Past Decade's Poor Economy Drove Health Declines
More than a decade of research points to the negative impact of the austerity that accompanies a flagging economy on the population's health, according to Reuters. The studies will be detailed in a new book to be released by an interesting research pairing including a political economist from Oxford University and a professor of medicine and epidemiology at Standford University. the researchers say more than 10,000 suicides and up to a million cases of depression have been diagnosed during what they call the "Great Recession" and its accompanying austerity across Europe and North America. For example, more than five million Americans have lost access to health care during the latest recession. Researchers also tie cuts in governmental public health programs to excess disease rates. "In Greece, moves like cutting HIV prevention budgets have coincided with rates of the AIDS-causing virus rising by more than 200 percent since 2011—driven in part by increasing drug abuse in the context of a 50 percent youth unemployment rate," according to the Reuters article. Read more on poverty and health.

What Influences Kids to Smoke (or Not to) Changes Over Time
Peer pressure may have a bigger influence on middle school-aged kids in starting to smoke, but that influence may wane as they get older. On the other hand, researchers said parents seem to remain influential over their children's smoking behavior throughout high school, as reported by HealthDay. Researchers looked at data from  the Midwestern Prevention Project, the longest-running substance abuse prevention, randomized controlled trial in the United States, which includes 1,000 teens. Read more on tobacco use. 

Facebook Could Help Predict, Track and Map Obesity
The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area's obesity rate, according to a new study. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. The study was conducted by Boston Children's Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys. 

"Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level," said study author John Brownstein, PhD, from the Boston Children's Hospital Informatics Program. "The tight correlation between Facebook users' interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns." The study was published in PLOS ONE. Read more on obesity.

Do we need an endgame strategy to finally end the devastating hold tobacco has on its users? Scholars, scientists and policy experts grapple with endgame proposals in a special supplement to the journal Tobacco Control. Some of the articles are based on a workshop held last year at the University of Michigan, with financial support from the Robert Wood Johnson Foundation and the American Legacy Foundation. The workshop was hosted by Kenneth Warner, PhD, a former dean at the University of Michigan School of Public Health and now a professor at the School.

Although smoking has declined significantly in most developed nations in the last half-century, due to policy changes and increased education about the health hazards, says Warner, too many people continue to die from the most preventable cause of premature death and illness. It's estimated that worldwide six million people a year die from illnesses caused by cigarettes, including more than 400,000 in the U.S. alone."There is a newfound interest in discussing the idea of an endgame strategy. The fact that we can talk about it openly reflects a sea change,” says Warner.

>>Read the articles in the tobacco endgame supplement.

Some of the strategies in the supplement include:

• Requiring manufacturers to reduce nicotine content sufficiently to make cigarettes nonaddictive.
• A "sinking lid" strategy that would call for quotas on sales and imports of tobacco, which would reduce supply and drive up price to deter tobacco purchases.
• A "tobacco-free generation" proposal calling for laws that would prevent the sale of tobacco to those born after a given year, usually cited as 2000, to keep young people from starting to smoke; or ban the sale of cigarettes altogether.

"What we are doing today is not enough," says Warner.  "Even if we do very well with tobacco control, as we have for several decades now, we'll have a huge number of smokers for years to come, and smoking will continue to cause millions of deaths.”

NewPublicHealth recently spoke with Dr. Warner about some of the strategies proposed for ending tobacco use.

NewPublicHealth: Why is there a need for novel, even radical, endgame strategy?

Ken Warner: While a lot of people have quit smoking, if you look at the rate at which people are quitting in the United States, in the last few years it may actually have declined. In Canada, there is some concern that their very low rates of smoking may actually have gone up. In Singapore, which had the lowest smoking prevalence among developed nations, the smoking rate went up from 12.6 percent to 14.3 percent between 2004 and 2010. So what we're observing is that in some of the countries that have had pretty good success with tobacco control, smoking is now being reduced somewhat more slowly, or possibly even increasing. And if we stay at the current rate of smoking, or even if the smoking rate continues to decline slowly, smoking will remain the leading cause of preventable premature death for many years to come.

NPH: What are some of the reasons that we’re seeing a plateau in the reduction of tobacco use?

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.

