Apr 22 2014
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Health is a Human Right: Race and Place in America

file Emerson Elementary School class picture, ca. 1947 Courtesy of Shades of San Francisco, San Francisco Public Library

“Of all the forms of inequality, injustice in health care is the most shocking and inhuman,” said the Rev. Dr. Martin Luther King Jr. in 1966 at the Convention of the Medical Committee for Human Rights, which was organized to support civil-rights activists during Mississippi's Freedom Summer. Those words are part of the Health is a Human Right: Race and Place in America exhibit on display at the David J. Sencer Centers for Disease Control and Prevention (CDC) Museum in Atlanta. The museum, located at the CDC’s Visitor Center, mounts several exhibits each year. The timing for the Health as a Human Right exhibit coincides with National Minority Health Month, observed each April to raise awareness of health disparities in the U.S. among ethnic and racial minorities. 

file “Incidence of Syphilis Among Negroes” chart From Shadow on the Land by Surgeon General Thomas Parran, 1936

The CDC exhibit, curated by museum director Louise Shaw, is organized by social determinants of health such as housing and transportation. Photographs, like those of teeming settlements in urban cities, are a key tool to show museum goers and online viewers the health disparities in U.S. history and present day. 

Among the items in the exhibit:

  • Mexican men sprayed with DDT on their arrival for a guest worker program in the 1950s.
  • A corroded sanitation pipe and bottles of unsafe drinking water from the Community Water Center in the San Joaquin Valley, California.
  • An inventive and cheap air sampler from New Orleans that people used to catalogue pollution levels and share with law makers.
  • A Chinese version of the "Be Certain: Get Tested for Hepatitis B," campaign.
  • A March of Dimes poster depicting an African American child with polio from the late 1950s. (For a long time after the polio epidemic began, many believed African Americans could not contract the virus. As a result, precaution campaigns were rare and late among that population.) 
file “We Shall Survive, Without a Doubt” poster from The Black Panther, August 21, 1971, artwork by Emory Douglas Courtesy of the artist

The exhibition is sponsored by CDC's Office of Minority Health and Health Equity, the CDC's Office of the Associate Director for Communication and the California Endowment.

NewPublicHealth spoke with Louise Shaw in Atlanta.

NewPublicHealth: What made you decide to mount and curate this exhibit?

Louise Shaw: Three years ago the CDC Museum was approached by CDC’s Office of Minority Health and Health Equity (OMHHE) to organize an exhibition to commemorate its 25th anniversary. As curator of the Museum, I was excited by the possibilities and conceived of a project that extended beyond just honoring OMHHE accomplishments. Dr. Leandris Liburd, OMHHE director, and her terrific staff, quickly jumped on board, and we all agreed to develop a historic exhibition framed by the social determinants of health. 

file “Southern Farmer’s Burden” cartoon about the Georgia State Board of Health’s efforts against malaria among African American rural workers, United States Public Health Service, 1923 Courtesy of National Archives and Records Administration, College Park, MD, photo no. 90-G-22-4

NPH: What are some of the most striking issues you found in disparities between whites and minorities when it comes to social determinants of health?

Louise Shaw: Although we have made progress in many areas, we are still tackling similar issues in the 21st century that were debated 100 years ago. For instance, how we provide quality education to all children, regardless of race, ethnicity, or income status, was and is one of the greatest challenges facing our country. As the Robert Wood Johnson Foundation has documented, education and the optimum health outcomes are closely linked. Ultimately, education is the pathway to eliminating health disparities. Income equality/inequality is another complex issue that is being hotly debated today. One more specific example: although pre-term birth rates have greatly declined over the past century among all groups, the disparities of those rates between whites and minorities stubbornly remain, and are yet to be eliminated. We need to ask ourselves why that is so. Collectively, we have still not resolved what it means to live in a diverse, multicultural society.  

NPH: Do you know of any outcomes that have come from the exhibit?

