We call upon public officials to launch preventive health strategies that can help prevent and lessen the severity of disease – and to advance concerted research efforts that can expedite the process of bringing best preventive health practices to the public.

Examples of Preventive Health Initiatives to Enhance Immunity, Reduce Illness and Death Due to COVID-19, and Accelerate the Pace of Social and Economic Renewal

Medical Disclaimer: All information, material and content of this website is for informational purposes only, and are not intended to be, should not be interpreted as, or used as a substitute for, the consultation, diagnosis, advice and/or medical treatment of a qualified physician or healthcare provider, nor as recommendation for a specific test, doctor, care provider, procedure, treatment plan, product, or course of action.

One: Correct Vitamin D deficiency through a public information and case-appropriate supplementation campaign.

Widely available empirical data reveals that Vitamin D deficiency is extremely widespread among many populations, including those with dark skin pigmentation, those living in winter climes, those living in urban settings where sunlight is blocked, and those living mostly indoors.

Meta-analysis of existing research shows that among those who are markedly deficient in Vitamin D, incidence and severity of various respiratory infections is reduced by 70% by daily or weekly supplementation, and that the safety profile of such supplementation is extremely strong.

Said conversely, failing to provide adequate daily or weekly supplementation for those who are severely deficient more than triples the incidence and severity of respiratory infections. Significant elevation in co-morbidity factors such as COPD, pneumonia, and Acute Respiratory Distress Syndrome due to Vitamin D deficiency are also well-established.

Several recent studies show that the impact on COVID-19 outcomes may be at least as profound. One such study, while preliminary in its findings, found the risk of COVID-19 patients requiring Intensive Care is 20-fold greater in those who are Vitamin D deficient. Although further research is required to determine the exact impact on COVID, Vitamin D sufficiency represents a safe, affordable first-line immune response. 40% of Europeans, 42% of Americans and 82% of African Americans are deficient, and deficiency is higher still in regions, seasons, and populations that get less sunlight. (For specific information on Vitamin D supplementation, dosage, safety and sunlight click here.) The safety profile of case-appropriate supplementation is well established, and waiting for confirmative data specific to COVID-19 carries high costs in human life, health and well-being.

(For a more comprehensive analysis of Vitamin D efficacy, dosage, and method of delivery, see the Vitamin D page of this website: https://thehealthcampaign.org/vitamind)

Two: Distribute a Nutrition and Supplementation Guide for Enhancing Immune Function

As with Vitamin D, empirical evidence is strong for the role that specific nutritional choices and select vitamins and supplements can play in reducing the incidence, duration and severity of various respiratory infections.

Several controlled trials and observational studies point to especially substantial reductions conferred by short-term high-dose Vitamin C at the first sign of infection – in some cases as much as 85%, as well as to reduction in the incidence of pneumonia specifically.

Supplementation with zinc, probiotics, and other essential nutrients has also demonstrated marked improvements, as have basics of immune-friendly nutrition. The benefits of these interventions should be analyzed, summarized and widely disseminated for public benefit. Additionally, the cumulative effects of beneficial foods, nutrients and supplements along with the benefits of other PHI’s listed below should be prioritized for further research.

Three: Reduce Ambient, Localized, and Immediate-Vicinity Pollutants

As health officials and policymakers, you are no doubt well aware of the profound health impacts of various forms of air pollution. The World Health Organization estimates that roughly seven million people around the globe die annually from air pollution. While heart disease and stroke are the most widespread causes of air pollution-related mortality, COPD and other respiratory conditions account for significant deaths as well. Moreover, evidence is mounting that air pollution contributes significantly to the incidence and severity of respiratory infection generally, and COVID-19 in particular.

Various studies have demonstrated increases in respiratory infection of both short- term and long-term exposure to air pollution. And at least two recent studies focusing on Europe and the United States respectively have shown remarkably strong correlations between air quality and health outcomes. Even a small increase in particulate pollution correlates with significant increases in COVID mortality across the United States, while 78% of deaths due to COVID in Europe are in areas with the very highest levels of air pollution.

This clearly raises important public policy questions related to energy and air quality, but there are also smaller scale air quality measures that can be taken immediately to reduce the rate of serious illness, hospitalization, Acute Respiratory Distress Syndrome, and death due to COVID-19.

We proposed the following immediately actionable steps:

First, unless used as a matter of true economic necessity, solid fuel of the kind used in wood stoves and fireplaces should be prohibited. Use of solid fuel quickly and dramatically increases particulate pollution, makes it more likely that people will become ill with respiratory infections, and makes it more likely that they will be hospitalized or will die if they do become ill.

Second, leaf blowers and gas-powered outdoor equipment should be prohibited. Despite their diminutive size, leaf blowers and small gasoline-powered equipment of all kinds have outsized pollution impacts.

In the State of California, for example, the California Air Resources Board estimates that emissions from landscaping equipment is now surpassing automobile emissions. A single hour of leafblower use produces the emissions equivalent of 1100 miles of automobile travel, and even if battery-powered, the hurricane force winds that they produce spread unburnt fuel, road dust, particulates, toxins, allergens and irritants that produce inflammation that can increase vulnerability to and severity of respiratory infection.

Third, a guide of simple measures for reducing indoor air pollution should be produced and made widely available to the public. Simple cleaning strategies, changing an HVAC filter where there is central heating, leaving the HVAC fan running with or without heat, using a low cost HEPA filters in key areas of the home, avoiding VOC-intensive products and other respiratory irritants can all have beneficial impacts. These are measures that can be practiced now to reduce the incidence and severity of respiratory infection.

Four: Initiate A Daily Life “Minutes of Movement” Program

While the critical importance of physical movement for health may be universally understood, the way the issue is framed is often counterproductive. “Exercise” is typically seen as a special activity apart from life — a means to look good, avoid illness, or attain some external metric of “getting in shape.”

