U.S. Youth Exercise, Diet Improved Over Past Decade
Exercise and dietary habits of U.S. kids and teenagers seems to have improved over the past decade, according to a new study in the journal Pediatrics. The study found that from 2001-2002 to 2009-2010, the average number of days per week being physically active for at least 60 minutes for sixth through tenth graders climbed from 4.3 to 4.5; the days eating breakfast before school climbed from 3 to 3.3; and hours per day watching television dropped from 3.1 to 2.4. The findings suggest that it takes time for public health efforts to translate into behavioral changes. "I would like to believe that all the public health efforts focusing on increasing physical activity and increasing fruit and vegetable consumption are having an effect, because that seems to be a pattern," said Ronald Iannotti, study author from the University of Massachusetts Boston. "The fact that (obesity) is leveling off, that's a surprise and a major change from the steady increase that we've seen over time.” Read more on pediatrics.

Study: Kids of Same-sex Couples Less Likely to Have Private Health Insurance
Children of same-sex parents are less likely to have private health insurance, although the rates improve in states that recognize same-sex marriages or unions, according to a new study in the journal Pediatrics. Approximately two-thirds of U.S. youth with same-sex parents have private health insurance, compared to approximately 78 percent of U.S. youth with married heterosexual parents. When accounting for additional factors such as parental incomes and education level, researchers determined that youth living with same-sex parents were as much as 45 percent less likely to have private health insurance than were youth living with married heterosexual parents. The findings indicate yet another public health benefit of same-sex marriage, as access to health insurance directly affects a child’s health; previous studies have shown a connection between legal unions and improved mental health for gay and lesbian adults. A likely cause for the disparity is the fact that employers have not had to extend coverage to an employee’s same-sex partner or that employee’s children. "I think we are going to see more and more research like this that shows how marriage-equality laws have far-reaching health consequences," said Richard Wight, a researcher at the University of California, Los Angeles, who was not a part of the study. Read more on LGBT issues.

HHS: $67M for Expanded Preventive and Primary Care for 130,000 Americans
The U.S. Department of Health and Human Services (HHS) has awarded approximately $67 million for the creation of 32 new health service delivery sites to expand access to individuals, families and communities across the country. The sites will provide improved preventive and primary health care to more than 130,000 people. Another $48 million will go toward the approximately 1,200 existing centers. “Health centers have a proven track record of success in providing high quality health care to those who need it most,” said HHS Secretary Kathleen Sebelius. “New health center sites in some of the neediest communities in the country will provide access to health care for individuals and families who otherwise may have lacked access to high quality, affordable and comprehensive primary care services.” Read more on access to health care.

CDC: U.S. School Districts Seeing Improvements in Multiple Health Policies
U.S. school districts are seeing continued improvements in measures related to nutritional policies, physical education and tobacco policies, according to the U.S. Centers for Disease Control and Prevention (CDC). The findings are part of the 2012 School Health Policies and Practices Study, a periodic national survey assessing school health policies and practices at the state, district, school, and classroom levels. "Schools play a critical role in the health and well-being of our youth," said CDC Director Tom Frieden, MD, MPH. "Good news for students and parents – more students have access to healthy food, better physical fitness activities through initiatives such as ‘Let’s Move,’ and campuses that are completely tobacco free."

Among the key findings:

• The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
• Between 2006 and 2012, the percentage of districts that required schools to prohibit junk food in vending machines increased from 29.8 percent to 43.4 percent.
• The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
• The percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

Read more on school health.

Poor Oral Health Linked to Increased Risk for Oral HPV Infection
Poor oral health is associated with increased risk of the oral human papillomavirus (HPV) infection responsible for as many as 80 percent of oropharyngeal cancers, according to a new study in the journal Cancer Prevention Research. Researchers found that people who reported poor oral health had a 56 percent higher prevalence oral HPV, people with gum disease had a 51 percent higher prevalence and people with dental problems had a 28 percent higher prevalence. “The good news is, this risk factor is modifiable—by maintaining good oral hygiene and good oral health, one can prevent HPV infection and subsequent HPV-related cancers.” said Thanh Cong Bui, MD, postdoctoral research fellow at the University of Texas School of Public Health. Other factors also increased the risk, such as being male, smoking tobacco or using marijuana. Read more on cancer.

