Books, Libraries and Health #166

Doro Bush Koch:

30 million Americans still can't read, so our goal is 100% literacy for the nation. So we have work to do. It's an enormous problem, but it's a worthwhile endeavor and we're excited about trying new things.

Becky Dyer:

We do have results from last year's programs, and we were really pleased to see that on average, parents made gains of 2.3 grade levels in nine months, which is huge. So our programs must be doing something right.

Steve Podgajny:

Public library is about people reaching their individual potential and for a community, reaching its potential.

Dr. Sam Zager:

When you're at the public library, you're around other people who are nourishing their souls, and that is a fundamentally healthy endeavor.

Dr. Lisa Belisle:

This is Dr. Lisa Belisle and you are listening to Love Maine radio show number 166, books, libraries and Health, airing for the first time on Sunday, November 16, 2014. Early literacy is critical to health and wellness. Today we speak with Doro Bush Cook and Becky Dyer of the Barbara Bush foundation for Family Literacy, a national organization founded by the former first lady of the United States that has been promoting reading for the past 25 years. We also discuss the impact of libraries on individual and Community Health with Dr. Sam Zager and Steve Pagoni, Executive Director of the Portland Public Library. Thank you for joining us. As listeners of Love Maine Radio know, literacy is a big focus of mine. It has been for a long time as the medical advisor for Raising Readers, which is a literacy program that gets books to children at their doctor's offices here in the state of Maine. I've spent quite a lot of time thinking about reading and the impact of reading on children and their families. The two people who join me today have spent a lot of time thinking about the very Same thing. And it's really great to have these individuals to speak on the subject. I know they're just as passionate about this as I am. Our first guest is one that we've met before. This is my friend Becky Dyer, who is the director of research and program development for the Barbara Bush foundation for Family Literacy. And our other guest is one and I have just met but already have a great deal of respect for the work she's done. Also for the Barbara Bush foundation for Family Literacy. This is Dora Bush, who is the co chair. Thanks so much for coming in and having a conversation with us about family literacy.

Becky Dyer:

Thank you for having us here.

Dr. Lisa Belisle:

And we had Liza McFadden come in, also from the Barbara Bush foundation for Family Literacy. She came in all the way from Florida. And Doro, you're here all the way from.

Doro Bush Koch:

Well, I'm from Bethesda, Maryland, and I'm fortunate enough to spend my summers here in Maine in Kennebport.

Dr. Lisa Belisle:

Because you happen to have a family connection, right?

Doro Bush Koch:

So my parents live on Walker's Point. My father was the 41st president of the United States. And then, of course, my mother is Barbara Bush, who is the driving force behind the Barbara Bush Foundation. She's. I'm now the co chair with my brother Jeb, who has a passion for education and literacy. And my mom will tell you she stepped aside, but she's still involved and we're happy about that.

Dr. Lisa Belisle:

Why is literacy so important to your family? There are so many different things that you could have focused on.

Doro Bush Koch:

Well, I think my mom saw firsthand with one of my brothers, one of her children, who was dyslexic, how difficult life can be if you can't read. And from that experience, she began to research and realized how important it is to have the skill of reading for life. If you can't read, you can't take care of your health. If you can't read, you can't fill out a job application. And so she, 25 years ago, she became passionate about literacy and has not stopped.

Dr. Lisa Belisle:

What about your experience with dyslexia in your family? I mean, if this was your brother, you obviously had a front row seat to the difficulties that he had when it came to school and living right.

Doro Bush Koch:

And Neil was amazing. He struggled, he read backwards. And then something clicked and he began to overcompensate and he began to try very, very hard to get beyond it. And it made him very motivated in life to do things well. And he was able to get on with reading and his life and has been Very successful ever since. But I remember as a little boy, it was tough in the classroom. He was, you know, it was discouraging. You know, he was getting bad grades. He was, you know, he was, his self esteem was very low and all of that. And mom saw that and she spent hours with him and. But things are good now. And he's passionate about literacy, too. In fact, he runs our Houston initiative of the Barbara Bush foundation for Family Literacy.

Dr. Lisa Belisle:

Darrow, you raise a good point, and that is that the family and sometimes the mother, sometimes the father, sometimes another parental type influence has a lot to do with literacy, has a lot to do with helping kids read. Becky, is this something that you've spent time with as you've. As the director of research and program development for the foundation, is encouraging families to really get involved in helping their children with reading?