Hookahs Not a Safe Alternative to Cigarettes
Despite the belief of many, smoking tobacco using a hookah is not a safe alternative to cigarettes, according to a new study in the American Association for Cancer Research’s Cancer Epidemiology, Biomarkers & Prevention. Hookah use produces higher levels of carbon monoxide and benzene, linked with heart or respiratory conditions and increased risk of leukemia, respectively. “People want to know if it is a lesser health risk if they switch from cigarettes to smoking a water pipe on a daily basis,” said UC San Francisco research chemist Peyton Jacob III, PhD. “We found that water-pipe smoking is not a safe alternative to cigarette smoking, nor is it likely to be an effective harm-reduction strategy.” The mix of toxins produced by a hookah is due to the combination of the two difference materials smoked, according to researcher Neal Benowitz, MD, of the San Francisco General Hospital and Trauma Center. “You’re basically burning a charcoal briquette on top of the tobacco,” Benowitz said, “and most of what you’re smoking is a moist fruit preparation, which is mixed with the tobacco. It smells good and it tastes good.” Read more on tobacco.

CDC: Number of U.S. Foodborne Illness Cases at a Standstill
After dropping for many years, the number of foodborne illnesses in the United States has apparently leveled out, according to a new study in the Morbidity and Mortality Weekly Report. About 48 million people—or one in six—suffer from a foodborne illness each year. The most common cause is salmonella. "It is still the case now that numbers were lower than they were back in the 1990s," said Robert Tauxe, MD, deputy director of the division of foodborne, waterborne and environmental diseases at the U.S. Centers for Disease Control and Prevention (CDC). "But right now we're just about where we were in 2006 to 2008, and we may need to identify additional ways to reduce contamination, as well as heightening awareness among consumers about the importance of thoroughly cooking and safely handling ground beef in their own homes." Read more on food safety.

Exercise, Healthy Eating Helps Keep Sleep Apnea in Check
The combination of exercise and healthy eating is a simple way to ease the effects of mild sleep apnea, according to a new study in JAMA Internal Medicine. The key is weight loss. Researchers “found obese study participants who went through a one-year lifestyle intervention were about half as likely to see their sleep apnea progress to more severe disease,” according to Reuters. "It usually takes at least a few years to progress from mild disease to the more severe disease, and mostly it's due to weight gain," said Henri Tuomilehto, MD, who led the new study at the Oivauni Sleep Clinic in Kuopio, Finland. "With these results, we can say that if we change our lifestyle…we really can stop the progression of sleep apnea.” Read more on obesity.

Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government. 

This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.

>>View the original posting of this interview over at GrassrootsChange.net.
>>Read more on preemption and grassroots movement building.

Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?

Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention]. 

Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science. 

Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.

GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies. 

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.

What’s the number one littered item on U.S. roadways? Cigarette butts.

And that’s not much of a surprise given a new survey from Legacy, an advocacy group focused on ending youth smoking, and Leave No Trace Center for Outdoor Ethics, which found that more than 44 percent of those polled who’ve smoked admit to having dropped a cigarette on the ground. And nearly 32 percent of responders who’ve smoked have dropped a cigarette out of a car window.

Cigarette butts do way more harm than simply adding to unsightly litter. The butts include the cigarette’s plastic filter, which pose risks to animals and biodegrade only under extreme conditions. And cigarette butts contain carcinogens that can leach into soil, as well as chemicals that are poisonous to wildlife and can contaminate water sources.

Legacy and Leave No Trace have developed a suite of materials to help push people to action and reduce the butt litter.

• An infographic on the dangerous materials in cigarette butts
• A toolkit to help spread the word about what people can do to rid the earth of cigarette butts
• Television and radio Public Service Announcement

Watch the PSA "Toxic Litter Everywhere" below.

Small Amounts of Daily Exercise Can Help Teens Quit Smoking
As little as 30 minutes of daily exercise can help kids quit smoking, according to a new study in the Journal of Adolescent Health. It can also help to reduce tobacco use. Researchers found that daily smokers were more likely to reduce or quit smoking if they combined a fitness program with a smoking cessation program, rather than just a cessation program alone. Every teen in the study smoked an average of half a pack of cigarettes each weekday and a full pack a day on weekends. And that was just one of the poor health habits of many of the participants. "It is not unusual for teenage smokers to engage in other unhealthy habits,” said author Kimberly Horn, associate dean for research at the George Washington University School of Public Health and Health Services. “Smoking and physical inactivity, for instance, often go hand in hand.” According to the U.S. Centers for Disease Control and Prevention, about 13 percent of Americans age 18 and under smoke tobacco. Read more on tobacco.

