additional help.

Originally Published by Kaiser Permanente.

As we celebrate Men's Health Month, it's important to stay aware of the most pressing health problems the men close to you may face, and to encourage early detection of these problems.

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Reducing Opioids Not Associated with Lower Patient Satisfaction Scores, Kaiser Permanente Study Finds

Opioid use has been a major health concern in the U.S. Opioid use increased in the United States by 300 percent from 1997 to 2010, and overdose deaths increased 200 percent from 2000 to 2014.

Originally Published by Kaiser Permanente.

A Kaiser Permanente study of nearly 2,500 patients who used high doses of opioids for at least six months showed that reducing their opioid use did not lower their satisfaction with care. The study, "Satisfaction With Care After Reducing Opioids for Chronic Pain," was published today in The American Journal of Managed Care.

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Five Questions with Dr. Ronald Copeland of Kaiser Permanente on Addressing Mental Health in the Workplace

Depression and other mental health conditions are a leading cause of workplace disability in the form of lost productivity because of how common they are–1 out of every 5 people are suffering from a mental health condition at any given time–and because they tend to occur when people are young.

Originally Published by National Organization on Disability.

Kaiser Permanente's focus on reducing mental health stigma for consumers and members also applies to its own employees. The National Organization on Disability caught up with Ron Copeland, MD, to understand how to best create a supportive and inclusive workplace for people who are experiencing a mental health condition.

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Kaiser Permanente Researchers Develop New Models for Predicting Suicide Risk

Approach may offer value to health systems and clinicians in targeting interventions to prevent suicide

Originally Published by Kaiser Permanente.

Combining data from electronic health records with results from standardized depression questionnaires better predicts suicide risk in the 90 days following either mental health specialty or primary care outpatient visits, reports a team from the Mental Health Research Network, led by Kaiser Permanente research scientists.

The study, "Predicting Suicide Attempts and Suicide Death Following Outpatient Visits Using Electronic Health Records," conducted in five Kaiser Permanente regions (Colorado, Hawaii, Oregon, California and Washington), the Henry Ford Health System in Detroit, and the HealthPartners Institute in Minneapolis, was published today in the American Journal of Psychiatry.

Combining a variety of information from the past five years of people's electronic health records and answers to questionnaires, the new models predicted suicide risk more accurately than before, according to the authors. The strongest predictors include prior suicide attempts, mental health and substance use diagnoses, medical diagnoses, psychiatric medications dispensed, inpatient or emergency room care, and scores on a standardized depression questionnaire.

Dr. Simon shares what inspired him to study mental health.

"We demonstrated that we can use electronic health record data in combination with other tools to accurately identify people at high risk for suicide attempt or suicide death," said first author Gregory E. Simon, MD, MPH, a Kaiser Permanente psychiatrist in Washington and a senior investigator at Kaiser Permanente Washington Health Research Institute.

In the 90 days following an office visit:

  • Suicide attempts and deaths among patients whose visits were in the highest 1 percent of predicted risk were 200 times more common than among those in the bottom half of predicted risk.
  • Patients with mental health specialty visits who had risk scores in the top 5 percent accounted for 43 percent of suicide attempts and 48 percent of suicide deaths.
  • Patients with primary care visits who had scores in the top 5 percent accounted for 48 percent of suicide attempts and 43 percent of suicide deaths.

This study builds on previous models in other health systems that used fewer potential predictors from patients' records. Using those models, people in the top 5 percent of risk accounted for only a quarter to a third of subsequent suicide attempts and deaths. More traditional suicide risk assessment, which relies on questionnaires or clinical interviews only, is even less accurate.

The new study involved seven large health systems serving a combined population of 8 million people in nine states. The research team examined almost 20 million visits by nearly 3 million people age 13 or older, including about 10.3 million mental health specialty visits and about 9.7 million primary care visits with mental health diagnoses. The researchers deleted information that could help identify individuals.

"It would be fair to say that the health systems in the Mental Health Research Network, which integrate care and coverage, are the best in the country for implementing suicide prevention programs," Dr. Simon said. "But we know we could do better. So several of our health systems, including Kaiser Permanente, are working to integrate prediction models into our existing processes for identifying and addressing suicide risk."

Suicide rates are increasing, with suicide accounting for nearly 45,000 deaths in the United States in 2016; 25 percent more than in 2000, according to the National Center for Health Statistics.

Other health systems can replicate this approach to risk stratification, according to Dr. Simon. Better prediction of suicide risk can inform decisions by health care providers and health systems. Such decisions include how often to follow up with patients, refer them for intensive treatment, reach out to them after missed or canceled appointments — and whether to help them create a personal safety plan and counsel them about reducing access to means of self-harm.