Promoting One Health: The University of Missouri Research Center for Human/Animal Interaction

Abstract

The University of Missouri’s College of Veterinary Medicine is home to the Research Center for Human-Animal Interaction. This center uniquely addresses a growing area of research that focuses on how the human-animal bond impacts health in people and animals. This article highlights the One Health basis for the center, several research projects, and future goals for the center.

Pets, especially dogs, have been shown in rigorous studies to improve both the mental and physical health of most of their owners.

Introduction: One Health Defined

There is considerable evidence that there has been an interrelationship between humans and animals since well before the domestication of animals. In varying degrees, the health of humans and of animals was then, and continues to be, interdependent. In particular, humans relied on animals for food, protection, and warmth. The concept of One Health is based on this premise and has resulted in a movement between human and veterinary medicine promoting cross-disciplinary collaboration to address not only illnesses common across species, but also interventions to facilitate health as more than just the absence of illness.

The American Veterinary Medical Association has arrived at the following definition:

“One Health is the collaborative effort of multiple disciplines - working locally, nationally, and globally - to attain optimal health for people, animals, and our environment. Together, the three make up the One Health triad, and the health of each is inextricably connected to the others in the triad. Understanding and addressing the health issues created at this intersection is the foundation for the concept of One Health.”¹

In recognition of the importance of long-standing cross-species interconnectedness, in recent years there has been considerable growth in human-animal interaction research. One specific area in this field is human-companion animal interaction. This interaction commonly takes place in four contexts: pet ownership; animal assisted activity in which specially trained and registered therapy animals and their handlers visit patients in acute and long term care settings; animal assisted therapy in which an animal is incorporated by a licensed professional as part of a patient-specific treatment plan; and service animals commonly dogs trained to perform specific tasks to facilitate independent living of their owner.²

Health Benefits Abound, Especially for Dog Owners

Pet ownership benefits human health in a number of ways, and to greater degrees in particular populations. In adults, research demonstrated that the presence of a pet has been associated with better performance on mental tasks.³ Pets are commonly identified as nonjudgmental members of families.⁴ Pet ownership has been associated with greater exercise levels (particularly dogs and in older adults); dog walking was associated with sustained physical functioning over a three-year period,⁵ and fewer patient-initiated physician visits.⁶ Dog ownership has been associated with better lipid panel outcomes^7,8 and pet owners have been found to be more likely to survive one year after myocardial infarction than non-pet owners controlling for age, severity of illness and comorbidities.⁹ Older pet owners were found to be less depressed than non-pet owners.¹⁰ This outcome is important for preventing the downward spiral in functional ability, mood, and social engagement that may lead to nursing home placement.

Human animal interaction and pet ownership have been found to be beneficial in relation to obesity prevention and treatment. Obesity is now a major public health problem given that there are over 79 million obese adults in the U.S. and 12.5 million children and adolescents. This condition is ranked as the leading cause of preventable death and resulted in annual national health care expenditures of over $147 billion in 2008. Missouri is one of nine states with an adult obesity rate of over 30% (http://www.cdc.gov/vitalsigns/AdultObesity/index.html#). The problem also occurs in companion animals. An estimated 34% of dogs are overweight or obese.¹¹ Existence of this problem on both ends of the leash suggests an opportunity for health care providers to engage the human-dog relationship to promote physical activity and one health across the two species.

Commitment to owning a dog has been found to promote exercise through dog walking as owners meet the needs of their dog for exercise and in doing so, benefit themselves. Australian dog owners walked 18 minutes per week more than non-owners and met physical activity recommendations of 150 minutes per week.¹² In the United States, adults who walked dogs accumulated a minimum of 30 minutes of walking per day in bouts of at least 10 minutes.¹³ One trial found that obese adults with pets increased their moderate physical activity over those who did not have a pet.¹⁴ Older adults who walked shelter dogs were found to have significantly increased walking speeds when compared with those who walked with a human companion.¹⁵ Stress reduction commonly associated with exercise was demonstrated in one study in which older Japanese adults experienced increased parasympathetic neural activity. This activity was sustained while dog-walking and was cumulative over succeeding walks.¹⁶ These findings suggest that dog ownership may be one way to facilitate healthy physical activity patterns benefitting both owners and their dogs. Two recent resources for promoting pet owners’ exercise with their companion animal are books co-authored/co-edited by the author of this paper: (See sidbar on page 196.)

The goal of PALS (Pet Assisted Love and Support for Seniors) is to improve the quality of life, and to bring healing to the team: the volunteer, the animals, and the older adults who benefit from this program.

Animal Assisted Activity

Animal assisted activity appears beneficial in anxiety-inducing disease states or treatment protocols. It is thought to provide distraction and stress relief, particularly in settings in which patients may feel isolated and need additional interaction and companionship (e.g. in hospitals and nursing homes).¹⁷ Nursing home residents who had dog visits were significantly less lonely than those not having visits.¹⁸ Companion animals have been found to facilitate social interaction. People are more likely to interact positively with others when an animal is present.¹⁹ Increased positive social interaction occurred between nursing home staff, residents and staff, and residents with other residents when a dog was present.²⁰ Indirect interaction with animals has also been found to be of benefit for nursing home residents. Patients with Alzheimer’s disease sat for longer periods and ate significantly more food when watching fish swim in an aquarium placed in front of them during meals.²¹ Hospitalized patients reported less pain and used fewer analgesics during and after an animal visit.²² In patients with heart failure, anxiety, and epinephrine levels decreased during and after an animal visit.²³

Animal Assisted Therapy

Animals are used in rehabilitation settings to facilitate patients’ progress with specific therapy goals. In this and other therapeutic settings (e.g. psychotherapy), licensed professionals (e.g. psychologists, physical and occupational therapists and social workers) include interaction with animals in therapy protocols. Children with autism were better able to stay on task with their therapist with a therapy dog present.²⁴ In other modalities such as in therapeutic horseback riding, patients increased their balance, and improved their gait through specific activities while riding specially selected and trained horses.²⁵ Animal Assisted Therapy has increased; however, in order to ensure that such programs persist and continue to be adopted, randomized clinical trials are needed to define less equivocal and more replicable outcomes.

