Thomas A Glass

• Ph.D.
• Professor at Johns Hopkins Bloomberg School of Public Health

We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 200...

Understanding contextual influences on obesity requires comparison of heterogeneous communities and concurrent assessment of multiple contextual domains. We used a theoretically-based measurement model to assess multidimensional socioeconomic and built environment factors theorized to influence childhood obesity across a diverse geography ranging f...

The obesity epidemic progresses everywhere across the globe, and implementing frequent nationwide surveys to measure the percentage of obese population is costly. Conversely, country-level food sales information can be accessed inexpensively through different suppliers on a regular basis. This study applies a methodology to predict obesity prevalen...

Background Genetics explains a small proportion of variance in body mass index at the population level. Epigenetics, commonly measured by gene methylation, holds promise for understanding obesity risk factors and mechanisms. Methods Participants were 431 adolescents aged 10?15 years. BMI z-score, waist circumference z-score, and percent body fat we...

Background: : In the 20th century, periods of macroeconomic growth have been associated with increases in population mortality. Factors that cause or mitigate this association are not well understood. Evidence suggests that social policy may buffer the deleterious impact of economic growth. We sought to explore associations between changing unempl...

Objective: Early-life antibiotic exposure, whether through prenatal or childhood antibiotic use, may contribute to increased child body mass. Associations of prenatal and childhood antibiotic use with body mass index z-score (BMIz) were evaluated at age 3 years. Methods: Electronic health records were utilized from 8,793 mothers and singleton ch...

There are currently no direct observation environmental audit tools that measure diverse aspects of the obesity-related environment efficiently and reliably in a variety of geographic settings. The goal was to develop a new instrument to reliably characterize the overall properties and features of rural, suburban, and urban settings along multiple...

Network methods have been applied to obesity to map connections between obesity-related genes, model biological feedback mechanisms and potential interventions, and to understand the spread of obesity through social networks. However, network methods have not been applied to understanding the obesogenic environment. Here, we created a network of 32...

Objective: No prior studies have evaluated depression diagnoses and cumulative antidepressant use in relation to longitudinal body mass index (BMI) trajectories in a population-representative sample. Methods: Electronic health record data from 105,163 children ages 8 to 18 years with 314,648 BMI values were used. Depression diagnoses were evalua...

Purpose: To investigate agreement and associations between parent and youth acknowledgment of home food rules, youth eating behaviors, and measures of body composition and excess weight. Methods: Parent-youth dyads (N = 413) completed the "rules for eating at home" scale (Active Where Survey) and reported dietary intake. Trained research staff o...

Background: Antibiotic use in early life has been linked to disruptions in the microbiome. Such changes can disturb immune system development. Differences have been observed in the microbiota of children with and without allergies, but there have been few studies on antibiotic use and allergic disease. Objective: We evaluated associations of ear...

Objectives: Slow afternoon cortisol decline may be a marker of aging. We hypothesize that lower socioeconomic status (SES) and African American race are associated with lower waking cortisol and slower afternoon decline. Method: Six salivary cortisol samples, collected within a 24-hr period from 566 cohort participants aged 56-78 years, were exa...

Background/Objectives Antibiotics are commonly prescribed for children. Use of antibiotics early in life has been linked to weight gain but there are no large-scale, population-based, longitudinal studies of the full age range among mainly healthy children.Subjects/Methods We used electronic health record data on 163 820 children aged 3-18 years an...

Past research has assessed the association of single community characteristics with obesity, ignoring the spatial co-occurrence of multiple community-level risk factors. We used conditional random forests (CRF), a non-parametric machine learning approach to identify the combination of community features that are most important for the prediction of...

Background: Macroeconomic growth has been shown to be associated with increases in cardiovascular (CVD) mortality. However, it is unclear whether concurrent social protection policies may mitigate the observed associations. Objective: To study if social protection expenditure modifies the association between macroeconomic growth and cardiovascular...

Socioeconomic resources, such as education, prevent disability but are not readily modifiable. We tested the hypothesis that household and neighborhood conditions, which may be modifiable, partially account for associations between education and physical capacity in a population-based sample of older adults. The National Health and Aging Trends Stu...

Objectives Longitudinal studies of the role of community context in childhood obesity are lacking. The objective of this study was to examine associations of community socio economic deprivation (CSD) with trajectories of change in body mass index (BMI) in childhood and adolescence.Methods Data came from electronic health records on 163,473 childre...