Becky Dyer:

Absolutely. We're looking at new ways constantly to get families engaged because we know that children's brains develop early and we need to reach them before they go to school. So there are simple things that parents can do. For example, when you're changing a diaper, you can sing to the child. You can talk to the child about what you're doing. If you're putting laundry in the washer, you can talk to them about whites and darks and just some simple things. It doesn't have to be an extra activity, just part of your daily life, simple little things that you do as you build your child's vocabulary. That's what's going to help that child learn to read.

Dr. Lisa Belisle:

So you're talking about before they even start to sit down with a book, before they even go to kindergarten and start learning their letters. You're talking about putting words out there and consonants and syllables so that children can start to hear these things and process them.

Becky Dyer:

And that's what makes the brain connections. So from the time they are born, you should be talking to them, singing silly songs. You can dance around the room with them so they can feel the movement while you're singing. Just any simple little thing that involves language, just keep talking to them. Even if you feel like an idiot because you're talking to somebody who's not responding, you need to still talk to them.

Dr. Lisa Belisle:

Dora, your story really rings true for me because my brother had an auditory processing issue. So he could read fine, but he wasn't able to process what was going on around him well. So this learning disability caused him no end of frustration. He would kind of focus in enough over the course of a school day to kind of get what he needed to get done. But he would come home and he would just explode. He would just be so. It would be so difficult. And I remember all the time that my mom spent with him trying to kind of help him find another way of dealing with the information that the school required. So it is a. It's a big deal. It's a big thing that a parent needs to start doing if there's some sort of issue that comes up that is beyond. Beyond the norm, let's say.

Doro Bush Koch:

Yeah, and the thing about that is that if you're the parent and you can't read, you're never going to break the cycle of illiteracy. I mean, you can't help your child. You won't notice those things. And so that's the whole mission of the Barbara Bush foundation, is to advocate and establish literacy in every home. And that's why we. We need the complete involvement of the family, because nothing will happen. You'll go home, you know, the child will go home, and the parent is watching television, you know, and so we need to get the entire family involved.

Becky Dyer:

And that's a good point, Doro, that television does not replace the parent talking to the child. I've had parents who have said, well, I put my child in front of the television, so they're hearing vocabulary words. But that's very different from the parent engaging that child with vocabulary. So when you're right there talking to them, they can see your mouth move, they hear it, they can sense it. If you're doing, you know, manipulating things with them. It's very different than sitting someone in front of a flat screen and expecting them to gain language.

Doro Bush Koch:

Right.

Dr. Lisa Belisle:

And there's also an emotional thing that takes place if you are a child and you're with someone that you care about and they're suggesting that you read a book or even. Even they're just having a conversation with you, that's going to have much more of an impact on your brain than if you're sitting in front of a television that has no interactive component and you have no emotional attachment to.

Doro Bush Koch:

That's right. And I think everybody wants to be loved. And if you can tie together the reading with cuddling up with your mom or your dad or your grandmother, your grandfather, your brother, your sister, there's that. I mean, there's that double whammy, really, of having that reading time together and then having that love connection with people that care about you, and that if you have love and you can read, imagine where you could go.

Dr. Lisa Belisle:

I think it's also interesting the way that you're describing. And I think that love is something. You're absolutely right. And I know that all of the happy memories I have of reading to my children there is that it was actually really good for me as well. I mean, I actually really miss now having kids. Two kids in college and an eighth grader. I really miss that time with them, that bonding. I actually was thinking about when my daughter was a baby and having that ability to just hold this child close to your heart. And I think that when you read to them, that creates memories all around. I think that's right. That's right. What if you are a parent who doesn't read? I think you. You alluded to this, that some parents don't know how to read and they don't feel comfortable, and so it becomes an internal struggle for them.

Doro Bush Koch:

Well, I think. And Becky can. Can follow up, but that's what we do is to provide wonderful programs that not only provide early learning for children, but also we have those same programs teach the adults to read as well. And then the adults and parents come together in these programs and reinforce each other. And so we encourage people who. And a lot of people are afraid to acknowledge the fact that they can't read to go to the Barbara Bush foundation website and see what kind of programs can help, because those are the kinds of programs we're creating and funding. And what do you think, Becky?

