Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages.

Yesterday, NPR reported that business owners near the blast site are beginning to return and reopen their doors.

"They fled in a panic last week and returned both eager and anxious," said NPR reporter Tovia Smith. The piece describes how business owners returned to find food left half-eaten and rotting, because so many left in such a hurry, and blood splattered in some spots from those who were injured.

To help make sure businesses get the help they need to reopen safely, public health inspectors played a role in visiting every building on every block. "They also stood ready with trauma counselors, pro-bono attorneys and clean-up crews," said Smith.

But the public health response to any disaster goes beyond helping to restore normalcy in the immediate aftermath. An earlier interview with John Lumpkin, director of the Health Care Group at the Robert Wood Johnson Foundation, about the sustained response to Hurricane Sandy also applies here:

We saw with Katrina and are seeing again now with Sandy, [public health officials] are not only concerned with food, air, and water during and immediately after an emergency, but also with ensuring that services related to health care delivery and mental health are provided when and where they’re needed. It’s an interesting statistic, for instance, that the demand for mental health services was higher five years after Hurricane Katrina than it was immediately after the hurricane hit.

The Boston Public Health Commission announced this week, for example, that the organization has opened a new drop-in center to continue to provide emotional support to anyone affected by the Boston Marathon attack.

"While the physical injuries and destruction that resulted from the bombings might be the most visible signs of trauma, many people experience serious emotional distress based on what they saw, heard, and felt during and after the attack. Sometimes these symptoms do not surface immediately," according to the Commission release. "Understanding the deep impacts of this emotional distress, city officials opened the drop-in center as a safe place for people to come together and talk about their experiences over the past week."

>>Read more about building community resilience to recover from disaster.

New York City Moves to Ban Cigarette Sales to People Under 21
A bill introduced to the New York City Council would ban cigarette sales to anyone under the age of 21. The current age limit is 18. "Too many adult smokers begin this deadly habit before age 21," City Council Speaker Christine Quinn said. "By delaying our city's children and young adults access to lethal tobacco products, we're decreasing the likelihood they ever start smoking, and thus, creating a healthier city." Though not introduced by Mayor Michael Bloomberg, he does support the bill. New York City also has the highest taxes on cigarettes of any U.S. city, with a city tax of $1.50 on top of a state tax of $4.35. Read more on tobacco.

Insurance Authorization Delays Trap Psychiatric Patients in ERs
Thousands of hours of physician time is lost each year caring for emergency department patients in need of psychiatric care, but waiting for insurance authorization to be admitted into the hospital, according to a letter to be published in the May issue of Annals of Emergency Medicine. Researchers found that about half of authorizations were completed in less than 20 minutes, but 10 percent took at least an hour. About 2.5 million people are admitted to hospitals for psychiatric care each year. "Psychiatric care is really the poor stepchild in the world of insurance coverage," said lead author Amy Funkenstein, MD, of Brown University in Providence, R.I.. "Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better." Read more on mental health.

Report Finds Positive, Negative News on U.S. Air Quality
Areas across the country have seen a mix in terms of improvement of air quality over the past decade, according to a new report from the American Lung Association (ALA). "The long-term trend is positive and headed to much cleaner air," said author Janice Nolen, ALA's assistant vice president of national policy and advocacy. "[However], there is an uptick in some areas that are a concern and some areas where the problem remains very, very serious." Approximately half of the 25 most polluted cities in 2000 saw improvements in air quality, with the others seeing declines. And some of the “improved” cities still were highly polluted, such as Los Angeles and Bakersfield, Calif. Houston, Dallas, Oklahoma City, Cincinnati, New York City and Washington, D.C. were the other cities with the highest levels of ozone. Overall, the report found that 132 million people were living in 254 counties with unhealthy levels of ozone or particle pollution. Read more on environment.

Supreme Court Lets FDA Move Forward with Graphic Cigarette Warnings and Other Tobacco Regulations
The Supreme Court yesterday announced that it will not hear the tobacco industry's appeal of a March 2012 ruling by the U.S. Court of Appeals for the Sixth Circuit on graphic cigarette warnings and several other tobacco regulations. That decision allows the U.S. Food and Drug Administration (FDA) to move forward in developing graphic cigarette warnings allowed by a 2009 law that gave the FDA sweeping new authority over tobacco, and other recent court rulings.