Louise Shaw: Internally at CDC, the exhibition has been an important touchstone for discussion and debate. I have received incredible feedback about the honesty of the exhibition, thanking me for connecting the dots visually among race, place, and health. By the time it closes on April 25th, over 30,000 people will have seen the show. I don’t think we have ever mounted an exhibition that has been visited by so many college and university students — some even virtually. A consortium of faculty members from the University of Connecticut, Emory University, and Georgia State University, have developed a formal evaluation tool. In addition, there is a local and national movement underfoot to figure out how the show can live on whether online or in another form. 

Apr 22 2014
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Public Health News Roundup: April 22

Study: False-Positive Mammograms Have Minimal Effect on Anxiety
Women whose mammograms suggest the presence of breast cancer that is eventually ruled out by further testing experience slightly increased anxiety that does not affect their overall health, according to a new study in the Journal of American Medical Association (JAMA) Internal Medicine. Researchers from the Geisel School of Medicine at Dartmouth College compared 534 cancer-free women whose mammograms initially suggested breast cancer to 494 women whose screenings were negative. The women were interviewed after the first mammogram but before they were cleared of a cancer diagnosis and again a year later. Immediately after their first mammogram, the women who received false-positive results had more anxiety than those who received a clean bill of health but the anxiety leveled off after one year. There was no difference in overall health between the two groups of women. Read more on cancer.

Bullying Victims Feel Psychological Effects into Middle Age
Children who are bullied suffer the psychological affects for years to come, leading to increased risk of depression and other mental health issues, according to a new study in the American Journal of Psychiatry. British researchers have found that children bullied at the ages of 7 and 11 experienced feelings of poor general health at ages 23 and 50 and poor cognitive functioning at 50. The study used surveys that were conducted over 50 years, looking at children who said they were bullied occasionally or frequently at 7 and 11, and comparing the impact at ages 23, 45 and 50. Read more on mental health.

Earth Day: The Impact of the Environment on Health
April 22 is Earth Day and people across the country are taking action to protect and improve our environment. The quality of our environmental has significant effects on our overall health. Air pollution, such as ground-level ozone and airborne particles, can irritate the respiratory system, induce asthma and even lead to lung disease. In addition, UV exposure due to ozone layer depletion can lead to skin cancer, cataracts and suppression of the immune system. Below are tips to help create a healthier planet today:

  • Conserve energy and improve air quality by turning off appliances and lights when you leave a room.
  • Keep stoves and fireplaces well maintained to reduce air pollution.
  • Plant deciduous trees near your home to provide shade from UV rays in the summer.
  • Buy energy efficient appliances produced by low- or zero-pollution facilities. 

Read more on environment.

Apr 21 2014
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Boston Marathon: Disabled Runners Inspired to Join Today’s Marathon

Photo credit: Larry Sillen | Mery Daniels crosses the finish line at the Hope and Possibility race. Photo credit: Larry Sillen | Mery Daniels crosses the finish line at the Hope and Possibility race.

In the wake of disasters communities often share stories of resiliency, not just to show how far they have come, but to model for others the critical need for an infrastructure of planning and preparedness when disaster hits. When the bombs went off at the Boston Marathon last year, Achilles International, a non-profit group that pairs able-bodied runners with disabled people, already had a chapter in place in the Boston area.

The group reached out using social media, as well as bright yellow banners and shirts during twice-weekly training sessions along the Charles River, to help attract attention and encourage Bostonian volunteers and potential athletes to join up. One survivor did. Thirty-one-year old Mery Daniel, a single mother of a five-year-old, who is close to completing her medical boards to become a general practitioner physician, lost one leg and suffered damage to the other during the blast. She joined up with Achilles and ran its 5K Hope and Possibility race—her first race ever—using a hand cycle last June.

The community rallying around the Boston Marathon over the last year has resulted in several new competitors joining up to compete in the Boston Marathon. A team of thirty differently abled Achilles runners, each with at least one guide for the race, will be wearing yellow Achilles shirts in today’s marathon. Their disabilities—ranging from Dwarfism and scoliosis to visual impairment—have not held them back.

“The stories about the survivors’ recoveries brought attention to the fact that people with disabilities have opportunities to do things they enjoy and learn new skills,” said Eleanor Cox, director of chapter development for Achilles. “So when the chapter put extra effort this past year into outreach through social media, word of mouth and the bright yellow banners on the Charles—matched up with people wanting to volunteer and people with disabilities wondering what was possible—it turned a previously quieter Achilles chapter into a strong one. Boston Strong.”