Becky Dyer:

Well, I agree with you. We have five of those programs here in Maine. But you also, if you can't read, pick up a book and turn the pages because your child is learning a simple literacy skill in how a book opens and how the pages turn point to colors. It's a red balloon, it's a green ball, it's a brown dog. They're learning their colors point to, you know, shapes. That's a star, that's a circle. Those types of things are building literacy skills as well, something you can do very simply at home. So even if you can't read the words, you can still engage the child with the book, and that's very important. But if you can't read, you really need to seek help. And we have great programs through the Barbara Bush Foundation. We also have a great system of literacy volunteers in this state, and we have a pretty robust adult ed program. So I would encourage any parents who are struggling readers to seek help in any one of those locations.

Dr. Lisa Belisle:

You've had some new initiatives, I believe, in the last few years with family literacy. Do you want to talk about those?

Doro Bush Koch:

Sure. We're really excited about our teen trendsetters program. And we've brought 22 teen trendsetter programs here in 11 counties. And these are programs where first graders are paired with high school students, and they spend an hour each week together, and they read, and it's a great program. And we had a pilot program here. We've had a pilot program here already. And recently we had the opportunity to talk to an adorable first grader and her mentor and hear how really great this program is. And it was very cute once these two were paired together. And then the summertime came, and they bumped into each other at the grocery store, and the little girl came running up to her mentor and saying, you know, how are you? How are you? I'm reading this. I'm doing that. And so they created this incredible bond, and it's as beneficial for the first grader as it is for the mentor. The mentor was, you know, loving having this relationship. And so it's a good program. Great program.

Becky Dyer:

It's a great program. Actually. The pilot in Windom, the first graders started on average in middle kindergarten with reading. When they started first grade at the end of the program, they ended at the end of first grade with their peers. And the aside benefit for the teen mentor, other than earning community service credit, was that they polished some of their own reading skills. So we had several mentors come back and say, oh, I'd forgotten about pre reading. I'd forgotten that I was supposed to do that, and now I'm using that skill in my own homework, and it's helping me. And an additional benefit is that some of these young mentors have decided to go on to become teachers. And as our educational workforce is graying out, we need some of those young people to choose education as a career. So it has multiple benefits that way. The biggest benefit for us is obviously the first graders being able to read on grade level when they leave first grade, because we know that they're learning to read at that age.

Doro Bush Koch:

And they advance by doing this program. They advance a year.

Becky Dyer:

In nine months.

Doro Bush Koch:

In nine months, which is pretty remarkable and a great achievement for the first grader as well as the high school mentor.

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

how do you help those people who are also not just teachers, but how do you help all the people that are surrounding a child as he or she is developing to encourage literacy?

Becky Dyer:

Well, one of the biggest things we do here in Maine is we sponsor the Barbara Bush Literacy Connections Conference. This is our seventh or eighth year. I think it's the seventh year. We're holding it at Thomas College. This year we're going to a two day conference. It'll be April 1st and 2nd. And an example of what we've done last year we had a keynote speaker from the Momentous Institute, which is a private school in Dallas, talk to us about social emotional behavior and its impact on literacy. She was so well received that people said we want more. We're bringing her back for the pre conference and she's doing a six hour training with lots of hands on techniques for teachers, for librarians, for anybody who's touching the child. So we also have Nancy Stewart who is from Washington state and she's a musician who's played with several big names. When she had her children, she started looking at literacy and music and how they're related. So she says, how many of you learned your ABCs through the ABC song? Raise your hand. Now how many of you have forgotten that ABC song, Put yout Hands down and everybody's hand stays up. She's going to talk to us about the importance of music in literacy. And the other person that we have scheduled right now is Laura Overdeck from Bedtime Math, which is a non profit out of Virginia, I think, and they have a whole process for teaching children math by doing little simple math problems at bedtime. So those are just some examples of some things that we have coming. We're still building the conference out, but this is our seventh year and we touch about 260 people at this conference.

Dr. Lisa Belisle:

Yeah, it is. I think that is really great. I mean, this is something that is going to continue to evolve. Doro, you are saying we'd like to eradicate illiteracy and obviously that's something that it's a good goal. Have you seen progress? The Barbara Bush foundation has been around now for two decades.

Becky Dyer:

25 years.

