A recent survey by the American Institute of Certified Public Accountants (AICPA) found that more than half of about 1,000 American adults polled could not correctly define common health insurance financial terms such as premium, deductible or copay. That’s concerning considering that opening day to sign up for health insurance under the Affordable Care Act is October 1. “Half of Americans would fail health insurance 101,” said Ernie Almonte, CPA, chair of the Institute’s National CPA Financial Literacy Commission. “That’s critical insight as consumers prepare to make important decisions with implications for both their physical and fiscal well-being,” says Almonte. “Americans need to take time in the coming weeks to familiarize themselves with key terms and assess their needs so they make the best decisions for their health and financial situations.”

Knowing what the terms mean can help people make informed choices when they sign up for health insurance. For example, a copay is the out of pocket cost to a patient for a health service. Choosing a plan with lower co-pays can help individuals save money, according to the Institute.

The survey found that people with high school diplomas or less education were significantly more likely than those with a college education to be unable to define financial health terms. The survey also found that 41 percent of  responders said they were not at all knowledgeable about the Affordable Care Act; just under half of responders said they thought they were somewhat knowledgeable.

"We have medicalized what is in fact an environmental-driven set of diseases," said Richard Jackson, MD, MPH, professor and chair of environmental health science at the UCLA School of Public Health, in a keynote presentation that energized and galvanized discussion among the diverse audience of city planners, architects and public officials at this week’s International Making Cities Livable Conference. This year’s conference focuses on bringing together a vision— across sectors—of how to shape healthy suburban communities.

Jackson, a prominent pediatrician and host of the “Designing Healthy Communities” series that aired on PBS, told an all-too-familiar story of a child who comes into a doctor’s office overweight and with alarming cholesterol and blood pressure results even at a young age. So the doctor prescribes behavior change: No soft drinks in the house. No screens in the bedroom. Exercise, do more, and come back in two months. In two months, what’s changed? Nothing. The food at school is still unhealthy, the neighborhood is still unsafe to play in and the family still uses the car to get absolutely everywhere because there is no other choice. The likely outcome for that child and so many others, said Jackson, is to end up on costly cholesterol medication just two months later when the child’s vital statistics continue to spiral out of control.

"It’s a 20th century idea that our minds are separated from our bodies, and our communities are separated from ourselves,” he Jackson, who reminded the crowd that the most critical health advancements in the last century took place because of changes in infrastructure, not medicine—primarily new sanitary standards to curb out-of-control infectious disease.

Now, said Jackson, “We’ve built America around the car” and we need a whole new set of infrastructure changes to re-build communities that offer better opportunities for health as part of everyday life. “The built environment is social policy in concrete.”

“We know PSA campaigns can make a big impact; that they can improve people’s lives.”

The Advertising (Ad) Council has just launched a new version of its digital distribution platform, PSA Central, which is geared toward PSA directors and media outlets, but is also valuable for anyone who wants to share the messages including educators and public health practitioners. The site offers easy access to video, print, radio, online, mobile and outdoor media public service advertisements that range from bullying prevention to food safety education.

Public Service Advertisements (PSAs) may actually date back to the civil war when newspapers offered free advertising space to the U.S. government to advertise bonds whose revenues were used to pay for the war effort. These days, PSAs are much more likely to be public safety messages such as a United Kingdom video PSA, downloaded over 2 million times on YouTube, reminding people just why they should buckle up in a car. And more importantly, these efforts are being measured and tracked to show impact on health behavior change and health outcomes, such as the Ad Council’s drunk driving prevention campaign that has encouraged 70 percent of Americans to take action to stop a friend from driving drunk.

NewPublicHealth recently spoke with Peggy Conlon, president and CEO of the Ad Council, about the public health messages PSAs can convey and how new media has expanded their reach.

NewPublicHealth: How have PSAs evolved over the years?

Peggy Conlon: PSAs have evolved quite a bit. The Ad Council is 71 years old and back in the earliest days PSAs were seen in newspapers and heard over the radio. Since then they have been showcased on just about all media platforms. In the 90s we were introduced to the Internet and everything changed forever. The Internet added another new dimension to our ability, in a very tangible and personal way, to engage communities around social issues.

NPH: What are some of the most effective and iconic campaigns in public service advertising?

