Jul 25 2014
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Faces of Public Health: Lisel Loy, Bipartisan Policy Center

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Late last month, the Bipartisan Policy Center, a think tank based in Washington, D.C., released a new white paper, Teaching Nutrition and Physical Activity in Medical School: Training Doctors for Prevention-Oriented Care, that strongly recommends providing greater training in nutrition and physical activity  for medical students and physicians in order to help reduce U.S. obesity rates. The report was jointly published with the American College of Sports Medicine and the Alliance for a Healthier Generation, a nonprofit founded by the American Heart Association and the Clinton Foundation as a response to the growing rate of childhood obesity. The report found that current training for medical professionals and students in nutrition and exercise is inadequate to cope with the nation’s obesity epidemic.

A survey conducted for the new report found that more than 75 percent of physicians felt they had received inadequate training to be able to counsel their patients on changing diet and increasing activity levels. It also found that while some schools have stepped up their performance, fewer than 30 percent of medical schools meet the minimum number of hours of education in nutrition and exercise science recommended by the National Academy of Sciences.

“The health care marketplace needs to place greater value on preventive care,” said Jim Whitehead, Chief Executive Officer and Executive Vice President of the American College of Sports Medicine. “Doing so will provide medical schools with the incentive to train their students accordingly. And it will give medical professionals the leverage they need to address healthy lifestyles with their patients.”

NewPublicHealth recently spoke with Lisel Loy, director of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center, about the report and about how to improve training for medical professionals on nutrition and exercise.

NPH: What was the idea that propelled you to look into making changing to medical school education?

Loy: Well, the technical launching pad was our June 2012 policy report called Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future. And in that, my four co-chairs recommended a suite of policy changes that would improve health outcomes and lower costs for families, communities, schools and work sites. Within that community context they called out the need to improve training for health professionals—not just physicians but health professionals much more broadly defined than that—in pursuit of the goal of reducing obesity and chronic disease and cutting costs.

So that’s sort of the technical answer to your question. The more philosophical answer is as we as a country shift toward more preventive care, they really saw a gap in the education and training of health professionals in terms of being able to best support improved health outcomes. So that’s how they determined that that belonged in our report as a policy recommendation, and since we put out that report we prioritized a handful of recommendations, one of which had to do with health professional training.

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Jul 25 2014
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Public Health News Roundup: July 25

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United States, Mexico to Enhance Safety of Certain Agricultural Products
The U.S. Food and Drug Administration (FDA) and Mexico’s National Service for Agro-Alimentary Public Health, Safety and Quality and Federal Commission for the Protection from Sanitary Risks have entered an agreement to form a partnership to improve and promote the safety of fresh and minimally processed agricultural products. Each year, Mexico exports approximately $4.6 billion in fresh vegetables; $3.1 billion in fresh fruit, excluding bananas; $1.9 billion in wine and beer; and $1.5 billion in snacks to the United States.

The preventive practices and verification measures will include:

  • Exchanging information to better understand each other’s produce safety systems
  • Developing effective culturally-specific education and outreach materials that support industry compliance with produce safety standards
  • Identifying common approaches for training auditors who will verify compliance with such standards
  • Enhancing collaboration on laboratory activities as well as outbreak response and traceback activities

“To be successful as regulators, the FDA must continue developing new strategies and partnerships that allow us to more comprehensively and collectively respond to the challenges that come with globalization,” said FDA Commissioner Margaret A. Hamburg, MD, in a release. “The FDA is working with our Mexican government counterparts as well as stakeholders from industry, commerce, agriculture, and academia to ensure the safety of products for American and Mexican consumers.” Read more on food safety.