Doro Bush Koch:

25 years, and we have seen progress. But you know, as I mentioned before, 30 million Americans still can't read. So our goal is 100% literacy for the nation. So we have work to do. But I think we're excited to take the Barbara Bush foundation into this new direction of trying all these new things. And you know, I just think it's an enormous problem, but it's a worthwhile endeavor and we're excited about trying new things.

Becky Dyer:

We do have results from last year's programs and we were really pleased to see that on average, parents made gains of 2.3 grade levels in nine months, which is huge. So our programs must be doing something right.

Dr. Lisa Belisle:

Well, I appreciate the work that you are continuing to do in the field of literacy, certainly not only as a doctor, but also as a mother and member of the community. I see the importance of reading and of having a facility with language written, spoken. And I really think that for me it's also fostering communication, which is something that as human beings, we all benefit from trying to understand each other. So if we can understand somebody better by being able to read their story or by being able to see it on YouTube and understand their story, I think it's really kind of a great and amazing time to be in the world. There's so many connections that are being made. So I appreciate all the work that you've been doing. Becky, tell me what website people should go to to find out more about the Barbara Bush foundation for family literacy.

Becky Dyer:

It's www.barbarabush.org.

Dr. Lisa Belisle:

doro, thanks so much for coming in. And please give my thanks to your mother, Barbara Bush, for creating the foundation for Family Literacy. And Becky, thank you for being the director of research and program development for the foundation for Family Literacy. I encourage people to learn more about what's going on in this field because it's new and exciting and ever changing and really worthwhile.

Doro Bush Koch:

And can I just add one thing? We rely We're a public charity, so we rely on the generosity of people. And so we just want you to know that and hope that you can help.

Dr. Lisa Belisle:

So anyone who's looking to put their money in a good place consider the Barbara Bush foundation for Family Literacy. Go to the website and find out more. Thank you so much for being here.

Becky Dyer:

Thank you, Dr. Lisa

Dr. Lisa Belisle:

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Dr. Lisa Belisle:

As individuals who have been listening to the Love Maine Radio show for a while, understand reading is one of my favorite activities. Today we have with us two individuals who understand the importance of reading, of literacy and health and libraries. We have with us Stephen Pagoni, who is the executive director of the Portland Public Library, and also Dr. Sam Zager, who is a family physician at Martin's Point Healthcare in Portland and a volunteer with the Portland Public Health Department. The two collaborated on a research project in which the aim was to document and clarify any associations between health and public libraries. What emerged was the Health and libraries of public use. Retrospective study, also called Helpers, and some fascinating findings. Thanks so much for coming in today.

Steve Podgajny:

Thank you.

Dr. Lisa Belisle:

It's an interesting thing for me to be in a room with people who have a mindset that's similar to mine, because that doesn't always happen. So I'm with you, Steve. You've been working with libraries for maybe your entire career, or at least a pretty long portion of it.

Steve Podgajny:

Yeah. The last 35 years, 36 years of working in public libraries. The last 33 or so, directing them. In Maine.

Dr. Lisa Belisle:

In Maine. I knew when you were up in Brunswick, I know you're a longtime runner. As I was saying to you before we went on the year, I used to see your name up in the winner's circle quite often at races. And then, Sam, I've never met you, but you went through the Maine Medical Center Family Practice Residency Program, which is where I went through as a family practice resident. And. And you trained with my father, Charlie Belisle.

Dr. Sam Zager:

I did. It was a terrific honor. I was so grateful to have the opportunity to train here at Maine Medical center, and it's given my wife, Tracy, and me a chance to establish roots here. We're glad to be here in Maine.

Dr. Lisa Belisle:

So it's interesting work that you've been doing, Sam. Dr. Zager, but it's work that started before you even got to Maine. This is something you became interested in when you were living in Boston and you saw that there was some chance that public library branches in places that were less well off than where you were living were in danger of being closed. And this became important to you.

Dr. Sam Zager:

It really did. As with a lot of things, I think in life, you sort of stumble into it because you realize that something that's happening around you matters. In 2010, I was indeed living in Boston, and there was a proposal to cut costs by shutting down some branches in five neighborhoods in Boston. And initially it seemed to make sense, but when I found out more about it through an organization that opposed the closures, called the People of Boston branches, organized by a very energetic young psychologist named Brandon Abs, that these were branches in less educated and poorer neighborhoods, which just seems fundamentally wrong. But as I got more involved with the advocacy effort, I posed the question, well, is it also unhealthy? Is it also bad for the public health and for individual health to shut down access to all the things, not only circulation items, but all the services that libraries provide as they're embedded in their neighborhoods?