Each of these three factors – segmentation from daily life, extrinsic rather than intrinsic motivation, and a deferred and static goal – actually make exercise harder to accomplish. Policymakers can guide this critical aspect of public health in new directions, in part by deemphasizing common notions of exercise in favor of “healthy movement” that feels good.

To focus on intrinsic motivation and the pleasures of healthy living is not to downplay the positive health impact of movement. On the contrary it points to the significant and often unrecognized benefits of even moderate levels of movement, especially for those who were previously sedentary.

Among the empirical sources cited below are findings that modest levels of activity for those who have not been physically active reduces the incidence of respiratory infection by 50%, and that the onset of this benefit begins quickly. Another study shows that among previously sedentary individuals, replacing thirty minutes of sitting time with light activity reduces mortality risk by 14%.

By helping to construct a new narrative around movement that better and more inclusively weaves it into the fabric of daily life, public officials can leverage the benefits of this simple health factor in major ways.

We therefore call upon you to create a “Minutes of Movement” initiative that includes a) an educational component for members of the public, and b) a movement-interval health-and safety standard in typically sedentary workplaces that can remind employees to regularly move, ideally to get outside when possible.

By placing this and other simple, low-cost PHI’s at the forefront of your directives over the coming weeks and months, the process of “restarting the economy” can be more than a cautionary tale of sanitation and facemasks. It can be a key transitional moment toward a more sustainable health and economic future.

Five: Launch a Sleep Hygiene Educational Outreach Program

It will come as no surprise that sleep deprivation increases the likelihood of respiratory illness. The University of California, San Francisco, conducted a study that found that people who sleep less than six hours per night over the course of a week are 4.2 times more likely to catch a cold than those who got more than seven hours per night. Short sleep, concluded researchers, was the single most important factor they could identify that determined susceptibility to colds.

Poor sleep impairs immunity generally; this is well known and so obvious it may hardly seem worth mentioning. Why then aren’t even the basics — let alone the less commonly known subtleties of sleep hygiene – placed at the forefront of public health messages? Or even in the vast majority of doctor’s offices? Why isn’t every physician trained in sleep hygiene (or for that matter in all the other first-line interventions that are discussed in this document?) Yes, doctors can prescribe sleep medications that may be useful in some cases – but are also associated with significant reductions in life expectancy. They can prescribe sleep studies and cpap machines at thousands of dollars in patient expense. But room temperature? Air circulation? Sleep ergonomics? Variations among magnesium or glycine supplements? Strategies for cooling body core temperature and warming extremities? Minimizing visual and central nervous system effects of electronic equipment? Adjusting light temperature in the morning and evening? And so on.

Why can’t just one hour in the life of an insomniac be dedicated to learning and implementing these basics? Why can’t one week in the training of any medical professional include this? Why can’t this receive funding commensurate with its impact? And what about the other major dimension of the same issue?  What about stress management?

 

Six: Launch a Multidimensional Stress-Management Initiative

This initiative should be focused on evidence-based approaches, including mindfulness, empathy, creativity and positive emotional affect – all of which have been shown to markedly enhance immune response to respiratory viruses, and to improve other major health outcomes.

In one recent example, a randomized control trial on the effects of mindfulness-based stress reduction (MBSR) found a 33%, 43%, and 60% proportional reductions in the incidence, duration and global severity of acute respiratory infection. A plethora of other studies find diverse, powerful, and positive health outcomes resulting from non-pharmaceutical stress-management interventions.

Additionally, as the field of integrative wellness continues to evolve, new approaches that incorporate multiple modalities are opening the possibility of even greater outcomes. As one example, there are wellness and leadership programs that now incorporate mindfulness, limbic self-regulation (a psychological term that relates to emotional well-being) performance psychology, and social integration to expand the impact of more conventional practices such as MSBR.

If we are to tap the substantial power of these practices for public health, it will be necessary to outgrow irrational biases that may persist even to this day in relation to psychological work and “personal growth.” Physical and emotional wellbeing are powerfully, demonstrably intersectional. In the wake of the COVID-19 pandemic, this dynamic is playing itself out in detrimental ways. Anxiety about the disease, sudden economic dislocation, social isolation, and the physical constraints of lockdown that can strain personal relationships (evidenced, for example, by increased rates of domestic violence) all add up to a brewing mental health crisis that may ultimately come to rival the severity of COVID-19 itself.

To be clear, physical and emotional illness do not necessarily “cause” each other. But they do influence each other in ways that can spiral, both individually and collectively. On the other hand, the same is true of physical and emotional wellbeing. As policymakers, you have a chance to lead on these issues. Many forward-looking corporations (Cisco, Salesforce, Google and others) have robust integrative wellness programs that treat people as whole human beings rather than machines that break and suddenly have to be fixed. Hospitals and health organizations are also beginning to catch up. Public agencies may in some cases also have such programs, but they are typically marginal and scarcely funded.

We call upon you to lead out of this archaic morass, to chart a course that will put wellness first: with equivalent focus in policy, communication to the public, and equivalent financial resources given to integrative wellness as is given to the treatment of disease.

Seven: Government Support For Wellness Professionals and Community Organizations

The objection may be raised that the responsibility for leadership in these areas should not fall exclusively upon the shoulders of public officials. We agree with this assessment. Leadership will have to come from different quarters and should include people with diverse backgrounds and skillsets.