JAMA: Health Experts Call for End on Blood Donation Ban for Gay and Bisexual MenEx
perts writing in the Journal of the American Medical Association have called for the repeal of a 30-year ban on blood donations from gay and bisexual men. The U.S. Food and Drug Administration (FDA) instituted the ban for any man who had sex with another man in 1983, near the beginning of the AIDS crisis. Now, however, the experts said that technological and societal advances mean the ban should be lifted. "We think it's time for the FDA to take a serious look at its policy, because it's out of step with peer countries, it's out of step with modern medicine, it's out of step with public opinion, and we feel it may be legally problematic," said Glenn Cohen, who directs Harvard Law School's Petrie-Flom Center for Health Law Policy, Biotechnology & Bioethics, who co-wrote the article with Jeremy Feigenbaum of Harvard Law School and Eli Adashi, MD, of Brown University's medical school. They also noted that the ban is not in line with other FDA policies regarding people considered high-risk donors due to their sexual behavior. Read more on HIV/AIDS.

CDC Re-Opens Clinical TB Lab; Safety Reviews of Other Labs Continues
Less than two weeks after closing laboratories due to two serious lapses with anthrax and avian flu virus and an intensive review by its CDC’s internal Laboratory Safety Improvement Working Group, the U.S. Centers for Disease Control and Prevention (CDC) has resumed the transfer of inactivated materials out of its high-containment Clinical Tuberculosis Laboratory. The moratorium on material transfers remains in effect for BSL-3 and BSL-4 laboratories, with those supporting direct patient care receiving priority review. The working group’s ongoing lab assessments focus on two main areas:

  • Each lab must demonstrate that its protocols for key control points—such as inactivation of a pathogen—are not only being used but that they are being used by appropriately trained and supervised individuals.
  • Each lab is expected to establish redundant controls, similar to the two-key system used in other contexts for critical control points. For example, in the TB lab when heat is used to kill a pathogen, a second trained lab technician will witness the process to make sure the right temperature is used for the right amount of time. Both individuals then sign off on the process.

There will also be unannounced safety inspections by internal auditors. Read more on infectious disease and research.

Jul 24 2014
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Public Health Campaign of the Month: A Public Health Reason to Post a Selfie

NewPublicHealth continues a new series to highlight some of the best public health education and outreach campaigns every month. Submit your ideas for Public Health Campaign of the Month to info@newpublichealth.org.

The March of Dimes has launched a PSA “selfie” campaign to remind women that if a pregnancy is healthy then it’s best to aim for at least 39 completed weeks of gestation before scheduling a delivery. The campaign features photos of women well into their pregnancies—bellies out to there and all with broad smiles.

According to the March of Dimes, important development of the brain, lungs and other organs occurs during the last weeks of pregnancy. The organization, along with state and local health departments, has increased its attention on the issue in the last few years.

“Every week of pregnancy is crucial to a newborn’s health,” said March of Dimes President Jennifer L. Howse, MD. “We believe that using ‘selfie’ photos will help reach today’s mothers-to-be, so they understand that healthy babies are worth the wait.”

The campaign photos all come (with permission) from women who have downloaded a free March of Dimes app, Cinemama, which lets expecting moms take and store selfies to give them a photo record of their pregnancies. Television stations across the country are giving free air time to broadcast the PSA.

>>Bonus Link: Read more on NewPublicHealth about maternal and infant health.

Jul 24 2014
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Public Health News Roundup: July 24

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FDA Approves New Oxycodone with Abuse-deterrent Properties
The U.S. Food and Drug Administration (FDA) has approved a new extended-release oxycodone with abuse-deterrent properties. Targiniq ER—which should be used to treat pain severe enough to require daily, around-the-clock, long-term opioid treatment—contains naloxone which blocks the euphoric effects of oxycodone when crushed and snorted, or crushed, dissolved and injected. The drug is consistent with the FDA’s 2013 draft guidance for industry, Abuse-Deterrent Opioids – Evaluation and Labeling. "The FDA is committed to combatting the misuse and abuse of all opioids, and the development of opioids that are harder to abuse is needed in order to help address the public health crisis of prescription drug abuse in the U.S.,” said Sharon Hertz, MD, deputy director of the Division of Anesthesia, Analgesia and Addiction Products in the FDA’s Center for Drug Evaluation and Research. “Encouraging the development of opioids with abuse-deterrent properties is just one component of a broader approach to reducing abuse and misuse, and will better enable the FDA to balance addressing this problem with meeting the needs of the millions of people in this country suffering from pain.” Read more on substance abuse.