Study: Hospital Pediatric Readmission Rates Not an Effective Measure of Quality of Care
Hospital readmission rates for children are not necessarily an effective measurement of the quality of care, according to a new study in the journal Pediatrics. "As a national way of assessing and tracking hospital quality, pediatric readmissions and revisits, at least for specific diagnoses, are not useful to families trying to find a good hospital, nor to the hospitals trying to improve their pediatric care," study author Naomi Bardach, MD, an assistant professor of pediatrics at the University of California, San Francisco, Benioff Children's Hospital. "Measuring and reporting them publicly would waste limited hospital and health care resources." After analyzing 30- and 60-day readmission rates for seven common pediatric conditions, researchers found that at 30 days readmission for mood disorders was most common, at 7.6 percent, followed by 6.1 percent for epilepsy and 6 percent for dehydration. Readmission rates for asthma, pneumonia, appendicitis and skin infections were all below 5 percent. Bardach said the low rates leave “little space for a hospital to be identified as having better performance.” Further study could improve the way readmission rates are utilized to assess the quality of pediatric care. Read more on pediatrics.

U.S. Circumcision Rate Down 10 Percent over Past Three Decades
The circumcision rate of U.S. newborns dropped approximately 10 percent from 1979 to 2010, according to new date from the National Center for Health Statistics. In 2010 about 58.3 percent of boys born in U.S. hospitals were circumcised; the rate was 64.5 percent in 1979. While beginning as a religious ritual, the use of circumcision expanded due to potential health benefits such as reduced risk of urinary tract infections in infants and reduced risk of sexually transmitted diseases. Last August the American Academy of Pediatrics said that these benefits outweigh any risks. However, the procedure also has many opponents. While the report did not go much into the reasons for the decline, possible explanations include the fact that Medicaid has stopped paying for circumcisions in 18 U.S. states, some insurers are not covering procedures without strong medical justifications and shorter hospital stays for new mothers means some circumcisions are performed later as outpatient procedures. Read more on maternal and infant health.

Eating Fruit Helps Prevent Certain Aneurysms
An apple—or any other fruit—a day may lower a person’s risk of an abdominal aneurysm, according to a new study in the journal Circulation. The thirteen year study of 80,000 people ages 48 to 64 in Swede found that people who reported eating more than two servings of fruit daily had a 25 to 31 percent lower risk of abdominal aortic aneurysm than those who ate little or no fruit. High levels of antioxidants in fruits might protect against abdominal aortic aneurysm by preventing oxidative stress that can promote inflammation, according to the researchers, who found no similar association for vegetables, which are also rich in antioxidants, but may lack some of the components in fruits. However, vegetables remain important to a person’s diet, say the study authors. Combined with fruit they may help decrease the risk of cardiovascular diseases, type 2 diabetes, high blood pressure and several cancers. The American Heart Association advises the average adult to eat four to five servings each of fruits and vegetables daily, based on a 2,000 calorie diet. Read more on nutrition.

Study: CTE Victims First Present with Impaired Mood or Thinking
People suffering from chronic traumatic encephalopathy (CTE)—a neurodegenerative disease that can only be diagnosed after death—will likely first begin exhibiting either impaired behavior and mood or impaired memory and thinking abilities, according to a new study in the journal Neurology. CTE is characterized by impulsivity, depression and erratic behavior. "The study itself is relatively preliminary, [but] we found two relatively distinct presentations of the disease," said study co-author Daniel Daneshvar, a postdoctoral researcher at the university's Center for the Study of Traumatic Encephalopathy. "So little is known about the clinical presentation of CTE that anything we found is not necessarily surprising, simply because there's a dearth of information about CTE." Researchers emphasized that far more study is needed. CTE and other head trauma have become increasingly prominent issues over the last several years, with cases linked to both sports injuries and battlefield injuries. There is currently a lawsuit by almost 4,000 former NFL players claiming the league did not properly inform them of the dangers of concussions or adequately protect their health. Read more on injury prevention.