This chapter examines psychosocial intervention as a core function of the mission of social epidemiology. The focus is on experimental interventions aimed at changing some psychosocial process for the explicit purpose of modifying physical health or functioning. This includes the primary prevention of disease onset, recovery from illness, secondary...

Objectives: We present a system dynamics model that quantifies the energy imbalance gap responsible for the US adult obesity epidemic among gender and racial subpopulations. Methods: We divided the adult population into gender-race/ethnicity subpopulations and body mass index (BMI) classes. We defined transition rates between classes as a functi...

Introduction: The effects of economic crisis, like the current recession affecting Europe since 2008, on health have been widely debated. Our objective was to evaluate the effects of economic changes on mortality trends from ischemic heart disease (IHD) in Europe for the period 1980-2010. Hypothesis: We hypothesize that economic recession is associ...

Childhood attention-deficit/hyperactivity disorder (ADHD) has been associated with childhood and adult obesity, and stimulant use with delayed childhood growth, but the independent influences are unclear. No longitudinal studies have examined associations of ADHD diagnosis and stimulant use on BMI trajectories throughout childhood and adolescence....

The association between neighborhood conditions and cortisol is rarely studied in children or adolescents and has been hampered by small sample size and racial/ethnic and geographic homogeneity. Our objective was to estimate the association between neighborhood disadvantage and salivary cortisol levels in a large, geographically and racially/ethnic...

We introduce an explicit set of metrics for human activity based on high-density acceleration recordings from a hip-worn tri-axial accelerometer. These metrics are based on two concepts: (i) Time Active, a measure of the length of time when activity is distinguishable from rest and (ii) AI, a measure of the relative amplitude of activity relative t...

Purpose: Inconsistent evidence of a relationship between neighborhood disadvantage and adolescent mental health may be, in part, attributable to heterogeneity based on urban or rural residence. Using the largest nationally representative survey of US adolescent mental health available, we estimated the association between neighborhood disadvantage...

Coal abandoned mine lands (AMLs), persistent and prevalent across Pennsylvania, offer an instructive evaluation of potential contextual influences of chronic environmental contamination (CEC) on individual health. We evaluated associations between the burden of AMLs, represented by 10 contextual metrics at the community level, and individual-level...

Older adults may be more vulnerable to negative health effects from alcohol as they age. Distress and adverse neighborhood conditions that provoke distress may influence drinking behavior. Using baseline data from the Baltimore Memory Study, a cohort study of adults aged 50-70 years living in 65 Baltimore City neighborhoods, we investigated the ass...

Causal inference has a central role in public health; the determination that an association is causal indicates the possibility for intervention. We review and comment on the long-used guidelines for interpreting evidence as supporting a causal association and contrast them with the potential outcomes framework that encourages thinking in terms of...

Reichman and Teitler (Chap. 9) review the complex literature on social class and child health and find ample evidence of consistent associations, operating through multiple pathways that arise early in life and compound over the life course. They conclude, as do most such reviews, that the relationship between social class and child health is compl...

We tested the hypothesis that social engagement is associated with larger brain volumes in a cohort study of 348 older male former lead manufacturing workers (n = 305) and population-based controls (n = 43), age 48 to 82. Social engagement was measured using a summary scale derived from confirmatory factor analysis. The volumes of 20 regions of int...

Population exposure to multiple chemicals in air presents significant challenges for environmental public health. Air quality regulations distinguish criteria air pollutants (CAPs) (e.g., ozone, PM2.5) from hazardous air pollutants (HAPs)-187 chemicals which include carcinogens and others that are associated with respiratory, cardiovascular, neurol...

Background. Pennsylvania, with thousands of abandoned coal mines and miles of streams polluted with acid mine drainage, has the largest domestic coal mining burden contributing to deterioration of communities. Objectives. To evaluate contextual aspects by examining associations between coal abandoned mine lands (AML) and community measures of socio...

Recent technological advances provide researchers with a way of gathering real-time information on an individual's movement through the use of wearable devices that record acceleration. In this paper, we propose a method for identifying activity types, like walking, standing, and resting, from acceleration data. Our approach decomposes movements in...

Several methodological issues have been identified in analysis of epidemiological data to better assess the distributional effects of exposures and hypotheses about effect modification. We discuss the hierarchical mixed model and some more complex methods. Methods of capturing inequality are a second dimension of risk assessment, and simulation stu...

The central paradigm of the Environmental Protection Agency is risk assessment. We examined how differential responses across population groups could be better integrated into the environmental risk assessment process, providing tools to achieve greater equity in health status in addition to risk reduction. Such integration was difficult with parad...

