CDC: Cutting Smoking in Subsidized Housing Would Save $521M Annually
Eliminating the ability to smoke in U.S. subsidized housing would save approximately $521 million each year in health care, renovation and fire-related costs, according to the U.S. Centers for Disease Control and Prevention (CDC). This includes public housing and rental assistance programs. Secondhand smoke can be especially problematic in multi-unit buildings with at-risk populations and smoking in common rooms. "Many of the more than 7 million Americans living in subsidized housing in the United States are children, the elderly or disabled," said Tim McAfee, MD, MPH, director of the Office on Smoking and Health at CDC. "These are people who are most sensitive to being exposed to secondhand smoke. This report shows that there are substantial financial benefits to implementing smoke-free policies, in addition to the health benefits those policies bring." Read more on tobacco.

HHS Campaign to Promote Breastfeeding by African American Mothers
The new It’s Only Natural public education campaign from the U.S. Department of Health and Human Services will work to raise awareness of the importance of breastfeeding among African American women, according to Surgeon General Regina M. Benjamin, MD, MBA. “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed,” she said in a release. “By raising awareness, the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends and the community.” While overall 80 percent of U.S. women start out breastfeeding, that number is only 55 percent for African American women. The new campaign provides material specifically targeting African American women and giving them the information and encouragement they need to start and continue breastfeeding. Read more on maternal and health disparities.

U.S. Infant Mortality Rates Down; More Improvement Still Needed
Improvements in prenatal care and a reduction in elective deliveries helped cut the U.S. infant mortality rate by 12 percent from 2005 to 2011, according to a new study in the NCHS Data Brief. The National Center for Health Statistics (NCHS) said the rate was down to 6.05 deaths per 1,000 live births in 2011 from 6.87 in 2005. The rate of death from SIDS also dropped 20 percent over the period. Still, study author Marian MacDorman, PhD, an NCHS statistician, said more work is needed, noting that “preterm birth rates are much higher than in other countries, and the same is true with infant mortality" and that "[i]nfant mortality among blacks is about twice what it is for white women,” according to HealthDay. Jeffrey Biehler, MD, a pediatrician at Miami Children's Hospital, said that we "need to continue to advocate for prenatal care for every woman, and make sure they are educated so they know to seek care as early as possible and avoid smoking and alcohol and other things that put them and their babies at risk.” Read more on maternal and infant health.

Hospital-based Quality Improvement Programs Cut Early Elective Deliveries
Elective early term deliveries are down significantly in part due to multistate, hospital-based quality improvement programs, according to a new study in the journal Obstetrics & Gynecology. Labor inductions and Cesarean sections without a medical reason were down 83 percent from 27.8 percent to only 4.8 percent over a one-year program at 25 hospitals. Early term babies are at increased risk of a host of medical problems and even death, according to the March of Dimes. “Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” said Edward R.B. McCabe, MD, medical director of the March of Dimes. Read more on maternal and infant health.

Study: School Lunch Standards Help Kids Maintain Healthy Weight
States with strict school lunch standards may be helping students maintain healthier weights, according to a new study in JAMA Pediatrics. The U.S. Department of Agriculture’s National School Lunch Program standards include maximums calories for lunches and the serving of only skim or reduced-fat milk. Depending on grade level, school lunches are between 550 and 850 calories. The preliminary findings help refute the concern that students would simply compensate with unhealthy snacks, according to Daniel Taber, MD, lead author from the Institute for Health Research and Policy at the University of Illinois at Chicago. Nutritionist Marion Nestle of New York University said that this “is important work and should stimulate government agencies to take a closer look at what they might do to make the food environment a lot healthier for children and adults.” Read more on obesity.

CDC: Many Skipping Medications to Save on High Health Care Costs
Lack of insurance and other factors are leading many Americans to request cheaper medications or even skip taking prescribed drugs, according to a new report from the U.S. Centers for Disease Control and Prevention. "Adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations and cardiovascular events," said Robin Cohen of the NCHS's Division of Health Interview Statistics. About 20 percent of U.S. patients ages 18 to 64 requested cheaper medications from their health care providers; the uninsured in that group was also twice as likely—23 percent total—as those ages 65 and older to simply skip the medications entirely. Read more on prescription drugs.