TFAH: U.S. Adult Obesity Rates Relatively Level, But Still Extremely High
Though adult obesity rates are level in all states except Arkansas, the rates are still far too high, according to F as in Fat: How Obesity Threatens America's Future 2013, a new report from the Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation. The plateau comes after mostly 30 years of rising rates. No state had higher than a 15 percent obesity rate in 1980; today every state is about 20 percent and 13 states have rates higher than 30 percent. “While stable rates of adult obesity may signal prevention efforts are starting to yield some results, the rates remain extremely high,” said Jeffrey Levi, PhD, executive director of TFAH. “Even if the nation holds steady at the current rates, Baby Boomers—who are aging into obesity-related illnesses—and the rapidly rising numbers of extremely obese Americans are already translating into a cost crisis for the healthcare system and Medicare. In order to decrease obesity and related costs, we must ensure that policies at every level support healthy choices, and we must focus investments on prevention.” Read more on obesity.

Soda Consumption Tied to Higher Aggressive Behavior in Kids
Soda consumption is tied to higher aggressive behavior in kids, according to a new study in The Journal of Pediatrics. Study authors cautioned that the increase may not be apparent in individuals and the study does not show causation. However, previous studies have demonstrated a link between soda consumption and violent behavior. The researchers analyzed data of mothers’ assessment of their children’s aggressiveness, including acts such as destroying their belongings or the belongings of others. On an aggression scale of 0-100, kids who drank no soda scored an average of 56, kids who drank one scored 57, who drank two scored 58, who drank three scored 59 and who drank at least four scored 62. Janet Fischel, director of developmental and behavioral pediatrics in the department of pediatrics at Stony Brook University School of Medicine in New York, who was not involved in the study, believes it represents a strong first step. "I think it's really important and a giant first step in gathering an evidence base for what's becoming a very widespread dietary habit. I think that's really important.” Read more on pediatrics.

People with Insomnia Need Regular Exercise, Not a Quick Trip to the Gym
It takes time for exercise to help cure insomnia, so people shouldn’t expect one trip to the gym to do the trick, according to a new study in the Journal of Clinical Sleep Medicine. "The message here is that exercise is not a quick fix, which I don't really think is discouraging at all," said study author Kelly Baron, director of the Behavioral Sleep Medicine Program with the Feinberg School of Medicine at Northwestern University in Chicago. "Our previous work found that exercise over a 16-week period is very effective in promoting sleep, on par with any kind of medication. But like with weight loss or any sort of behavioral change, it doesn't happen immediately. You have to measure progress over months, not day-to-day." Baron said it is important for people with insomnia to make exercise a part of their routine, planning ahead and being sure to make it a regular endeavor. She also noted that a poor night of sleep makes it less likely for someone to exercise the next day, further emphasizing the need for routine. Approximately 14 percent of the population experiences chronic insomnia. Read more on physical activity.

New Tools from DOT to Help Keep Pedestrians Safe
The U.S. Department of Transportation has released a new set of tools to help communities reverse a rise in pedestrian deaths in the last two years. As part of the campaign, the National Highway Traffic Safety Administration (NHTSA) is making $2 million in pedestrian safety grants available to cities with the highest rate of pedestrian deaths. States have until August 30 to apply for the grants. In addition, NHTSA and the Federal Highway Administration have launched a new website that includes pedestrian safety tips and resources for community officials, city planners and community residents. According to NHTSA data, 4,432 pedestrians were killed in traffic crashes in 2011. That’s an 8 percent increase since 2009. Three out of four pedestrian deaths occurred in urban areas and 70 percent of those killed were at non-intersections. The data also shows that 70 percent of deaths occurred at night and many involved alcohol. Read more on injury prevention.

National Farmers Market Week
In observance of National Farmers Market Week, the U.S. Department of Agriculture (USDA) has released data showing that that 8,144 farmers market are now listed in USDA's National Farmers Market Directory, up from about 5,000 in 2008. The agency has also announced that the Food and Nutrition Service has increased the number of farmers markets able to accept SNAP (Supplemental Nutrition Assistance Program) payments, which will improve access to fresh produce for SNAP recipients. Currently, more than 3,800 farmers markets are authorized to accept SNAP in FY 2012, and farmers markets generate more than $16 million in SNAP sales. Read more on nutrition.