The 2009 law requires graphic warnings that cover the top half of the front and back of cigarette packs and 20 percent of cigarette ads. According to the Campaign for Tobacco-Free Kids (CTFK), a tobacco control advocacy group based in Washington, D.C., the graphic warnings are needed to better inform Americans about the deadly consequences of smoking. According to CTFK, the current, text-only warnings which are printed on the side of cigarette packs haven’t been updated since 1984 and often go unnoticed.

The appeals court ruling also upheld other key provisions of the law that:

• Tobacco companies are prohibited from making health claims about tobacco products without FDA review
• Several forms of tobacco marketing that appeal to children would be banned, including brand name sponsorships; tobacco-branded merchandise such as caps and t-shirts; and free samples of tobacco products
• Tobacco companies are prohibited from making statements implying that a tobacco product is safer because it is regulated by the FDA.

In a statement released yesterday, CTFK Executive Director Susan Liss said: “The FDA should move forward aggressively to reduce the death and disease caused by tobacco use, which is the nation's number one cause of preventable death.” Read more on tobacco.

Task Force Finds Insufficient Evidence for Universal Suicide Risk Screenings
While the U.S. Preventive Services Task Force’s latest draft guidelines stated that there is not enough evidence to support universal screening to identify people at risk of suicide, it’s still critical for health care professionals to be wary of certain signs, said David Grossman, MD, MPH, a member of the Task Force. "Although we did not find enough evidence to say ‘here are the right questions and tools to find the people who may be at risk for suicide,' doctors should be screening for depression and alcohol abuse disorders in their primary care population," he said. Top risk factors include depression and alcohol abuse. There are approximately 37,000 cases of suicide in the United States each year. Read more on mental health.

Poll: Nearly 1 in 4 High School Students Have Abused Prescription Meds
Approximately 24 percent of high school students have abused prescription drugs, according to a new poll from by Partnership at Drugfree.org. With about 5 million kids admitting to the medication abuse, the rate is up 33 percent since 2008. About 13 percent say they’ve experimented with Ritalin or Adderall, both of which are used to treat attention-deficit/hyperactivity disorder. At the heart of the problem is the misconception by both kids and parents that misusing prescription drugs is not as dangerous as taking other drugs. "The key here is that kids and often their parents are buying into the myth and misunderstanding that prescription drug abuse is a safer way to get high, a safer alternative to street drugs, and that they can control it," said said Steve Pasierb, president and CEO at the Partnership organization. "And it's very important to note that, on this, kids and parents are in the same place. Kids say that they don't think that their parents are going to be upset if they know about this, and parents are essentially saying the same thing." Read more on prescription drugs.

Experts Debate Expected Changes to ADHD Diagnosis
Medical experts are at odds as to what to ultimately expect from the predicted changes to the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 will be released in May by the American Psychiatric Association. The broadened criteria should increase the number of people diagnosed with ADHD in part by expanding the age time frame for the onset of symptoms. "In the current version, it's seven years,” James Norcross, MD, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas. “That will be changed to 12 years in the DSM-5, which may make things easier for adults and adolescents, because they'll be able to better recall some of the challenges that may have occurred." Norcross said the changes are positive overall. However, Allen Frances, MD, chair of the task force for the DSM-4 and former chair of psychiatry at Duke University School of Medicine in Durham, N.C., worries the new criteria will serve to increase the unnecessary use of stimulant medications. "We're already overdiagnosing ADHD,” he said. “Almost 20 percent of teen boys get the diagnosis of ADHD, and about 10 percent of boys are on stimulant drugs. We don't need to make it easier to diagnose ADHD.” Read more on mental health.

FDA Releases Violations on Several Dozen Compounding Pharmacies
Yesterday the U.S. Food and Drug Administration (FDA) released a list of violation reports for 28 of the 31 drug compounding pharmacies it’s inspected since April. The safety of drugs produced at compounding pharmacies came into question last year after the Framingham, Massachusetts-based New England Compounding Center was linked to a meningitis outbreak that caused 39 deaths and 656 cases of illness in 19 states. Found violations range from “inappropriate clothing for sterile drug processing to insufficient testing for contaminants,” according to Reuters. Still, FDA reiterated its stance that it needs more increased regulatory authority when it comes to compounding facilities. Last month Commissioner Margaret A. Hamburg, MD, proposed 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. Read more on prescription drugs.