Study: Low Food Security, Exposure to Violence Closely Linked
There is a close correlation between low food security and exposure to violence, according to a new study in Public Health Nutrition. Researchers spoke with forty-four mothers of children age 3 and under who participated in public assistance programs, finding increased exposure to violence, which in turn increased the chance of negative mental health, an inability to continue school and an inability to make a living wage.  The violence included child abuse, neglect and rape. The study clearly demonstrates the need to consider and include violence prevention efforts when establishing policies to deal with hunger. Read more on violence.

Size of Parents’ Social Groups Can Affect Whether Kids are Vaccinated
What they hear from friends and the people in their social group may affect whether parents have their children vaccinated, according to a new study in the journal Pediatrics. Parents who were less likely to vaccinate were also more likely to have large social groups and rely on books, pamphlets and the Internet for information on vaccines. "I think that what needs to be done is that everybody needs to understand the importance of vaccines,” said Joseph Anthony Bocchini, Jr., MD, chairman of Pediatrics Medicine at Louisiana State University Health Sciences Center in Shreveport. “And they're not only important for the people who receive them but they're also important for the community." About 95 percent of kindergarten-aged children are appropriately vaccinated, according to the U.S. Centers for Disease Control and Prevention. Read more on vaccines.

Smoking in Youth-rated Movies Up Dramatically
Smoking scenes in youth-rated movies is back up to the same levels as about a decade ago, with approximately half of such movies in 2012 providing 14.8 billion “tobacco impressions,” according to a new study funded by Legacy. Tobacco impressions are calculated by multiplying incidents of tobacco use by the number of film tickets. From 2010 to 2012 alone the rate was up 169 percent; 2010 was an historic low for tobacco impressions. This trend is dangerous because of the way movies can influence youth behavior. "Increases in smoking imagery in the movies are discouraging," said Tom Frieden, MD, director of the U.S. Centers for Disease Control and Prevention. "Every day in the United States approximately 3,800 youth under 18 smoke their first cigarette, and approximately 1,000 become daily cigarette smokers. Reducing smoking and tobacco use in youth-oriented movies will help save lives, money, and years of suffering from completely preventable smoking-related chronic diseases." Read more on tobacco.

Online Tool Helps Family, Friends Determine Whether an Older Driver is Safe
A new free online tool can help family members and caregivers of drivers age 65 and older determine whether they’re safe to continue going out on the roads. The Fitness-to-Drive Screening Measure questionnaire, developed by researchers at the University of Florida (UF), provides a rating profile, recommendations on how to move forward and links to an array of resources. Sherrilene Classen, PhD, MPH, an associate professor of occupational therapy at the UF College of Public Health and Health Professions and the tool’s lead developer, said it’s designed to give a realistic assessment of the driving abilities without requiring an on-the-road evaluation. “We know from our research and others’ that drivers do not give valid self-reports,” said Classen, “Most everybody thinks they are driving better than they actually are. Because we don’t have the evaluators to assess the 36 million older adults who may potentially at some stage require a driving evaluation, we went to the next-best step, which is involving their caregivers or family members.” Read more on aging.

Study Links Breakfast Cereal, Healthier BMIs for Kids
Helping kids maintain a low BMI could be as simple as giving them cereal for breakfast, according to a new study in the Journal of the Academy of Nutrition and Dietetics. The study found that children who had cereal for breakfast four out of nine mornings were in the 95th percentile for BMI; kids who had cereal every day were in the 65th percentile. Researchers say the study shows the ability to combat childhood obesity by making breakfast cereal available to low-income kids; one in four U.S. kids live in a “food insecure household,” according to lead author Lana Frantzen, PhD. "(Cereal) is an excellent breakfast choice, it's simple, and gets those essential nutrients that children need, especially low income minority children," she said. Read more on obesity.