Researchers Create Home Safety Self-Assessment Tool to Help Prevent Falls
One in three adults ages 65 and older suffer falls every year—many at home, since more seniors are continuing to live in their homes as they grow older. To help prevent falls, researchers and occupational therapists at the University at Buffalo SUNY School of Public Health and Health Professions have created the Home Safety Self-Assessment Tool which details ways to prevent falls. The tool includes safety tips and checklists for each room of a home, including common hazards such as area rugs, which account for many home falls when people catch a shoe heel at the edge. Read more on aging.

Tackling the problem of obesity in the United States cannot be done with a single step solution. There are many factors that need to be addressed at the family, school and community levels in order for obesity rates to continue to decline across the country. Unfortunately, not everyone has equal access to the education and options that allow us to make healthier food choices. Higher prices and lack of accessibility to fresh produce serve as barriers for lower income communities in the battle against obesity and improving public health.

In urban areas across the country, groups focused on healthy living and eating are working to develop programs to create more healthy options for everyone. Programs in cities such as New York, Los Angeles and Philadelphia—to name just a few—have caught on with local food vendors, store owners, public health departments and the general public as we start to see rates of obesity drop in those targeted areas.

>>Read more about the fight against childhood obesity and the signs of progress in different areas across the country.

We have found some great examples of programs across the country that are proving successful in their attempts to increase the number of healthy options available to at-risk children and the greater community.

• In New York City, pediatricians at Lincoln Medical Center in the Bronx and Harlem Hospital have started prescribing fruits and vegetables for children. The prescriptions allow them to use coupons for produce at local farmers markets and city green carts. Medical professionals see this as a longer-term solution to the issues they are seeing children come in with, rather than simply prescribing them medicine.
• With Philadelphia weighing in as the most obese city in the nation, The Food Trust’s Brianna Almaguer Sandoval has enlisted the help of corner store owners to start providing healthier options on their shelves. The Healthy Corner Store Initiative provides store owners with free marketing materials such as labels and recipe cards; trainings on how to select, price and display the healthier offerings; and for some even funding for new shelves and refrigerator cases to help better stock fresh food.
• Groups in Athens, Ohio, are joining together to host an event called “Bounty on the Bricks,” to raise money to create a new grant program to enhance the capacity for local food pantries to provide more healthy options for their visitors in need. Those who bought tickets to the event will enjoy a meal celebrating local farmers and fresh produce along one of the main streets in Athens. The dinner will be held August 10 and organizers have already surpassed expected ticket sales.

Six States to Split $89.2M for Early Learning Programs
Six states will split approximately $89.2 million in federal funding as supplemental awards from the 2013 Race to the Top-Early Learning Challenge (RTT-ELC), which works to expand and improve early learning programs. The six states are California, Colorado, Illinois, New Mexico, Oregon and Wisconsin. Each must now submit detailed budgets, budget narratives, revised performance measures and signed assurances. The funds will go toward developing new programs and strengthening existing programs that help close the “opportunity gap,” according to U.S. Department of Education Secretary Arne Duncan. Added U.S. Department of Health and Human Services Secretary Kathleen Sebelius: “Kids who attend high-quality early learning and pre-school programs are more likely to do well in school. They're more likely to secure a good job down the road; and they're more likely to maintain successful careers long-term.” Read more on education.

A Single Fight-related Injury Can Reduce Adolescent IQ by Equivalent of One Lost School Year
A single fight-related injury can reduce an adolescent or teen girl’s IQ by about 3.02 points, according to a new study in the Journal of Adolescent Health. For a boy it can mean a loss of 1.62 points. Studies have measured the effect of missing a year of school as about a 2-4 point decrease in IQ. IQ loss is generally associated with poorer school and work performance; mental disorders; behavioral problems; and longevity, according to the researchers from the Florida State University researchers noted. About 4 percent of U.S. high school students suffer from fight-related injuries annually. "We tend to focus on factors that may result in increases in intelligence over time, but examining the factors that result in decreases may be just as important," said study co-author Joseph Schwartz, a doctoral student in the College of Criminology and Criminal Justice, in a release. "The first step in correcting a problem is understanding its underlying causes. By knowing that fighting-related injuries result in a significant decrease in intelligence, we can begin to develop programs and protocols aimed at effective intervention.” Read more on violence.