Especially in the wake of the current medical and economic crisis, the role of independent wellness providers, health supportive community organizations – small businesses as well as non-profits – will be indispensable to public health, both physical and emotional. It is for these reasons that we have proposed specific support measures for wellness activities and providers as well as non-profit organizations. The petition for those measures can be found at https://supportwellness.org/

Select Sources

(A large number of additional sources are being compiled for transfer to this summary. Some of these can be found on the Empirical Resources page of this website: https://thehealthcampaign.org/empiricalsources)

Vitamin D Supplementation

  1. Martineau, A. R., Jolliffe, D. A., Hooper, R. L., Greenberg, L., Aloia, J. F., Bergman, P., Dubnov-Raz, G., Esposito, S., Ganmaa, D., Ginde, A. A., Goodall, E. C., Grant, C. C., Griffiths, C. J., Janssens, W., Laaksi, Manaseki-Holland, S., Mauger, D., Murdoch, D. R., Neale, R., Rees, J. R., … Camargo, C. A., Jr (2017). Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ (Clinical research ed.), 356, i6583. https://doi.org/10.1136/bmj.i6583
  2. Forrest, K. Y., & Stuhldreher, W. L. (2011). Prevalence and correlates of vitamin D deficiency in US adults. Nutrition Research, 31(1), 48–54. doi: 10.1016/j.nutres.2010.12.001
  3. Cannell, J. J., Vieth, R., Umhau, J. C., Holick, M. F., Grant, W. B., Madronich, S., Garland, C. F., & Giovannucci, E. (2006). Epidemic influenza and vitamin D. Epidemiology and infection, 134(6), 1129–1140. https://doi.org/10.1017/S0950268806007175  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870528/
  4. Johnson, K. (2008). Many elderly, particularly in nursing homes, lack Vitamin D. Family Practice News. doi:10.1016/S0300-7073(08)70610-8
  5. Yenupotula, Sri et al. (2008). Vitamin D Deficiency in Nursing Home Residents. Journal of the American Medical Directors Association, Volume 9, Issue 3, B29. DOI: https://doi.org/10.1016/j.jamda.2007.12.048
  6. Denio, A. (2012). Vitamin D Deficiency: The Silent Epidemic of the Elderly. The International Society for Clinical Densitometry. https://www.iscd.org/publications/osteoflash/vitamin-d-deficiency-the-silent-epidemic-of-the-elderly/
  7. Office of Dietary Supplements – Vitamin D. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/VitaminD-Consumer/#h3
  8. Mitsuyoshi Urashima, Takaaki Segawa, Minoru Okazaki, Mana Kurihara, Yasuyuki Wada, Hiroyuki Ida (2010). Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. The American Journal of Clinical Nutrition, Volume 91, Issue 5, May 2010.   https://doi.org/10.3945/ajcn.2009.29094
  9. Zhu, M., Wang, T., Wang, C., & Ji, Y. (2016). The association between vitamin D and COPD risk, severity, and exacerbation: an updated systematic review and meta-analysis. International journal of chronic obstructive pulmonary disease, 11, 2597–2607. https://doi.org/10.2147/COPD.S101382  https://www.ncbi.nlm.nih.gov/pubmed/27799758
  10. Anglin, R. E. S., Samaan, Z., Walter, S. D., & Mcdonald, S. D. (2013). Vitamin D deficiency and depression in adults: systematic review and meta-analysis. British Journal of Psychiatry, 202(2), 100–107. doi: 10.1192/bjp.bp.111.106666  https://www.ncbi.nlm.nih.gov/pubmed/23377209
  11. Alshishtawy M. M. (2012). Vitamin D Deficiency: This clandestine endemic disease is veiled no more. Sultan Qaboos University medical journal, 12(2), 140–152. https://doi.org/10.12816/0003106
  12.  Marcinowska-Suchowierska, E, et al. “Vitamin D Toxicity-A Clinical Perspective.” Frontiers in Endocrinology, 2018. Gale Academic OneFile, https://www.ncbi.nlm.nih.gov/pubmed/30294301/
  13. Office of Dietary Supplements – Vitamin D. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
  14. Arnarson, A, PhD. (2017). Is Vitamin D Harmful without Vitamin K? Healthline. https://www.healthline.com/nutrition/vitamin-d-and-vitamin-k#section4
  15. Marcinowska-Suchowierska, E., Kupisz-Urbańska, M., Łukaszkiewicz, J., Płudowski, P., & Jones, G. (2018). Vitamin D Toxicity-A Clinical Perspective. Frontiers in endocrinology, 9, 550. https://doi.org/10.3389/fendo.2018.00550
  16. Hoel, D. G., Berwick, M., de Gruijl, F. R., & Holick, M. F. (2016). The risks and benefits of sun exposure 2016. Dermato-endocrinology, 8(1), e1248325. https://doi.org/10.1080/19381980.2016.1248325
  17. Raman, R., MS, RD. (2018). How to Safely Get Vitamin D from Sunlight.  Healthline. https://www.healthline.com/nutrition/vitamin-d-from-sun#amount-of-skin
  18. Moan, J., Dahlback, A., & Porojnicu, A. C. (2008). At what time should one go out in the sun?. Advances in experimental medicine and biology, 624, 86–88. https://doi.org/10.1007/978-0-387-77574-6_7
  19. Calton, E. K., Keane, K. N., Newsholme, P., & Soares, M. J. (2015). The Impact of Vitamin D Levels on Inflammatory Status: A Systematic Review of Immune Cell Studies. PloS one, 10(11), e0141770. https://doi.org/10.1371/journal.pone.0141770
  20. Adegoke, S. A., Smith, O. S., Adekile, A. D., & Figueiredo, M. S. (2017). Relationship between serum 25-hydroxyvitamin D and inflammatory cytokines in paediatric sickle cell disease. Cytokine, 96, 87–93. https://doi.org/10.1016/j.cyto.2017.03.010
  21. Verway, M., Bouttier, M., Wang, T. T., Carrier, M., Calderon, M., An, B. S., Devemy, E., McIntosh, F., Divangahi, M., Behr, M. A., & White, J. H. (2013). Vitamin D induces interleukin-1β expression: paracrine macrophage epithelial signaling controls M. tuberculosis infection. PLoS pathogens, 9(6), e1003407. https://doi.org/10.1371/journal.ppat.1003407
  22. Dancer RCA, Parekh D, Lax S, et al. (2015). Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax 70:617-624.

