Category Archives: Health disparities

Feb 21 2014
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Faces of Public Health: Nadine Gracia, HHS Office of Minority Health

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Last year, the U.S. Department of Health and Human Services released updated national Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care to help health organizations improve care in diverse communities.

When the updated standards were released, Howard K. Koh, MD, MPH, the Assistant Secretary for Health in the U.S. Department of Health and Human Services (HHS), said “the enhanced CLAS Standards provide a platform for all persons to reach their full health potential.” Koh added that the updated CLAS Standards provide a framework for the delivery of culturally respectful and linguistically responsive care and services. By adopting the framework, health professionals will be better able to meet the needs of all individuals at all points of contact.

“As our nation becomes increasingly diverse, improving cultural and linguistic competency across public health and our health care system can be one of our most powerful levers for advancing health equity,” said Nadine Gracia, MD, MSCE, and Deputy Assistant Secretary for Minority Health and Director of the HHS Office of Minority Health.

NewPublicHealth recently spoke with Gracia about the updated standards and opportunities that efforts to increase health equity can bring to the health of individuals and communities.

NewPublicHealth: How does cultural respect help improve health in diverse communities?

Nadine Gracia: As we see the growing diversity of our country and the persistence of health disparities, really having everyone engaged in the discussion of health equity and the attainment of the highest level of health for all people is vital. Culture and cultural respect are really important when we talk about health equity as well as quality of care, and that’s because culture really influences health beliefs and practices. It influences one’s health-seeking behaviors and attitudes and the experience that someone may have in a health care setting.

So, it is essential that providers and health care delivery institutions understand the critical role that they play in providing culturally and linguistically appropriate services. We define those services as ones that are respectful of and responsive to an individual’s cultural health beliefs, their preferred languages, their health literacy levels and their communication needs. They are really applied by and employed by all members of an organization at every point of contact.

Culturally and linguistically appropriate services are essential when we talk about the health care encounter because they are increasingly recognized as being effective in improving the quality of services and increasing patient safety by preventing miscommunication; facilitating accurate assessment and diagnosis of a patient’s condition; and enabling everyone engaged in health services to truly develop an accurate and effective treatment plan.

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Feb 13 2014
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Public Health News Roundup: February 13

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SAMHSA Disaster Distress Helpline Open 24/7 to Help People Impacted by the Severe Weather
The Substance Abuse and Mental Health Administration (SAMHSA) issued a bulletin yesterday to remind public health officials and the community that its Disaster Distress Helpline (1-800-985-5990) can provide immediate counseling to anyone who needs help in dealing with the damage caused by the winter storms in the Mid-Atlantic and Southern states. The helpline is a 24 hours-a-day, seven-days-a-week resource that responds to people who need crisis counseling after experiencing a natural or man-made disaster or tragedy. The helpline immediately connects callers to trained professionals from the closest crisis counseling center; helpline staff provide confidential counseling, referrals and other needed support services. Assistance is available in several languages. The helpline can also be accessed by texting TalkWithUs to 66746, by going here and by TTY for deaf and hearing impaired at 1-800-846-8517. Read more on disasters.

Well-Child Visits Linked to More than 700,000 Cases of Flu-Like Illness
A recent study in Infection Control and Hospital Epidemiology links well-child doctor appointments for annual exams and vaccinations with an increased risk of flu-like illnesses in children and family members within two weeks of the visit. This risk translates to more than 700,000 potentially avoidable illnesses each year, costing more than $490 million annually, according to the researchers.

"Well child visits are critically important. However, our results demonstrate that healthcare professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics [and] more attention should be paid to these guidelines by healthcare professionals, patients, and their families," said Phil Polgreen, MD, MPH, lead author of the study.

The researchers used data from the Agency for Healthcare Research and Quality's (AHRQ) Medical Expenditure Panel Survey to examine the health care trends of 84,595 families collected from 1996-2008. After controlling for factors including the presence of other children, insurance and demographics, the authors found that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points. A commentary in the journal on the study also pointed out the likelihood of some unnecessary antibiotics being prescribed for some of the illnesses.

