Several leading cancer organizations recently formed a think tank to address health disparities in cancer research with the goal of improving treatment access and outcomes for underserved populations. “Closing the inequality gap will not happen easily, and won’t get done if any of us goes it alone," said Otis W. Brawley, MD, chief medical officer of the American Cancer Society (ACS), one of four groups involved, in addition to the American Association for Cancer Research (AACR); the American Society of Clinical Oncology (ASCO); and the National Cancer Institute (NCI), a branch of the National Institutes of Health (NIH).
“Cancer mortality rates are decreasing for most minorities, but absolute death rates continue to be higher," said NCI Deputy Director Doug Lowy, MD. Lowy adds that it’s important to understand the sources of the disparities in order to reduce them.
The goal of the collaboration is to address the fact that that some racial and ethnic minorities in the United States are more likely to develop cancer, less likely to access high-quality cancer care and more likely to die from cancer when compared to others and to whites. For example, the death rate for cancer among African-American males is 33 percent higher than among white males, and the rate for African-American females is 16 percent higher than it is for white females.
“We must move from describing the problems to more quickly identifying and implementing solutions to address the racial and economic-based disparities that continue to affect many cancer patients and families in the United States,” said ASCO president Clifford A. Hudis, MD.
NewPublicHealth recently spoke with Hudis about the new collaboration.
NewPublicHealth: What key issues help explain—and then overcome—differences in cancer incidence and severity among different populations?
Clifford A. Hudis: We can’t completely disentangle environmental factors, which include nutrition, access to care, general health behaviors, exercise and education, which relates to behaviors such as tobacco use. And of course underlying that is the socioeconomic status. But there also is a burgeoning understanding of the role of genetic variations that may be clustered in various populations and may influence things such as drug metabolism and diseases.
Army, NIH Studies Look at Mental Health Risks, Resilience in U.S. Soldiers
JAMA Psychiatry has released a collection of three articles detailing the findings of a large-scale study of mental health risk and resilience in members of the U.S. Military. Among the findings of The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS):
- The rise in suicide deaths from 2004 to 2009 occurred not only in currently and previously deployed soldiers, but also among soldiers never deployed.
- Nearly half of soldiers who reported suicide attempts indicated their first attempt was prior to enlistment.
- Soldiers reported higher rates of certain mental disorders than civilians, including attention deficit hyperactivity disorder (ADHD), intermittent explosive disorder (recurrent episodes of extreme anger or violence), and substance use disorder.
“These studies provide knowledge on suicide risk and potentially protective factors in a military population that can also help us better understand how to prevent suicide in the public at large,” said National Institute of Mental Health (NIMH) Director Thomas R. Insel, M.D.
The emphasis on mental health in the military comes at the same time as a small group of Vietnam veterans has filed suit against the U.S. government, alleging they received other-than-honorable discharges for violations that the psychiatric community and Army now understand were attributable to post-traumatic stress. The veterans say the government has resisted their attempts to upgrade the discharges. Read more on mental health.
NIH: Allergy Prevalence Consistent Across U.S. Regions, Although Type Varies
Allergy prevalence of allergies is consistent across all regions of the United States in every demographic except for children age 5 years and younger, according to a new study from the U.S. National Institutes of Health (NIH). Researchers analyzed blood serum data from approximately 10,000 Americans between 2005 and 2006. “Before this study, if you would have asked 10 allergy specialists if allergy prevalence varied depending on where people live, all 10 of them would have said yes, because allergen exposures tend to be more common in certain regions of the U.S.,” said Darryl Zeldin, MD, scientific director of the National Institute of Environmental Health Sciences (NIEHS), part of NIH, in a release. “This study suggests that people prone to developing allergies are going to develop an allergy to whatever is in their environment. It’s what people become allergic to that differs.” The comprehensive study also examined and outlined risk factors that would make a person more likely to develop an allergy. Read more on the environment.