USPSTF: Limit Oral Cancer Screenings to Patients with Signs, Symptoms
Primary care physicians should limit oral cancer screenings to adult patients who actually show signs or symptoms of the condition, according to new draft recommendations from the U.S. Preventive Services Task Force (USPSTF). "The evidence shows that it is difficult to detect oral cancer and that the evidence is not clear whether oral cancer screening improves long-term health outcomes among the general adult population or among high-risk groups," said Jessica Herzstein, MD. "We need more high-quality research on whether screening tests can accurately detect oral cancer and if screening adults for oral cancer in primary care settings improves health outcomes." Tobacco and alcohol are both major risk factors for oral cancer. The task force also recommended physicians take into account patient wishes, medical histories and other expert opinions when making decisions. Read more on cancer.

Media Coverage of Mass Shootings Harms Attitudes on Mental Illness
Media coverage of mass shootings by people with mental illness can increase support for policies to reduce gun violence, but can also increase the stigmatization of people with mental illness and lessens the chance they will seek help, according to a new study in the American Journal of Psychiatry. “The aftermath of mass shootings is often viewed as a window of opportunity to garner support for policies to reduce gun violence, and this study finds public support for such policies increases after reading news stories about a mass shooting,” said study author Emma E. McGinty, MS, a PhD candidate with the Johns Hopkins Center for Gun Policy and Research, part of the Johns Hopkins Bloomberg School of Public Health. “However, we also found that the public’s negative attitudes toward persons with serious mental illness are exacerbated by news media accounts of mass shootings involving a shooter with mental illness.” Read more on violence.

Study Links Excessive Television Viewing, Antisocial Behavior in Young Children
Antisocial behavior is more likely in young children who watch three or more hours of television a day, according to a new study in the Archives of Disease in Childhood. Researchers found that five-year-olds in that demographic were more likely to exhibit such behavior by the age of seven. Study author Alison Parkes, of the University of Glasgow in Scotland, said the findings support the decision by many parents to limit television time. Still, the researchers noted that this correlation does not equal causation. Excessive television watching by kids has also been linked to poorer physical health and performance in classrooms. Read more on mental health.

Cutting Medical Interns’ Hours Reduces Training Time, Increase Risks to Patients
Efforts to increase the amount of sleep by medical interns by reducing the number of continuous hours they work actually decreases the number of training opportunities and increases the risk to patients, according to a new study in the journal JAMA Internal Medicine. They also don’t get any more sleep in an average week. "Despite the best of intentions, the reduced work hours are handcuffing training programs, and benefits to patient safety and trainee well-being have not been systematically demonstrated," said study leader Sanjay Desai, an assistant professor of medicine at the Johns Hopkins University School of Medicine and director of the internal medicine residency program at the Johns Hopkins Hospital. "We need a rigorous study. We need data to inform this critical issue." Read more on access to health care.

CDC: U.S. Kids Consume Nearly as Much Salt as U.S. Adults
The average U.S. kid consumes about as much salt in a day as the average U.S. adult—which is to say far too much, according to a new study in the journal Pediatrics. Researchers at the U.S. Centers for Disease Control and Prevention (CDC) found the average youth age 8 to 18 has a daily sodium intake of approximately 3,387 mg; the recommended daily limit is 2,300 mg. Processed foods are one of the biggest culprits. Excessive sodium is linked to a myriad of health issues. "We found that higher sodium intake was associated with higher blood pressure," said Janelle Gunn, a public health analyst with the CDC. "We found among overweight and obese participants (in the study), that for every 1,000 mg of sodium they consumed, their blood pressure response was seven times greater (compared to healthy-weight children)." Read more on nutrition.

Norovirus Top Cause of Pediatric Medical Care for Acute Gastroenteritis
Norovirus will cause about 1 in every 14 children to seek emergency care treatment and 1 in 6 to need outpatient care before the age of 5, according to a new study in the New England Journal of Medicine. Researchers determined the highly infectious norovirus is now the number one cause of the need for medical care for acute gastroenteritis in that age group. From 2009 to 2010 there were about 1 million pediatric medical care visits linked to norovirus. “Infants and young children are very susceptible to norovirus infections, which often result in a high risk of getting dehydrated from the sudden onset of intense vomiting and severe diarrhea,” said Daniel Payne, MD, an epidemiologist in the Division of Viral Diseases at the U.S. Centers for Disease Control and Prevention. Read more on infectious disease.