Dr. Lisa Belisle:

And you ended up helping reverse that decision.

Dr. Sam Zager:

It was. I was one of many people But I think the role that I played was in really making the health argument. I dug into the literature in the medical journals, public health journals, social science journals, and looked for everything I could to see what we knew about the intersections between health and public libraries. Not only reading, but the libraries as entities in and of themselves. I found a fair amount of indirect evidence through two main mechanisms. One is that libraries certainly are good for education and literacy, and both of those are very good for health. That connection is well documented in many spheres. But in addition, it had something to do with social connections. The social bonds that people have are fundamental to health. This has been shown in many organ systems, in many fields of medicine. People recover from strokes faster, for instance, if they have good social connections. And libraries are very important neighborhood based places where people can make connections with others. So it's not just about the text that can be transmitted over the Internet or saved on a thumb drive. But there's something about the institution that I thought was important. And I wasn't the only one. I found some co signatories to this position paper that were eminent in their fields. Among these 19 CO signatories, there was a National Medal of Science recipient, which is Congress's highest scientific award. There was a Nobel laureate. So these were not people who just also just started thinking about what makes people healthy and what makes communities healthy. They signed on. I presented this consensus statement as a expert opinion to the Ways and Means Committee of the city Council in June of that year. And indeed, by July 1, all of the libraries had received the funding, even in these endangered neighborhoods, which was terrifically gratifying. It left me though, with a little. I noticed that there was a gap in the research or there. You know, this was predicated on expert opinion. But as I think you know, that's actually the lowest level of scientific evidence. It's literally opinion certainly qualified, but I was looking for something that didn't exist, which was empiric, quantified evidence of the connection between libraries and health. And that's what helpers became.

Dr. Lisa Belisle:

Well, let me back up because I want to. I give you a lot of credit for doing this because it sounds like you were actually doing this while you were simultaneously completing your medical education.

Dr. Sam Zager:

I was, yes. And we have two daughters, which it's

Steve Podgajny:

a zone education born during.

Dr. Sam Zager:

Yeah, that's right. Things don't always happen when you plan on them. My wife Tracy is an incredible partner and has made a lot of things possible and we try to do that for each other.

Dr. Lisa Belisle:

Well, as I say, I give you A lot of credit. It's really gratifying because I think we're in a time where we all have to understand that health goes beyond the room in which a doctor and a patient interact. And, Steve, I know that for you, public libraries have been so important your entire career. It's something that you really felt passionate about. I'm wondering, though, when you started this whole process, were libraries as important as they seem to have become now, or what has the progression been?

Steve Podgajny:

Well, I was on sabbatical when Sam first brought this up, and someone said, wait till I get back. So I came back and I met Sam, and he brought up this gap in the research. And I remember we had the conversation. I think Sam said, well, how do you know? How would you articulate that the library is good for community health? Because we have a health team. So we have a series of what we call constituency or user teams, and we identify literacies that we would love to promote in the community. So some of them can be civility, science and technology, business and government, Portland history. One of them happens to be health. So the point of this team is to do everything it can to contribute to a healthy Portland and healthy individuals. And what I said to Sam was, well, you know, public libraries and just assume they do quality work about developing collections. People take the things out, or they buy databases, take them out, and hopefully some good comes of it, because it's good stuff. But you never know whether there is this association or whether someone's behavior changes, whether they seek out a healthcare provider, what triggers result from someone using library resources. So I was terribly interested in this idea that Sam had about seeing if we could. If there was a relationship, could we establish it, could we demonstrate it? And I knew that it was something that didn't exist or thought it didn't exist in the public library world, because I hadn't seen it anywhere. And yet it was a terribly important area for us to investigate. After all, we were designating that it was an area of interest for us.

Dr. Lisa Belisle:

So these areas of interest that you're describing when you first started work within the public library system, is this something that existed then?

Steve Podgajny:

No, no. I think the. I mean, a lot of places use a team strategy. I suspect Martin's point does, and maybe even the magazine does, you know, that you have different things, but public libraries have this unique ability to interpret their relationship or their mission any way they want, programmatically. I mean, they all do similar things, like they lend stuff, they have databases, they have a digital profile, they have a physical profile. But the idea for us to make a statement that this was one of the areas that we wanted to focus on is actually a very powerful statement. And so you can build, I'll refer to them as literacies again, about health knowledge, health, education, living a full and productive life on many levels, whether it's civility or knowing things about science and technology for contributing to public debate. But this idea of living a healthy life physically and emotionally is very, very important to us because it's. In the end, the public library is about people reaching their individual potential and for a community, reaching its potential.