Study: SNAP for Just 6 Months Increases Kids’ Food Security Significantly
Children in households that participate in the Supplemental Nutrition Assistance Program (SNAP)—previously known as the Food Stamp Program—for just six months experience significant increases in their “food security,” according to a new study in the journal Pediatrics. Food insecurity—or lack of easy access—is tied to a range of health and developmental problems. The study concluded that “SNAP serves a vital role in improving the health and well-being of low-income children by increasing food security” and that “Future research is needed to determine whether specific groups of children experience differential improvements in food security.” SNAP provided assistance to approximately 47 million people in 2013, with about half of those children. Read more on nutrition.
This month the Johns Hopkins Bloomberg School of Public Health published a special issue of its magazine devoted to food. There weren’t any recipes, unless you count “recipes” for a healthier planet, which can be reached by following some of the recommendations in the supplement.
“Changing what we eat is more complex than it sounds,” writes the school’s dean, Michael Klag, MD, MPH. “It involves not just personal choice but also changing methods of food production and delivery systems so that the right choice becomes the default choice. A new ‘Green Revolution’ that relies on sustainable methods of food production will require partnerships of farmers, agronomists, development agencies and policymakers. Interventions to change the norms of what we eat must be culturally appropriate, and take into account the context of nutritional needs within the population. Such interventions will require partners who understand human and plant biology, behavior, economics and policy. This type of multidisciplinary, population-based effort is a centerpiece of public health...”
Key features of the issue include:
- RX for the Future: How the WIC program got its start
- Planting Health: The seeding of public health
- Photo Gallery: Capturing our relationship with food across the globe
EPA Sets Cleaner Fuel and Car Standards to Cut Air Pollution and Improve Health
The U.S. Environmental Protection Agency (EPA) today finalized emission standards for cars and gasoline to significantly reduce harmful pollution and prevent thousands of premature deaths and illnesses. According to the EPA, the new standards will also create efficiency improvements for cars and trucks. The standards go into effect by 2017.
The new standards cut emissions of a range of harmful pollutants that can cause premature death and respiratory illnesses. By 2030, EPA estimates that up to 2,000 premature deaths; 50,000 cases of respiratory ailments in children; 2,200 hospital admissions and asthma-related emergency room visits; and 1.4 million lost school days, work days and days when activities would be restricted due to air pollution will be prevented. Total health-related benefits in 2030 will be between $6.7 and $19 billion annually.
The program will also reduce exposure to pollution near roads. More than 50 million people live, work, or go to school in close proximity to high-traffic roadways, and the average American spends more than one hour traveling along roads each day. Read more on environment.
Study Finds Many Parents Support Flu Shots at School
Half of parents in the United States would agree to have their children get their flu shots at school, according to a survey from the Brown School of Public Policy at Washington University in St. Louis. Researchers at the school conducted a nationally representative online survey of more than 1,000 parents of school-aged children. Convenience was the chief reason for parents supporting flu shots at school. Thirty two percent of parents surveyed were not sure if they would consent to giving the shots at school and 17 percent said they would not consent. Most likely to support flu shots at school were college-educated parents and parents of uninsured children. The study was published in the journal Vaccine.
Flu season can last in the United States through April, according to the U.S. Centers for Disease Control and Prevention (CDC). This is especially the case in communities where the season started later in the fall or early winter. In a recent report, CDC researchers found that the flu vaccine “offered substantial protection against the flu this [2013-2014] season,” reducing a vaccinated person’s risk of having to go to the doctor for flu illness by about 60 percent across all ages
“We are committed to the development of better flu vaccines, but existing flu vaccines are the best preventive tool available now. This season vaccinated people were substantially better off than people who did not get vaccinated. The season is still ongoing. If you haven’t yet, you should still get vaccinated," said CDC director Tom Frieden, MD, MPH, in a recent release. Read more on flu.
Online Ratings Currently Not Used Much to Choose Physicians
Online ratings that review physicians can influence which doctor a patient chooses, but most patients rank insurance acceptance and distance from home or office as more important, according to a new study in JAMA.