Nutrition and Other Dietary Supplements

  1. Raposo SE, Fondell E, Ström P, et al. Intake of vitamin C, vitamin E, selenium, zinc and polyunsaturated fatty acids and upper respiratory tract infection-a prospective cohort study. Eur J Clin Nutr. 2017;71(4):450–457. doi:10.1038/ejcn.2016.261
  2. Mousa H. A. (2017). Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. Journal of evidence-based complementary & alternative medicine, 22(1), 166–174. https://doi.org/10.1177/2156587216641831

Zinc:

  1. Prasad A. S. (2009). Zinc: role in immunity, oxidative stress and chronic inflammation. Current opinion in clinical nutrition and metabolic care, 12(6), 646–652. https://doi.org/10.1097/MCO.0b013e3283312956
  2. Wang L, Song Y. Efficacy of zinc given as an adjunct to the treatment of severe pneumonia: A meta-analysis of randomized, double-blind and placebo-controlled trials. Clin Respir J. 2018;12(3):857–864. doi:10.1111/crj.12646

Vitamin C:

  1. Nahas, Richard & Balla, Agneta. (2011). Complementary and alternative medicine for prevention and treatment of the common cold. Canadian family physician Médecin de famille canadien. 57. 31-6.
  2. Office of Dietary Supplements – Vitamin C. (n.d.). Retrieved from https://ods.od.nih.gov/factsheets/VitaminC-HealthProfessional/
  3. Gorton, H. and Jarvis, K. (1999). The effectiveness of vitamin C in preventing and relieving the symptoms of virus-induced respiratory infections. Journal of Manipulative Physiological Therapeutics, 22(3) 530-533. DOI:https://doi.org/10.1016/S0161-4754(99)70005-9
  4. Hemilä, H. (2004). Vitamin C supplementation and respiratory infections: a systematic review. Military Medicine, (169)11:920.
  5. Hemilä, H and Douglas RM. (1999). Vitamin C and acute respiratory infections. Int J Tuberc Lung Dis., (9)756-61.
  6. Hemilä, H. (1997). Vitamin C intake and susceptibility to pneumonia. Pediatr Infect Dis J.,(9):836-7. PMID: 9306475 DOI: 10.1097/00006454-199709000-00003

Garlic:

  1. Percival S. S. (2016). Aged Garlic Extract Modifies Human Immunity. The Journal of nutrition, 146(2), 433S–436S. https://doi.org/10.3945/jn.115.210427
  2. Bielory L. (2004). Complementary and alternative interventions in asthma, allergy, and immunology. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology, 93(2 Suppl 1), S45–S54. https://doi.org/10.1016/s1081-1206(10)61486-x

Selenium:

  1. Avery, J. C., & Hoffmann, P. R. (2018). Selenium, Selenoproteins, and Immunity. Nutrients, 10(9), 1203. https://doi.org/10.3390/nu10091203
  2. Hoffmann, P. R., & Berry, M. J. (2008). The influence of selenium on immune responses. Molecular nutrition & food research, 52(11), 1273–1280. https://doi.org/10.1002/mnfr.200700330
  3. Huang, Z., Rose, A. H., & Hoffmann, P. R. (2012). The role of selenium in inflammation and immunity: from molecular mechanisms to therapeutic opportunities. Antioxidants & redox signaling, 16(7), 705–743. https://doi.org/10.1089/ars.2011.4145
  4. Steinbrenner, H., Al-Quraishy, S., Dkhil, M. A., Wunderlich, F., & Sies, H. (2015). Dietary selenium in adjuvant therapy of viral and bacterial infections. Advances in nutrition (Bethesda, Md.), 6(1), 73–82. https://doi.org/10.3945/an.114.007575

Echinacea:

  1. Sperber, S. J., Shah, L. P., Gilbert, R. D., Ritchey, T. W., & Monto, A. S. (2004). Echinacea purpurea for prevention of experimental rhinovirus colds. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 38(10), 1367–1371. https://doi.org/10.1086/386324
  2. Hudson, J., & Vimalanathan, S. (2011). Echinacea—A Source of Potent Antivirals for Respiratory Virus Infections. Pharmaceuticals, 4(7), 1019–1031. https://doi.org/10.3390/ph4071019
  3. Hudson J. B. (2012). Applications of the phytomedicine Echinacea purpurea (Purple Coneflower) in infectious diseases. Journal of biomedicine & biotechnology, 2012, 769896. https://doi.org/10.1155/2012/769896

Probiotics:

  1. Pu, F., Guo, Y., Li, M., Zhu, H., Wang, S., Shen, X., He, M., Huang, C., & He, F. (2017). Yogurt supplemented with probiotics can protect the healthy elderly from respiratory infections: A randomized controlled open-label trial. Clinical interventions in aging, 12, 1223–1231. https://doi.org/10.2147/CIA.S141518
  2. Lenoir-Wijnkoop, I., Gerlier, L., Roy, D., & Reid, G. (2016). The Clinical and Economic Impact of Probiotics Consumption on Respiratory Tract Infections: Projections for Canada. PloS one, 11(11), e0166232. https://doi.org/10.1371/journal.pone.0166232
  3. Lehtoranta, L., Pitkäranta, A., & Korpela, R. (2014). Probiotics in respiratory virus infections. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 33(8), 1289–1302. https://doi.org/10.1007/s10096-014-2086-y