Dr. Sam Zager:

One of the things that we discussed early on in this whole process was that we kind of see ourselves in the same business of helping people realize their full potential. As, you know, as a physician, if somebody's not well, if they don't feel well, if they're not physically well, they. They can't realize their full potential. And that's largely what libraries do. And so there was a tremendous kinship I think we had from the beginning.

Steve Podgajny:

Yeah, I think the engage. You know, we're essentially humanities based institutions. People engage with the text through us often. And there are other things that elucidate or expand that engagement, such as programming. But whether it's digital resources or print resources, that's what people are doing with us primarily. And there's expertise on the staff level. There are other things, but we have 650,000 people visit the Portland Public Library System. It's the largest engagement with a public cultural institution in the state of Maine. So the opportunity that we have now, particularly fired by the results of the study, to potentially affect in a very positive way, but now a much more intentional way. I would argue that prior to this study, our benefits were coming. We thought we were doing the right things. But this points, this study points for us a way forward that can be a much more discreet and intentional investment of resources, whether it's staff, types of space and individual collections that might reinforce some of the findings from the study.

Dr. Lisa Belisle:

I'm interested in this idea of space because the Portland Public Library just did a very large and beautiful renovation not too long ago. And having cared for the same patients that I know Dr. Zager cared for up on Munjoy Hill, as a family practice resident, I know that this library space really is. You know, I've done home visits with the patients, some of the patients who live in the Portland area, and not all of the people who go to the Portland Public Library fall in this category, but some of the patients. This is the more beautiful space, the Portland Public Library is far more beautiful than any space that they have the chance to inhabit on a regular basis.

Becky Dyer:

Right?

Steve Podgajny:

And you know, it's very interesting, the presence of art, the presence of furnishings and fixtures that are of a certain quality. All of these things as a public space are so important to well being. And it's Sam has a lot deeper thoughts on on what these spaces might mean, but clearly folks are entering a space that is aesthetically beautiful. But there are also behaviors happening there that are healthy. For the most part.

Dr. Lisa Belisle:

this research study that you did, the Health and Library is a public use retrospective study, also called Helpers, which you have presented at the Main Academy of Family Physicians meeting and won an award for. You've gone to the Society of Teachers of Family Medicine and presented there. This had some interesting studies specifically with regard to health. So tell me about the study and what did you find?

Dr. Sam Zager:

So the study Helpers was a retrospective study. We had 243 people consent to enroll. These are all adults who live in Portland. They're all eligible for Portland Public Library cards and they understood through the consenting process that we would take discrete items from their medical record and connect that in a secure research database with any records that the public library may have about their quantity, recency and duration of their borrowing. We did not look at any titles. The library doesn't keep those data in their records. And we also that was not the interest of the study. We also did not even look at the types of materials that people borrowed. In other words, if somebody borrowed something, whether it was a book, a DVD A piece of sheet music. It all looked the same in the study. So we consented these individuals and then went about the technical task of marrying these databases. And we looked at demographic information, age, gender, insurance type as a proxy for socioeconomic status. We looked at health variables such as BMI or body mass index. We looked at blood pressure. We also looked at diagnoses in the so called problem list. We wanted to know what problems their providers had identified and these individuals were working on for their own health and wellness. The library variables, as I mentioned, included essentially circulation information. So what we found was that some really interesting things indeed the Experts back in 2010 were on tip something there is a connection between health and public libraries. The improved clarity was that the connections centers largely in mental health, in particular depression, anxiety disorders and especially substance abuse. There was some consistency in the findings, for instance in smoking and drug abuse. And mind you, this is not a survey do you smoke? But this is very reliable medical chart information. So we found for instance that among those who had ever smoked, and that's more than it's about half the study population had ever smoked in their life. Those who used the library at least a moderate amount had more than twice the odds, more than two times the odds of quitting smoking as those who didn't use it at all or use it only a little bit. Which is fascinating to me. Kind of reminds me of home fitness equipment. It's a good thing to have, but it really needs to be used if you're going to achieve what you want to achieve. I think libraries perhaps fall into that category. It's not only good to have groundbreaking on a library in a community, but to invest in the library so that it can yield good things for the health and wellness of the community and for individuals. So there was the finding about smoking, which was fascinating to me, that was also consistent with drug abuse. Those who've been to the library in the last six months had statistically lower rates of drug abuse than those who had so called remote usage or hadn't been to the library for at least six months. So it's not just having the card, but it's. Which is obviously an important first step, but it's using it and also using it with some regularity. It doesn't require that much or at least we found that there was an association with just a little bit of usage, like seven or eight items in a whole year. Borrowed put somebody in that moderate usage category which was associated with smoking cessation, with not being, not having a drug substance abuse problem. Drug abuse. It also had associations with depression, anxiety disorders, which was interesting in its own way.