HHS: 10.3 Million Adults Gained Coverage in the ACA’s First Open Enrollment Period
An estimated 10.3 million uninsured adults gained health care coverage following the first open enrollment period in the Health Insurance Marketplace, according to a new study from the U.S. Department of Health and Human Services appearing the New England Journal of Medicine. The study looked at insurance trends before and after the open enrollment period, finding that the uninsured rate for adults ages 18-64 dropped from 21 percent in September 2013 to 16.3 percent in April 2014, which corresponded to a 5.2 percentage-point change, or 10.3 million adults gaining coverage. Read more on the Affordable Care Act.

Study: Parents of Obese Kids Often Don’t Realize They’re Unhealthy
Parents of obese children often don’t see their child’s weight as unhealthy and are more likely to make changes in their eating habits than to increase exercise, according to a new study in the Journal of the Academy of Nutrition and Dietetics. In a survey of more than 200 families in 2008 and 2009 to evaluate their readiness to help their children lose weight, researchers found that 28 percent of the parents did not see their child's weight as a health problem and 31 percent thought their child’s health was excellent or very good. The study also found that while 61 percent said they were trying to improve eating habits, only 41 percent were attempting to increase their child's activity level. Read more on obesity.

 

Jul 23 2014
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TEDMED Great Challenges: A Candid Conversation About Childhood Obesity

A 2012 report from the Robert Wood Johnson Foundation (RWJF) and Trust for America’s Health concluded that if the adult and childhood obesity rates in 2011 continued to increase at their steady paces, then by 2030 nearly two-thirds of U.S. adults would be obese and every single state would have obesity rates above 44 percent.

Data now show that childhood obesity rates have stabilized. In fact, for the first time in a decade the obesity rates among young children from low-income families in many states is trending down.

Helping lead the way in this important public health issue has been the city of Philadelphia, Penn., which has worked to improve access to healthy foods and opportunities for physical activity.

“We were very fortunate in Philadelphia to have colleagues...who have developed a better understanding of childhood obesity,” said Don Schwarz, former Health Commissioner and Deputy Mayor for Health and Opportunity, City of Philadelphia, and will also soon take on the role of director for RWJF’s Demand Team. “What that has meant is that Philadelphia was able to take a body of knowledge and bring it to scale. The partnership in Philadelphia that has allowed that to happen goes across government and between government and the private sector and community organizations—just everyday Philadelphians. So that kind of partnership, that wonderful knowledge base, has I believed turned the corner on childhood obesity, particularly for children who are of disadvantaged communities.”

Schwarz’s comments came during the Tuesday, July 22 Google Hangout TEDMED Great Challenges: A Candid Conversation About Childhood Obesity. The panel was moderated by Richard Besser, Chief Health and Medical Editor for ABC News.

Every member of the panel echoed the importance of partnerships, and Besser succinctly explained their critical role in not just obesity prevention but all public health efforts.

“The more creatively you can think and the wider variety of partners you can pull in, the more likely you are to be successful,” he said.

At the heart of Philadelphia’s success has been the important role that schools play in that community partnership. According to Schwarz, for the past decade the city’s schools have worked to reshape how they approach children’s health and wellbeing, including comprehensive nutrition policies, a new food environment that emphasizes healthy choices and more opportunities for kids to be physically active. One can’t be successful without the other.

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Jul 23 2014
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From Flyers to Tweets to Apps, Food Programs are Looking for Hungry Kids this Summer

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While more than 30 million children receive free or reduced-cost meals through the U.S. Department of Agriculture’s (USDA) National School Lunch Program during the school year, only about 3 million of those kids sign on for summer meals through the USDA’s Summer Food Service Program, according to agency statistics. While not all 30 million need the summer meals—many are enrolled in summer programs that offer food or have parents that are able to take responsibility for providing meals—USDA and hunger experts know that millions are going hungry each summer, impacting their day-to-day lives, the learning gains of the previous year and learning readiness for the next grade.