In an interview with NewPublicHealth last year, Yvette Roubideaux, MD, MPH, head of the Indian Health Service, spoke about the need for "cultural humility" as stakeholders and partners work to improve healthier lifestyles in cultural and ethnic communities throughout the United States. A five-year-old program in Prince Georges County, Md., does just that. Building on the quinceañera, the traditional coming of age party for many fifteen-year-old girls of Latino heritage, Mis Quince Años (“My Fifteen Years”) is a program run by the county’s Parks and Recreation Department that offers writing and speaking seminars and teaches the girls about health and fitness, their culture, college preparation and provides service programs in their communities.

>>Read more about the program in the Washington Post.

Students at the Yale School of Public Health teamed up with fellow classmates at the university’s School of Art to develop original public health posters. The goal was to provoke awareness, stimulate thought and change behavior on health issues such as obesity, breast cancer screening, and self-respect and child development.

The posters were the idea of School of Public Health Assistant Professor Catherine Yeckel, who challenged students to apply and translate theoretical scientific knowledge into a public health campaign to educate the public on a specific health topic.

“The progression from complex to simple communication, letting the image speak, was probably the most powerful insight for all the groups,” says Yeckel. “In my mind, gaining this insight becomes the launching point for tackling a public-health campaign and movement.”

Fourteen pairs of public health/art students worked together. The Connecticut State Office of Health Reform and Innovation will display the posters beginning in July, and a tour of other communities is expected after that.

View the online exhibit.

Bonus view: The World Health Organization has just released a video to raise awareness about malaria called T3 (Test. Treat. Track) that, like the Yale posters, uses few words but imparts a powerful message.

Weigh In: What messages have been effective in your community?

CDC Says Plane Scare Unlikely to Have Been Monkey Pox

Investigators from The Centers for Disease Control and Prevention boarded a plane to examine—and then release—a woman with a rash who arrived back in the US from Uganda late last week. The immediate concern had been monkey pox, a sometimes fatal infectious disease that is similar to smallpox, but CDC investigators say her symptoms were not consistent with the illness. News sources say her rash was likely the result of bed bug bites

Read an interview with the screen writer and an advisor to the film “Contagion”

Low Literacy in Math and Reading Can Lead to Medication Dosing Errors by Parents

Parents with math skills at the third grade level or below were five times more likely to measure the wrong dose of medication for their child than those with skills at the sixth grade level or higher, according to a study presented at the Pediatric Academic Societies (PAS) annual meeting in Boston.

Researchers say dosing liquid medications correctly can be especially confusing because parents have to read and understand dosing for different ages and weights and understand the measurement markings on dosing cups, droppers and syringes.

Read more on health literacy.

Text Messaging May Help Increase Immunization Rates

A new study by researchers at the Columbia University Mailman School of Public Health found that text message reminders to parents about flu vaccinations may help boost the number of children vaccinated. The study was published in the Journal of the American Medical Association and followed 9,213 children and adolescents ages six months to 18 years—primarily from minority households. Parents of children assigned to the text-message intervention received up to five weekly texts providing educational information and instructions on where the vaccinations were administered. Everyone in the study received an automated telephone reminder, and access to informational flyers posted at the study sites.

At the end of the study, a higher proportion of children and adolescents in the intervention group (43.6 percent) than in the control group (39.9 percent) had been vaccinated against the flu.

Read about text messaging interventions in public health.

Kids in Neighborhoods with Biking and Walking Trails Exercise More

Children living in a neighborhood designed with a special bike trail were three times as likely as those in a traditional neighborhood to engage in vigorous physical activity, according to new research presented at the American Heart Association’s Epidemiology and Prevention/Nutrition, Physical Activity and Metabolism 2012 Scientific Sessions.

Researchers compared two low-income neighborhoods in Chattanooga, Tenn. One had a specially-designed, two-mile, extra-wide trail for biking and walking that connected public housing and single-family residences to a school, library, recreational facility, and park and retail shops. The other area has traditional homes, public housing, a new school, a park and an older, regular-width sidewalk. Researchers found that there was more vigorous activity in former community in the park and along the new trail, including jogging and bike riding. Read more on healthy communities.

Department of Labor Announces Grants to Help Young Offenders Rejoin Communities

The Department of Labor has announced $20 million in grants to provide employment-related training and support services to youth who have been involved in the juvenile justice system. The grants will be used to fund programs including workforce development, education and training, case management, mentoring, and community-wide violence reduction.