Study Links Sugary Drinks, Obesity in Preschoolers
Even though the percentage as a calorie source is relatively minor, preschoolers who drink sugar-sweetened soda, sports drinks or juices every day are at greater risk for obesity, according to a new study in the journal Pediatrics. The findings parallel studies on teens and adults, which show a link between sugary drinks and extra weight. Kids who consumed at least one of the drinks each day were 43 percent more likely to be obese than their counterparts. They were also more likely to have an overweight mother and to watch at least two hours of television daily from ages four to five; researchers adjusted for these factors, as well as socioeconomic status. Potential reasons include the possibility that the sugary drinks were not filling, so did not replace other calories in the children’s diets. The study did not account for other eating habits or physical activity. Read more on nutrition.

The Supplemental Nutrition Assistance Program (SNAP) is the federal government’s principal program for helping low-income families purchase enough food. More than 47 million Americans currently receive SNAP benefits; approximately half of the beneficiaries are children. As part of the debate over the Farm Bill—legislation that authorizes SNAP and other federal nutrition programs—Congress is considering legislation that would cut SNAP benefits and limit who qualifies for the benefits.

Yesterday, the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts, released a white paper that provides a rigorous, objective and nonpartisan analysis of the potential health impacts of the proposed changes to SNAP.

NewPublicHealth spoke with Aaron Wernham, MD, director of the Health Impact Project, along with lead researcher Marjory Givens, to learn more about the study’s findings.

NewPublicHealth: What is the goal of the health impact assessment on the potential changes to the SNAP program?

Aaron Wernham: Congress is deliberating reauthorizing the U.S. Farm Bill, and one of the parts of that is the Supplemental Nutrition Assistance Program or SNAP, which was formerly known as food stamps. This is one of the federal government’s main programs for ensuring that people who have low incomes are able to get enough to eat. We did this health impact assessment because so far the public health effects of these proposed policy changes have not really been a part of the political debate. We wanted to make sure that the best available public health evidence was brought to bear to help ensure that everyone has complete information—those affected by the change, the general public and decision-makers in Congress.

NPH: What’s the big picture on what SNAP has to do with health in the first place?

Wernham: Not having enough to eat—or being what’s called “food insecure”—is attached to a higher risk of a lot of diseases. So, adults who are food insecure have a higher risk of heart disease, high blood pressure, diabetes and some other problems. Children who are food insecure are more likely to be reported by their parents as being in poor health, are more likely to be hospitalized and also have a higher risk for a number of health related problems from asthma, to depression and anxiety. We actually have a number of studies that have looked at the health benefits of receiving SNAP and found, for example, that adults who had access to SNAP when they were children are less likely to have problems in adulthood, such as obesity, high blood pressure and heart disease.

NPH: What did the health impact assessment find?

Wernham: We looked at ways in which the House and Senate have proposed to change how eligibility for SNAP benefits is determined and how the amount of benefits is determined. Both the House and Senate have proposed changes, and we found that as many as 5.1 million people could actually lose eligibility under changes proposed by the House. Under the changes in the Senate, about 500,000 people might receive lower benefit amounts. With the House changes, as many as 1.4 million children and nearly 900,000 older adults would be among those five million people who could be affected. So, for those people, they would lose upward of an average of 35 percent of their total income and would be at higher risk for the health problems that relate to food insecurity.

Tainted Salad Mix Linked to Parasite Outbreak in Two States; 13 Other States Still Looking for Answers
State and federal health officials have narrowed in on a prepackaged salad mix as the possible source of a cyclospora outbreak that has sickened 370 people in 15 states. Both Nebraska and Iowa officials have identified the salad as the source; a total of 221 people in those states have fallen ill so far from the stomach-sickening parasite. The U.S. Food and Drug Administration (FDA) is still working to identify the cause in the 13 other states. “FDA will continue to work with its federal, state and local partners in the investigation to determine whether this conclusion applies to the increased number of cases of cyclosporiasis in other states,” the FDA said in a statement. ”Should a specific food item be identified, the FDA, the U.S. Centers for Disease Control and Prevention, state and local partners will work to track it to its source, determine why the outbreak occurred, and if contamination is still a risk, implement preventive action, which will help to keep an outbreak like this from happening again.” Read more on food safety.

