Category Archives: Health disparities
Study: Pertussis Booster Only ‘Moderately’ Effective
The “booster” vaccine for pertussis—or whooping cough—is only “moderately” effective in preventing the disease in adolescents and adults, according to a new study in the journal BMJ. The Kaiser Permanente-backed study, which is the first to look at the effectiveness of the Tdap booster shot in the new generation that has only received acellular vaccines, found the effectiveness to be between 53 and 64 percent. This indicates that additional vaccinations may be required to adequately prevent outbreaks according to lead author Roger Baxter, MD, co-director of the Kaiser Permanente Vaccine Study Center. The state of California saw its highest number of cases of pertussis in more than 60 years in 2010, when it had more than 9,000 cases that led to 809 hospitalizations and 10 deaths, according to the National Center for Biotechnology Information. Read more on vaccines.
NYC Hospitals Prescribing Fruits, Vegetables to At-risk Youth
An apple a day to keep the doctor away? At two New York City hospitals, you can get a prescription for just that. Under a four-month pilot program, doctors at Lincoln Medical Center in the Bronx and Harlem Hospital are giving prescriptions for fruits and vegetables to at-risk youths. The kids and their families receive coupons which can be redeemed for product at local farmers markets and city green carts. “This is probably going to prevent an awful lot more disease over the long-term than a lot of the medicines we tend to write for,” said New York City Health Commissioner Thomas Farley, MD, said Tuesday in the green market outside Lincoln Medical Center. Read more on nutrition.
Breast Cancer Survival Times Shorter for Black Women
The fact that black women receive less health care overall than their white counterparts, combined with the lack of early screening and detection programs in many black communities, means they live an average of three fewer years with a breast cancer diagnosis, according to a new study in The Journal of the American Medical Association. Researchers at the University of Pennsylvania found that black women were less likely to receive an early diagnosis when the cancer was more treatable; they also found that quality of care was in general lower, though not enough to explain the survival gap. Data showed that 70 percent of white women lived at least five years after a breast cancer diagnosis, compared to 56 percent of black women. “Something is going wrong,” said Jeffrey H. Silber, MD, a professor at the University of Pennsylvania and the director of the Center for Outcomes Research at the Children’s Hospital of Philadelphia, which studies disparities in health care. “These are huge differences. We are getting there too late. That’s why we are seeing these differences in survival.” Read more on cancer.
Adults with Mobility Issues Have Higher Rates of Obesity, Chronic Illness
Adults with a disability that causes mobility issues are more likely to be obese or suffer from a chronic illness, according to a new study in the American Journal of Preventative Medicine. The chronic illnesses include those commonly linked to overall health and exercise, such as diabetes, hypertension and high cholesterol. They are also twice as likely to take medication for hypertension and lipid-lowering medicine. Researchers say the findings demonstrate the need for health care providers to emphasize lifestyle changes and exercise over just medication. “Health care providers face a challenge when it comes to helping their patients with a disability manage their weight when exercise and physical activity play such an important role in weight management,” said Katherine Froehlich-Grobe, PhD, lead author of the paper and associate professor of health promotion and behavioral science at The UT School of Public Health Dallas Regional Campus. “People with disabilities are underserved by national efforts aiming at reducing and preventing obesity. We must focus on managing and reducing weight for individuals with a disability.” About 54 million Americans have a disability. Read more on obesity.
Study: One in Four Injured Youth in ER Visits Had a Gun
In a study of emergency room treatments for assault injuries in teenagers and young adults in Michigan, approximately one in four of the injured reported owning or carrying a gun. The study appeared in the journal Pediatrics. Researchers found that most were obtained illegally, and while “well-off young men” were most likely to have a gun, the rate did not vary by race. According to a 2003 study, the rate of gun homicides for Americans 15 to 24 years old were about 40 times higher than the rates in comparable nations. While it recommends against guns in the home, the American Academy of Pediatrics says gun-owning families with children should keep guns locked and separate from ammunition. Lead researcher Patrick Carter, MD, from the University of Michigan in Ann Arbor, said more programs need to be developed to prevent future gun violence, but in the mean time communities with high rates of violence need to place more emphasis on safety and responsibility when it comes to discussing guns with youth and young adults. "I would say to parents, talk to your kids about firearms and the dangers associated with firearms and try to look at ways to prevent kids from getting involved in both substance use and violence," he said. Read more on violence.
Even With Same Care, Black Blood Cancer Patients Have Worse Outcomes than White Patients
Even when they receive the same type and level of care, black Americans with chronic lymphocytic leukemia (CLL) do not live as long as white Americans with the same blood cancer, according to a new study in the journal Cancer. While black patients generally saw a shorter time between diagnosis and referral, they also had more advanced CLL at the time of referral and their cancers progressed more quickly. The researchers from the University of Texas M.D. Anderson Cancer Center in Houston and Duke University Medical Center in Durham, N.C., said that biological factors may account for the different survival rates. Research consistently shows that minority patients tend to have worse cancer outcomes than white patients; poverty and access to care have also been identified as potential factors. Read more on health disparities.