Genetic factors, other exposures, individual disease states and allostatic load, psychosocial stress, and socioeconomic position all have the potential to modify the response to environmental exposures. Moreover, many of these modifiers covary with the exposure, leading to much higher risks in some subgroups. These are not theoretical concerns; rat...

Background/Aims No prior studies in children have evaluated how age may modify relations of the built and social environments with obesity outcomes, nor evaluated the range of scales and contexts over which these influences may operate. Methods We performed a cross-sectional, multilevel analysis of body mass index (BMI) data from over 47,000 Geisin...

No prior studies in children have evaluated how age may modify relationships of the built and social environments with BMI, nor evaluated the range of scales and contexts over which places may influence health. To systematically evaluate associations of 33 environmental measures in three domains (land use, physical activity, and social environments...

The social environment may influence cognitive function in aging. However, to our knowledge, no studies have investigated whether specific genes modify this association. To examine whether the apolipoprotein E (APOE) ε4 allele modifies the association of neighborhood psychosocial hazards and cognitive function. A cross-sectional analysis. The Balti...

This paper analyzes recently released data from the 2002 National Air Toxics Assessment. This assessment incorporates data assembled in accordance the Clean Air Act concerning emissions of chemicals officially classified as hazardous pollutants (HAPs). The 2002 assessment includes modeled ambient air concentrations of 132 chemicals and associated r...

The National Research Council's Committee on Improving Risk Analysis recently called for incorporating nonchemical stressors into cumulative risk assessment to improve risk science and better protect vulnerable populations. Nonchemical stressors, such as neighborhood poverty and socioeconomic deprivation, are critical to consider in risk assessment...

Neighborhood socioeconomic environment may be a determinant of injection drug use cessation. The authors used data from a prospective cohort study of Baltimore City, Maryland, injection drug users assessed between 1990 and 2006. The study examined the relation between living in a poorer neighborhood and the probability of injection cessation among...

Rates of sexually transmitted infections (STIs) are strongly associated with neighborhood poverty; however, the mechanisms responsible for this association remain unclear. Using a population-based study of sexual networks among urban African American adolescents, we tested the hypothesis that poverty, unemployment, and the sex ratio drive STI rates...

Background: The current population of older Americans has accumulated substantial lifetime lead doses, which raises concern about the possibility of adverse cognitive outcomes. We evaluated whether cumulative lead dose from environmental exposures is associated with cognitive function and decline, and whether such effects are persistent, reversible...

Background: Inadequate availability of healthy foods may be a barrier to achieving recommended diets. Objective: The objective was to study the association between the directly measured availability of healthy foods and diet quality. Design: We conducted a cross-sectional study of 759 participants from the Baltimore site of the Multi-Ethnic Study o...

We completed a systematic search of the epidemiologic literature on built environment and obesity and identified 63 relevant papers, which were then evaluated for the quality of between-study evidence. We were able to classify studies into one of two primary approaches for defining place and corresponding geographic areas of influence: those based...

A population-based sexual network study was used to identify sexual network structures associated with sexually transmitted infection (STI) risk, and to evaluate the degree to which the use of network-level data furthers the understanding of STI risk. Participants (n = 655) were from the baseline and 12-month follow-up waves of a 2001-2 population-...

Drawing from collective efficacy and social disorganization theories, we developed and validated measures of neighborhood-level social processes. Data came from 2 large, population-based cohort studies of urban-dwelling older adults, the Chicago Neighborhood and Disability Study (CNDS, n = 3,882) and the Baltimore Memory Study (BMS, n = 1,140). Dat...

Before the 1970s, today's older Americans were exposed to high levels of lead in the environment. The authors previously reported that lifetime cumulative lead dose was associated with lower cognitive test performance in older adults. Experiments suggest that environmental stress may intensify the detrimental influence of lead. No large, population...

There is little empirical translation of multimodal cognitive activity programs in "real-world" community-based settings. This study sought to demonstrate in a short-term pilot randomized trial that such an activity program improves components of cognition critical to independent function among sedentary older adults at greatest risk. We randomized...

Currently, one-third of children and two-thirds of adults in the United States are overweight or obese; this trend has persisted for the last decade and shows no sign of abatement.1,2 Obesity tracks from childhood into adulthood, with unfolding and serious medical and economic consequences throughout the life course. One recent estimate suggests th...