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CDC Vital Signs: 1 in 5 Teen Births is a Repeat Birth
Although teen births have fallen over the past 20 years, nearly one in five is a repeat birth, according to a Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC). More than 365,000 teenage girls ages 15-19 years gave birth in 2010, and almost 67,000 (18.3 percent) of those were repeat births. A repeat birth is a second (or more) pregnancy resulting in a live birth before the mother turns 20. “Teen birth rates in the United States have declined to a record low, which is good news,” said CDC Director Tom Frieden, MD, MPH. “But rates are still far too high. Repeat births can negatively impact the mother’s education and job opportunities as well as the health of the next generation. Teens, parents, health care providers, and others need to do much more to reduce unintended pregnancies.” Data from CDC’s National Vital Statistics System show that repeat teen births in the United States decreased by more than 6 percent between 2007 and 2010. Despite this decline, the number of repeat births remains high and there are substantial racial/ethnic and geographic differences. Repeat teen births were highest among American Indian/Alaska Natives (21.6 percent), Hispanics (20.9 percent), and non-Hispanic blacks (20.4 percent), and lowest among non-Hispanic whites (14.8 percent). Read more on maternal and child health.

Health Impact Project Announces Eight New Funded Projects
The Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, has recently added eight more grantees who will receive funding to conduct health impact assessments, or HIAs. The projects will bring health considerations into upcoming decisions on topics including education, sanitation infrastructure, and energy. “Our new grantees will use health impact assessments to uncover opportunities to improve health in a wide range of policy decisions, as well as to identify and avoid potential unintended consequences,” said Aaron Wernham, MD, director of the Health Impact Project. “These eight HIAs are the latest in a fast-growing field, as more cities and states find them a useful way to bring health into decisions in other sectors.” By the end of 2007, there were 27 completed HIAs in the United States. There are now more than 225 completed or in progress, according to the Health Impact Project map of HIA activity in the United States. Read more on health impact assessment.

Post-ER Visit for Chest Pain Reduces Heart Attack Risk
Seeing a doctor within a month of an emergency room visit for chest pain significantly reduced the risk of a heart attack or death among high risk patients, according to a recent study in the journal Circulation. Researchers analyzed data on 56,767 adults (average age 66, 53 percent men) in Ontario, Canada, who were diagnosed with chest pain in an emergency room between April 2004 and March 2010 and had been previously diagnosed with heart disease or diabetes. They tracked data for a median 3.7 years and accounted for differences in key patient characteristics such as age, gender, health status and location. According to the study, only 17 percent of high risk chest pain patients seen in the emergency room were evaluated by cardiologists within a month; 58 percent saw a primary care physician and 25 percent had no physician follow-up within a month. Patients who followed up with a cardiologist within 30 days were 21 percent less likely to have a heart attack or die within one year, compared with patients who failed to seek additional care within that time. Patients seen by a primary care physician were 7 percent less likely to have a heart attack or die compared to those patients who sought no follow up care. Read more on heart health.

National Public Health Week Events: ‘Public Health is ROI: Saves Lives, Saves Money’
"Public Health is ROI: Saves Lives, Saves Money" is the theme of this year’s National Public Health Week, from April 1 to 7. By emphasizing prevention and ensuring strong public health systems, public health helps to saves lives and stop diseases before they have a chance to happen. The end result is improved public health and reduced health care spending, meaning those valuable financial resources can go toward strengthening other aspects of a community. Communities and public health schools across the county are celebrating the week and spreading the messages of public health. Read more about National Public Health Week.

WHO: Strain of Bird Flu Kills Two in China; Third Person Infected
While a strain of bird flu has taken the lives of two Chinese men, there is at the moment no evidence to show it can be transmitted from person to person, according to the World Health Organization. The men died in February; a third person, a woman, is in critical condition. The H7N9 virus had previously infected only animals. "At this point, these three are isolated cases with no evidence of human-to-human transmission", said Michael O'Leary, MD, the WHO representative in China. "A new virus tends to be more virulent in the beginning. Either it is going to become a truly human virus, in which case we have to start dealing with it regularly, or it is going to be primarily an animal virus with just a rare human case." Read more on infectious disease.

Given Disease Labels for Children, Many Parents Push for Ineffective Medications
When it comes to doctors insisting sick infants don’t need medication, many parents refuse to take that “no” as an answer, according to a new study in the journal Pediatrics. Instead when given a simple disease label they often push for medications that won’t actually have any effect. Researchers say this demonstrates how simple disease labels can influence parents’ decision-making and shows the importance of good communication. "The disease label seems to send the message that there is an illness that requires medical treatment," said lead author Laura Scherer, an assistant professor in the department of psychological sciences at the University of Missouri. "But, depending on the situation, medical treatments may be necessary, or not. In the case of [gastroesophageal reflux disease], an otherwise healthy infant probably will not benefit from medication. So in this case [that] label can be misleading." Read more on infant and maternal health.