Air Quality

  1. Ogen, Y. (2020). Assessing nitrogen dioxide (NO2) levels as a contributing factor to coronavirus (COVID-19) fatality. Science of The Total Environment, 726. https://doi.org/10.1016/j.scitotenv.2020.138605
  2. Xiao Wu, Rachel C. Nethery, Benjamin M. Sabath, Danielle Braun, Francesca Dominici. (2020). Exposure to air pollution and COVID-19 mortality in the United States. medRxiv. Doi: https://doi.org/10.1101/2020.04.05.20054502
  3. Bourouiba, L. (2020). Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19. JAMA. doi:10.1001/jama.2020.4756
  4. Guan, W., Liang, W., Zhao, Y., Liang, H., Chen, Z., Li, Y., … He, X. (2020). Comorbidity and its impact on 1590 patients with Covid-19 in China: A Nationwide Analysis. European Respiratory Journal. DOI: 10.1183/13993003.00547-2020
  5. Stanković, A., Nikolić, M., & Arandjelović, M. (2011). Effects of indoor air pollution on respiratory symptoms of non-smoking women in Niš, Serbia. Multidisciplinary respiratory medicine, 6(6), 351–355. https://doi.org/10.1186/2049-6958-6-6-351
  6. Cohen, A. J., Brauer, M., Burnett, R., Anderson, H. R., Frostad, J., Estep, K., Balakrishnan, K., Brunekreef, B., Dandona, L., Dandona, R., Feigin, V., Freedman, G., Hubbell, B., Jobling, A., Kan, H., Knibbs, L., Liu, Y., Martin, R., Morawska, L., Pope, C. A., 3rd, … Forouzanfar, M. H. (2017). Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet (London, England), 389(10082), https://doi.org/10.1016/S0140-6736(17)30505-6
  7. Vawda, S., Mansour, R., Takeda, A., Funnell, P., Kerry, S., Mudway, I., … Walton, R. (2014). Associations Between Inflammatory and Immune Response Genes and Adverse Respiratory Outcomes Following Exposure to Outdoor Air Pollution: A Huge Systematic Review. American Journal of Epidemiology, 179(4), 432–442. https://doi.org/10.1093/aje/kwt269
  8. Croft, D. P., Zhang, W., Lin, S., Thurston, S. W., Hopke, P. K., Masiol, M., Squizzato, S., van Wijngaarden, E., Utell, M. J., & Rich, D. Q. (2019). The Association between Respiratory Infection and Air Pollution in the Setting of Air Quality Policy and Economic Change. Annals of the American Thoracic Society, 16(3), 321–330. https://doi.org/10.1513/AnnalsATS.201810-691OC
  9. Meng, Xia, Cuicui Wang, Dachun Cao, Chit-Ming Wong, and Haidong Kan. “Short-Term Effect of Ambient Air Pollution on COPD Mortality in Four Chinese Cities.” Atmospheric Environment77 (2013): 149–54. https://doi.org/10.1016/j.atmosenv.2013.05.001.
  10. Horne, B. D., Joy, E. A., Hofmann, M. G., Gesteland, P. H., Cannon, J. B., Lefler, J. S., … Pope, C. A. (2018). Short-Term Elevation of Fine Particulate Matter Air Pollution and Acute Lower Respiratory Infection. American Journal of Respiratory and Critical Care Medicine, 198(6), 759–766. doi: 10.1164/rccm.201709-1883oc
  11. Inserro, A. (2010, May 6). Air Pollution Linked to Lung Infections, Especially in Young Children. Retrieved from https://www.ajmc.com/newsroom/air-pollution-linked-to-lung-infections-especially-in-young-children
  12. Bauer, R. N., Diaz-Sanchez, D., & Jaspers, I. (2012). Effects of air pollutants on innate immunity: the role of Toll-like receptors and nucleotide-binding oligomerization domain-like receptors. The Journal of allergy and clinical immunology, 129(1), 14–26. https://doi.org/10.1016/j.jaci.2011.11.004
  13. Bell ML, McDermott A, Zeger SL, Samet JM, Dominici F. Ozone and short-term mortality in 95 US urban communities, 1987–2000. JAMA. 2004;292(19):2372–2378.
  14. Qin Jiang, X., Dong Mei, X., & Feng, D. (2016). Air pollution and chronic airway diseases: what should people know and do? Journal of Thoracic Disease, 8(1). doi: 10.3978/j.issn.2072-1439.2015.11.50
  15. Banks, J. and McConnell, R. (2015). Emissions from Lawn and Garden Equipment. US Environmental Protection Agency.
  16. JA Bernstein et al. (2008). The health effects of non-industrial air pollution. Journal of Allergy and Clinical Immunology. Vol 121, Issue 3. https://www.jacionline.org/article/S0091-6749(07)02209-9/pdf
  17. Ozone Effects on Human Health. (n.d.). Retrieved from https://www.nps.gov/subjects/air/humanhealth-ozone.htm
  18. Fisk, W. J., Lei-Gomez, Q., & Mendell, M. J. (2007). Meta-analyses of the associations of respiratory health effects with dampness and mold in homes. Indoor Air, 17(4), 284–296. doi: 10.1111/j.1600-0668.2007.00475.x
  19. Sauni, R., Verbeek, J. H., Uitti, J., Jauhiainen, M., Kreiss, K., & Sigsgaard, T. (2015). Remediating buildings damaged by dampness and mould for preventing or reducing respiratory tract symptoms, infections and asthma. The Cochrane database of systematic reviews, 2015(2), CD007897. https://doi.org/10.1002/14651858.CD007897.pub3
  20. Gostner, J., Zeisler, J., Alam, M. et al. Cellular reactions to long-term volatile organic compound (VOC) exposures. Sci Rep 6, 37842 (2016). https://doi.org/10.1038/srep37842
  21. Ezzati, Majid, Lopez, Alan D, Rodgers, Anthony A & Murray, Christopher J. L. (‎2004)‎. Comparative quantification of health risks : global and regional burden of disease attributable to selected major risk factors / edited by Majid Ezzati … [‎et al.]‎. World Health Organization. https://apps.who.int/iris/handle/10665/42770
  22. Cone, M. (2010, October 20). Volatile Organic Compounds May Worsen Allergies and Asthma. Retrieved from https://www.scientificamerican.com/article/volatile-organic-compounds/
  23. https://ww2.arb.ca.gov/our-work/programs/small-off-road-engines-sore)