"Even with interventions, such as the restricted use of communal toys or separate sick and well-child waiting areas, if hand-hygiene compliance is poor and potentially infectious patients are not wearing masks, preventable infections will continue to occur," said Polgreen. Read more on infectious disease.

NIH Study Seeks to Improve Asthma Therapy for African-Americans
A new study by researchers at the National Heart Lung and Blood Institute, a division of the U.S. National Institutes of Health, is enrolling about 500 African-American children and adults with asthma in a multi-center clinical trial to assess how they react to therapies and to explore the role of genetics in determining the response to asthma treatment. The study will be conducted at 30 sites in 14 states, and its goal is to determine the best approach for asthma management in African-Americans, who suffer much higher rates of serious asthma attacks, hospitalizations and asthma-related deaths than whites. “While national asthma guidelines provide recommendations for all patients with asthma, it is possible that, compared with other groups, African-Americans respond differently to asthma medications,” said Michael Wechsler, MD, principal investigator for the study and professor of medicine at National Jewish Health in Denver. “Our study is designed to specifically address how asthma should be managed in African-American asthma patients, both adults and children.” Read more on health disparities.

Feb 11 2014
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Public Health News Roundup: February 11

AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:

  • Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
  • Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
  • Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
  • Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
  • Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
  • Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.

Read more on prevention.

New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.

The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.

Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.

The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.

Feb 7 2014
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Faces of Public Health: Dennis Andrulis

Dennis Andrulis

In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:

  • Health insurance and exchanges;
  • Health care safety net;
  • Workforce support and diversity;
  • Data, research and quality; and
  • Public health and prevention.

To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.

NewPublicHealth:  How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?

Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?

The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.

NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?

Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.

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Jan 22 2014
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Public Health News Roundup: January 22

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Survey: Latinos See Diabetes as Greatest Family Health Concern
A new NPR/Robert Wood Johnson Foundation/Harvard School of Public Health poll found that Latinos see diabetes as the biggest health concern for their families. Almost 19 percent of Latinos surveyed cited diabetes as the top worry, including across both immigrant (19 percent) and non-immigrant (22 percent) populations. Cancer, at 5 percent, was the second-biggest concern. In addition to health and health care, the poll also asked about communities, financial situation and discrimination. According to the U.S. Centers for Disease Control and Prevention, Hispanic adults are 1.7 percent more likely than non-Hispanic whites to be diagnosed with diabetes, and 1.5 percent more likely to die from it. Read more on health disparities.

Heart Attack Patients in ER Off-Hours Seeing Higher Mortality Rates
Heart attack patients who present during off-hours—at night and on weekends—are more likely to die, according to a new study from the journal BMJ. Their emergency care is also more likely to take longer than it would during normal hospital hours, including inflation of the coronary artery, which can take an additional 15 minutes. After analyzed records on 1,896,859 patients, researchers at the Mayo Clinic determined that heart attack patients who present during off-hours had a 5 percent relative increase in mortality—or an additional 6,000 U.S. deaths. The study’s authors concluded that emergency departments "should focus on improving their off-hour care, with the goal of providing consistently high quality care 24 hours a day and seven days a week." Read more on heart health.

Study: HPV Vaccination Rate Remains Low, More Physician Recommendations Needed
Only 14.5 percent of girls ages 11 and 12 have received at least one does of the human papillomavirus (HPV) vaccination, with only 3 percent having completed a three-dose series, according to a new study in the American Journal of Preventive Medicine. The study from the Moffitt Cancer Center indicates that increasing the rate of physician recommendations, which so far remains low, could do much to up the vaccination rate and cut the risk of cancer. The vaccination protects against the two types of HPV that cause 70 percent of cervical cancer cases. “This study demonstrates that the change in consistent HPV vaccine recommendations to early adolescent females was modest, and for older adolescent females was virtually nonexistent, from three to five years after the vaccine became available,” explained Susan T. Vadaparampil, PhD, MPH, associate member of the Health Outcomes and Behavior Program at Moffitt. “Physician recommendation is central to increasing HPV vaccination rates because it is one of the most important predictors of whether a patient gets the HPV vaccine.” Read more on cancer.