>>Bonus Link: Read more from Boston Marathon Survivor Adrianne Haslet-Davis on Recovery, Care, and Collaboration on the RWJF Culture of Health blog.

 

 

Apr 21 2014
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Public Health News Roundup: April 21

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Study: Monday the Best Time to ‘Reset’ and Improve Personal Health Regimens
People are more likely to think about their health earlier in the week, which could help researchers and officials determine how to better improve public health strategies, according to a new study in the American Journal of Preventive Medicine. Researchers from San Diego State University (SDSU), the Santa Fe Institute, Johns Hopkins University and the Monday Campaigns analyzed Google searches that utilized the term “healthy” and were health-related in the United States from 2005 to 2012, finding searches for healthy topics were 30 percent more frequent at the beginning of the week than later in the week; Saturday saw the fewest searches. The findings correspond with previous research indicating Mondays offered the opportunity for a “heath reset”—a chance to get back into healthy habits. "Many illnesses have a weekly clock with spikes early in the week," said SDSU's John W. Ayers, lead author of the study. "This research indicates that a similar rhythm exists for positive health behaviors, motivating a new research agenda to understand why this pattern exists and how such a pattern can be utilized to improve the public's health.” Read more on prevention.

Despite Recommendations Against, Codeine Still Prescribed to Many Kids During ER Visits
Codeine is often prescribed by emergency room physicians to treat coughs and other pains for children, even though the powerful opioid is not recommended for use in children by groups such as the American Academy of Pediatrics (AAP) and American College of Chest Physicians (ACCP), according to a new study in the journal Pediatrics. For the new study, the researchers used data from 189 million ER visits by children and teens between the ages of three and 17 years old. The visits took place between 2001 and 2010. Researchers from the University of California, San Francisco analyzed data from 189 million ER visits for youth ages 3-17, finding that while emergency room prescriptions were down slightly from 2001 to 2010, as many as 877,000 children are still taking the drug each year. Codeine can slow breathing and breaks down differently in children of different ethnicities, increasing the chance of overdose. Read more on prescription drugs.

Rates of Childhood Obesity Keeps Rising, Especially Among the Most Obese
A recent study out of the University of North Carolina (UNC) finds that childhood obesity is up for all classes of obesity in U.S. children over the past 14 years, with more severe forms of obesity—a body mass index (BMI) 120 to 140 percent higher than the averages—seeing the greatest increase. The study appeared in JAMA Pediatrics. “An increase in more severe forms of obesity in children is particularly troubling,” said Asheley Cockrell Skinner, PhD, lead author of the study and assistant professor of pediatrics in the UNC School of Medicine, in a release. “Extreme obesity is more clearly associated with heart disease and diabetes risk in children and adolescents, and is more difficult to treat.” Researchers analyzed data on 26,690 children ages 2-19 years from 1999 to 2012 collected as part of the National Health and Nutrition Examination Survey (NHANES). Read more on obesity.

Apr 18 2014
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Faces of Public Health: Esther Chernak, Drexel University School of Public Health

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The Center for Public Health Readiness and Communication (CPHRC) at the Drexel University School of Public Health in Philadelphia recently re-launched DiversityPreparedness.org, a clearinghouse of resources and an information exchange portal to facilitate communication, networking and collaboration to improve preparedness, build resilience and eliminate disparities for culturally diverse communities across all phases of an emergency. The site had originally been developed by Dennis Andrulis, now at the Texas Health Institute, and Jonathan Purtle, who co-writes a blog on public health for the Philadelphia Inquirer.

>>Bonus Links:

NewPublicHealth recently spoke with Esther Chernak, MD, MPH, the head of CPHRC, about the re-launched site and her work in preparedness.

NewPublicHealth: Tell us a little bit about your background and how you came to lead the Center for Public Health Readiness and Communication.