- 9 percent of responders said they consider doctor rating websites “very important” in their search for a physician
- 89 percent of responders ranked “accepts my health insurance” as “very important.”
- 59 percent said a convenient office location very important
The study also found that only five percent of those surveyed have ever posted ratings online, although two-thirds of responders were aware of ranking sites, a higher percentage than found in previous studies.
“These may seem useful, but no one is regulating this ‘crowdsourced’ information about doctors. There’s no way to verify its reliability, so online ratings may not currently be the best resource for patients,” David Hanauer, a primary care pediatrician and clinical associate professor of pediatrics at C.S. Mott Children’s Hospital in Detroit. Read more on community health.
As the demand for walkable communities keeps growing, experts are moving from asking “If they build it, will they come?” to questioning how to fund the new developments, as well as keeping our eyes on issues such as transit, affordability and improving population health. As of January sharing best practices for those and many other issues is the job of Chris Zimmerman, who recently joined the staff of Smart Growth America as Vice President for Economic Development, following a very long stint as a member of the Arlington County Board in Virginia. Before his post in Arlington, Zimmerman was Chief Economist and Committee Director for Federal Budget and Taxation at the National Conference of State Legislatures. In his new role, Zimmerman will focus on the relationships between smart growth strategies and the economic and fiscal health of communities.
NewPublicHealth spoke with Zimmerman soon after he landed in his new office.
NewPublicHealth: What did you do before joining Smart Growth America?
Chris Zimmerman: For the last 18 years I’ve been a member of the Arlington County Board, the governing body of Arlington County, Virginia, an urban county of about 220,000 people right next to Washington D.C. The county functions as a comprehensive local government, with functions from school funding to land use and development to standard municipal functions such as parks and recreation, public safety, waste removal and managing public infrastructure. We don’t run the schools, but the funds for the schools are part of the county budget, at a cost of a little more than $1 billion annually.
Arlington County has become a model for transit-oriented development that is studied by folks around the country and even around the world, particularly because of the way the county has chosen to develop around the Metro system. That includes the initial commitment to be involved in Metro Rail, to fund underground Metro stations and then to focus development around them, beginning even before the ideas of the vocabulary of Smart Growth and urbanism had really gotten started, decades ago.
Prior to serving on the county board, I served on the county’s planning commission and a number of other commissions. So I’ve had about 20 to 25 years of involvement in the development of every aspect of the community, including housing, planning development and economic development, and even agencies such as the Washington Metropolitan Area Transit Authority, which runs Metro Rail and Metro Bus and every other regional transportation planning body there is here in Washington. I was involved in a lot of regional transportation issues that obviously were fundamental to our county because of the way we chose to develop and because of where we’re located. There are seven crossings of the Potomac River and five of them go through Arlington, so although there are a couple hundred thousand people in Arlington, there’s a million and a half or so in northern Virginia and large numbers of them go through Arlington every day.
WIC Expands to Offer More Options to 9 Million Poor Women and Children
Newly announced changes to the U.S. Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants and Children—also known as WIC—will expand access to fruits, vegetables and whole grains for approximately 9 million poor women and young children. The changes include an increase over 30 percent, or $2 per month, in the allowance for each child's fruit and vegetable purchases. They also allow fresh produce instead of jarred infant food for babies. The changes, which were recommended by the Institute of Medicine, mark the first comprehensive revisions to the voucher program allowances since 1980. Read more on nutrition.
Survey Finds Majority of Hispanic Adults Are Not Confident in Their Understanding of Key Insurance Terms
While the majority of white, non-Hispanic adults feel confident in their understanding of key insurance terms, the same cannot be said for Hispanics. According to the Urban Institute’s Health Reform Monitoring Survey (HRMS), only one in four Hispanic adults express confidence in their understanding of terms such as “premium,” “copayment” and “deductible.” This disparity is an impediment to Affordable Care Act marketplace and Medicaid enrollment. The findings demonstrate the need for culturally appropriate education campaigns and bilingual navigators to provide assistance in target communities. The quarterly HRMS is funded by the Robert Wood Johnson Foundation and the Ford Foundation. Read more on health disparities.