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.
At least two million children in the U.S. have at least one parent in prison, a situation now recognized as an adverse childhood experience, which can put children at risk for poor mental and physical health, due in part to isolation and a lack of family connectedness with their incarcerated parents.
The Osborne Association, based in New York City, works with people who have been in conflict with the law, and their families. Osborne is currently using funding from a Robert Wood Johnson Foundation Roadmaps to Health community grant to advocate for the use of Family Impact Statements in New York State during prison sentencing and the inclusion of "proximity to children" as a factor in prison assignments in New York State. Family Impact statements convey to a judge how the family of a person convicted of a crime will be affected by various sentencing decisions. With their proximity advocacy, the goal is to increase visiting opportunities for families during periods of incarceration by assigning parents to closer prisons and expanding opportunities for kids to have contact with incarcerated parents through televisiting. Research has shown that having strong family ties increases the likelihood of family reunification following a parent’s prison stay, as well as the child’s long-term health and wellbeing. The goal of both policy reform efforts is to reduce the trauma of parent-child separation for children, thereby promoting their health and well-being.
Elizabeth Gaynes, Osborne’s executive director, was recognized recently as a White House Champion of Change for her work with the children of incarcerated parents. NewPublicHealth spoke with Gaynes about ways to protect the health and wellbeing of the 2.7 million children whose parents are in prison on any given day. Gaynes also spoke about how her former husband, the father of her two children, spent over twenty years in prison, and the impact this had on her family.
NewPublicHealth: Why do you think this issue of parental incarceration has not gotten enough attention previously?
Elizabeth Gaynes: There is no specific agency with direct responsibility for kids of incarcerated parents and the kids don’t tend to identify themselves. And until recently it wasn’t thought of as anything that needed identifying. When I was looking for a therapist for my kids, the people I spoke to said “we would treat this like any other abandonment.” And I said, “Really? But he didn’t actually abandon them.” So I think that there is no system that is responsible for them and because of the stigma they don’t self-identify. We’ve had some young people who went to do talks in high schools and asked the kids in the class at the beginning if they knew anyone who was in, or had been in, prison. At the beginning of her talk, two kids raised their hands. She said after she spoke and said her own dad had been in prison, she asked the question again and 12 kids raised their hands.
CPR Quality Varies Among EMS Personnel
The quality of CPR (cardiopulmonary resuscitation) given to victims may vary depending on the EMS department or hospital administering it, according to the American Heart Association. “There have been huge advances in CPR and there’s no question that high-quality CPR saves lives,” said Peter Meaney, MD, MPH, an assistant professor of anesthesia and critical care at Children’s Hospital of Philadelphia and author of a new statement on quality CPR for the AHA. “Right now,” said Meaney, “there is wide variability in the quality of CPR—and we can do better.” Each year in the United States, more than a half-million children and adults suffer cardiac arrest, but survival rates vary significantly: 3 percent to 16 percent for arrests outside of hospitals and 12 percent to 22 percent in hospitals, according to the study authors.
In its statement the AHA offered some recommendations to improve CPR quality:
- Minimize interruptions to chest compressions.
- Provide the right rate of compressions—100 to 120 per minute are optimal for survival.
- Give deep enough compressions—at least 2 inches for adults and at least 1/3 the depth of the chest in infants and children.
- Give no more than 12 rescue breaths a minute, with the chest just visibly rising, so pressure from the breath doesn’t slow blood flow.
The AHA recommends that to ensure quality improvement, providers, managers, institutions and systems of care should do debriefings, follow CPR delivery checklists, measure patient response measurements, provide frequent refresher courses and participate in CPR data registries. Read more on heart health.
Minority Children Less Likely to Receive ADHD Diagnosis
Minority children are less likely than their white counterparts to be diagnosed with attention deficit hyperactivity disorder (ADHD), according to a new study in the journal Pediatrics. Compared to white children, Hispanic children were 50 percent less likely, black children were 69 percent less likely and minority children overall were 46 less likely. The health care disparities start as early as kindergarten and last at least through the eighth grade, and the lack of access to medications and specialized learning programs puts them at a disadvantage in terms of learning and behavior. Researchers say the findings demonstrate the need for improved ADHD awareness and questioning by health care providers, school psychologists and teachers. Read more on health disparities.