Jan 13 2014
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Public Health News Roundup: January 13

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Study: School Assaults Lead to Nearly 90,000 ER Visits Annually
Assaults at school account for almost 90,000 emergency-room visits annually, according to a new study in the journal Pediatrics. In a review of data on students ages 5-19, researchers determined that an average of 92,000 annual emergency visits were a result of deliberate injury, with student-on-student assault accounting for about 88,000. About 40 percent of the injuries were bruises or scratches, with few leading to later hospitalization. "[The number of injuries] appears to be concerningly high, especially when you realize that such a substantial number of injuries are occurring in the school setting, where safety measures are already in place," said lead author Siraj Amanullah, MD, an assistant professor of emergency medicine and pediatrics at Brown University's Alpert Medical School. "There is a need to continue addressing this issue at various levels—at home, at school and in the medical care setting—and there is a need to ramp up our existing prevention and safety strategies.” Read more on violence.

WHO: India Can Now Be Declared Polio-Free
With now three years passed since its last reported cased of polio—January 13, 2011—the country of India can now be declared polio-free, according to the World Health Organization (WHO). The certification process should be completed by the end of March. The country’s last victim was a two-year-old girl in West Bengal. This now leaves Afghanistan, Pakistan and Nigeria as the only countries where polio remains endemic. As part of our recent Outbreak Week, NewPublicHealth recently spoke with Sona Bari, WHO’s senior communications officer, about the efforts underway to eradicate polio globally. Read more on infectious disease.

Translation Errors Plague ACA’s Spanish-language Site, Impede Enrollment
Problems with the Spanish-language version of the Affordable Care Act’s website are making it difficult for many of the site’s users to navigate the site and enroll for coverage. In addition to launching late and sending users to English-language forms when they are clearly looking for Spanish-language content, CuidadoDeSalud.gov is also full of grammatical and other language mistakes. "When you get into the details of the plans, it's not all written in Spanish. It's written in Spanglish, so we end up having to translate it for them," said Adrian Madriz, a health care navigator who helps with enrollment in Miami. Several states with large Hispanic populations have fallen short in their goals to enroll Spanish-speakers, with critics pointing to the website as a major impediment. For example, while it’s not know how many of California’s 4.3 million residents who only speak Spanish intend to seek coverage under the Affordable Care Act, through the end of November only 5,500 had successfully enrolled. Read more on the Affordable Care Act.

Jan 9 2014
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Public Health News Roundup: January 9

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North America Sees First Death from H5N1 Bird Flu
North America has seen its first fatal case of H5N1 bird flu after a passenger on a Dec. 27 flight from Beijing to Canada first became ill. Canada’s health minister has stated it was an isolated case and the general public is at little risk. The victim, who died in Alberta, had only visited Beijing while in China, and not been to any farms or markets, which raises additional concerns. "This is the first evidence of this particular virus circulating in Beijing. Chinese authorities are going to be very interested. We've contacted them already," said Gregory Taylor, MD. According to the World Health Organization, as of mid-December there were 648 laboratory-confirmed human cases of H5N1 flu, with 384 leading to death. Read more on infectious disease.

Study: Full-service Restaurants Need Standard Definitions for ‘Health Choice’ Tags
Full-service restaurants should adopt standard definitions for ''healthy choice'' tags and for entrees, especially those that target vulnerable age groups, according to a new study in the Journal of Nutrition Education and Behavior. The study found that despite popular belief, food from full-service restaurants is not always healthier and higher in quality than food from fast-food restaurants, and can ever have much higher calorie, fat and sodium levels. The push to adopt these standards is especially significant because about one-third of all calories purchased in the United States are from food prepared away from home. "The need to educate customers about the nutritional content of restaurant foods is acute because consumers increasingly eat away from home, restaurants serve large portions of energy-dense and high-sodium foods, and obesity and the prevalence of other diet-related diseases are high," said lead researcher Amy Auchincloss, PhD, MPH, of the Drexel University School of Public Health. Read more on nutrition.