“Most of the reason eligible kids aren’t getting meals in the summer is simply because parents don’t know about them,” said Audrey Rowe, head of the USDA’s Food and Nutrition Service, which runs the meal programs.

Last year, USDA made increasing the number of kids getting summer meals (sites typically serve one meal and a snack or two meals) a top priority, according to a the report Summer Doesn’t Take a Vacation, published by the Food Research and Action Center (FRAC), a Washington, D.C.-based nonprofit aimed at ending child hunger. According to the report, the summer of 2013 marked the first major increase in the number of low-income children eating sponsored summer meals in 10 years, and the program grew last year to serve nearly three million children, an increase of 161,000 children or 5.7 percent from 2012. This represents the largest percentage increase since 2003.

To reach those increases, the USDA worked with organizations including FRAC, Feeding America, Share Our Strength, the YMCA and other national, state and local stakeholders to target states with high rates of poverty, food insecurity and low participation rates in summer food programs. Efforts ran from high-level conversations with state governors—some of whom had known nothing about summer meal programs—to dozens of webinars to teach officials and private partners the nuts and bolts of running the programs. For example, sites are eligible in communities where more than half the area children receive subsidized school meals. 

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Jul 23 2014
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Public Health News Roundup: July 23

New EPA Tool Helps Communities Become More Flood Resilient
The U.S. Environmental Protection Agency (EPA) has released a new tool, the Flood Resilience Checklist, to help communities prepare for, deal with and recover from floods. The checklist includes strategies that communities can consider, such as conserving land in flood-prone areas; directing new development to safer areas; and using green infrastructure approaches, such as installing rain gardens, to manage storm water. “Flooding from major storms has cost lives and caused billions of dollars in damage,” said EPA Administrator Gina McCarthy. “With climate change, storms are likely to become even more powerful in many regions of the country. Where and how communities build will have long-term impacts on their flood resilience, and on air and water quality and health and safety. This checklist will help flood-prone communities think through these issues and come up with the solutions that work best for them.” Find more resources on EPA’s Disaster Recovery and Resilience page.

Home Blood Pressure-Monitoring Devices Lower Health Care Costs 
A new study in the journal Hypertension finds that home blood pressure monitors can improve health care quality and save money. In the United States, more than 76 million adults have been diagnosed with hypertension and many more are undiagnosed. The researchers analyzed 2008-11 data from two health insurance plans—a private employer plan and a Medicare Advantage plan where 60 percent of members had high blood pressure. Net savings associated with home blood pressure monitoring ranged from $33 to $166 per member in the first year, and $415 to $1,364 over 10 years. Researchers found reasons for the savings differed by age groups and whether the monitors were used for treatment or diagnosis. In people 65 and older, home monitoring saved more when used to track high blood pressure treatment, by helping them avoid future adverse cardiovascular events. In people younger than 65, savings were higher in diagnostic use of the monitors, with fewer false positive diagnoses and fewer people starting unnecessary treatment. Read more on prevention.

New Mobile App Helps Parents Discuss Underage Drinking with their Kids
The Substance Abuse and Mental Health Services Administration (SAMHSA) has launched a new mobile app that features a simulated video game-like tool to help parents practice having conversations about underage drinking. SAMHSA experts say the timing of the release is intentional, as the rate of youth alcohol use rises during the summer. The mobile app is the newest component of “Talk. They Hear You,” SAMHSA’s underage drinking prevention campaign that launched last year to provide parents and caregivers with information and tools to start talking to youth early—as early as nine years old—about the dangers of alcohol. The new app uses avatars to engage in interactive conversations and each virtual role-play conversation is structured as a 10- to 15-minute interactive, video game-like experience. Users engage in a conversation with an intelligent, fully animated, emotionally responsive avatar that models human behavior and adapts its responses and behaviors to the user’s conversation decisions. Read more on substance abuse.

