Category Archives: Addiction
Fifteen Years after Tobacco Settlement, States Falling Short in Funding Tobacco Prevention: Q&A with Danny McGoldrick
On November 23, 1998, 46 states settled their lawsuits against the nation’s major tobacco companies to recover tobacco-related health care costs, joining four states—Mississippi, Texas, Florida and Minnesota—that had reached earlier, individual settlements.
These settlements require the tobacco companies to make annual payments to the states in perpetuity, with total payments estimated at $246 billion over the first 25 years.
Yesterday a coalition of health advocacy groups released the latest edition of A Broken Promise to Our Kids, an annual report on state use of tobacco funds for tobacco prevention and cessation efforts. As in years past, the report finds that most states fall short in the amount of money they allocate to prevent kids from smoking and to help current smokers quit.
The groups that jointly issued the report include the Campaign for Tobacco-Free Kids, the American Heart Association, American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers’ Rights.
Key findings of the 2013 report include:
- Over the past 15 years, states have spent just 2.3 percent of their total tobacco-generated revenue on tobacco prevention and cessation programs.
- The states this year will collect $25 billion from the tobacco settlement and tobacco taxes, but will spend just 1.9 percent of it—$481.2 million—on tobacco prevention programs. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use.
- States are falling short of the U.S. Centers for Disease Control and Prevention’s (CDC) recommended funding levels for tobacco prevention programs. Altogether, the states have budgeted just 13 percent of the $3.7 billion the CDC recommends.
- Only two states—Alaska and North Dakota—currently fund tobacco prevention programs at the CDC-recommended level.
To discuss the ramifications of the latest edition of the Broken Promises report, NewPublicHealth recently spoke with Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.
NewPublicHealth: Can you give us some background on the Tobacco Master Settlement Agreement?
Danny McGoldrick: This is the 15th anniversary of the Tobacco Master Settlement Agreement, when 46 states and the District of Columbia settled their lawsuits against the tobacco companies mostly to recover the costs that they’d incurred treating smoking-caused disease in their states. Four other states had settled individually with the tobacco companies prior to the Master Settlement Agreement, and so this provided for some restrictions on tobacco company marketing; they promised never to market to kids again, which is ironic, but it also resulted in the tobacco companies sending about $250 billion over just the first 25 years of the settlement for the states to spend as they saw fit. They left that to the province of the state legislators and governors to decide how those funds should be spent.
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus link: Mobile Health and FDA Guidance
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
While men are more likely to die of a prescription painkiller overdose, since 1999 the percentage increase in deaths has been greater among women than among men, according to the Vital Signs monthly health indicator report released today by the Centers for Disease Control and Prevention (CDC). The increase in deaths between 1999 and 2010 has been 400 percent in women compared to 265 percent in men, according to the new report. The overdoses killed nearly 48,000 women during that time period.
“Prescription painkiller deaths have skyrocketed in women…” says CDC Director Tom Frieden, MD, MPH. “Stopping this epidemic in women – and men – is everyone’s business. Doctors need to be cautious about prescribing and patients about using these drugs.”
Key findings include:
- About 42 women die every day from a drug overdose.
- Since 2007, more women have died from drug overdoses than from motor vehicle crashes.
- Drug overdose suicide deaths accounted for 34 percent of all suicides among women compared with 8 percent among men in 2010.
- More than 940,000 women were seen in emergency departments for drug misuse or abuse in 2010.
For the Vital Signs report, CDC analyzed data from the National Vital Statistics System (1999-2010) and the Drug Abuse Warning Network public use file (2004-2010).
According to the CDC, studies have shown that women may become dependent on prescription painkillers more quickly than men and may be more likely than men to engage in “doctor shopping” (obtaining prescriptions from multiple prescribers).
CDC Issues First Comprehensive Report on Children’s Mental Health in the United States
As many as one in five American children under the age of 17 has a diagnosable mental disorder according to a new report from the Centers for Disease Control and Prevention. The report is the first expansive report on children's mental health ever done by the U.S. government and looked at six conditions:
- attention-deficit/hyperactivity disorder (ADHD)
- behavioral or conduct disorders
- mood and anxiety disorders
- autism spectrum disorders
- substance abuse
- Tourette syndrome
The most common disorder for children age 3 through 17 is ADHD (7 percent) followed by behavioral or conduct problems (3.5 percent), anxiety (3 percent), depression (2 percent), and autism spectrum disorders (1 percent).
Five percent of teens reported abusing or being dependent on illegal drugs, 4 percent abused alcohol and 3 percent reported smoking cigarettes regularly. Boys were more likely than girls to have the disorders. Read more on mental health.