Minutes of Movement

  1. Matthews, C. E., Ockene, I. S., Freedson, P. S., Rosal, M. C., Merriam, P. A., & Hebert, J. R. (2002). Moderate to vigorous physical activity and risk of upper-respiratory tract infection. Medicine and science in sports and exercise, 34(8), 1242–1248. https://doi.org/10.1097/00005768-200208000-00003
  2. Nieman, D., Nehlsen-Cannarella, S., Markoff, P., Balk-Lamberton, A., Yang, H., Chritton, D., … Arabatzis, K. (1990). The Effects of Moderate Exercise Training on Natural Killer Cells and Acute Upper Respiratory Tract Infections. International Journal of Sports Medicine, 11(06), 467–473. doi: 10.1055/s-2007-1024839
  3. Barrett, B., Hayney, M. S., Muller, D., Rakel, D., Brown, R., Zgierska, A. E., … Coe, C. L. (2018). Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial. Plos One, 13(6). doi: 10.1371/journal.pone.0197778
  4. Nieman, D. (2011). Moderate exercise improves immunity and decreases illness rates. American Journal of Lifestyle Medicine, (5)4: 338-345. https://journals.sagepub.com/doi/10.1177/1559827610392876
  5. Khosravi, N., Stoner, L., Farajivafa, V., & Hanson, E. D. (2019). Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain, behavior, and immunity, 81, 92–104. https://doi.org/10.1016/j.bbi.2019.08.187
  6. University of Georgia. (2010, February 28). Regular exercise reduces patient anxiety by 20 percent, study finds. ScienceDaily. Retrieved April 4, 2020 from www.sciencedaily.com/releases/2010/02/100222161848.htm
  7. Craft, L. L., & Perna, F. M. (2004). The Benefits of Exercise for the Clinically Depressed. The Primary Care Companion to The Journal of Clinical Psychiatry, 06(03), 104–111. doi: 10.4088/pcc.v06n0301
  8. Ullrich-French, S., Cox, A., Bumpus, M. (2013). Physical Activity Motivation and Behavior Across the Transition to University. Sport, Exercise, and Performance Psychology, 2(2), 90-101.
  9. Courneya, K., Friedenreich, C., Arthur, K., Bobick, T. (1999). Understanding Exercise Motivation in Colorectal Cancer Patients: A Prospective Study Using the Theory of Planned Behavior. Rehabilitation Psychology, 44(1), 68-84.
  10. Mata, J., Silva, M., Vieira, P., Carraça, E., Andrade, A., Coutinho, S., Sardinha, L., Teixeira, P. (2009) Motivational ‘Spill-Over’ During Weight Control: Increased Self-Determination and Exercise Intrinsic Motivation Predict Eating Self-Regulation. Health Psychology, 28(6), 709-716.
  11. D’Angelo, M., Pelletier, L., Reid, R., Huta, V. (2014). The Roles of Self-Efficacy and Motivation in the Prediction of Short- and Long-Term Adherence to Exercise Among Patients with Coronary Hearth Disease. Health Psychology, 33(11), 1344-1353.
  12. Wiltermuth, S. and Gino, F. (2013) I’ll Have One of Each: How Separating Rewards Into (Meaningless) Categories Increases Motivation. Journal of Personality and Social Psychology, 104(1), 1-13.
  13. Campbell, J. P., & Turner, J. E. (2018). Debunking the Myth of Exercise-Induced Immune Suppression: Redefining the Impact of Exercise on Immunological Health Across the Lifespan. Frontiers in Immunology, 9. doi: 10.3389/fimmu.2018.00648
  14. Ceddia, M. et al. (1999). Differential leukocytosis and lymphocyte mitogenic response to acute maximal exercise in the young and old. Medicine & Science in Sports & Exercise. 31(6), 829-836.
  15. Wong C-M, Lai H-K, Ou C-Q, Ho S-Y, Chan K-P, Thach T-Q, et al. (2008) Is Exercise Protective Against Influenza-Associated Mortality? PLoS ONE 3(5): e2108. https://doi.org/10.1371/journal.pone.0002108
  16. Wen, C. P., Wai, J. P. M., Tsai, M. K., Yang, Y. C., Cheng, T. Y. D., Lee, M.-C., … Wu, X. (2011). Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet, 378(9798), 1244–1253. doi: 10.1016/s0140-6736(11)60749-6
  17. https://www.ajpmonline.org/article/S0749-3797(19)30026-1/abstract