Color-coding Helps Tobacco Companies Get Around Marketing Restrictions
Tobacco manufacturers are essentially getting around the ban on descriptors such as “light,” “mild” and “low” by adding color-coding to cigarette packages, according to a new study in Tobacco Control. The study also found that tobacco companies trying to differentiate light cigarettes from “regular” cigarettes—implying they’re safer—did not file legal applications to have them approved as new products. “After a new federal law was passed in 2009 to end the tobacco industry’s deceptive marketing practices, the industry has apparently circumvented it by using new and sophisticated ways to deceive consumers and has not sought Food and Drug Administration approval for these products as required by law,” said study co-author Gregory N. Connolly, DMD, MPH, director of the Center for Global Tobacco Control at the School and professor of the practice of public health in the department of social and behavioral sciences. Read more on tobacco.

Study: 40 Percent of Parents Give Kids Solid Foods Too Early
Despite the recommendations of child development experts, about 40 percent of parents feed their infants solid food before they are 4 to 6 months old, according to a new study in the journal Pediatrics. Parents who formula-feed their infants rather than breastfeed were more likely to give solid foods too early, which has been linked to childhood obesity, celiac disease, diabetes and eczema. Researchers found one of the main reasons for the switch to solids was parents saying their children were getting hungrier. The researchers also said that health care providers should provide clear, accurate information on an infant’s dietary needs. Read more in infant and maternal health.

FDA’s Hamburg Proposes Improved Oversight of Compounding Facilities
The meningitis outbreak linked to tainted steroids produced at the Framingham, Massachusetts-based New England Compounding Center has led U.S. Food and Drug Administration (FDA) Commissioner Margaret A. Hamburg, MD, to propose the FDA be given greater authority to oversee high-risk sterile compounding facilities that distribute drug products in advance of or without receiving a prescription. Her proposal was posted on the FDAVoice blog. According to Hamburg, a Senate committee is drafting a proposed framework that would include requiring:

• Compliance with federal quality standards
• Federal registration of the compounding facilities
• Compounding pharmacies to report to FDA serious adverse drug reactions

Read more on infectious disease.

NIH: Cardiovascular Benefits Outweigh Small Weight Gain for Former Smokers
When it comes to health, the small amount of weight someone can gain after quitting smoking is inconsequential compared to the improvement in cardiovascular health, according to a new study in the Journal of the American Medical Association. Researchers from the National Institutes of Health found that current smokers were at twice the risk of developing cardiovascular disease as were former smokers without diabetes. “Our findings suggest that a modest weight gain, around 5-10 pounds, has a negligible effect on the net benefit of quitting smoking,” said study co-author Caroline Fox, MD, MPH, senior investigator in the Laboratory for Metabolic and Population Health at the NIH’s National Heart, Lung, and Blood Institute (NHLBI). “Being able to quantify to some degree the relationship between the benefits and side effects of smoking cessation can help in counseling those who have quit or are thinking about quitting.” Read more on tobacco.

FDA: Antibiotic Azithromycin Can Cause Fatal Irregular Heart Rhythm
The antibiotic azithromycin, also known as Zithromax, can lead to a potentially fatal irregular heart rhythm by changing the heart’s electrical activity, the U.S. Food and Drug Administration (FDA) has warned. The FDA is cautioning physicians to be wary of certain risk factors when prescribing the antibiotic, including low levels of potassium or magnesium, a slower-than-normal heart rate and the presence or other drugs to treat abnormal heart rhythms. Read more on heart health.

Study: Breast-feeding has No Effect on Weight Later in Life
Despite previous studies suggesting a possible link, breast-feeding does not reduce the chances that a child will grow up to be overweight or obese, according to a new study in the Journal of the American Medical Association. Still, breast-feeding does bring several health benefits, including a reduced risk of gastrointestinal and respiratory infections; a higher IQ; and lower incidence of eczema. It also reduces the risk of breast and ovarian cancer in the mother. "Although breast-feeding is unlikely to stem the current obesity epidemic, its other advantages are amply sufficient to justify continued public health efforts to promote, protect and support it," said the study's lead author, Richard Martin, a professor of clinical epidemiology at the University of Bristol in England. Read more on infant and maternal health.

"When the day comes that we’re not able to respond in the way that we think we should, that there will be a price to pay."

The U.S. Centers for Disease Control and Prevention and the National Association of County and City Health Officials (NACCHO) are among the partners hosting this week’s 2013 Public Health Preparedness Summit, which provides a national forum for public health and health care professionals, emergency managers, and other leaders to collaborate, learn, and share best practices—especially as budget cuts threaten strides that have been made to better prepare communities for disasters.