New PSAs Help Parents Talk to Younger Kids about the Dangers of Underage Drinking
“Talk. They Hear You,” is a new national public service announcement (PSA) campaign from the Substance Abuse and Mental Health Services Administration (SAMHSA) to empower parents to talk to children as young as nine about the dangers of underage drinking. SAMHSA research shows that more than a quarter of American youth engage in underage drinking, and though there has been progress in reducing the extent of underage drinking in recent years, particularly among those aged 17 and younger, the rates of underage drinking are still unacceptably high, according to SAMHSA. A report from late last year shows that 26.6 percent of 12-20 year-olds report drinking in the month before they were surveyed and 8.7 percent of them purchased their own alcohol the last time they drank, despite the fact that all fifty states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21.
“Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death,” said said SAMHSA Administrator Pamela S. Hyde.
The goal of the new PSA is to help parents start a conversation about alcohol before their children become teenagers. Read more on addiction.
Advocacy Groups Petition FDA to Ban Menthol Flavored Cigarettes
In response to a Citizen Petition by close to twenty health and tobacco control advocacy groups, the Food and Drug Administration has opened a docket for public comment on banning menthol in cigarettes. In 2009, according to the Tobacco Control Legal Consortium, the lead group on the petition, Congress banned all flavors in cigarettes except menthol, and directed the FDA to decide whether continued sale of menthol cigarettes is “appropriate for public health." According to the petition, menthol cigarettes are the source of addiction for nearly half of all teen smokers. Read more on tobacco.
U.S. Spends More on Dementia than Either Heart Disease or Cancer
At as much as $215 billion annually, the cost of dementia care in the United States is now higher than the costs for either heart disease or cancer, according to a new study in the New England Journal of Medicine. That includes the costs for both professional and family care. And the costs will only rise as the population ages, with as many as 14 million Americans expected to have Alzheimer’s by 2050, according to HealthDay. "It's not a happy situation," said lead researcher Michael Hurd, a senior principal researcher at the nonprofit research institute RAND. "A lot of the costs fall on families, and right now, there's no solution in sight." Read more on aging.
Brain Stimulation Could ‘Turn Off’ Compulsive Drug-Taking
Targeting a specific region of the brain could help turn off addictive behavior, according to a new study in the journal Nature. Researchers at the Intramural Research Program of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the University of California, San Francisco were able to reduce compulsive cocaine-seeking in rates by stimulating their prefrontal cortexes. They believe this technique could ultimately be used to stop compulsive drug-taking in humans. “We already knew, mainly from human brain imaging studies, that deficits in the prefrontal cortex are involved in drug addiction,” said NIDA Director Nora D. Volkow, MD. “Now that we have learned how fundamental these deficits are, we feel more confident than ever about the therapeutic promise of targeting that part of the brain.” Read more on addiction.
Study: Black Men Wait Longer to Begin Prostate Cancer Treatment
Black men wait longer than white men to begin prostate cancer treatment after diagnosis, according to a new study in the journal Cancer. Researchers at the University of North Carolina found a delay of seven days with early prostate cancer and nine days with aggressive prostate cancer. As the study looked at Medicare data, the researchers know all the men were insured so it wasn’t a lack of insurance stopping them from seeking treatment earlier. Multiple studies also show that black men in general are less likely to be screen for cancers and to receive aggressive treatment. "Now we have shown that African American patients also wait longer for treatment,” said study leader Ronald Chen, MD, an assistant professor at UNC's Lineberger Comprehensive Cancer Center. “I think all of these disparities together add up to contribute to worse long-term survival outcomes for African American patients." Read more on health disparities.
Folic Acid Supplements Early in Pregnancy May Reduce Risk of Autism by 40%
Prenatal folic acid supplements appear to reduce the risk for autistic spectrum disorders, according to a study in the Journal of the American Medical Association. The study included more than 85,000 babies born in Norway. Researchers noted prenatal eating habits of the mothers and followed up with families for three to ten years after birth to measure the development of autism spectrum disorders. A total of 270 cases were identified among the children in the study and a review by the researchers found that mothers who took folic acid supplements in early pregnancy had a 40 percent reduced risk of having children with autistic disorders. The researchers say that the timing of a mother’s intake of folic acid appears to be a critical factor. A child’s risk of autism was reduced only when the supplements were taken between 4 weeks before to 8 weeks after the start of pregnancy. Read more on maternal and infant health.
Prescription Drug Abuse Programs in Middle School Reduce Abuse Later in Life
A new study by researchers at the National Institutes of Health (NIH) found that middle school students from small towns and rural communities who were involved in community-based prevention programs were less likely to abuse prescription medications in late adolescence and young adulthood. The study was published in the American Journal of Public Health. According to the NIH, prescription drug abuse is one of the most serious public health problems in the United States. In 2011, about 1.7 million people ages 12 to 25 abused a prescription drug for the first time, according to the National Survey on Drug Use and Health . “The intervention effects were comparable or even stronger for participants who had started misusing substances prior to the middle school interventions, suggesting that these programs also can be successful in higher-risk groups,” said Richard Spoth, PhD, of the Partnerships in Prevention Science Institute at Iowa State University and the lead author of the study. Those findings contrast with a recent study published by the Substance Abuse and Mental Health Administration that found that 12th grade dropouts have higher rates of cigarette, alcohol and illegal drug use. Read more on addiction.