Dr. Lisa Belisle:

From this information, what can you. What do you think is going on? What do you think is happening? What is it about the libraries? Maybe? Is it the use of space? Is it the socialization? What is it that's causing people to engage in healthier behaviors or have less anxiety, less depression?

Dr. Sam Zager:

That's a great question. We've been puzzling over this. I think that there's potentially a number of things going on. There's a physician named Nicholas Christakis who has published out of, published in the New England Journal, published in the British Medical Journal, has done work at Harvard and now more recently at Yale, who looks at the social connections, how the social bonds affect health outcomes. This has been shown in smoking cessations, obesity, mood disorders, et cetera. So this, I think part of what could be happening, and this is a hypothesis at this point, is that when you're at the public library, you're around other people who are nourishing their souls. And that is a fundamentally healthy endeavor. And that can take many forms. And one of the beauties of public libraries is that they can be whatever you need them to be. It can be a place where there's performing arts done in the community. It can be a place where people get voting or citizenship information. It can be a place where somebody literally learns to read. Certainly take out any of the things in the holdings. The bookmobile goes out into the community and brings the resources of the library to where into individuals who don't necessarily have as much mobility or ability to get to a branch. So there's a number of things that libraries can do for people. And it seems that being around other people who are doing something that is sort of life affirming, that is healthy, that is forward looking, is a healthy thing to do.

Steve Podgajny:

And I think the sort of confirming that some of the programs that we were doing have this effect in retrospect. So things such as creative aging initiatives, where we're going out to various locations, housing and various things that encourage seniors to continue creative enterprise, aging in place initiatives, basic outreach, things that were going out. Sam mentioned the bookmobile. So it is a lot about the space itself, the physical space, but it's also about the relationship building that happens with a public institution that again, is not necessarily interested in your growth, is not necessarily delivering a service in quotes or addressing a problem you have. It's interested in a very positive kind of interaction in how you're living your life.

Dr. Lisa Belisle:

I'm struck By a couple of things. One is that some have complained about the negative impact of technology upon human development, relationships, health, that sort of thing. But you're a library, and what you've just described to me is more than just books. It's about digital access. It's a very multi platform thing that you're offering the public. So you're using technology in a very positive way through the library system. And also, Sam, you never could have done this project if you did not have access to electronic medical records, I suspect. So both the library's electronic records and your records had to be available in order to even do this study in the first place. So these are very positive uses of technology.

Becky Dyer:

Right.

Steve Podgajny:

I mean, I think people are, you know, I think it's our propensity to, you know, as individuals to do either or. So, you know, you have these people making broad assumptions that because there's digital reading, there's no longer print reading, or because you can stay at home and search databases or you can search the catalog. Well, a lot of times searching the catalog says, I've identified something either at Portland Public Library or Bowdoin or Bates or the University of Maine or Bangor Public Library, please deliver it to our Burbank branch. I mean, it's a wonderful thing. It's all about active minds and people reading potential. In the end, when you distill it, the vehicles don't matter. But what does have to exist is a public infrastructure for public learning that does not require enrollment. It does not require a certain socioeconomic class or membership in a faith. It just needs to be there for people. And Sam's earlier comment was a really good one, which is the public library can be for people whatever they want it to be, almost in whatever area of inquiry or excitement is currently involved in their life.

