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Growing Up in Toxic Environments
Robert Blum, MD, MPH, PhD
Johns Hopkins University
Section A
A Nested Model of What Children
Need for Healthy Development
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Food subsidies  Welfare-to-Work
legislation  No Child Left Behind
legislation  SSA Title 19 
UN Conventions on the Rights of the
Child  FCC (e.g., tolerance for
violence)  EPA standards  Urban
boundaries
4
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Food subsidies  Welfare-to-Work
legislation  No Child Left Behind
legislation  SSA Title 19 
UN Conventions on the Rights of the
Child  FCC (e.g., tolerance for
violence)  EPA standards  Urban
boundaries
5
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Community/Neighborhood
Physical deterioration  Exposure to
violence  Norms (e.g., civility,
violence, aggression)  Green spaces 
Green grocers  Neighborhood income
& education  Television  Fear 
Partner prospects  Mobility 
Collective efficacy
6
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Community/Neighborhood Environment
Daycare/Preschool, School
Access to Early Head Start  Quality
Daycare by age 2  Language & prereading skills development  Social
skills development  Small school 
Teacher/adult connectedness  High
expectations  Safety: physical,
emotion, & academic supports
7
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Community Environment
Schools and Daycare
Family Structure
Family mental health  Maternal
depression  Parental education &
income  Faith/religiosity  Parenting
“style”  Parent availability  Food/
housing security  Expectations
8
A Nested Model of Factors for Healthy Child Development
Macro-Level Environment
Community Environment
Family & School
Individual
Biological/cognitive vulnerability 
Irritable temperament  Aggressive
personality  Impulsive  High stress
reactivity  Interpersonal social skills
9