Esther Chernak: I’m an infectious disease physician by training and pretty much have been working in public health since I finished my infectious disease fellowship in 1991 at the University of Pennsylvania. I started working in the Philadelphia Department of Public Health in its city clinic system doing HIV/AIDS care, and then became the Clinical Director of HIV Clinical Programs for the health centers back in the early ’90s when the epidemic was obviously very different. I then moved to working in infectious disease epidemiology as a staff doctor in the acute communicable disease control program and was involved in infectious disease surveillance and outbreak investigations for a number of years.

Then in 1999, I took a job with the City Health Department in what was then called bioterrorism preparedness. That was the time when major cities in the country were just beginning to be funded to do bioterrorism response plans. Groups that were involved in bioterrorism preparedness recognized relatively quickly that despite the fact that we were dealing with planning for novel strains of influenza and pandemic preparedness and SARS and smallpox, we were also dealing with many, many really significant infectious disease outbreaks, and then ultimately non-infectious disease related issues that had huge impacts on public health, such as earthquakes and hurricanes. Those links helped prepare me for my role at the Center.

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Apr 18 2014
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Public Health News Roundup: April 18

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CDC: Mixed Progress in Food Safety Efforts
A new food safety progress report from the U.S. Centers for Disease Control and Prevention (CDC) shows mixed results for the country’s safety efforts. While the rate of salmonella infections was down approximately 9 percent in 2013 compared to the previous three years, campylobacter infections—often linked to dairy products and chicken—are up 13 percent since 2006-2008. The CDC also found that vibrio infections, which are often linked to raw shellfish, were at the highest level since tracking began in 1996. “This year’s data show some recent progress in reducing salmonella rates, and also highlight that our work to reduce the burden of foodborne illness is far from over,” said Robert Tauxe, MD, MPH, deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “To keep salmonella on the decline, we need to work with the food industry and our federal, state and local partners to implement strong actions to control known risks and to detect foodborne germs lurking in unsuspected foods.” The report’s data comes from the Foodborne Diseases Active Surveillance Network (FoodNet), a group of experts from CDC; ten state health departments; the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS); and the U.S. Food and Drug Administration (FDA). Read more on food safety.

FDA: Common Procedure to Remove Uterus, Uterine Fibroids Can Spread Cancer
A common procedure to remove the uterus or uterine fibroids can unintentionally spread cancerous tissue—such as uterine sarcomas—according to a new safety communication from the U.S. Food and Drug Administration (FDA), which is discouraging the use of laparoscopic power morcellation. The procedure divides the uterine tissue into smaller fragments in order to remove them via a small abdominal incision. “The FDA’s primary concern as we consider the continued use of these devices is the safety and well-being of patients,” said William Maisel, MD, MPH, deputy director for science and chief scientist at the FDA’s Center for Devices and Radiological Health. “There is no reliable way to determine if a uterine fibroid is cancerous prior to removal. Patients should know that the FDA is discouraging the use of laparoscopic power morcellation for hysterectomy or myomectomy, and they should discuss the risks and benefits of the available treatment options with their health care professionals.” Read more on cancer.

Approximately 12M U.S. Outpatients Misdiagnosed Each Year
Approximately 12 million U.S. adults are misdiagnosed each year in doctors’ office and other outpatient settings, with an estimated half of those mistakes potentially leading to serious harm, according to a new study set to be published in the journal BMJ Quality & Safety. The overall total means about one in every 20 patients are misdiagnosed. For the study researchers used data from three studies covering a sample pool of approximately 3,000 medical records. "It's important to outline the fact that this is a problem," said Hardeep Singh, MD, the study's lead author and a patient safety researcher at Baylor College of Medicine and at the Michael E. DeBakey VA Medical Center, both in Houston, according to Reuters. "Because of the large number of outpatient visits, this is a huge vulnerability. This is a huge number and we need to do something about it.” Read more on access to care.

Apr 17 2014
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Recommended Reading: ‘Pollution is Segregated, Too’

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After decades of studies demonstrating that poor people and minorities are more likely than their white counterparts to live near health hazards such as toxic waste sites, landfills and congested highways, a new study in the journal PLOS One took a more refined look at a particular aspect in the area of “environmental injustice”: exposure to nitrogen dioxide. The pollutant—which is produced by cars, construction equipment and industrial sources—is linked to higher risk of both asthma and heart attack.