Stress Management

  1. D’Acquisto F. (2017). Affective immunology: where emotions and the immune response converge. Dialogues in clinical neuroscience, 19(1), 9–19.
  2. Dockray, S., & Steptoe, A. (2010). Positive affect and psychobiological processes. Neuroscience and biobehavioral reviews, 35(1), 69–75. https://doi.org/10.1016/j.neubiorev.2010.01.006
  3. Black, D. S., & Slavich, G. M. (2016). Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Annals of the New York Academy of Sciences, 1373(1), 13–24. https://doi.org/10.1111/nyas.12998
  4. Jazaieri, H., McGonigal, K., Jinpa, T., Doty, J., Gross, J., & Goldin, P. (2014). A randomized controlled trial of compassion cultivation training: Effects on mindfulness, affect, and emotion regulation. Motivation and Emotion, 38(1), 23–35. https://doi.org/10.1007/s11031-013-9368-z
  5. Pace, T. W., Negi, L. T., Adame, D. D., Cole, S. P., Sivilli, T. I., Brown, T. D., Issa, M. J., & Raison, C. L. (2009). Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology, 34(1), 87–98. https://doi.org/10.1016/j.psyneuen.2008.08.011
  6. Antoni MH. Stress Management Effects on Psychological, Endocrinological, and Immune Functioning in Men with HIV Infection: Empirical Support for a Psychoneuroimmunological Model. Stress. 2003;6(3):173-188. doi:10.1080/1025389031000156727
  7. Antoni, M. H., & Dhabhar, F. S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 125(9), 1417–1431. https://doi.org/10.1002/cncr.31943
  8. Bennett, M. P., & Lengacher, C. (2009). Humor and Laughter May Influence Health IV. Humor and Immune Function. Evidence-Based Complementary and Alternative Medicine, 6(2), 159–164. doi: 10.1093/ecam/nem149
  9. Kiecolt-Glaser, J. K., Glaser, R., Gravenstein, S., Malarkey, W. B., & Sheridan, J. (1996). Chronic stress alters the immune response to influenza virus vaccine in older adults. Proceedings of the National Academy of Sciences, 93(7), 3043–3047. doi: 10.1073/pnas.93.7.3043
  10. Marchant, J. (2013, November 27). How Happiness Boosts the Immune System. Retrieved from https://www.scientificamerican.com/article/how-happiness-boosts-the-immune-system/
  11. Khoury Bassam, Sharma Manoj, Rush Sarah, Fournier Claude (2015). Mindfulness-based Stress Reduction for Healthy Individuals: A Meta-Analysis. Journal of Psychosomatic Research. Vol 78(6), 519-528, https://doi.org/10.1016/j.jpsychores.2015.03.009
  12. Sharma, M., & Rush, S. E. (2014). Mindfulness-Based Stress Reduction as a Stress Management Intervention for Healthy Individuals: A Systematic Review. Journal of Evidence-Based Complementary & Alternative Medicine, 19(4), 271–286. https://doi.org/10.1177/2156587214543143
  13. Cohen, S., Alper, C. M., Doyle, W. J., Treanor, J. J., & Turner, R. B. (2006). Positive Emotional Style Predicts Resistance to Illness After Experimental Exposure to Rhinovirus or Influenza A Virus. Psychosomatic Medicine, 68(6), 809–815. doi: 10.1097/01.psy.0000245867.92364.3c
  14. Malcom D. R. (2019). The Critical Role of Self-Compassion and Empathy in Well-Being. American journal of pharmaceutical education, 83(10), 7784. https://doi.org/10.5688/ajpe7784
  15. Carr, L., Iacoboni, M., Dubeau, M. C., Mazziotta, J. C., & Lenzi, G. L. (2003). Neural mechanisms of empathy in humans: a relay from neural systems for imitation to limbic areas. Proceedings of the National Academy of Sciences of the United States of America, 100(9), 5497–5502. https://doi.org/10.1073/pnas.0935845100
  16. (http://www.annfammed.org/content/10/4/337.long

Healthy Sleep Habits

  1. Potter, L. M., & Weiler, N. (2020, March 30). Short Sleepers Are Four Times More Likely to Catch a Cold. Retrieved from https://www.ucsf.edu/news/2015/08/131411/short-sleepers-are-four-times-more-likely-catch-cold
  2. Besedovsky, L., Lange, T., & Haack, M. (2019). The Sleep-Immune Crosstalk in Health and Disease. Physiological reviews, 99(3), 1325–1380. https://doi.org/10.1152/physrev.00010.2018
  3. Irwin M. R. (2019). Sleep and inflammation: partners in sickness and in health. Nature reviews. Immunology, 19(11), 702–715. https://doi.org/10.1038/s41577-019-0190-z
  4. Irwin, M. R., & Opp, M. R. (2017). Sleep Health: Reciprocal Regulation of Sleep and Innate Immunity. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 42(1), 129–155. https://doi.org/10.1038/npp.2016.148
  5. Besedovsky, L., Lange, T., & Born, J. (2012). Sleep and immune function. Pflugers Archiv : European journal of physiology, 463(1), 121–137. https://doi.org/10.1007/s00424-011-1044-0
  6. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally assessed sleep and susceptibility to the common cold. SLEEP 2015;38(9):1353 –1359.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531403/pdf/aasm.38.9.1353.pdf
  7. Rico-Rosillo, M. G., & Vega-Robledo, G. B. (2018). Sueño y sistema immune [Sleep and immune system]. Revista alergia Mexico (Tecamachalco, Puebla, Mexico : 1993), 65(2), 160–170. https://doi.org/10.29262/ram.v65i2.359
  8. Wright, K. P., Jr, Drake, A. L., Frey, D. J., Fleshner, M., Desouza, C. A., Gronfier, C., & Czeisler, C. A. (2015). Influence of sleep deprivation and circadian misalignment on cortisol, inflammatory markers, and cytokine balance. Brain, behavior, and immunity, 47, 24–34. https://doi.org/10.1016/j.bbi.2015.01.004