Study: Online Venting Will Probably Just Make You Angrier
That little bit of relaxation you feel right after responding to an infuriating comment on the internet may just be a brief respite on the path to long-term frustration, according to a new study in the journal Cyberpsychology, Behavior, and Social Networking. Lead author Ryan Martin, an associate professor of human development and psychology at the University of Wisconsin-Green Bay, said the anonymity and social distance of many online sites makes responding quickly and in anger too easy. While there are many good reasons to be angry, he said the healthier approach is to get involved with an issue that frustrates you and try to change things, rather than railing at a stranger on Facebook, Twitter or a blog site. "Most of these sites encourage venting as a way of dealing with anger," Martin said. "They think of venting as a healthy adaptive approach, and it's not." Read more on mental health.

AAP Policy Statement Supports Same-sex Marriage
The American Academy of Pediatrics (AAP) has released a new policy statement in the journal Pediatrics in support of same-sex marriage, as well as the right for all to adopt kids and provide foster care. "Children thrive in families that are stable and that provide permanent security, and the way we do that is through marriage," said policy statement co-author Benjamin Siegel, MD, chair of the AAP Committee on Psychosocial Aspects of Child and Family Health. "The AAP believes there should be equal opportunity for every couple to access the economic stability and federal supports provided to married couples to raise children.” Added Ellen Perrin, MD, another co-author: "If a child has two loving and capable parents who choose to create a permanent bond, it's in the best interest of their children that legal institutions allow them to do so." Read more on LGBT issues.

1 in 50 U.S. Kids Have Autism
Approximately one in 50 youth ages 6 to 17 had autism from 2011 to 2012, according to a new report from the U.S. Centers for Disease Control and Prevention and the Health Resources and Services Administration. The share was about 1.2 percent in 2007. The greatest increase was seen in boys an in those ages 14 to 17. Health officials say the increase doesn’t mean autism is becoming more prevalent, but that it is being diagnosed more frequently, according to CBS News. Under the new statistics approximately 1 million U.S. children have autism. Read more on mental health.

Study Links Gulf War Syndrome to Brain Damage
A link has been found between Gulf War Syndrome and damage to the brain, according to a new study in the journal PLOS ONE. James Baraniuk, senior author and professor of medicine at Georgetown University Medical Center, said the study clearly demonstrates that Gulf War Syndrome—a collection of symptoms experienced by approximately 250,000 veterans of the 1991 war—is not psychological. Researchers and Georgetown University used fMRI machines to identify “anomalies in the bundle of nerve fibers that interpret pain signals in the brain in 31 Gulf War veterans,” according to USA Today. This quick form of diagnosis could also end up helping people with chronic fatigue syndrome and fibromyalgia. Read more on the military.

CDC: Daily Caloric Intake Down, But Obesity Rates Still Rising
Obesity rates continue to climb despite the fact that U.S. adults are consuming fewer and fewer calories, according to a survey from the U.S. Centers for Disease Control and Prevention appearing in the American Journal of Clinical Nutrition. Average daily caloric intake dropped by 74 from 2003 to 2010, after rising 314 calories from 1971 to 2003. About 35 percent of U.S. adults are obese. "It's hard to reconcile what these data show, and what is happening with the prevalence of obesity," said co-author William Dietz, MD, former CDC director of Nutrition, Physical Activity and Obesity. Read more on obesity.

Agencies Outline Responsibilities for Restoring Public Transportation after a Disaster
The Federal Transit Administration (FTA) and the Federal Emergency Management Agency (FEMA) have signed a Memorandum of Agreement (MOA) that outlines the roles and responsibilities of both agencies in providing federal assistance to repair and restore public transportation systems in areas the president has declared a major disaster or emergency. “After disasters hit, our federal, state and local partners must be able to move quickly and make the necessary repairs to our nation’s transit systems, roads, rails and bridges,” said U.S. Transportation Secretary Ray LaHood. FEMA will continue to have primary federal responsibility for emergency preparedness, response and recovery in major disasters and emergencies. The new emergency relief authority provides FTA with primary responsibility for reimbursing emergency response and recovery costs after an emergency or disaster that affects public transportation systems and for helping to mitigate the impact of future disasters. Read more on transportation.