New Study Shows Significant Health Benefits of Americans Reducing Their Sodium Intake
Hundreds of thousands of lives could be saved over 10 years if Americans reduced their sodium consumption to the levels recommended in federal guidelines, which would prevent many heart attacks and strokes, according to a new study by researchers at UC San Francisco, Harvard Medical School and Simon Fraser University in Canada. The study was published in the journal Hypertension. The study resulted from a workshop conducted by the U.S. Centers for Disease Control and Prevention which brought together scientists from the three universities. Each university group used different computer models to estimate the risk reduction of lowering sodium, but all found consistent, substantial benefits of reducing U.S. sodium consumption to a level close to the upper limit of the federal guideline of 2,300 mg/day. According to the study, the overall average sodium consumption in the United States has been estimated at 3,500 mg/day, well above the upper limit of the level recommended by federal agencies and the Institute of Medicine. American men consume twice the recommended level on average. Read more on nutrition.
New York Announces Companies Reducing their Sodium Content
Earlier this week, the city of New York announced that 21 companies met one or more of their voluntary commitments to reduce sodium content in pre-packaged or restaurant foods. Those reductions were the result of the National Salt Reduction Initiative (NSRI), the first-ever nationwide partnership to reduce sodium in the U.S. food supply. The NSRI is a nationwide partnership of more than 90 city and state health authorities and organizations coordinated by New York City since 2009. The NSRI’s goal is to cut excess salt in packaged and restaurant foods by 25 percent over five years through voluntary corporate commitments. Support for the initiative has come from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, the New York State Health Foundation and the National Association of County & City Health Officials. The project funding is administered by the Fund for Public Health in New York, a private non-profit organization that supports innovative initiatives of the New York City Department of Health and Mental Hygiene. Read more on prevention.
New Report Finds Underage Drinking in all States
More than a quarter of Americans who are legally too young to drink are doing so anyway, according to a new report issued today by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report says there has been progress in reducing the extent of underage drinking in recent years, especially among youth ages 17 and younger, but that the rates of underage drinking “are still unacceptably high.” Over 25 percent of people ages 12-20 report drinking in the month before they were surveyed, and 8.7 percent of them purchased their own alcohol the last time they drank. “Underage drinking should not be a normal part of growing up. It’s a serious and persistent public health problem that puts our young people and our communities in danger,” says SAMHSA Administrator Pamela S. Hyde. “Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death.” All 50 states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21. Find resources to prevent and treat underage drinking here. Read more on addiction.
Helmets Can Save Lives on the Slopes
Wearing a helmet while skiing or snowboarding can prevent injuries and reduce injury severity, according to a review article of 16 published studies in the Journal of Trauma and Acute Care Surgery. About 600,000 skiing and snowboarding injuries occur each year, according to reporting by Johns Hopkins researchers who wrote the new report. Up to 20 percent of those are head injuries, and 22 percent of those head injuries are severe enough to cause loss of consciousness, concussion or more serious injuries. Read more on injury prevention.
Study: Low-Level Air Pollution Impacts Fetal Growth
Exposure to low levels of air pollution seems to have a small effect on fetal growth, according to a study in the Puget Sound area by the University of Washington Schools of Public Health and Medicine and the Seattle Children’s Research Institute. The study looked at more than 367,000 births between 1997 and 2005 in the four-county Puget Sound region, including metropolitan areas Seattle and Tacoma, and estimated prenatal exposure to traffic-related air pollutants such as nitrogen oxide. The researchers found associations between increased levels of nitrogen dioxide exposures and an increased risk of small-for-gestational-age birth. Health problems for low birth weight babies can include decreased oxygen levels and low blood sugar, according to the researchers. Read more on maternal and infant health.
Third Vaccine Dose May Help Prevent Mumps Outbreaks
A third dose of measles-mumps-rubella (MMR) vaccine may have helped to control a mumps outbreak in a highly vaccinated New York community during 2009 and 2010, according to a new study, the first on the effects of a third MMR dose, published recently in Pediatrics. Most of the people in the community had received the two MMR doses currently recommended in the United States. In the outbreak community, a third-dose of MMR vaccine was offered to eligible 11 to 17-year-olds. After that intervention, mumps declined by 96 percent in the age group and by 75.6 percent in the community overall. Read more on vaccines.