New Program to Train Police Officers in Bleeding Control for Mass Casualty Victims
As part of ongoing efforts to increase the number of survivors of active shooter or mass casualty incidents, more than 36,000 police officers across the country will receive bleeding control kits and training this year. The goal is to train officers to slow or stop bleeding at the scene before other first responders arrive. The five-step “THREAT” approach:
- T - Threat suppression
- H – Hemorrhage control
- RE – Rapid Extrication to safety
- A – Assessment by medical providers
- T – Transport to definitive care.
The initiative is led by the Hartford Consensus, a collaborative group of trauma surgeons, federal law enforcement and emergency responders, and driven by the American College of Surgeons, the Federal Bureau of Investigation, the Major Cities Chiefs Association and the Prehospital Trauma Life Support program. “Controlling hemorrhage has to be a core law enforcement tactic,” said Alexander Eastman, MD, MPH, FACS, chief of trauma at UT Southwestern/Parkland Memorial Hospital and Dallas Police Department lieutenant, in a release. “We saw the dramatic impact of this tactic in the Tucson, Ariz. shooting in 2011. With training and tourniquets, law enforcement officers will save lives – many lives.” Read more on violence.
Future of Public Health is an ongoing series focused on the emerging faces in the world of public health. We spoke with Azmina Lakhani, MD, MPH, about what helped lead her to the field and where she hopes to go from here.
NPH: What’s your educational background in public health?
Azmina Lakhani: I went to the Illinois Mathematics and Science Academy for high school, and then I did medical school, undergraduate and public health all at Northwestern University in Chicago. I received a BA in psychology and global health as an undergrad and then for the next five years I attended medical school and earned a Master’s in Public Health, as well.
NPH: This seems like something that you went into knowing full well that this is what you’re interested in. What was it that encouraged you to pursue a degree and a career in public health?
Lakhani: I had sort of been interested in health care in general in high school, and I wasn’t really sure whether I was going to do research or clinical work or public health work, but in college I really started becoming interested in public health. First through global health, I started learning about different health care systems abroad and doing some volunteer work in Ecuador and Mexico City. That’s really when I got interested in health care delivery systems and also how one can have a greater influence on health.
I appreciate the clinical side. I’m a family medicine resident in training currently, so I love working one-on-one with patients. I also see a lot of value in making an impact on a larger scale—whether that’s how someone gets their health care, what insurance systems we have in place, or the traditional public health things that you think of such as vaccines—that have a really large impact on people. But I think for a shorter answer to your question, I really got interested in college and then built on that in medical school while I was getting my MPH.
NPH: Within the field of public health, what’s your primary interest? What really speaks to you? The global approach?
Lakhani: I think public health is just so awesome because it has so many different facets, and to be honest, I don’t have one particular interest in terms of public health. During my year at the Chicago Department of Public Health (CDPH) I worked on a project called PlayStreets. It’s a very simple idea where we close down streets in the city—neighborhood streets—to allow children with little access to public spaces to have a place to play. The whole intent is to get people out there, meeting their community members, and, in the long term, trying to reduce childhood obesity. It’s kind of a lofty goal, but I am interested in making resources available to people so they can take control of their own health on a broader scale and PlayStreets was one example of that.
Much of the country is still facing at least a few more weeks of winter weather, so harbingers of spring are especially welcome. In Washington, D.C., one of those signs is an increase in the number of “TapIt” posters on the city’s metro system letting city dwellers and visitors know where they can get clean drinking water throughout the area for their reusable water bottles. TapIt is a six-year-old national network of cafes, coffee shops and some retail stores that offer free drinking water to anyone who asks and brings their own vessel to fill and drink from. Partners that have helped with costs often include local water utility companies.