Jul 22 2014
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Public Health News Roundup: July 22

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Study: Low-income Teens in Better High Schools Engage in Fewer Risky Behaviors
Low-income teenagers attending “high-performing” high schools are less likely than their peers in lower-performing schools to engage in risky behaviors such as carrying a weapon, binge drinking, using drugs other than marijuana and having multiple sex partners, according to a new study in the journal Pediatrics. Researchers analyzed 521 students who were accepted into a high-performing charter school; when compared to 409 students who also applied to top charter schools but were not selected in a random lottery, the kids in the high-performing schools were less likely to engage in at least one of the identified “very risky” behaviors—36 percent, compared to 42 percent. There was no statistical difference for more common risky behaviors, such as lighter drinking and smoking cigarettes. Read more on education.

Too Few People At Risk for Heart Disease are Receiving Recommendations for Aspirin Therapy
Despite the important role it can play in preventing heart disease, only 40 percent of the people who are at high risk of cardiovascular disease reported receiving a doctor’s recommendation for aspirin therapy, according to a new study in the Journal of the American Heart Association. Approximately one-quarter of people at low risk received the recommendation. “Cardiovascular disease is a significant problem in the United States and the appropriate use of prevention strategies is particularly important,” said Arch G. Mainous III, PhD, the study’s lead investigator and chairman of the department of health services research, management and policy at the University of Florida’s College of Public Health and Health Professions, in a release. “Aspirin has been advocated as a prevention strategy but only for certain patients. There are health risks associated with the treatment. It is important that doctors are directing the right patients to get aspirin for cardiovascular disease prevention.” The U.S. Preventive Services Task Force recommends aspirin use to prevent heart attack and stroke in men ages 45-79 and women ages 55-79. Read more on heart health.

Study: Coping Skills Programs for Mothers of Children With Autism Helps All Involved
Mothers of children with autism who participated in coping skills programs saw reduced stress, illness and psychiatric problems—all of which they are at higher risk for—while also improving their connections with their children, according to a new study in the journal Pediatrics. Such programs also benefit their children, as these risk factors are associated with poorer health outcomes for the children. Researchers entered 243 mothers of children with disabilities (two-thirds of which were autism) into six weeks of either Mindfulness-Based Stress Reduction (mindfulness practice) or Positive Adult Development (positive psychology practice), finding that both reduced stress and other negative impacts. Read more on mental health.

Jul 21 2014
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Child ‘Vehicular Heatstroke’: Good Samaritan Laws and Other Public Health Solutions

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Earlier this month, following the heatstroke death of a Georgia toddler who was left in a sweltering car for hours, Tennessee became the first state in the nation to pass a law that specifically protects people from liability for forcibly breaking into cars and rescuing kids they think are at risk of heatstroke. The law requires those individuals to call 911 first and follow instructions.

Many states have Good Samaritan laws that may protect people in such instances, but the specifics vary from state to state, according to Cristina M. Meneses, JD, MS, a staff attorney with the Network for Public Health Law’s Eastern Region. A recent Today show poll found that 88 percent of the 44,000 people asked would break into a car to rescue a child they thought was in danger, but specific laws can increase the response—and potentially remove penalties—while raising awareness of the issue. More such laws could soon follow. Janette Fennell, founder and head of KidsAndCars, a nonprofit based in Kansas City, Mo., which advocates for laws that will protect kids from heat in vehicles, said she’s received inquiries from two states about those laws since Tennessee’s law was passed. Another set of laws that KidsAndCars tracks are those that penalize adults for leaving kids in cars. Nineteen states currently have such laws on the books.

“It’s a good deterrent for anyone who might think, ‘Oh, I’ll just leave them in the car for a minute,’” said Fennell, “because it’s often that minute that turns into much longer and results in injury or death.”