Sexual networks play an important role in the transmission of sexually transmitted infections (STIs) and HIV. However, because of the challenges of collecting network data, relatively few empirical reports exist about the structure of sexual networks in general population samples. This study describes the structure of the sexual networks of a house...

Differential access to healthy foods may contribute to racial and economic health disparities. The availability of healthy foods has rarely been directly measured in a systematic fashion. This study examines the associations among the availability of healthy foods and racial and income neighborhood composition. A cross-sectional study was conducted...

We examined associations between cardiovascular disease and neighborhood psychosocial hazards, such as violent crime, abandoned buildings, and signs of incivility, to evaluate whether features of place are associated with older adult health. We analyzed first-visit data from the Baltimore Memory Study of randomly selected residents aged 50 to 70 ye...

Background: Elevated cortisol indicates stress and may be a risk factor for cognitive decline in aging. Genetic factors may influence individual vulnerability to the adverse effects of stress on cognitive function in aging. The authors investigated whether the gene-environment interaction between the genotype for the apolipoprotein E gene (APOE) an...

We sought to identify predictors of lead concentrations in the blood, tibias, and patellae of older adults and to describe differences by gender, race/ethnicity, and other factors that can influence lead toxicokinetics and, thus modify health effects. Participants aged 50 to 70 years (N=1140) were randomly identified from selected neighborhoods in...

The objective of this study was to evaluate the relations between bone mineral density (BMD) and lead in blood, tibia, and patella and to investigate how BMD modifies these lead biomarkers in older women. In this study, we used cross-sectional analysis. We studied 112 women, 50-70 years of age, including both whites and African Americans, residing...

Little is known about the possible effects of social resources on stroke survivors' level and change in cognitive outcomes. Understanding this association may help us identify strategies to improve stroke recovery and help elucidate the etiology of dementia. We examined the relationship of social ties and social support to cognitive function and co...

Frailty is a common clinical syndrome in older adults that carries an increased risk for poor health outcomes. Little is known about the behavioral antecedents of frailty. In this study, the authors hypothesized that constriction of life space identifies older adults at risk for frailty, potentially a marker of already-decreased physiologic reserve...

Recently several researchers have hypothesized pathways that attempt to explain how the sociobehavioral environment is related to health and health disparities (Acheson, 1998; Adler & Ostrove, 1999; Baum, Garofalo, & Yali, 1999; Birch, 1999; Capitman, Bhalotra, Calderon-Rosado, & Gibbons, 2003; Fuhrer et al., 2002; Macintyre, 1997; Macintyre, Ellaw...

We examined the relationships between the National Institute of Health Stroke Scale (NIHSS) and physical, cognitive, and social participation outcomes across subpopulations of stroke survivors on the basis of cortical involvement and lesion lateralization. Families in Recovery from Stroke Trial participants were classified with respect to lesion la...

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Objective : To evaluate the impact of a psychosocial intervention on instrumental activities of daily living, physical performance, cognition and mortality after stroke. Design : A randomized clinical trial. Setting : Patients were recruited from hospitals and rehabilitation centres; the intervention took place in subjects' homes. Subjects : Two-hu...

Disentangling the myriad determinants of disease, within the context of urban health or health disparities, requires a transdisciplinary approach. Transdisciplinary approaches draw on concepts from multiple scientific disciplines to develop a novel, integrated perspective from which to conduct scientific investigation. Most historic and contemporar...

Although there is substantial evidence of declining prevalence of disability among the older population during the late 1980s and 1990s, evidence on trends in the underlying dynamics of disability is lacking. For this study, we estimated models of transitions between discrete disability and vital states that incorporated simple linear time trends....

The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues a...

Obesity has reached epidemic proportions. Although its causes are not well understood, its increasing prevalence is not likely to be due to genetic factors or underlying biology. This has led to interest in the role of environmental factors, although few studies have focused on the role of the social environment. This study investigated whether nei...

The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues a...

Physical activity is important for maintaining functional independence of older persons, especially for those with existing functional deficits. Since such deficits may pose barriers to activity, it would be instructive to examine activity patterns in relation to specific types of deficits to determine the amount and type of physical activity older...

To determine if long-term exposure to high levels of lead in the environment is associated with decrements in cognitive ability in older Americans. We completed a cross-sectional analysis using multiple linear regression to evaluate associations of recent (in blood) and cumulative (in tibia) lead dose with cognitive function in 991 sociodemographic...

Objectives: The purpose is to investigate whether social engagement protects against depressive symptoms in older adults. Method: Three waves of data from a representative cohort study of community-dwelling adults aged 65 years and above from the New Haven Established Populations for the Epidemiologic Study of the Elderly are examined using random...