"This network protects the environment, as well as people’s wallets," said TapIt Campaign Director Will Schwartz in a recent release. "In fact, users could save up to $700 per year if they were to use TapIt instead of buying a bottle of water each day."
Other reasons to actively look for easy access to water in the community include:
- A 2012 study in the American Journal of Clinical Nutrition found that replacing sugary drinks with water resulted in a 2 to 2.5 percent weight loss for study participants during a six month clinical trial.
- In 2011, the American Academy of Pediatrics issued a parents advisory urging them to make water the primary form of hydration for kids.
- A 2013 survey published in the U.S. Centers for Disease and Control and Prevention’s journal Preventing Chronic Disease found that low drinking water intake is common and associated with known unhealthful behaviors such as insufficient physical activity and unhealthy eating.
Local TapIt apps, available via the internet or on Android and iPhone smartphone platforms, fix on a user’s location and display a map of nearby outlets that offer water. Users click on map markers for names of locations, addresses and distances. Information includes beverage specifics such as whether the offered water is filtered, chilled, self-serve, or needs to be requested. For example, at the Birchwood Café in Minneapolis, Minn. consumers help themselves to chilled, filtered tap water from the soda dispenser, while at the Village Bean Co. in Des Moines, Iowa, water drinkers must ask wait staff for water and will be offered room-temperature, non-filtered tap water.
National outlets welcoming TapIt users include REI outdoor clothing retail stores and Whole Food supermarkets.
Also, if you don’t have a computer or smartphone at the ready, many of the water partners post TapIt stickers on storefront windows or doors to let people know they’re invited in for a drink.
>>Bonus Link: Read an FAQ on the TapIt program.
FDA Proposes New ‘Nutrition Facts’ Food Labels
The U.S. Food and Drug Administration (FDA) has put forth a new proposed Nutrition Facts label for packaged foods. The updated design would reflect scientific information not available when the current label was designed two decades ago. For example, it would replace out-of-date serving sizes and feature a design that highlights key parts of the label, such as calories and serving sizes. “For 20 years consumers have come to rely on the iconic nutrition label to help them make healthier food choices,” said FDA Commissioner Margaret A. Hamburg, MD. “To remain relevant, the FDA’s newly proposed Nutrition Facts label incorporates the latest in nutrition science as more has been learned about the connection between what we eat and the development of serious chronic diseases impacting millions of Americans.” Read more on nutrition.
Study: One in Five U.S. Health Facilities Don’t Provide Hand Sanitizer Everywhere Needed
One in five U.S. health facilities don’t make hand sanitizer available everywhere necessary, needlessly increasing the risk for health-care associated infections, according to a new study in the American Journal of Infection Control. In addition, approximately half of the hospitals, ambulatory care facilities and long-term care facilities included in their budgets funds for proper hand hygiene training. The study examine compliance with the World Health Organization’s hand hygiene guidelines at 168 facilities in 42 states and Puerto Rico. "When hospitals don't focus heavily on hand hygiene, that puts patients at unnecessary risk for preventable health care-associated infections," said by Laurie Conway, RN, MS, CIC, PhD student at Columbia Nursing, in a release. "The tone for compliance with infection control guidelines is set at the highest levels of management, and our study also found that executives aren't always doing all that they can to send a clear message that preventing infections is a priority." Read more on infectious disease.
CDC Foundation Expands Safe Injection Campaign
The CDC Foundation and Eli Lilly are partnering to expand the U.S. Centers for Disease Control and Prevention’s (CDC) Safe Injection Practices Coalition—a safety awareness campaign that provides information for health providers and patients. According to CDC data, more than 150,000 patients have been notified of potential exposure to hepatitis and HIV because of unsafe injection practices in U.S. health care settings since 2001, and CDC researchers have found that medical injections are an overlooked source of infections and outbreaks. Planned actives of the partnership include:
- Expand the One & Only Campaign to new audiences such as individual and group-owned physician practices
- Educate health care providers through new and enhanced training and communication materials to address emerging issues
- Improve the Safe Injection Practices Coalition website and social media platforms to share resources and toolkits with new audiences
- Engage new and existing Safe Injection Practices Coalition partners
Read more on prevention.