NCI Issues Guidelines to Speed Up Clinical Trials
Opening a clinical trial can sometimes take years, which can slow down introduction of new or improved therapies. The National Cancer Institute (NCI) has issued new recommendations to help get trials underway. Under the new guidelines, the target time to open a trial should be should be 210 days from the start date for the first two phases of clinical trials which assess safety and effectiveness in a small number of patients, and 300 days for phase III trials which include a much larger number of participants. According to NCI incorporating the new guidelines in some recent trials has sped up the start date for those trials. Read more on cancer.
APHA, National Center for Healthy Housing Release Housing Standards to Improve Health
The National Center for Healthy Housing (NCHH) and the American Public Health Association (APHA) have released a National Healthy Housing Standard aimed at improving the health of Americans by addressing serious health and safety hazards in U.S. homes. About 30 million families live in unsafe and unhealthy housing with broken heating and plumbing; holes in walls and windows; roach and rodent infestation; falling plaster; crumbling foundations; and leaking roofs. Millions more live in housing with serious health and safety hazards that can cause allergies, asthma, injuries, cancer and lead poisoning, which add billions of dollars to health care costs and harm children’s health, development and wellbeing, according to the APHA. The new standard would not apply to new construction or housing renovation, but will be used by government agencies to ensure that the existing housing stock—with more than 100 million units across the country—is maintained to protect the health and safety of Americans. The housing standard would be implemented through adoption by federal state and local agencies. NCHH is requesting comments from health and housing practitioners, advocates and other stakeholders in healthy housing on the standard through July 31, 2013 at NCHH.org. Read more on housing.
Black, Hispanic Kids With Autism Less Likely to See Specialists
Black and Hispanic children with autism are less likely than their white counterparts to access specialists such as gastroenterologists, neurologists and psychiatrists, according to a new study in the journal Pediatrics. Study author Sarabeth Broder-Fingert, MD, a fellow in the department of pediatrics at MassGeneral and Harvard Medical School, said that while she expected to see differences, she was surprised by the extent of the disparity. Diagnosing and treating the disorders that often accompany is critical so that they do not lead to further health complications. "I do worry because autism is such a complicated disorder," she said. "The children have some sort of communication difficulty, so if they have stomach problems or sleep problems they may have difficulty expressing that. I always worry these kids are not getting all the care they need in general, and minority kids are more at [risk] of not getting the care they need." The study indicated that doctors need to be more aware of when to refer patients to specialists. About one in 50 school-age children have autism in the United States, according to the U.S. Centers for Disease Control and Prevention. Read more on health disparities.
Volunteer Time Reduces High Blood Pressure Risk in Older Adults
Time spent volunteering can help reduce the risk of high blood pressure in older U.S. adults, according to a new study in the journal Psychology and Aging. Researchers analyzed data on more than 1,100 adults, finding that those who volunteered at least 200 hours per year saw a 40 percent saw a 40 percent cut in high blood pressure risk four years down the line. Approximately 65 million American suffer from high blood pressure, or hypertension. "As people get older, social transitions like retirement, bereavement and the departure of children from the home often leave older adults with fewer natural opportunities for social interactions,” said lead author Rodlescia Sneed, a PhD candidate in psychology at Carnegie Mellon University. "Participating in volunteer activities may provide older adults with social connections that they might not have otherwise. There is strong evidence that having good social connections promotes healthy aging and reduces risk for a number of negative health outcomes." Read more on heart health.
The ‘Nocebo Effect’: Media Reports Can Trigger False Symptoms
News media stories about various disease and syndromes—even those that aren’t real—can lead people to report symptoms, according to a new study in the Journal of Psychosomatic Research. Researchers call it the “nocebo effect” and say it clearly shows the importance of news organizations making sure their stories are based on scientific evidence and presented in a balanced, cautious way. The study uses the idea of a Wi-Fi signal that could cause health problems, finding that 54 percent of participants reported symptoms of the made-up syndrome. "It appears essential to stay critical about any kind of scientific, or pseudo-scientific, information in the media," said researcher Michael Witthoft, with the psychology department at Johannes Gutenberg University of Mainz, in Germany. "I would advise consumers not to jump to simple conclusions prematurely, but to critically review several sources of evidence." (See the accompanying cartoon by Politico's Matt Wuerker for a humorous take on the issue.) Read more on environment.
Cedars-Sinai Aims to Involve More Women in Clinical Research
A new initiative from Cedars-Sinai hopes to improve the representation of women in medical research by registering at least 2,000 women with or without a history of breast and gynecologic cancers. Compared to men, relatively few women participate in clinical studies, meaning not nearly enough is known about how the biological differences might factor into disease diagnosis and treatment. This research for her initiative will work to “close this gap.” “What we try to tell women, especially women who do not have cancer or a family history of it, is that they can help make a difference in the fight against women’s cancers in a noninvasive, very simple way,” said BJ Rimel, MD, co-principal investigator of the research for her registry and gynecologic oncologist in the Department of Obstetrics and Gynecology at Cedars-Sinai. “We try to tell them how much of a benefit they are to others. That's our strongest weapon in this fight.” Read more on cancer.
