As we end the year and head into 2013, NewPublicHealth spoke with U.S. Centers for Disease Control and Prevention director Thomas Frieden, MD, MPH, about public health in 2012—and what’s ahead for 2013.

NewPublicHealth: What were the high points for public health in 2012?

Dr. Thomas Frieden: Two really stand out. First, public health got even better at finding outbreaks quickly and stopping them. We saw that with Listeria, E. Coli, Salmonella and with the fungal meningitis outbreak. That is important because we are seeing that there are an ever-increasing number of ways that outbreaks can start and spread and we need to be on our guard. The second highlight that comes to mind immediately was the Tips from Former Smokers Campaign. This is the first-ever federally funded national anti-tobacco campaign and it was a stunning success. We had very ambitious goals for it. We hoped that half a million people would try to quit and at least 50,000 people would succeed for good. Based on calls to quitlines—and we will know more in the next few months—it looks like the campaign probably had at least twice that impact. This is a campaign that will have saved tens of thousands of lives and probably paid for itself in pretty short order in terms of reduced medical and societal expenses. It shows that when you invest in tobacco control you can make a big difference and save a lot of lives.

NPH: And your hopes for public health in 2013?

Frieden: There are a lot of things that are important and we can make progress on in the coming year. First is to be safer from threats whether they are from this country or abroad, and public health works 24/7 to keep us safe both at the federal level as well as the state and local level. We do have challenges, though, in terms of the fiscal climate that we are in, and we need to ensure that we have the resources needed to keep Americans safe from threats.

The proportion of flu-related doctor visits has reached a nine-year high for this time of year, according to the Centers for Disease Control and Prevention, as reported by USA TODAY. Correct anyone who tells you it’s too late to get a flu shot, though. The Centers for Disease Control and Prevention intentionally schedules National Influenza Vaccination Week in December as a reminder to get the shot for the many millions of Americans who still haven’t.

 “Flu season typically peaks in February and can last as late as May,” says Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and Director of CDC’s National Center for Immunization and Respiratory Diseases. “We are encouraging people who have not yet been vaccinated to get vaccinated now.”

December holiday gatherings are optimal opportunities to spread the flu, and since it takes up to two weeks for full immunity to take effect, this week is a good time to roll up your sleeve if you’re still shot-less.

Flu shots come in several varieties. Children who never had a flu shot need two doses the first year they get the vaccine. There’s a nasal spray for adults 18-49 and a higher dose version for people 65 and older. Learn more from the CDC about different versions of the flu shot and what might be best for you and your family.  

The Office for State, Tribal, Local and Territorial Support (OSTLTS) at the Centers for Disease Control and Prevention (CDC), was launched in 2009 as a central office dedicated to advancing public health at the state and local levels and identifying both gaps and opportunities for collaboration. Judith Monroe, the office's director, spoke to us last year about challenges facing health departments in a tough time. Recently, at the ASTHO Annual Meeting, we had a chance to catch up with Dr. Monroe to hear what she and her office have been up to since we last spoke in the summer of 2011.

>>Read our earlier Q&A with Dr. Monroe.

NewPublicHealth: The focus of the ASTHO annual meeting this year is on the intersection of health care and public health. What efforts is CDC engaged in right now in that intersection?

Dr. Monroe: We’ve been involved in a number of areas. The IOM report on the integration of primary care and public health, was co-funded by the Health Resources and Services Administration and CDC. And CDC had a seat at the table when ASTHO and the IOM came together to develop the strategic map for the integration. We’re excited about that and we continue to be on those calls.

We have an office here at CDC recently created called the Office of Prevention Through Healthcare that is looking at this intersection and where the gains might be, working with the Centers for Medicare and Medicaid Services very closely. And, in addition, our office—the Office of State, Tribal, Local and Territorial Support—has forged a relationship with all of the primary care residency programs across the nation. That’s dear to my heart because I was a residency program director in family medicine for a number of years. We’ve had a number of educational venues taking the science from CDC and packaging it in a way that the residency programs can use. We’re looking toward some quality improvement projects with the residency programs as well as “playing matchmaker” in many ways, between health departments and residency programs. And, I am the point person here at CDC for our relationships between the American Academy of Family Physicians and the American College of Physicians so we have a lot going on. Those are the biggies, but there are many daily activities taking place as well.