Dr. Lisa Belisle:

Well, I think that's a really good point. And I think what's nice for me to hear is that we've had people on the show who are educators and scientists and nonprofit leaders, and for all of them, the sort of numbers, availability in our culture right now is so high that everybody's being asked to prove value. So in the healthcare system, you know, you're asked to prove that you can bring a person's cholesterol levels down and that they're going to live longer and stop smoking. And now the libraries are able to start justifying in a more tangible way, you know, that we are going to also help with people's health and education, cultural advancement, that sort of thing.

Steve Podgajny:

I think the striking thing about the study, looking at it from the public library perspective, there was nothing embedded in it that was a reach. In other words, we didn't do anything. The retrospective nature of it was very powerful because it was, we weren't doing anything that we don't normally do. So that if you look at it that way, it's very, very powerful. So we're not, you know, we didn't rig something that we suddenly are doing this other great program and we had an isolated population that addressed it and we got X result. The power of this is to go back and say, you know, what we do has real value. But now pointing forward, some of these conclusions really inform how we could probably leverage some of those results to a higher, higher efficacy or whatever you might say.

Dr. Sam Zager:

I would add to that that the, there's two main implications of the helpers. One is that I think it prompts us to recalculate our understanding of the return on public investment in public libraries. And that's sort of what Steve was just saying. The second thing is that I think it, it prompts clinicians to think about what does this mean in say, a primary care practice. It wasn't that long ago that reading itself wasn't considered a medical intervention. But now we have the reach out and read program and it's a very evidence based thing that pediatricians and family docs do all the time to recommend reading. And so what helpers I think adds to that is it's, you know, that there's this other facet. It's maybe perhaps, you know, with future randomized studies we can demonstrate that just recommending library use, library exposure, library utilization would be an evidence based health intervention to do. So I think both in terms of what we do as a community, but also what clinicians do within that one on one patient, doctor patient relationship. I think helpers adds in both spheres

Dr. Lisa Belisle:

and I would be remiss if I didn't add in that Maine has its own version of Reach out and Read, which is raising readers, which has been in place for almost 15 years now, I think. And the final thing that is done with the 5 year old, because children get books from birth to age 5, is to give them their library card and they're supposed to go to their public library. So it's interesting that you, you know, this is where I started my career. You're coming in at this point and it's really nice to be able to see that this thing that you're talking about is the value is being proven. So how can people find out more about the Helpers Study or the Portland Public Libraries.

Steve Podgajny:

Well, they can certainly visit our website@portlandlibrary.org portlandpubliclibrary.org, we just changed our URL. So portlandpubliclibrary.org there's information there under one of our research topics called health. So we have some summary there of the study, but they could certainly call us at 871-1700, extension 755 and we could, depending on the nature of the questions, we would certainly refer them to Sam for some of the deeper conversations around the study.

Dr. Sam Zager:

And my co authors, which include Dr. Christina Holt and Amy Haskins, who's an epidemiologist and Catherine Malan, who's a hard charging medical student, and I are preparing a manuscript that we hope will be out in the not too distant future. So we see this as a conversation that we have so started, not one that we have concluded.

Dr. Lisa Belisle:

And so of course, if they would like to reach you, Dr. Zagar, you are at Martin's Point here in Portland.

Dr. Sam Zager:

Martin's Point here in Portland on Veranda Street.

Dr. Lisa Belisle:

Well, very good. I really appreciate the work you're doing with libraries, the work that you've been doing a long time, Steve, and the work that you've been doing a little bit less long, but still in a very important way. We've been speaking with Stephen Pagoni, the executive director of the Portland public library, and Dr. Sam Zager, a family physician volunteer at Portland Public Health and also researcher. We appreciate all the time that you've spent trying to bring culture and reading and literacy and wellness to the world.

Dr. Sam Zager:

Thank you very much.

Steve Podgajny:

Thank you very much, Dr. Lisa.

Dr. Lisa Belisle:

You have been listening to Love Maine radio show number 166, books, libraries and Health. Our guests have included Doro Bush Cook, Becky Dyer, Steve Bogoni, and Dr. Sam Zager. For a preview of each week's show, sign up for our E Newsletter and like our LoveMain Radio Facebook page, follow me on Twitter and see my daily running photos as bountiful1 on Instagram. We'd love to hear from you, so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows. Also let our sponsors know that you have heard about them here. We are privileged that they enable us to bring the Love Maine Radio show to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our books, libraries and health show. Thank you for allowing me to be part of your day. May you have a bountiful life.

Becky Dyer:

Sa.