With the passage of the Mental Health Parity Act and the implementation of the Affordable Care Act (ACA), behavioral health experts are pushing to improve the quality of that care so that people seeking help—some for the first time—receive evidence-based care that best suits their individual needs. As part of that conversation, the U.S. Senate Health, Education, Labor and Pension committee held a hearing this week on mental health treatment trends in the United States.
Sen. Tom Harkin (D-Iowa) the committee chair opened the hearing by “pointing to disturbing new trends [including]...significant increases in the prescribing of psychotropic medications, while the use of behavioral and psychological treatments among children and youth has increased only slightly, and has actually decreased among adults.”
According to committee research on recent use of psychotropic drugs, use of antipsychotic medications has increased eight-fold among children and five-fold among adolescents, and has doubled among adults between 1993 and 2009.
The key witness at the hearing was William Cooper, MD, MPH, a professor of pediatrics and health policy at the Vanderbilt University School of Medicine who conducts population-based studies of medication use in children. Cooper told the committee about a nine-year-old boy he treated for weight gain—which turned out to be a side effect of a psychotropic drug the child had been prescribed by a primary care provider given for disturbing the classroom. No mental illness diagnosis had been made for the child, and no mental illness was detected after evaluation at Vanderbilt.
Cooper said that in recent years the United States has seen a tremendous increase in the numbers of children diagnosed with mental health disorders.
“Whether this is a result of increased awareness, improved diagnosis, or other factors is not clearly understood,” said Cooper, who added that “while we must acknowledge that a part of the increase could be due to over-diagnosis, there is no disputing the fact that a large number of children and their families suffer significantly because of mental illness.”
Furthermore, added Cooper, given the fact that suicide is the second leading cause of death for children ages 12-17, “tragic consequences of childhood mental health disorders highlight our sense of urgency in addressing this important problem.”
Cooper added that treating mental health disorders can be challenging and that 50-75 percent of the care for children with mental health disorders occurs in primary care settings “making it critical that consultation and communication between primary care professionals and experts in mental health be enhanced.”
Significantly, Cooper told the panel that despite guidelines, much of the mental health care for children occurs in a manner “inconsistent with optimal practice,” including:
- Use of medications for diagnoses for which there is little evidence of benefit.
- Use of multiple medications at the same time, especially among particularly vulnerable children such as children in foster care, where a recent study found multiple psychiatric medications in up to 75 percent of children being treated.
- Use of medications alone without proven psychotherapies.
Cooper attributed the problems to several factors, among them:
- Many general practice doctors are unaware of current mental health treatment guidelines.
- Inadequate mental health resources to provide best treatments.
- Too few professionals with training in providing mental health care to children.
- Barriers to treatment, including cost or the need to travel long distances.
- Stigma associated with mental illness, which may reduce families’ willingness to acknowledge a mental health disorder and seek treatment.
The HELP committee plans to hold additional hearings to address mental health issues. Other attention to the issues addressed at the hearing include a recent meeting in Washington, D.C. among professionals who conduct psychiatric clinical trials. They stressed the need to involve patients and families more in trial design and access, as well as to work with trial designers on mental health needs not currently being met.
The Substance Abuse and Mental Health Services Administration, a federal agency, recently announced several new funding grants to help individual groups facing mental health concerns including:
- A grant program for residential treatment of pregnant and postpartum women.
- A grant program to expand and sustain comprehensive community mental health services for children and their families, in order to improve behavioral health outcomes for children and youth with serious emotional disturbances, as well as improve the health and well-being of their families.
- A grant program to provide tribal and urban American Indian and Alaskan Native communities with tools and resources to plan and design a holistic, community-based coordinated system of care approach to support mental health and wellness for children, youth and families.
Read more about mental health on NewPublicHealth.