NPH: Thank you for that overview. Since you’ve been at OSTLTS, what are some successes that you’d point to?

Today is World Suicide Prevention Day
Worldwide, suicide is the third leading cause of death among adults ages 18 to 45. In observance of World Suicide Prevention Day, the World Health Organization has released  the Public Health Action Plan for Prevention of Suicide, and later today The National Action Alliance for Suicide Prevention will release the National Strategy for Suicide Prevention, a report from the U.S. Surgeon General and the Alliance. The report will identify community-based approaches to help curb the incidence of suicide, new ways to identify people at risk for suicide, and outline national priorities for suicide prevention. Follow NewPublicHealth for coverage of the release. Read more on mental health.

USDA Diet Tracker Reaches 1 Million Users
The U.S. Department of Agriculture’s (USDA) SuperTracker diet planning and tracking tool has reached one million registered users. According to the USDA, the tool helps people make healthy lifestyle choices to improve their dietary pattern, maintain a healthy weight, track their level of physical activity, and reduce their risk of chronic disease. Read more on obesity.

Multistate Salmonella Outbreak Linked to Turtles
The Centers for Disease Control and Prevention (CDC), the Food and Drug Administration and public health officials in several states are investigating multistate outbreaks of human Salmonella infections linked to exposure to turtles or their environments (such as water from a turtle habitat). More than 160 illnesses have been reported from 30 states; 64 percent of ill persons are children age 10 or younger, and 27 percent of ill persons are children age one year or younger. Fifty-six percent of ill persons are Hispanic.

The CDC reminds households:

• Don’t buy small turtles from street vendors, websites, pet stores or other sources.
• Keep reptiles out of homes with young children or people with weakened immune systems.
• Reptiles should not be kept in child care centers, nursery schools, or other facilities with young children.
• Always wash your hands thoroughly with soap and warm water immediately after touching a reptile or anything in the area where they live and roam. Use hand sanitizer if soap and water are not readily available. Adults should always supervise hand washing for young children.

Read more on infectious disease.

CDC: Millions of Americans with High, Untreated Blood Pressure
High blood pressure affects 67 million of U.S. adults, or almost one-third, according to the Centers for Disease Control and Prevention (CDC). And as many as 36 million of those aren’t treating the condition properly. High blood pressure contributes to about 1,000 deaths each day and about $131 billion each year in health care costs. The CDC says the key to treating high blood pressure in U.S. adults is for everyone—from patients to providers—to act together as a team. “We have to roll up our sleeves and make blood pressure control a priority every day, with every patient, at every doctor’s visit,” said CDC Director Thomas R. Frieden, MD, MPH. “With increased focus and collaboration among patients, health care providers and health care systems, we can help 10 million Americans’ blood pressure come into control in the next five years.” Read more on heart health.

HUD Releases New Lead-Paint Guidelines for Housing Providers
The U.S. Department of Housing and Urban Development (HUD) has released new Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing, updating its guidance from 1995. The guidelines are designed to help property owners, government agencies and private contractors dramatically reduce childhood exposure to lead while still keeping renovation costs as low as possible. “HUD is committed to providing healthier housing for all families,” said Jon L. Gant, Director of HUD’s Office of Healthy Homes and Lead Hazard Control. “These Guidelines will help communities around the nation protect families from lead exposure and other significant health and safety hazards.” Read more on housing.

People More Likely to Guzzle Beer from a Curved Glass than a Straight One
A new study in PLoS ONE shows social drinkers will drink beer almost twice as fast from a curved glass than they will from a straight one—meaning they will become intoxicated far quicker. Researchers at the University of Bristol School of Experimental Psychology said this could be because it is harder to judge the amount consumed when using a curved glass. “Due to the personal and societal harms associated with heavy bouts of drinking, there has been a lot of recent interest in alcohol control strategies,” said Angela Attwood, PhD, adding that “[p]eople often talk of ‘pacing themselves’ when drinking alcohol as a means of controlling levels of drunkenness, and I think the important point to take from our research is that the ability to pace effectively may be compromised when drinking from certain types of glasses.” Read more on alcohol.