Conferences sessions include presentations on catastrophic preparedness, community resilience, biosurveillance, volunteer management, mass prophylaxis, public health law, and crisis standards of care.

NewPublicHealth will be on the ground at the Preparedness Summit in Atlanta this week covering sessions, exploring new tools at the conference expo and talking with plenary speakers and other leaders. Follow the conversation on Twitter at #PHPS13 and follow our coverage here.

In advance of the conference NewPublicHealth spoke with Jack Herrmann, senior advisor for public health preparedness at NACCHO.

NewPublicHealth: How do disasters that happen during the course of the year—such as Superstorm Sandy and the past year’s mass shootings in Colorado and Connecticut—impact the sessions at the Summit?

Jack Herrmann: Unfortunately over the last number of years we’ve always had some kind of event that we’ve had to focus on during the summit, some disaster that has occurred, so this year really is not unique. Last year we also had hurricanes and major tornadoes, and so we found ourselves having to rally around major disasters and pointing out how poignant the Preparedness Summit is because of the events that unfolded. This year, the Aurora shooting, the Newtown shooting, Hurricane Sandy and other events that have occurred really define why we all come together each year for this summit.

It is an opportunity to reflect back and remember how important it is for us to be able to prepare for events every day. I suspect many of the people who have sat in the audience never expected a disaster to occur in their community. So, it is a lesson for all of us in that we never know when disaster is going to strike and that it’s critically important that we’re always on our toes and looking for ways that we can enhance and build the preparedness efforts across our communities and across our nation.

U.S. Cesarean Delivery Rates Vary Widely
A new study in the journal Health Affairs finds that the rates of cesarean deliveries, the most common surgery in the United States, vary widely across the country, ranging from 7.1 percent to 69.9 percent of deliveries at close to 600 hospitals studied since 2009. About four million babies are born in the country each year. The study authors also looked at cesarean rates among low risk mothers and found that the variation rate for this group was higher—from 2.4 percent to 36.5 percent. "The variations we uncovered were striking in their magnitude, and were not explained by hospital size, geographic location, or teaching status," said Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the lead researcher of the study. Cesarean rates have increased in the United States from 20.7 percent in 1996 to 32.8 percent in 2011, according to the study. There has been an increased focus on some cesarean deliveries performed before the baby is full term because of the many risks a baby faces when it is born prematurely. Another critical reason to address the issue, say the study authors, is that half of all U.S. births are paid for by the Medicaid program and cesarean births are much more costly than vaginal deliveries. Read more on maternal and infant health.

Chronic Disease Management for Medicaid Beneficiaries Could Lower Health Costs
A recent study of 75,000 women on Medicaid by researchers at the East Tennessee State University found that women with low incomes have a high prevalence of physically disabling conditions and chronic disease. Common chronic diseases included high blood pressure, depression, multiple sclerosis, arthritis, injury, back disorder and Parkinson’s disease. The researchers also found that women who used a mobility device—such as a walker, crutches, or wheelchair—were more likely to suffer from chronic diseases such as diabetes, pulmonary disease, and depression. “These are not women of retirement age. These are rates of chronic disease and disability in a working-age population, so the economic loss to society and the impact on health care costs is substantial," said Amal Khoury, MD, a professor and chair in the department of health services management and policy and the lead author of the study.  "Strategies to improve chronic disease management in the younger adult population may curtail higher disability rates in working-age adults and lower Medicaid and Medicare costs in the long run." Read more on prevention.

Fundraisers at U.S. Schools Too Often Sell Unhealthy Foods
Many public U.S. elementary schools ignore state and district policies banning unhealthy fundraisers, according to a study by researchers at the University of Illinois at Chicago. In the study, principals of 1,215 schools across the United States completed surveys on school food policies for the 2009-11 school years. Overall, only 39 percent of schools had nutritional restrictions on fundraisers, but schools within districts and states with strong policies were more than twice as likely to limit the sale of high-calorie and high-fat foods to raise money. Lindsay Turner, a researcher at the Institute for Health Research and Policy at the university and the lead author of the study, said “[i]t’s hard for schools to give up those financial resources, so that’s why it is essential to have alternative fundraising activities that don’t involve high-calorie products.” Turner ticked off alternatives suggested by the Center for Science in the Public Interest, including walk-a-thons and selling books, greeting cards, fruit, holiday decorations or wrapping paper. “This study puts fundraising on the radar as an issue that needs to be attended to in policy making,” said Turner. “There has been a lot of attention paid to competitive foods and beverages, and this is a really important piece of the entire picture of what’s going on in schools.” Read more on obesity.