New Model Shows Kids Consuming Far More Calories than Previously Realized
It takes far more calories for kids to gain weight than was previously realized, according to a new study in The Lancet Diabetes & Endocrinology. And, given the high rate of childhood obesity, this means kids are consuming far more calories than either their parents or health care providers realize. The new caloric model takes into account the energy requirements for boys and girls; the fact that kids generally have higher metabolisms than adults; the average drop in physical activity as kids age; and the energy required to maintain a bigger body size as they age. Whereas the old model said a normal-weight girl at age 5 would need to consume about 40 extra calories a day to be 22 pounds overweight by age 10, the new model shows its actually 400 extra calories. "Importantly, given the rather large calorie excesses fueling childhood obesity, this model is a rebuttal to the food industry arguments that exercise alone can be the answer," said David Katz, MD, director of the Yale Prevention Research Center and editor of the journal Childhood Obesity, who was not involved in the study. "For our kids to achieve healthy weight, control of calories in, not just calories out, will have to be part of the formula." Read more on obesity.

Sequester to Close all HUD Offices on Friday, August 2
Every office of the U.S. Department of Housing and Urban Development (HUD) will be closed on Friday, August 2 as part of the sequester which is being felt across all of government. The automatic spending cuts took effect March 1. HUD’s plan is to pair its seven required furlough days with holidays and weekends. HUD is encouraging people and businesses that work with the agency to plan around the schedule day of shutdown. Read more on budgets.

Study: Pertussis Booster Only ‘Moderately’ Effective
The “booster” vaccine for pertussis—or whooping cough—is only “moderately” effective in preventing the disease in adolescents and adults, according to a new study in the journal BMJ. The Kaiser Permanente-backed study, which is the first to look at the effectiveness of the Tdap booster shot in the new generation that has only received acellular vaccines, found the effectiveness to be between 53 and 64 percent. This indicates that additional vaccinations may be required to adequately prevent outbreaks according to lead author Roger Baxter, MD, co-director of the Kaiser Permanente Vaccine Study Center. The state of California saw its highest number of cases of pertussis in more than 60 years in 2010, when it had more than 9,000 cases that led to 809 hospitalizations and 10 deaths, according to the National Center for Biotechnology Information. Read more on vaccines.

NYC Hospitals Prescribing Fruits, Vegetables to At-risk Youth
An apple a day to keep the doctor away? At two New York City hospitals, you can get a prescription for just that. Under a four-month pilot program, doctors at Lincoln Medical Center in the Bronx and Harlem Hospital are giving prescriptions for fruits and vegetables to at-risk youths. The kids and their families receive coupons which can be redeemed for product at local farmers markets and city green carts. “This is probably going to prevent an awful lot more disease over the long-term than a lot of the medicines we tend to write for,” said New York City Health Commissioner Thomas Farley, MD, said Tuesday in the green market outside Lincoln Medical Center. Read more on nutrition.

Breast Cancer Survival Times Shorter for Black Women
The fact that black women receive less health care overall than their white counterparts, combined with the lack of early screening and detection programs in many black communities, means they live an average of three fewer years with a breast cancer diagnosis, according to a new study in The Journal of the American Medical Association. Researchers at the University of Pennsylvania found that black women were less likely to receive an early diagnosis when the cancer was more treatable; they also found that quality of care was in general lower, though not enough to explain the survival gap. Data showed that 70 percent of white women lived at least five years after a breast cancer diagnosis, compared to 56 percent of black women. “Something is going wrong,” said Jeffrey H. Silber, MD, a professor at the University of Pennsylvania and the director of the Center for Outcomes Research at the Children’s Hospital of Philadelphia, which studies disparities in health care. “These are huge differences. We are getting there too late. That’s why we are seeing these differences in survival.” Read more on cancer.