According to the National Highway Traffic Safety Administration (NHTSA), more than 40 kids—often under age 2—die each year of “vehicular heatstroke.” Seventeen U.S. kids have died after being left or trapped in car since the beginning of 2014. Fennell and other experts say many people just don’t realize how quickly temperatures can climb in a car, even if the window is cracked open a bit—when outside temperatures are in the low 80's, the temperature inside a vehicle can reach deadly levels in only 10 minutes, even with a window rolled down two inches. Children's bodies, in particular, overheat easily; and infants and children under four years old are at the greatest risk for heat-related illness.

NHTSA research shows that heatstroke deaths and injuries often occur after a child gets into an unlocked vehicle to play without a parent or caregiver's knowledge. Other incidents can occur when a parent or caregiver who is not used to transporting a child as part of their daily routine inadvertently forgets a child sleeping in the back.

Last week, KidsAndCars launched a petition drive to encourage NHTSA to require technology in all cars that would remind a driver that there is a child in the back. There are devices parents can install, but a 2012 study by NHTSA found that none that the agency studied were consistently effective.

“You get a warning if you don't buckle your seatbelt, leave a car door open, your gas is low or you leave your headlights on,” said Fennell. “If a child is left behind then you absolutely need a warning.”

Guidelines from NHTSA and other safety experts aimed at never leaving a child unattended in a car include:

  • Make a habit of looking in the vehicle—front and back—before locking the door and walking away
  • Ask childcare providers to call if a child doesn't show up for care as expected
  • Put items in the back seat you’ll have to retrieve such as a purse or briefcase, or put a stuffed animal in sight of the driver to indicate there’s a child in the car.

>>Bonus Links:

Jul 21 2014
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Public Health News Roundup: July 21

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Strokes Fall Among Older Americans
Fewer older Americans are having strokes and those who do have a lower risk of dying from them, according to researchers at the Johns Hopkins Bloomberg School of Public Health. The study, published in JAMA, followed close to 15,000 stroke-free patients ages 45 to 64, beginning in the 1980s and ending in 2011. It found a 24 percent overall decline in first-time strokes in each of the last two decades and a 20 percent overall drop per decade in deaths after stroke. However, the decline was found mainly in people over age 65, with little progress in reducing the risk of strokes among younger people. The researchers say the decrease in stroke incidence and mortality is partly due to more successful control of risk factors such as blood pressure, smoking cessation and use of statin medications for controlling cholesterol, but that more efforts are needed to reduce strokes in younger people, including reducing obesity and diabetes and increasing physical activity. Read more on mortality.

Study: Insufficient Sleep Can Harm Memory
Lack of sleep, currently considered a public health epidemic in the United States, can also lead to errors in memory, according to a new study in Psychological Science. The study found that participants who didn’t get a full night’s sleep were more likely to make mistakes on the details of a simulated burglary they were shown in a series of images. “We found memory distortion is greater after sleep deprivation,” said Kimberly Fenn, an associate professor of psychology at Michigan State University and a co-investigator of the study. “And people are getting less sleep each night than they ever have.” The U.S. Centers for Disease Control and Prevention has linked the insufficient sleep epidemic to car crashes, industrial disasters and chronic diseases such as hypertension and diabetes. Read more on mental health.

New EPA Graphic Will Give Consumers More Information on Insect Repellent Products

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The U.S. Environmental Protection Agency (EPA) has recently released a new graphic design available for use by insect repellent makers to more easily show how long the product is effective. “We are working to create a system that does for bug repellents what SPF labeling did for sunscreens,” said Jim Jones, Assistant Administrator of the Office of Chemical Safety and Pollution Prevention. “By providing vital information to consumers, this new graphic will help parents, hikers and the general public better protect themselves and their families from serious health threats caused by mosquitoes and ticks.” The release of the graphic design was accompanied by a joint statement from the EPA and the U.S. Centers for Disease Control and Prevention (CDC) urging the public to use insect repellents and take other precautions to avoid biting insects that carry serious diseases, including Lyme and West Nile virus. Incidence of insect-borne diseases is on the rise, according to the CDC. In order to place the new graphic on their labels, manufacturers must submit a label amendment, including test results on effectiveness. The public could see the graphic on repellent products early next year. Read more on infectious disease.