Support For Wellness Professionals and Community Organizations

  1. Estacio, E. V., Oliver, M., Downing, B., Kurth, J., & Protheroe, J. (2017). Effective Partnership in Community-Based Health Promotion: Lessons from the Health Literacy Partnership. International journal of environmental research and public health, 14(12), 1550. https://doi.org/10.3390/ijerph14121550
  2. Sandel SL, Judge JO, Landry N, Faria L, Ouellette R, Majczak M. (2005). Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer Nurs, 28(4):301-9.
  3. Heather L. Stuckey, DEd and Jeremy Nobel, MD, MPH. (2010). The Connection Between Art, Healing, and Public Health: A Review of Current Literature. American Journal of Public Health, 100(2):254–263.
  4. Falkenberg, R. I., Eising, C., & Peters, M. L. (2018). Yoga and immune system functioning: a systematic review of randomized controlled trials. Journal of behavioral medicine, 41(4), 467–482. https://doi.org/10.1007/s10865-018-9914-y
  5. Hanna J. L. (1995). The power of dance: health and healing. Journal of alternative and complementary medicine (New York, N.Y.), 1(4), 323–331. https://doi.org/10.1089/acm.1995.1.323
  6. Rahim, M., Ooi, F. K., & Wan Abdul Hamid, W. Z. (2016). Blood immune function parameters in response to combined aerobic dance exercise and honey supplementation in adult women. Journal of traditional and complementary medicine, 7(2), 165–171. https://doi.org/10.1016/j.jtcme.2016.06.001
  7. Conner, T. S., Deyoung, C. G., & Silvia, P. J. (2016). Everyday creative activity as a path to flourishing. The Journal of Positive Psychology, 13(2), 181–189. doi: 10.1080/17439760.2016.1257049
  8. Petrie KJ, Fontanilla I, Thomas MG, Booth RJ, Pennebaker JW. Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosom Med. 2004;66(2):272–275. doi:10.1097/01.psy.0000116782.49850.d3
  9. Wahbeh, H., Elsas, S. M., & Oken, B. S. (2008). Mind-body interventions: applications in neurology. Neurology, 70(24), 2321–2328. https://doi.org/10.1212/01.wnl.0000314667.16386.5e
  10. Fernros, L., Furhoff, A. & Wändell, P.E. (2008). Improving quality of life using compound mind-body therapies: evaluation of a course intervention with body movement and breath therapy, guided imagery, chakra experiencing and mindfulness meditation. Quality of Life Research, 17(3), 367-376. https://doi.org/10.1007/s11136-008-9321-x
  11. Hirokawa, E., & Ohira, H. (2003). The effects of music listening after a stressful task on immune functions, neuroendocrine responses, and emotional states in college students. Journal of music therapy, 40(3), 189–211. https://doi.org/10.1093/jmt/40.3.189
  12. Linnemanna, A., Ditzenb, B., Strahlera, J., Doerra, J., Natera, U. (2015). Music listening as a means of stress reduction in daily life. Psychoneuroendocrinology, 60. p. 82-90. https://doi.org/10.1016/j.psyneuen.2015.06.008
  13. Jennifer M. Mellor and Jeffrey Milyo. (2005). State Social Capital and Individual Health Status. Journal of Health Politics, Policy and Law, 30(6): 1101-1130. https://doi.org/10.1215/03616878-30-6-1101
  14. Kawachi, I., Kennedy, B.P., Glass, R. (1999). Social Capital and Self-Rated Health: A Contextual Analysis. American Journal of Public Health, 89(8). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1508687/pdf/amjph00008-0043.pdf
  15.  Borgonovi F. (2008). Doing well by doing good. The relationship between formal volunteering and self-reported health and happiness. Social science & medicine (1982), 66(11), 2321–2334. https://doi.org/10.1016/j.socscimed.2008.01.011
  16.  Howard Litwin, DSW, Sharon Shiovitz-Ezra, PhD. (2011). Social Network Type and Subjective Well-being in a National Sample of Older Americans. The Gerontologist, (51)3: 379–388. https://doi.org/10.1093/geront/gnq094
  17. Yang, Y. C., Boen, C., Gerken, K., Li, T., Schorpp, K., & Harris, K. M. (2016). Social relationships and physiological determinants of longevity across the human life span. Proceedings of the National Academy of Sciences of the United States of America, 113(3), 578–583. https://doi.org/10.1073/pnas.1511085112
  18.  Fowler, J. H., & Christakis, N. A. (2008). Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ (Clinical research ed.), 337, a2338. https://doi.org/10.1136/bmj.a2338
  19. Gottlieb, B. H., & Gillespie, A. A. (2008). Volunteerism, health, and civic engagement among older adults. Canadian journal on aging = La revue canadienne du vieillissement, 27(4), 399–406. https://doi.org/10.3138/cja.27.4.399
  20. Theurer K, Wister A. (2010). Altruistic behaviour and social capital as predictors of well being among older Canadians, Ageing and Society, 30: 157-181. doi:10.1017/S0144686X09008848
  21.  Ponce, M. S., Rosas, R. P., & Lorca, M. B. (2014). Social capital, social participation and life satisfaction among Chilean older adults. Revista de saude publica, 48(5), 739–749. https://doi.org/10.1590/s0034-8910.2014048004759
  22.  Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS medicine, 7(7), e1000316. https://doi.org/10.1371/journal.pmed.1000316
  23. Coan, J. A., & Sbarra, D. A. (2015). Social Baseline Theory: The Social Regulation of Risk and Effort. Current opinion in psychology, 1, 87–91. https://doi.org/10.1016/j.copsyc.2014.12.021
  24. Schaller M. (2011). The behavioural immune system and the psychology of human sociality. Philosophical transactions of the Royal Society of London. Series B, Biological sciences, 366(1583), 3418–3426. https://doi.org/10.1098/rstb.2011.0029

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