Study: Smoking Down, Drinking Up in Popular Movies
While incidents of smoking are down on the big screen since 1998, the number of alcohol brand appearances is up in the top movies rated PG-13 and below and the overall screen time spent drinking is level, according to a new study in JAMA Pediatrics. A 1998 law forbade tobacco companies from paying for ad placements; there is not such law for alcohol products. Researchers looked at the movies with the top 100 box offices each year from 1996 to 2009, finding a drop in the appearances of tobacco. However, they also saw alcohol brand appearances in youth-rated movies rise from 80 to 145 per year. "Children who see smoking in the movies are more likely to initiate smoking," said Elaina Bergamini from the Norris Cotton Cancer Center in Lebanon, New Hampshire, to Reuters. "I think there is some concern that that may hold true for alcohol as well. The notorious thing you find in movies and in TV is heavy drinking without consequences. It leaves it up to parents to tell the consequences story." Read more on alcohol.
Devastation in Oklahoma, More Storms Possible
Following tornadoes in Oklahoma yesterday that killed and injured scores of people and leveled whole communities, the National Weather Service is warning that that severe weather could move eastward as far as the Gulf Coast and Northeast on Tuesday and Wednesday. “These are dangerous storms and we urge people to monitor the situation closely and be alert for severe weather warnings in their community,” said Trevor Riggen, vice president of Disaster Operations and Logistics for the Red Cross. The Red Cross has created a free tornado app, available in English or Spanish, whose features include a high-pitched siren tornado warning alert that signals when an alert from a National Oceanic and Atmospheric Agency (NOAA) tornado warning has been issued. The app, found in the Apple App Store and the Google Play Store for Android by searching for American Red Cross, also includes an all-clear alert that lets users know when a tornado warning has expired or has been cancelled. The app also includes one-touch “I’m safe” messaging to alert family and friends through social media outlets. Read more on preparedness.
Cost, Other Factors May Keep African-Americans from Calling 911 when they have Stroke Symptoms
African-Americans often know the signs of stroke, but concerns about medical cost, ambulance response time and lack of familiarity with the need for prompt hospital care impacted whether they called 9-1-1 immediately, according to a new study of 77 African American community members in Flint, Michigan by researchers at the University of Michigan. The study was published in Circulation: Cardiovascular Quality and Outcomes. To encourage 9-1-1 calls even if a stroke victim is concerned about cost, the study authors recommended highlighting the reduction in post-stroke disability if treatment is given quickly. Read more on access to health care.
Report: High SPF Sunscreens Not Any More Effective
Just in time for the Memorial Day Weekend, the Environmental Working Group has released its 7th annual Sunscreen Guide, which rates the safety and efficacy of more than 1,400 sunscreens, lotions, lip products and makeups that advertise sun protection. EWG researchers found that only 25 percent of products on the market in 2013 offer strong and broad protection and pose few safety concerns. “The vast majority of sunscreens available to the consumer aren’t as good as most people think they are, but there are a handful of products that rise above the rest,” said Sonya Lunder, senior research analyst at EWG and lead author of the report. Lunder says that’s important because “despite an increasing awareness of the sun’s risks, rates of melanoma have tripled over the past 35 years, with an annual increase of 1.9 percent per year since 2000.” EWG says it thinks the U.S. Food and Drug Administration (FDA) should push companies to stop selling high-SPF sunscreens (above 50+), which account for 1 in 7 products on the market. The FDA has said that it cannot vouch for any sunscreen above 30. According to Lunder, as a result of misleading and confusing marketing claims, consumers frequently misuse sunscreens and spend more time in the sun than they should, putting them at greater risk. Read more on cancer.
A recent Opinionator column in The New York Times by Nancy DiTomaso, vice dean for faculty and research at Rutgers Business School in New Jersey, suggests that some of the reason for the 13 percent unemployment rate among African-Americans—double the rate for whites—may stem from the fact that whites are more able to rely on their social networks for an edge when finding out about and applying for higher-wage jobs.
“Getting an inside edge by using help from family and friends is a powerful, hidden force driving inequality in the United States,” says DiTomaso, who adds that whites helping other whites is not the same as discrimination, and it is not illegal, “yet it may have a powerful effect on the access that African-Americans and other minorities have to good jobs, or even to the job market itself.”
Income—and lack of it—impact every aspect of health, from being able to afford safe housing to being able to purchase nutritious food to accessing high-quality healthcare. A study published in the British Medical Journal earlier this year found that there were nearly 40,000 extra hospital readmissions over a three-year period in states with the greatest income inequality.
NewPublicHealth illustrated the link between jobs and health in a recent infographic.
>> Read the post from The New York Times.
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.