Proximity to Bars May Increase Alcohol Consumption
A recent study in the journal Addiction finds that living close to a bar may increase the amount of alcohol that people drink. The study, conducted in Finland, found that when a person moved one kilometer (0.6 mile) closer to a bar, the odds of becoming a heavy drinker rose 17 percent. Read more on addiction.
Kid Screen Time Study Helped to Reduce Meals Eaten In Front of the TV
A new Pediatrics study finds that a program aimed at reducing the number of hours kids spend in front of televisions, computers and video games did not reach its goal of cutting screen time, but did reduce the number of meals children ate in front of the television. That may reduce childhood obesity rates, say the researchers from the Hospital for Sick Children in Toronto. Read more on obesity.
Young Blacks Living in Public Housing More Likely to be Smokers
A recent survey in three urban cities by a University of Missouri researcher found that young African-Americans who live in public housing communities are 2.3 times more likely to use tobacco than other African-American youth. The researchers say crime, poorer social relationships and high levels of stress may contribute to the increased smoking rate. The study was published in the journal, Addictive Behaviors. Read more on tobacco.
Study: Medicaid Expansion Improves Health
A new study in the New England Journal of Medicine by researchers at the Harvard School of Public Health found that expanding Medicaid to low-income adults leads to widespread gains in coverage, access to care, improved health and mortality reduction.
In the past decade, several states expanded Medicaid from its traditional coverage of low-income children, parents, pregnant women and disabled persons to include poor adults without any children living at home. The researchers analyzed data from three states—Arizona, Maine and New York—that had expanded their Medicaid programs to childless adults (aged 20-64) between 2000 and 2005 and compared outcomes with four neighboring states without major Medicaid expansions—New Hampshire (for Maine); Pennsylvania (for New York); and Nevada and New Mexico (for Arizona).
The researchers looked at data from five years before and after each state’s expansion. They found that, compared to the states that did not expand Medicaid, the Medicaid expansions in the three states were associated with a mortality reduction of 6.1%, which corresponds to 2,840 deaths prevented per year for every 500,000 adults gaining Medicaid coverage. Mortality reductions were greatest among older adults, non-whites and residents of poorer counties. Expansions also were associated with increased Medicaid coverage, decreased uninsurance, decreased rates of deferring care due to costs and increased rates of “excellent” or “very good” self-reported health. Read more on access to health care.
Use of Imaging as a Diagnostic Tool has Slowed
A new study published in Health Affairs finds that demand for new radiologists began declining in 2007 because of a decreased demand for imaging studies. The study authors found that use of magnetic resonance imaging (MRI) and computed tomography (CT) for patients in the United States slowed between 1 and 3 percent per year between 2006 and 2009, ending a decade of growth that had exceeded 6 percent annually. The authors say reasons for the decrease include the need for prior authorization for the tests, reduced reimbursement, increased cost sharing for patients and fears associated with radiation. Read more on radiation.
The Food and Drug Administration has released a strategy for physician and patient education on extended-release and long-acting opioids.
The strategy is part of a federal initiative to address prescription drug abuse, misuse, and overdose. “The FDA’s goal is to ensure that health care professionals are educated on how to safely prescribe opioids and that patients know how to safely use these drugs,” said Margaret Hamburg, MD, who is head of the FDA.
More than 20 drug companies will be required to make education programs available to prescribers based on an FDA Blueprint, as well as FDA-approved patient education materials on the safe use of the drugs. The companies will be required to conduct periodic assessments of the programs which will be reviewed by the FDA.
Materials for physicians are expected to be introduced in March 2013. Read more on addiction.
A new study in Pediatrics looks at the first national assessment of school counselors’ practices and perceptions of adolescent dating violence prevention and found that the majority of school counselors (81.3 percent) reported that they did not have a protocol in their schools to respond to an incident of dating violence. Ninety percent of school counselors reported that in the past two years, there had been no staff training to assist survivors of dating violence, and their school did not have a committee to address health and safety issues including dating violence. The schools did report that dating violence is an issue in their schools, however: the majority of school counselors (61 percent) reported that they had assisted a survivor of dating violence—usually female--in the past two years. The study researchers also found that school personnel who received formal training perceived dating violence to be a serious problem, and were significantly more likely to assist victims. Read more on violence.
Children who have a dog or cat or are around dogs and cats during the first year of life are reported to be healthier and have fewer respiratory infections than children who don’t’ have contact to with these animals, according to a new study in Pediatrics. Researchers followed 397 children in Finland from pregnancy to the age of 1 year and found that children with early dog contact seem to have fewer respiratory infectious symptoms and diseases, especially ear infections, and needed a shorter course of antibiotics. Kids in houses with cats also showed benefit from contact with the pet, though not as much as with dogs.
The authors say contact with animals may have an influence on the maturation of the immune system which may lead to shorter infection periods and better resistance to respiratory infections during early childhood. Read more on maternal and child health.