Mammography Rates Remained Steady After Change in Guidelines
The proportion of women undergoing screening for breast cancer every year did not change after U.S. Preventive Services Task Force released recommendations saying there wasn't enough evidence to support routine mammograms for women in their 40s, according to a new study published in the journal Cancer. In 2009, the Task Force changed their recommendations to state that women aged 50 to 74 should have a mammogram every other year, and screenings for women under age 50 should be evaluated by each woman with her doctor, according to individual risk factors. "When there are conflicting versions of guidelines, providers may err on the side of screening," said David Howard, a health policy researcher from Emory University in Atlanta, in an interview with Reuters. Read more on cancer.

Latest HIV Vaccine Study Halted
The National Institutes of Health halted a study testing an experimental HIV vaccine after an independent review board found the vaccine did not prevent HIV infection and did not reduce the amount of HIV in the blood. The trial, started in 2009, is the latest in a series of failed HIV vaccine trials, according to Reuters. The halted study included more than 2,500 volunteers in 19 U.S. cities. Study populations included men who have sex with men and transgender people who have sex with men. Read more on HIV.

CDC's Food Safety Report Card: Some Foodborne Illnesses Spiked in 2012
The Centers for Disease Control and Prevention (CDC) recently released the "nation’s annual food safety report card," and it shows that 2012 rates of infections from two types of foodborne bacteria—campylobacter and Vibrio—have increased significantly when compared to a baseline period of 2006-2008, while rates of most others have not changed during the same period. The data are part of the Foodborne Diseases Active Surveillance Network report. Campylobacter infections have been linked to tranmission in many foods, including poultry, raw milk and produce. These infections were at their highest level since 2000, up 14 percent since 2006-2008. Vibrio infections, often associated with raw shellfish, were up 43 percent.

“The U.S. food supply remains one of the safest in the world,” said CDC Director Tom Frieden, MD, MPH. “However, some foodborne diseases continue to pose a challenge. We have the ability, through investments in emerging technologies, to identify outbreaks even more quickly and implement interventions even faster to protect people from the dangers posed by contaminated food.” Read more on food safety.

Study: Single Can of Sugary Soda Can Increase Diabetes Risk 22 Percent
Drinking even a single 12-ounce can of sugary soda once a day can up the risk of diabetes by 22 percent, according to a new study out of Imperial College London. Researchers looked at the data of approximately 350,000 European residents. "Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population," said study leader Dora Romaguera, according to Reuters. Previous studies have also shown a link between sugary drinks and increased risk of obesity and type 2 diabetes, which affects approximately 310 million people, according to the World Health Organization. Read more on diabetes.

Teen Years in the ‘Stroke Belt’ Ups Risk of Stroke Later in Life
Growing up as a teenager in the U.S. “stroke belt”—an area in the country’s southeast—can increase the risk of stroke later in life by as much as 17 percent, according to a new study in the journal Neurology. Risk factors including high blood pressure and diabetes are only partially responsible for the increase risk. "Many social and behavioral risk factors, such as smoking, are set in place during the teenage years, and teens are more exposed to external influences and gain the knowledge to challenge or reaffirm their childhood habits and lifestyle," said study author Virginia Howard, with the School of Public Health at the University of Alabama at Birmingham, in a release. Across all age groups the risk was double for black Americans when compared to white Americans. Researchers were careful to note that the findings do not demonstration causation. Read more on strokes.

Poultry Probably Source of China’s New Bird Flu Strain
Researchers believe that poultry-to-human transmission from “wet” markets is likely responsible for the new H7N9 bird flu strain that has killed 22 people in China and infected more than 100. Wet markets sell and immediately slaughter poultry. So far the strain does not seem to pass easily between people, so the researchers feel relatively confident that closing the markets and slaughtering the birds will control the outbreak. “Overall, the evidence, in terms of epidemiology and virology, suggests that it is a pure poultry to human transmission, and that controlling [the epidemic in humans] will therefore depend on controlling the epidemic in poultry,” said Kwok-Yung Yuen of the University of Hong Kong, according to MSNBC. The findings were published in the journal Lancet. Read more on infectious disease.

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.

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.

A Buzzfeed article posted in the days after the explosions at the Boston Marathon last week reported on hashtags and Google docs that emerged in the hours after the explosions, and pointed out the need for expanded “disaster and crisis coordination online, beyond hashtags.” The article notes a new San Francisco initiative in collaboration with the design firm IDEO—a social networking website and app to connect people who want to help with those who need it, which will let individuals preregister homes where people in need can find emergency shelter, supplies and useful skills such as First Aid certification. According to the post, “instead of scanning hashtags [in order to offer assistance], people will be able to simply log in to a preexisting community.”

There was a soft launch of the system in January and the organizations are now collecting user feedback.  