Exercise Can Improve Self-Control in Kids, Young Adults
Short bursts of exercise—such as a half hour of running—can help youth and young adults improve their self control, according to a new study in the journal British Journal of Sports Medicine. "Tests conducted immediately after short bouts of exercise showed a clear improvement among higher-order functions like self-control, a cognitive [brain] function that is really important for daily activities in terms of both social life and academic performance," said lead author Lot Verburgh, a doctoral candidate in the department of clinical neuropsychology at VU University in Amsterdam. The results could help in the treatment of disorders associated with impaired inhibition, such as attention-deficit/hyperactivity disorder (ADHD) and autism. Read more on exercise. If exercise can also be linked to long-term improvement in higher-order mental processes, exercise may soon be not only a treatment option for heart disease patients and individuals looking to control their weight, but also for ADHD and Alzheimer's patients," said Ali Weinstein, an assistant professor and deputy director of the Center for Study of Chronic Illness and Disability at George Mason University in Fairfax, Va. Read more on mental health.

Study: Better Fitness Equals Better Grades for Kids
Getting kids more exercise may also make them more likely to get better grades, according to a new study in the Journal of Pediatrics. The study found that physically fit elementary and middle school students were 2.4 times more likely to pass math tests and about 2 times more likely to pass reading tests . The findings are especially significant at a time when schools across the country are cutting physical education programs. "Schools sacrificing physical education and physical activity time in search of more seat time for math and reading instruction could potentially be pursuing a counterproductive approach," said lead researcher Robert Rauner, MD, of Creighton University and Lincoln Public Schools in Lincoln, Neb. Read more on physical activity.

Personalized Risk Assessments Lead to Smarter Patient Decisions
Providing patients with personalized risk assessments instead of generalized assessments makes them more likely to make educated decisions about screening tests, according to a new review of 41 studies published in the Cochrane Library. The personalized evaluations include factors such as age, race, gender, weight, lifestyle and family history. "Knowing your individual risk for a particular health problem may help you make an informed choice about what screening services you might be interested in," said Michael LeFevre, MD, MSPH, co-vice chair of the government-backed U.S. Preventive Services Task Force. "Over time, what would be ideal is that we're able to make more specific, individualized recommendations and fewer population recommendations.” Read more on access to health care.

Study: ADHD, Autism, Depression May Share Genetic Link
Autism, attention-deficit/hyperactivity disorder (ADHD), major depression and other mental disorders may share genetic risk factors, according to a new study in The Lancet. Bipolar disorder and schizophrenia were also linked. Researchers do not yet understand the link between the gene variants and the disorders, but the knowledge may help improve prevention and treatment methods. "This is the first clue that specific genes and pathways may cause a broader susceptibility to a number of disorders,” said lead researcher Jordan Smoller, MD, a professor of psychiatry at Harvard Medical School in Boston. “Now the important work will be to figure out how this actually happens.” Read more on mental health.

An article in the New York Times reports that health departments in some states are increasing their efforts on gun safety and suicide prevention in part because of a startling finding by researchers at the Harvard School of Public Health: far more Americans die from guns they aim at themselves than in mass shootings.

By the numbers:

• Nearly 20,000 of the 30,000 deaths from guns in the United States in 2010 were suicides.
• Wyoming, Montana and Alaska are the states with the three highest suicide rates; they’re also on the list of top gun owning states.
• The national suicide rate has climbed by 12 percent since 2003.
• Suicide is the third-leading cause of death for teenagers.
• Suicide attempts using a gun are fatal 85 percent of the time; suicide attempts with pills are successful 2 percent of the time.

State health departments in Missouri, North Carolina and Wyoming, the state with the highest suicide rate, are giving out gunlocks. In New Hampshire some gun shops post flyers with warning signs for suicide and a recommendation to keep guns from people who are at risk of harming themselves. Some gun owners in Maryland are considering a similar outreach project.

>>Read the article.

>>Bonus Link: Read a NewPublicHealth post about the Surgeon General’s National Strategy for Suicide Prevention, launched last year.