Racial Disparities in Deaths After Heart Bypass Surgery Linked to Hospital Quality
Racial disparities in the death risk after heart bypass surgery are linked to hospital quality, according to a new study in the journal JAMA Surgery. Researchers analyzed the records of more than 170,000 Medicare patients who had heart bypass surgery and found that nonwhite patients had a 33 percent higher death rate after the surgery. In hospitals with the highest rates of nonwhite patients, the death rate was 4.8 percent for nonwhite patients and 3.8 percent for white patients. The disparity is explained in part because nonwhite patients have less access to high-quality hospitals with lower death rates, as well as by factors such as regional variations in hospital quality, how close patients live to high-quality hospitals and race-based referral decisions. Read more on health disparities.

Dec 31 2013
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Public Health News Roundup: December 31

Help for Keeping Those New Year’s Resolutions from the Federal Government
Losing weight
, helping others and quitting smoking are among the top New Year’s resolutions of the American people, according to the General Services Administration (GSA), the agency that oversees the business of the federal government. Links on the GSA site offer strategies, websites and help lines for 2014 resolutions. Click on the quit smoking link on the GSA resolution list for example, and you’ll find yourself at smokefree.gov, which offers tools you can access immediately, even before 2014 begins. Read more on community health.

NIH to Fund Research on Workforce Diversity Programs
The National Institutes of Health (NIH) will establish a national consortium to develop, implement and evaluate approaches to encourage individuals of all backgrounds to start and stay in biomedical research careers. “There is a compelling need to promote diversity in the biomedical research workforce,” said NIH Director Francis S. Collins MD, PhD. “A lack of diversity jeopardizes our ability to carry out the NIH mission because innovation and problem solving require diverse perspectives. The future of biomedical research rests on engaging highly talented researchers from all groups and preparing them to be successful in the NIH-funded workforce.” Read a new JAMA study that finds that minority physicians care for the majority of underserved patients in the United States. Read more on health disparities.

Twenty Percent of Drivers Admit They Often Drive Too Fast
A recent survey by the National Highway Traffic Safety Administration (NHTSA) finds that twenty percent of drivers say they “try to get where I am going as fast as I can." According to NHTSA, speeding-related deaths nationwide account for nearly a third of all traffic fatalities each year, taking close to 10,000 lives. And despite acknowledging the safety benefits of speed limits and reasons drivers should follow them, more than a quarter of those surveyed admitted "speeding is something I do without thinking" and "I enjoy the feeling of driving fast." And sixteen percent felt that "driving over the speed limit is not dangerous for skilled drivers." Most alarming, drivers with the least experience behind the wheel—those 16-20 years old—admitted to speeding more frequently than any other age group. And more than one in ten drivers ages 16-20 reported at least one speeding-related crash in the past five years, compared to 4 percent for the population as a whole. Read more on injury prevention.

Dec 27 2013
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Public Health News Roundup: December 27

Black Women Have Highest Rates of High Blood Pressure
More black women have high blood pressure than black men and white men and women, according to a new study in Circulation: Cardiovascular Quality and Outcomes.

The study included 70,000 people in the 12 southeastern states that are often referred to as the “stroke belt” because they collectively have a high rate of stroke incidence. Among the study participants, the high blood pressure rate among black women was 64 percent. Among white women the rate was 52 percent and among both black and white men the rate was 51 percent.

“For many years, the focus for high blood pressure was on middle-aged men who smoked; now we know better,” said Uchechukwu Sampson, MD, MPH. MBA, a lead author of the study and assistant professor of medicine at Vanderbilt University Medical Center in Nashville, Tenn. “We should look for [high blood pressure] in everyone and it should be treated aggressively — especially in women, who have traditionally gotten less attention in this regard.”

Dr. Sampson’s work was supported in part by the Harold Amos Medical Faculty Award of the Robert Wood Johnson Foundation. Read more on health disparities.

Over 40 Million Americans Experienced Mental Illness in 2012
Nearly one in five American adults, or 43.7 million people, experienced a diagnosable mental illness in 2012, a similar number to 2011, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA).

SAMHSA also reported that, consistent with 2011, less than half (41 percent) of these adults received any mental health services in the past year. And among adults with mental illness who reported an unmet need for treatment, the top three reasons given for not receiving help were:

  • they could not afford the cost;
  • they thought they could handle the problem without treatment; and
  • they did not know where to go for services.