Women Often Don’t Feel Chest Pain with Heart Attacks

Women, especially younger ones, are more likely than men to have a heart attack that isn't accompanied by chest pain or discomfort, according to a new study in the Journal of the American Medical Association. The lack of symptoms can result in delayed medical care and differences in treatment that may help explain why women in the study were also more likely to die of their heart attacks, according to the researchers. Younger women with no chest pain were almost 20 percent more likely to die than men. According to the study, instead of chest pain, some people having a heart attack may instead have unexplained shortness of breath, or pain in other areas, such as the jaw, neck, arms, back and stomach. Read more on heart health.

NHTSA Launches a Crash Test Dummy Simulating a Ten Year Old Child

The National Highway Traffic Safety Administration (NHTSA) has unveiled a crash test dummy that simulates a ten year old. The dummy will be used to evaluate the growing number of child safety and booster seats for children weighing more than 65 pounds.

According to NHTSA, the new dummy’s debut follows more stringent child safety seat recommendations issued by the agency last year that encourages parents and caregivers to keep children in a car seat with a harness for as long as possible, up to the height and weight specifications of the seat. The agency’s updated child seat guidance also recommends that children ride in a booster seat until they are big enough to fit in a seat belt properly, which is typically when the child is somewhere between 8-12 years old and about 4 feet 9 inches tall. Read more on transportation safety.

NIDA Creates Easy-to-Read Website on Drug Abuse

A new, easy-to-read website on drug abuse designed for adults with a low reading literacy level (eighth grade or below) has been posted by the National Institute on Drug Abuse (NIDA). The site provides plain language information on drug abuse prevention and treatment and is also a resource for adult literacy educators. Features include a simple design, audio accompaniment for most text, large text size and animated videos that explain how drugs affect the brain.

"Drug abuse and addiction affects people of all reading levels, yet there are no websites with drug abuse information created specifically for adults with limited literacy," said NIDA Director Dr. Nora D. Volkow. "We hope this new site will inform a large segment of our population who may not have otherwise received potentially life-saving information." Read more on health literacy.

Measles at the Super Bowl?

The American Academy of Pediatrics (AAP) sent out an advisory yesterday that the Indiana State Department of Health is tracking two confirmed and two probable cases of measles in the state, including one person who attended Super Bowl festivities at the Super Bowl village in Indianapolis on Feb. 3.

The American Academy of Pediatrics, the American Academy of Family Physicians, and the Centers for Disease Control and Prevention recommend children be vaccinated against measles at age one, and again at four to six years of age before entering kindergarten.

"The vaccine is very effective, which is why we don’t see many cases of measles in the U.S. today," said Dr. Block. "But the virus is still out there, and people who are not immunized—including infants who are too young to be immunized—are at risk. Measles can be deadly. High rates of immunization in the community help to slow the transmission of diseases like measles, protecting everyone."

Read more news on vaccines.

HHS Issues Rule on Making Private Health Insurance Benefits Easy to Understand

Under a rule announced yesterday by the U.S. Department of Health and Human Services (HHS), health insurers must provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new explanations will be available about the end of September and will benefit the 150 million Americans who currently have health insurance, according to HHS.

The new rule will provide consumers two important documents to help understand their health insurance choices, including a short, easy-to-understand summary of benefits and a uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-payment.” Read more on access to health care.

The journal Health Affairs has released a new report on health literacy. The article authors include U.S. Department of Health and Human Services Assistant Secretary for Health Howard Koh, former Center for Medicare and Medicaid Services Director Donald Berwick, and Carolyn Clancy, Director of the Agency for Health Research and Quality. The authors conclude, “the promises of medical research, health information technology, and advances in health care coverage and delivery cannot be realized if our nation does not simultaneously address the challenge of limited health literacy. The federal initiatives of the past few years, combined with a growing commitment to health literate organizations and systems change, can help the nation tackle health literacy and ultimately help us all lead longer, healthier lives.”

According to the report, tens of millions of Americans have limited health literacy—a health issue, that the authors say has, until recently, been relegated to the sidelines. Federal policy initiatives include the National Action Plan to Improve Health Literacy, released in 2010 and the Plain Writing Act of 2010.

Several organizations and government agencies have created useful health literacy resources:

• HHS Overview of Health Literacy
• CDC Health Literacy blog
• Health Literacy Missouri
• Resources from the National Library of Medicine
• Resources from the American Medical Association
• Updated review of health literacy resources and issues from the Agency for Health Care Research and Quality

>>Read our earlier Q&A with HHS's Linda Harris and ARHQ's Cindy Brach, also two of the study authors, on efforts to improve health literacy.