Using data from the 2000 Census, researchers determined that minorities are on average exposed to 38 percent higher levels of outdoor nitrogen dioxide. The gap varies depending where in the country they live, with the upper Midwest and the Northeast seeing the greatest disparities, as well as major cities. All told the disparity accounts for an additional 7,000 deaths due to heart disease annually.

"The biggest finding is that we have this national picture of environmental injustice and how it varies by state and by city," said Julian Marshall, a professor of environmental engineering at the University of Minnesota and one of the authors of the study, according to The Washington Post. "The levels of disparity that we see here are large and likely have health implications."

There are a number of possibilities to account for the disparities. For example, according to The Post, many “urban highways...were originally routed through minority communities that were politically easier to uproot than middle-class white neighborhoods” and “highways and landfills also depress nearby property values, meaning that people who can afford to live elsewhere do, while those who can't remain within their influence.”

Read the full story from The New York Times here.

>>Bonus Link: April is National Minority Health Awareness month. Read more of NewPublicHealth’s coverage of the annual event here.

Apr 17 2014
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Public Health News Roundup: April 17

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Study: Banning Chocolate Milk in Elementary Schools Also Decreases Overall Sales, Increases Waste
Banning chocolate milk in 11 Oregon elementary schools and replacing it with healthier fat-free white milk had the unintended consequence of reducing milk consumption overall, according to a recent study in the journal PLOS One. The study determined that the chocolate milk ban led to a 10 percent overall drop in milk sales; a 29 percent increase in the amount of wasted milk; drops in calcium and protein intake; and a 7 percent decrease in the number of students taking part in the Eugene School District's lunch program. "Given that the role of the federal school meal program is to provide nutritious meals to students who may otherwise have no access to healthy foods, I wouldn't recommend banning flavored milk unless you have a comprehensive plan in place to compensate for the lost nutrients when kids stop drinking milk altogether,” said Nicole Zammit, former assistant director of nutrition services at the Eugene School District in Oregon, in a Cornell University news release. The study was conducted by the Cornell Food and Brand Lab. Read more on nutrition.

CDC: Significant Drops in Five Major Diabetes-related Complications
The last two decades has seen declines in five major diabetes-related complications, according to a new study in the New England Journal of Medicine. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found declining rates of lower-limb amputation (about 50 percent), end-stage kidney failure (about 30 percent, heart attack (more than 60 percent) , stroke (about 50 percent) and deaths due to high blood sugar (more than 60 percent). “These findings show that we have come a long way in preventing complications and improving quality of life for people with diabetes,” said Edward Gregg, Ph.D., a senior epidemiologist in CDC’s Division of Diabetes Translation and lead author of the study. “While the declines in complications are good news, they are still high and will stay with us unless we can make substantial progress in preventing type 2 diabetes.” A recent study determined that approximately one in 10 U.S. adults have either type 1 or type 2 diabetes. Read more on diabetes.

FDA Sees Rising Number of Cases of Injuries Linked to E-cigarettes
The rising use of e-cigarettes has been accompanied by a rising number of injury complaints linked to e-cigarettes, including burns, nicotine toxicity, respiratory problems and cardiovascular problems, according to new data. From March 2013 to March 2014 there were more than 50 such complaints filed with the U.S. Food and Drug Administration (FDA), roughly the total reported over the previous five years. The findings come as the FDA prepares to regulate e-cigarettes and other "vaping" devices for the first time. Read more on injury prevention.

Apr 16 2014
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Future of Public Health: Q&A with Patrick Ten Eyck, PhD Candidate at the University of Iowa

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Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Patrick Ten Eyck, MS, a PhD candidate in the Department of Biostatistics at the University of Iowa’s College of Public Health, about what helped lead him to the field, his work in biostatistics to determine the impact of anti-bullying policies and where he hopes to go from here.

NewPublicHealth: What encouraged you to pursue a degree and career in public health?