The Department of Health and Human Services recently launched MentalHealth.gov to help people find easy-to-understand information about basic signs of mental health problems, how to talk about mental health and mental illness, and how to locate help.

The recent SAMHSA report also found that 9 million American adults 18 and older (3.9 percent) had serious thoughts of suicide in the past year; 2.7 million (1.1 percent) made suicide plans and 1.3 million (0.6 percent) attempted suicide. People in crisis or who know someone they believe may be at immediate risk of attempting suicide can call the National Suicide Prevention Lifeline 1-800-273-TALK (8255) or go to SuicidePreventionLifeline.org, which provides immediate, free and confidential round-the-clock counseling to anyone in need throughout the country, every day of the year. Read more on mental health.

NHTSA Extends Its Partnership with Auto Makers on Technology to Stop Drunk Drivers
The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) has extended, for five years, its agreement with the Automotive Coalition for Traffic Safety (ACTS), made up of 15 auto makers, to continue researching advanced alcohol detection technology that could prevent vehicles from being driven by a drunk driver.

Under the partnership, NHTSA is working with ACTS to develop a car system that could accurately and reliably detect when a driver is above the legal alcohol limit of 0.08 BAC adopted by all 50 States and territories. The automatic system would be enabled every time the car is started, but not pose an inconvenience to a non-intoxicated driver.

“In this age of innovation, smart technology may be the breakthrough we need to prevent drunk drivers from getting behind the wheel and endangering the safety of others on our roads,” said NHTSA Administrator David Strickland. “The research program has shown significant promise to date, offering real potential in the future to prevent several thousand deaths annually.”

NHTSA expects to have models ready for testing in 2015. In 2012, deaths in crashes involving drunk drivers increased 4.6 percent, resulting in 10,322 deaths — up from 9,865 in 2011. Read about NHTSA’s “Drive Sober or Get Pulled Over" campaign.

 

Dec 13 2013
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Public Health News Roundup: December 13

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AAP Issues Recommendations on Reducing Youth Deaths from Gun Violence
Every day seven U.S. children are killed by gun violence and it remains the second-leading cause of death among youth in the country. The American Academy of Pediatrics (AAP) has issued a list of recommendations on how to keep kids safe and hopefully make an impact on these troubling statistics. “Gun violence is a public health issue that profoundly affects children and their families,” said AAP President Thomas K. McInerny, MD, FAAP. “We know what works—strong laws to enforce background checks and safe storage.” Watch a video on the APP recommendations and read more here. Read more on violence.

Study: African-American Men from Single-Parent Homes More Likely to Suffer from Hypertension
African-American men who grew up in two-parent homes are less likely to suffer from hypertension as adults than are their peers who grew up in single-parent homes, according to a new study in the journal Hypertension.  The researchers analyzed data on 515 men enrolled in the Howard University Family Study. Possible explanations for the disparity include the fact that children who live only with their mothers are three times as likely to live in poverty, and socioeconomic status has been linked to higher blood pressure. “Family structure is among a slew of environmental influences that, along with our genes, help determine our health as adults,” said Dan Kastner, MD, PhD, scientific director, National Human Genome Research Institute (NHGRI). “This study makes important observations about home life that may affect susceptibility to complex diseases later on in life.” The National Institutes of Health’s NHGRI and National Institute on Minority Health and Health Disparities conducted the study. Read more on health disparities.

Excessive Cellphone Use Tied to Higher Anxiety, Lower Productivity in College Kids
Excessive cellphone use is linked to higher levels of anxiety, less satisfaction with life and lower grades in college-age adults, according to a new study in the journal Computers in Human Behavior. Researchers examined data on approximately 500 men and women enrolled at Kent State University in 82 different fields of study. The average student spent 279 using their cellphone each day, sending an average of 77 text messages, and researchers believe that a perceived obligation to stay connected on social media may be behind the increased anxiety and decreased productivity. "At least for some students, the sense of obligation that comes from being constantly connected may be part of the problem,” said Andrew Lepp, lead study author and an associate professor at Kent State University. "Some may not know how to be alone to process the day's events, to recover from certain stressors." Read more on technology.