Service dogs perform specific tasks to assist their owners such as opening doors, turning on lights, or retrieving objects.

Service Animals

In contrast to pets, service animals live and work with their owners to facilitate independent living. These animals (generally dogs) are federally protected by the Americans with Disabilities Act and are permitted to accompany their owner wherever that person goes as long as the dog does not create a disturbance or unsafe situation through unruly or aggressive behavior. The dogs perform specific tasks to assist their owners such as opening doors, turning on lights, or retrieving objects. Presently, service dog roles are being expanded to alleviate post-traumatic distress symptoms (PTSD, e.g. in military veterans) through tasks such as alerting their owner to someone coming up from behind, going ahead around blind corners to signal the owner that it is safe to proceed, and creating personal space by standing in front of the owner in a crowded situation. The Veterans Administration has recently released a policy indicating that it will not provide financial support for veterans’ PTSD service dogs due to a lack of published research demonstrating their efficacy http://www.stripes.com/va-says-noservice-dogs-benefits-warrantedfor-ptsd-sufferers-1.188166. However, veterans continue to seek and obtain PTSD service dogs to assist them in daily life.

One Health Human Animal Interaction Work

The Research Center for Human Animal Interaction (ReCHAI) was established in 2005 at the University of Missouri, College of Veterinary Medicine, as a collaborative center with the Sinclair School of Nursing. ReCHAI’s mission is “Studying and promoting the health benefits of human-animal interaction (HAI).” ReCHAI plays a vital role in international initiatives to promote research, practice, and education in human animal interaction through the International Association of Human Animal Interaction Organizations (IAHAIO), a global umbrella association of over 40 organizations conducting varied work in HAI. The author of this paper is currently President of this Association. In July, 2013, IAHAIO will hold its triennial conference in tandem with the 150^th annual convention of the American Veterinary Medical Association. This will create unprecedented opportunities for collaboration and information sharing across human health and veterinary medical fields.

ReCHAI conducts both research and community programs. One example of a community program, the TigerPlace Pet Initiative, aims to enhance pet ownership among older adult residents of TigerPlace, an aging-in-place retirement residence originated by the Sinclair School of Nursing. ReCHAI provides older adults with support needed to keep their pets via a pet care assistant. This assistant visits pet owners at least three times each week to walk dogs (for those who are unable to do this), clean cat litter boxes, and provide other assistance as needed (e.g. administering medications to pets). We maintain an on-site veterinary medical exam room which is used by our faculty veterinarian who makes monthly house calls on the pets, and also gives presentations for the older adults and facility staff on matters pertaining to pet health. The program includes a fund for providing foster care for pets until their adoption when their owners pre-decease them. This program facilitates One Health by providing older adults who own pets support to help them keep their pets and benefit from the known positive outcomes of pet ownership. In addition to increasing TigerPlace residents’ happiness, this program also provides early detection of health problems in the pets, which enables prompt intervention, facilitating health of the animals.

Similar programs could be implemented in other retirement facilities by linking the facility with a local veterinarian willing to engage in this type of primary and preventive care for older adults’ pets. An auxiliary or volunteer corps could be formed to help older adults with the tasks done by the pet care assistant at TigerPlace. ReCHAI is called upon to advise other facilities wanting to establish similar pet-owner facilitating programs. This includes recommending procedures to address animal behavior problems (e.g. protective dog behavior toward staff working with older adults), pet overfeeding, and concerns of residents who do not like pets.

Since 2005, ReCHAI has conducted 13 studies including five which are currently underway. The center is a research training site for doctoral students across disciplines, professional veterinary medical students and undergraduate students completing capstone or practicum experiences. ReCHAI’s research investigates topics that include: alleviating US military veterans’ post traumatic stress through shelter dog obedience training, relieving anxiety of abused children during forensic interviews by placing a trained service dog with them during the experience, exploring the role of the family dog in families with children who have autism, and identifying the effect of training shelter dogs in basic obedience on prison inmates’ rehabilitation. The studies are funded by grants from external sources including but not limited to the National Institutes of Health, the Missouri Foundation for Health and several other foundations.

Future Directions and Goals

Future goals for ReCHAI are to expand its funding base through endowments, gifts, and additional research grants; and, to enable additional research, community programming, and student learning opportunities. A further goal is to develop pre and post-doctoral training fellowships in HAI and One Health through cross-disciplinary collaboration. Any reader interested in finding more information about the research and programs of the MU Research Center for Human-Animal Interaction can find it on the webpage at http://www.rechai.missouri.edu.

Biography

Rebecca A. Johnson, PhD, RN, FAAN, FNAP, is Professor and Director, Research Center for Human Animal Interaction, College of Veterinary Medicine, and the Millsap Professor of Gerontological Nursing, MU Sinclair School of Nursing, University of Missouri.

Contact: rajohnson@missouri.edu