Study Details Bullying Involvement for Adolescents with Autism Spectrum Disorder
Approximately 46 percent of adolescents with autism are the victims of bullying, according to a new study in the Archives of Pediatrics & Adolescent Medicine, a JAMA Network publication. Bullying is harmful behavior coming from a position of power, whether physical, social or cognitive. There is still very little research on bullying related to adolescents with an autism spectrum disorder (ASD), according to the study’s researchers. The study’s authors concluded that bullying intervention strategies need to address core ASD deficits, such as conversational ability and social skills, while also increasing social integration, empathy and social skills. Read more on bullying.

Back To School: Many Schools Unprepared for Pandemic Flu, Infectious Diseases
A new study in the American Journal of Infection Control shows that the majority of U.S. schools are not prepared to respond to a pandemic or an outbreak of an emerging infectious disease, as mandated by the U.S. Department of Education. Also, only 40 percent have even updated their pandemic response strategy since H1N1 in 2009. Researchers analyzed surveys from approximately 2,000 school nurses at elementary, middle and high schools across 26 states. “Findings from this study suggest that most schools are even less prepared for an infectious disease disaster, such as a pandemic, compared to a natural disaster or other type of event,” said Terri Rebmann, PhD, RN, CIC, lead study author and associate professor of Environmental and Occupational Health at the Saint Louis University School of Public Health. “Despite the recent H1N1 pandemic that disproportionately affected school-age children, many schools do not have plans to adequately address a future biological event.” Read more on infectious diseases.

Neurologic Disorders Puts Children at Higher Risk of Flu-related Death
Children with neurologic disorder are at higher risk than children without such disorders of dying from influenza-related health complications, according to a study of the H191 2009 pandemic by the Centers for Disease Control in the journal Pediatrics. Of the 336 children with reported underlying medical conditions who died during the pandemic, approximately 64 percent had a neurologic disorder, which can include cerebral palsy, intellectual disability or epilepsy. “Flu is particularly dangerous for people who may have trouble with muscle function, lung function or difficulty coughing, swallowing or clearing fluids from their airways,” said study coauthor and pediatrician Georgina Peacock, MD, of CDC’s National Center on Birth Defects and Developmental Disabilities.  “These problems are sometimes experienced by children with neurologic disorders.” Read more on influenza.

Coin-sized Batteries Present Health Danger for Children
The ingestion of coin-sized button batters—common in many household electronics—can result in serious injury and even death, according to a new report from the Consumer Product Safety Commission. Emergency department treated more than 40,000 children under the age of 13 for ingestion from 1997-2010—72 percent of the cases were for children ages 4 and under. The CPSC warns parents and caregivers to make sure these products are secure and out of the hands of children. Read more on pediatrics.

Post-storm Food Precautions from the USDA
As residents of four states hunker down to face Hurricane Isaac, the U.S. Department of Agriculture (USDA) urges anyone in the storm’s path to take precautions when using and preparing food after a severe storm. According to the USDA, power outages and flooding from weather emergencies compromise the safety of stored food. While people still have power, it is a good idea to access and download A Consumer’s Guide to Food Safety: Severe Storms and Hurricanes. USDA also has dedicated Twitter accounts with updated information on food preparation during and after the current severe weather: @FL_FSISAlert for Florida, @MS_FSISAlert for Mississippi and @LA_FSISAlert for Louisiana. USDA also has a “virtual representative”—Karen—available 24/7 online  and on smartphones. Consumers can also find a live representative at the toll-free USDA Meat and Poultry Hotline by calling 1-888-MPHotline (1-888-674-6854) from 10 a.m. to 4 p.m. ET, Monday through Friday. Operators speak English and Spanish. Read regular updates from the National Hurricane Center.