Jenine Harris, PhD, an assistant professor at the Brown School of Social Work at Washington University in St. Louis, reported on expanded use of social media by local health departments during the recent Keeneland Conference on public health services and systems research held in Lexington, Ky. Dr. Harris says of the San Francisco project that “the more active a social media channel, the more people follow it, so if these channels could be tweeting or retweeting regularly they would probably draw larger audiences.” Harris suggests that health departments could retweet information from their channels and increase visibility.

>>Read the Buzzfeed article.

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.

NewPublicHealth is speaking with directors of several health departments who recently were accredited by the Public Health Accreditation Board. Eleven health departments received the credential so far. We recently spoke with Mary Selecky, director of the Washington State health department, one of the first two state health agencies receive national accreditation status. Ms. Selecky recently announced her plans to retire from the health department.

>>Also read our interview with Terry Cline, health commissioner of Oklahoma, which also was recently accredited by PHAB.

NPH: How do you think accreditation will improve delivery of public health services and care in Washington State? Now that the health department is accredited, do you feel as though you are leaving the department in even better shape than it was?

Mary Selecky: Accreditation is really a quality improvement tool, and the standards that have been set by the Public Health Accreditation Board force you to examine whether you have the right processes in place for continuous, sustained quality improvement. And if you have found that you are not quite up to par in an area, then the processes help you ask what you will do to improve your performance in that area? The process helps you increase your performance, your effectiveness, and your accountability.

Public health touches people every single day—everybody in the state, from the moment they get up until they go to bed at night and even while they’re sleeping. This credential shows us that we have effective programs and measures in place to meet the needs of our communities. Drinking water systems are a good example. We regulate 16,000 drinking water systems, and I have a lot of drinking water engineers who are out in communities checking on water systems. I have to know that they’ve got a common set of operating procedures to assure the public that we’re looking out for their interests and when they turn on their tap from a municipal water system, that the water’s safe to drink. You can only do that when you have some procedures in place and that goes for the engineers, for laboratories or programs to make sure they are operating well in the community. Accreditation touches every part of the department.

NPH: How will you be promoting and explaining accreditation to policymakers?  

‘Clean Your Plate’ Order Can Lead to Negative Results
The seemingly reasonable parental edict of “clean your plate” may in fact be counterproductive toward maintaining a healthy weight, according to a new study in the journal Pediatrics. The same can be true with instruction to eat less. Researchers found that restrictive instructions were more common with kids who were overweight and obese, while kids who weren’t overweight were more often linked to encouragement to finish meals. "In the 1950s, cleaning your plate meant something different,” said author Katie Loth, a registered dietician, doctoral candidate and research assistant at the University of Minnesota in Minneapolis. “Portion sizes have gotten bigger over time, and if you encourage kids to rely on environmental indicators, like how much food is on their plates or the time of day, they'll lose the ability to rely on internal cues to know whether they're hungry or full." About 17 percent of U.S. youth and adolescents are obese, according to the U.S. Centers for Disease Control and Prevention. Read more on obesity.

Study: Lack of Insurance Leading Cause of Difficulty for Young Adults with Asthma
Leaving high school and a lack of adult supervision are both factors that may explain the general decline in asthma control for young adults once they’re over the age of 18. However, the main cause is a loss of health insurance, according to a new study in the journal Pediatrics. Researchers found that those under 18 were more likely to utilize primate care and medications. On the other hand, those over age 18 were more likely to turn to emergency care and have difficulty getting costly treatments. While young adults are generally healthier than older adults, people with chronic conditions such as asthma still need to be sure to seek out proper treatment. "Young people with asthma need to work with their care providers to create transition plans from pediatric to adult care that take into account their medical and social history," said study leader Kao-Ping Chua, a staff physician in the division of emergency medicine at Boston Children's Hospital. Read more on access to health care.

China’s Bird Flu Outbreak Keeps Growing; 20 Dead, 105 Infected
China’s outbreak of H7N9 virus—a new strain of bird flu—continues to spread, with 20 people dead and 105 overall infected, according to Reuters. The World Health Organization is conducting field investigations into the infections and the public health response to the outbreak. Ho Pak-leung, an associate professor in the Department of Microbiology at the University of Hong Kong, recently British Medical Journal that this outbreak has already caused twice as many Chinese infections as the H5N1 strain did in about a decade. "H7N9 is much more transmissible to humans, and it's much more difficult to track down," he said. "We don't understand why it's so difficult to find." Read more on infectious disease. Also, read more on what you need to know about H7N9 on APHA's Get Ready blog.

While laws to help make it easier for everyone to get their veggies are cropping up all over, some would-be planters get stopped in their carrot tracks by regulations that prohibit use of public spaces for planting, or even limit what can be grown on private property, according to a recent article in the Wall Street Journal [note: subscription required]. In some jurisdictions, according to the article, sidewalk gardeners have been fined and may lack the clout to advocate for changing the laws.

>>Bonus Link: Read about Urban Farming, a nonprofit group with high-profile corporate sponsors that supports gardens on unused land.