Patrick Ten Eyck: I received my undergraduate degree in math because it’s been an interest of mine and then I got my Master’s in statistics because I found it to be the most interesting. I wasn’t really interested so much in the theory of statistics as much as the application. So, when I decided to pursue my PhD I thought biostatistics would be the perfect route because it applied my knowledge of statistics to really practical applications in the real world, especially public health. It’s convenient that the Biostatistics Department is in the College of Public Health at the University of Iowa. I have the opportunity to collaborate with other departments and help share our knowledge of statistics. Together, we can make sense of large data sets and hopefully get some very useful results out of it.

NPH: Do you have primary interests on the public health side of biostatistics?

Ten Eyck: Actually, when I started at the program I really didn’t have any particular area that I was that interested in researching. Obviously, one of the big areas that the Biostatistics Department pursues is medical data, but we also work with more broad areas than just medical data. We help out with occupational, environmental, community and behavioral health topics, too. These topics opened many more doors as far as piquing my interest in different areas. So, I still don’t have a particular area that I’m focused on, but I like to get involved in a lot of different areas because it’s really interesting to see what’s going on in the different fields.

NPH: Tell us more about the work you’ve done to analyze the bullying data in the Iowa Youth Survey?

Ten Eyck: Obviously, bullying has been quite a large focus, especially in the media lately with many stories of students being bullied in schools. So, the Iowa Youth Survey looks at data from 2005, 2008 and 2010 and now we just got the data set for 2012. There was an anti-bullying law passed in 2007 in the state of Iowa that outlines what bullying is and helps teachers to recognize bullying and intervene to prevent it as best as possible. A survey was given to sixth-, eighth- and eleventh-grade students throughout the state of Iowa and more than 250,000 students filled out the survey and gave information.

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Apr 16 2014
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Public Health News Roundup: April 16

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Study: More ‘Masculine’ and ‘Feminine’ Youth at Higher Risk for Cancer-risk Behaviors
The most “feminine” girls and the most “masculine” boys are also the most likely to engage in behaviors that pose cancer risks, according to a new study in the Journal of Adolescent Health. Researchers at the Harvard School of Public Health (HSPH) analyzed data on 9,354 adolescents in the ongoing Growing Up Today Study, finding that cancer-risk behaviors such as tobacco use, indoor tanning and physical inactivity were significantly more common in adolescents who more closely adhered to the traditional societal norms of masculinity and femininity. "Our findings indicate that socially constructed ideas of masculinity and femininity heavily influence teens' behaviors and put them at increased risk for cancer,” said lead author Andrea Roberts, research associate in the Department of Social and Behavioral Sciences at HSPH. “Though there is nothing inherently masculine about chewing tobacco, or inherently feminine about using a tanning booth, these industries have convinced some teens that these behaviors are a way to express their masculinity or femininity." Read more on cancer.

Study: Casual Marijuana Use Can Cause Dangerous Changes in Youths’ Brains
Casual marijuana use in young people can lead to potentially harmful changes in the brain, according to a new study in the Journal of Neuroscience. Researchers from Northwestern University's medical school, Massachusetts General Hospital and Harvard Medical School determined that casual marijuana smoking—defined as one to seven joints per week—could lead to changes to the nucleus accumbens and the nucleus amygdale, which help regulate emotion and motivation. "What we're seeing is changes in people who are 18 to 25 in core brain regions that you never, ever want to fool around with," said co-senior study author Hans Beiter, PhD, professor of psychiatry and behavioral sciences at Northwestern University, according to Reuters, adding, "Our hypothesis from this early work is that these changes may be an early sign of what later becomes amotivation, where people aren't focused on their goals.” Read more on substance abuse.

CDC: ‘Herd Immunity’ Helped Reduce H1N1 Flu Strain’s Impact This Season
While the H1N1 influenza strain was the predominant strain in the United States this past flu season, prior widespread exposure and its inclusion in the current flu vaccine meant it did not have nearly the impact it did in 2009, according to the U.S. Centers for Disease Control and Prevention (CDC). According to Michael Jhung, MD, a medical officer in the CDC’s influenza division, an overall “herd immunity” helped stop this season from turning into the worldwide pandemic seen in 2009. "This year, not only do we have a vaccine that works well, but millions of people have already been exposed to the H1N1 virus," he said, according to HealthDay. The flu strain also hit differently this season, peaking earlier, although once again younger adults were affected more than the elderly. Read more on the flu.