Marijuana Use by Teens Impacts Intelligence Later On
Regular marijuana use by teens who continue the drug use into their adulthood can lead to an average drop in IQ of eight points, according to a new study from the Proceedings of the National Academy of Sciences. The study looked at more than 1,000 New Zealanders born in 1972 or 1973 who were tested at the ages of 13 and again at 38. The average IQ is 100, or the 50th percentile; an IQ of 92 would drop someone to the 29th percentile. “As an adolescent, your brain hasn’t fully developed. It’s undergoing some critical developmental changes,” said study author Madeline Meier, a postdoctoral research associate in psychology and neurology at Duke University, according to HealthDay. “This research suggests that because of that you are vulnerable to the effects of cannabis on your brain. If you start using as an adolescent and you keep using it, you are going to lose some of your mental abilities.” Read more on substance abuse.

Legionnaires’ Deaths and Illnesses Linked to Chicago Hotel
An outbreak of Legionnaires’ disease in an outbreak linked to a Chicago Marriott hotel has led to two people dying and six others falling ill, according to Reuters. Officials with the national hotel chain have contacted 80 percent of the approximately 8,500 people who stayed at the hotel from July 16 to August 16. Kathleen Ritger, MD, Medical Director over Communicable Disease at the Chicago Department of Public Health, has said there is “no ongoing health threat” at the location. Legionnaires’—a type of pneumonia—starts with high fever, chills and a cough and can lead to death in between 5 percent and 30 percent of cases, according to the Centers for Disease Control and Prevention. Read more on infectious diseases.

Dallas Mayor Declares West Nile Emergency, Calls For Aerial Pesticides
Dallas Mayor Mike Rawlings has declared a state of emergency and requested county and state officials begin aerial pesticide spraying to combat the West Nile Virus, according to The Dallas Morning News. Ten country residents have died of the disease, including five in the city. There have so far been 111 total infections reported in Dallas. West Nile is spread by mosquitoes and cause severe neurological effects, and even death, according to the U.S. Centers for Disease Control and Prevention. Read more on infectious disease.

Army Reports 26 Potential Suicides in July; 116 in 2012
The U.S. Army reported 25 potential suicides and one confirmed in July, up from 12 potential suicides in June. There have been 116 potential active-duty suicides in 2012. In a U.S. Department of Defense news release, Gen. Lloyd J. Austin III, vice chief of staff of the Army, said the military must help soldiers “build resiliency and strengthen their life coping skills.” “As we prepare for Suicide Prevention Month in September we also recognize that we must continue to address the stigma associated with behavioral health,” he said. “Ultimately, we want the mindset across our force and society at large to be that behavioral health is a routine part of what we do and who we are as we strive to maintain our own physical and mental wellness.” Soldiers and their families can call 1-800-273-TALK (8255) or visit the National Suicide Prevention Lifeline website  24 hours a day to speak with trained consultants. Read a Q&A with the head of the National Association of Social Workers on their growing role in suicide prevention among active military and veterans.

U.S. Adults Consume Too Much Sodium, Too Little Potassium
U.S. adults consume far too much sodium and too little potassium, according to a study in the American Journal of Clinical Nutrition. It found that 99.4 percent of adults had a higher daily sodium intake than recommended by the American Heart Association. Fewer than 2 percent of adults met the recommended potassium levels. The nature of most food in the United States makes it hard to avoid high salt levels. “People are trying to follow the guidelines, but it’s difficult because there’s so much sodium in the processed and restaurant food we eat,” said Dr. Mary Cogswell who led the study at the Centers for Disease Control and Prevention in Atlanta, told Reuters. Read more on nutrition.

CDC Says Baby Boomers Should Get Hep C Tests
The U.S. Centers for Disease Control and Prevention is recommending that all U.S. baby boomers be tested for hepatitis C, according to the latest recommendation in the agency’s Morbidity and Mortality Weekly Report. One in 30 boomers have hepatitis C—the majority of them unknowingly—which can lead to serious liver disease and death. “A one-time blood test for hepatitis C should be on every baby boomer’s medical checklist,” said CDC Director Thomas R. Frieden, MD, MPH, in a release. “The new recommendations can protect the health of an entire generation of Americans and save thousands of lives.” Read more on aging.