The U.S. preterm birth rate dropped for the fifth consecutive year in 2011 to 11.7 percent, the lowest in a decade, according to the March of Dimes 2012 Premature Birth Report Cards. That improvement means not just healthier babies, but also potential savings of roughly $3 billion in health care and economic costs, says Jennifer Howse, PHD, March of Dimes president.

Howse says the improved rates can be attributed to an expansion of successful programs and interventions, including actions by state health officials in 48 states, the District of Columbia and Puerto Rico, who set goals to lower their preterm birth rates 8 percent by 2014 from their 2009 rate, based on a challenge issued in 2011 by the Association of State and Territorial Health Officers.

Preventing premature birth and, by extension, increasing the number of babies born healthy, is one focus of the March of Dimes first pregnancy book, Healthy Moms, Healthy Babies, just published a few weeks ago in celebration of the organization’s 75th anniversary.

In observance of the 75th anniversary, NewPublicHealth spoke with Edward R.B. McCabe, MD, PhD, Senior Vice President and Medical Director of by the March of Dimes Foundation, about the organization’s continuing efforts to reduce premature births in the United States.

NewPublicHealth: What are the current vital statistics on prematurity?

Dr. McCabe: Worldwide, 15 million babies are born prematurely each year and more than a million of them die. The United States has one of the highest preterm birth rates in the world. Despite these somber statistics, there is good news. The U.S. infant mortality—and preterm birth—rates are declining.

A recent National Center for Health Statistics (NCHS) report found that much of the decrease in the infant mortality rate can be accounted for by a decrease in preterm births. Preterm birth has declined for five consecutive years to 11.7 percent of all births, but still above the March of Dimes goal for 2020 of 9.6 percent. Overall, infant mortality declined for four consecutive years to less than 26,500 in 2009, the most recent year for which statistics are available, according to the NCHS.

Better Nutrition Advice Comes From Doctors Who Cook
At the “Healthy Kitchens, Healthy Lives – Caring for our Patients and Ourselves” conference presented by Harvard University and the Culinary Institute of America, health care professionals have been learning about both nutritional science and how to cook. The program was influenced by the idea that healthcare professionals practicing healthful behaviors—such as healthy eating, exercising, or wearing a seat belt—may be more likely to pass these same behaviors onto their patients.

A 2010 survey of 219 conference participants before the conference and 192 participants three months after found:

• 58 percent of healthcare professionals cooked their meals before the conference; 64% afterwards with reports of eating more whole grains, nuts and vegetables
• 46 percent said they could successfully advise an overweight patient on nutrition and lifestyle before the conference; 81% said they could afterwards

The researchers believe they “need enhanced educational efforts aimed at translating decades of nutrition science into practical strategies whereby healthy, affordable, easily prepared and delicious foods become the predominant elements of a person’s dietary lifestyle.” Read more on nutrition.

Caffeine During Pregnancy Linked to Smaller, Later Newborns
Coffee and other caffeinated beverages consumed during pregnancy might increase the odds for low birth weight or an extended pregnancy, according to a new study in BMC Medicine. The study looked at about 60,000 pregnancies tracked by the Norwegian Institute of Public Health. Researchers found that caffeine from all sources was tied to a higher risk for reduced birth weight and that every 100 mg of caffeine consumed per day extended pregnancy by five hours. Caffeine from coffee extended pregnancy by eight hours. The World Health Organization advises women to limit their caffeine consumption to 300 mg a day during pregnancy, while the United States recommends a 200 mg daily limit. Read more on maternal and infant health.

CDC: Reductions in Some Types of Health Care-Associated Infections
Progress in the fight against certain bloodstream and surgical-site infections continues in hospitals in the United States, according to a U.S. Centers for Disease Control and Prevention (CDC) report. The report looked at data submitted to the National Healthcare Safety Network (NHSN), CDC’s infection tracking system. CDC reported a 41 percent reduction in central line-associated bloodstream infections since 2008 and a 17 percent reduction in surgical site infections since 2008. “The significant decrease in central line and surgical site infections means that thousands of patients avoid prolonged hospitalizations and the risk of dying in the hospital,” said Patrick Conway, chief medical officer of the Center for Medicare & Medicaid Services (CMS). The data indicates hospitals are making progress toward the goals established in 2008: 50 percent cut in central line-associated bloodstream infections and a 25 percent cut in surgical site infections in five years. Read more on injury prevention.