Engagement in social and generative activities has benefits for the well-being of older adults; hence, methods for broadly engaging them in such activities are desired. Experience Corps Baltimore, a social model for health promotion for older adult volunteers in public schools, offers insight to such successful recruitment and retention. We report...

The objective of this study was to describe the distribution and predictors of blood mercury levels in an adult population. This was a cross-sectional analysis of first-visit data (2001-2002) on a random sample of 474 subjects from the Baltimore Memory Study. After adjustment for race/ethnicity, education, assets, and diabetes, persons in the highe...

The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the "stream of causation" metaphor along two axes: t...

Few studies have compared associations of blood lead and tibia lead with blood pressure and hypertension, and associations have differed in samples with occupational exposure compared with those with mainly environmental lead exposure. African Americans have been underrepresented in prior studies. The authors performed a cross-sectional analysis of...

Due to its cardiovascular benefits, fish consumption is widely encouraged among older Americans. However, this fast-growing population is at increased risk of cognitive impairment and may be particularly sensitive to methylmercury, a neurotoxicant found in fish. To describe associations of blood mercury levels with neurobehavioral test scores in an...

To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons. A community-based, prospective, observational study. Participant data from the Cardiovascular Health Study. From the overall sample of 5,888 subjects, three types of participants were identified for this study...

Among 407 New England Medical Center Posterior Circulation Registry (NEMC-PCR) patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs before strokes, and 16% had only posterior circulation TIAs. Embolism was the commonest stroke mechanism accounting for 40% of cases (24% cardiac origin, 14% arterial origin, 2% had potenti...

To assess the relations between homocysteine levels and neurobehavioral test scores representing a broad range of cognitive domains in a population-based study of older adults. Cross-sectional analysis of first-visit data of subjects in the Baltimore Memory Study, a longitudinal study. Setting: Specific neighborhoods in Baltimore. Participants were...

Lead and homocysteine are both associated with cardiovascular disease and cognitive dysfunction. We evaluated the relations among blood lead, tibia lead, and homocysteine levels by cross-sectional analysis of data among subjects in the Baltimore Memory Study, a longitudinal study of 1,140 randomly selected residents in Baltimore, Maryland, who were...

Reduced length of stays for inpatient rehabilitation challenge psychologists to develop new models of psychosocial service. Crisis intervention is a useful model that can be adapted to meet the needs of stroke patients and their families. The authors describe a 1-session intervention, utilizing crisis intervention and psychoeducational and cognitiv...

Social support and family ties are strong predictors of functional recovery after stroke; however, development of successful psychosocial intervention programs has been difficult. This study examined whether a family-systems intervention designed to influence social support and self-efficacy affects functional outcome in older stroke patients. Two...

Among 407 New England Medical Center Posterior Circulation registry patients, 59% had strokes without transient ischemic attacks (TIAs), 24% had TIAs then strokes, and 16% had only TIAs. Embolism was the commonest stroke mechanism (40% of patients including 24% cardiac origin, 14% intraarterial, 2% cardiac and arterial sources). In 32% large artery...

The Baltimore Memory Study is a cohort study of the multilevel determinants of cognitive decline in 50-70-year-old randomly selected residents of specific city neighborhoods. Prior studies have demonstrated that cognitive function differs by race/ethnicity, with lower scores in minorities than in whites, but the underlying basis for these differenc...

This report evaluates whether a program for older volunteers, designed for both generativity and health promotion, leads to short-term improvements in multiple behavioral risk factors and positive effects on intermediary risk factors for disability and other morbidities. The Experience Corps(R) places older volunteers in public elementary schools i...

This article reports on the short-term impact of a school-based program using older adult volunteers and aimed at improved academic achievement and reduced disruptive classroom behavior in urban elementary school students. The Experience Corps Baltimore (Maryland) program places a critical mass of older adult volunteers, serving 15 hours or more pe...

Population aging portends a crisis of resources and values. Desired solutions could include intergenerational strategies to harness the untapped potential of older adults to address societal needs and to generate health improvements for older adults. Despite the desire of many older adults to remain socially engaged and productive, the creation of...

The Experience Corps program was designed to harness the social capital of an aging society to improve outcomes for public elementary schools. The objectives of this article are (1) to model the cost-effectiveness of the Experience Corps Baltimore using data from a pilot randomized trial, including costs, older adults' health status, and quality of...