Joseph Bresee, MD, chief of influenza epidemiology at the Centers for Disease Control and Prevention, issued an update this afternoon on swine flu (H3N2v virus), now circulating in the US. The number of cases has increased from 29 in three states last week to at least 145 cases in four states (Ohio, Illinois, Hawaii and Indiana.) Beginning tomorrow , CDC will issue a report each Friday on the number of cases, but states will be allowed to confirm their own case numbers (though CDC will still confirm the results at its labs) thanks to better testing now available at the state level.

Almost all cases have been reported in children who have had contact with pigs at county fairs, and Bresee says he suspect the increase in cases is because it’s now county fair season around the country. The flu, which has been largely mild, according to Bresee, can be spread when people have direct contact with pigs, when pigs spit or sneeze, or from surfaces touched by humans the pigs had contact with. Kids are less likely to have immunity to the swine flu than adults, which is why few adult cases have been reported, says Bresee. There have been two hospitalizations, and both patients have recovered and been discharged, and no deaths, though the CDC says it expects to see additional hospitalizations and, perhaps, deaths as cases increase.

The seasonal flu vaccine, now arriving at physicians’ offices, does not protect against the swine flu, but precautions can help including washing hands before and after coming in contact with swine and avoiding visits to the swine pens at county fairs by anyone with a compromised immune system, including the very young and the very old.

Bresee says no recommendations has been issued at this point to close swine shows at county fairs, and that there is no evidence of sustained human to human transmission, though CDC does expect to see some limited spread among humans. “This is not a pandemic situation” said Bresee on a call with reporters this afternoon, but CDC is continuing to monitor the cases and will provide frequent updates. “So far, if you’re not exposed to pigs, we don’t think your risk is appreciable,” Bresee says.

The CDC says people who exhibit flu symptoms should contact their doctor; antiviral drugs for influenza are effective on the swine flu now circulating.

Precautions that can help children and adults contract swine flu include:

• Wash hands frequently with soap and running water before and after exposure to animals.
• Never eat, drink or put things in your mouth while in animal areas and don’t take food or drink into animal areas.
• Young children, pregnant women, people 65 and older and people with weakened immune systems should be extra careful around animals.
• If you have animals – including swine – watch them for signs of illness and call a veterinarian if you suspect they might be sick.
• Avoid close contact with animals that look or act ill, when possible.
• Avoid contact with pigs if you are experiencing flu-like symptoms.

The August Centers for Disease Control and Prevention Vital Signs monthly report on health indicators focuses on adult walking and finds that 62 percent of U.S. adults get their physical activity by walking at least once for ten minutes or more per week, up from 56 percent n the 2005. However, close to 50 percent of adults don’t get enough physical activity to improve their health, the report finds. The 2008 Physical Activity Guidelines for Americans recommend at least 2.5 hours of moderate intensity aerobic activity per week, such as brisk walking.

“Having more places for people to walk in our communities will help us continue to see increases in walking, the most popular form of physical activity among American adults,” says CDC Director Thomas Frieden, MD, MPH.

“People need more safe and convenient places to walk,” adds Joan M. Dorn, PhD, branch chief of the Physical Activity and Health Branch in CDC’s Division of Nutrition, Physical Activity and Obesity. “People walk more where they feel protected from traffic and safe from crime.  Communities can be designed or improved to make it easier for people to walk to the places they need and want to go.”

The Vital Signs report offers suggestions to provide better spaces and more places for walking:

• State and local governments can consider joint use agreements to let community residents use local school tracks or gyms after classes have finished.
• Employers can create walking paths around or near the work place and promote them with signs and route maps.
• Residents can participate in local planning efforts that identify best sites for walking paths and priorities for new sidewalks.

>>Read more on smart growth for more walkable cities.