U.S. Cesarean Delivery Rates Vary Widely
A new study in the journal Health Affairs finds that the rates of cesarean deliveries, the most common surgery in the United States, vary widely across the country, ranging from 7.1 percent to 69.9 percent of deliveries at close to 600 hospitals studied since 2009. About four million babies are born in the country each year. The study authors also looked at cesarean rates among low risk mothers and found that the variation rate for this group was higher—from 2.4 percent to 36.5 percent. "The variations we uncovered were striking in their magnitude, and were not explained by hospital size, geographic location, or teaching status," said Katy Kozhimannil, an assistant professor at the University of Minnesota’s School of Public Health and the lead researcher of the study. Cesarean rates have increased in the United States from 20.7 percent in 1996 to 32.8 percent in 2011, according to the study. There has been an increased focus on some cesarean deliveries performed before the baby is full term because of the many risks a baby faces when it is born prematurely. Another critical reason to address the issue, say the study authors, is that half of all U.S. births are paid for by the Medicaid program and cesarean births are much more costly than vaginal deliveries. Read more on maternal and infant health.

Chronic Disease Management for Medicaid Beneficiaries Could Lower Health Costs
A recent study of 75,000 women on Medicaid by researchers at the East Tennessee State University found that women with low incomes have a high prevalence of physically disabling conditions and chronic disease. Common chronic diseases included high blood pressure, depression, multiple sclerosis, arthritis, injury, back disorder and Parkinson’s disease. The researchers also found that women who used a mobility device—such as a walker, crutches, or wheelchair—were more likely to suffer from chronic diseases such as diabetes, pulmonary disease, and depression. “These are not women of retirement age. These are rates of chronic disease and disability in a working-age population, so the economic loss to society and the impact on health care costs is substantial," said Amal Khoury, MD, a professor and chair in the department of health services management and policy and the lead author of the study.  "Strategies to improve chronic disease management in the younger adult population may curtail higher disability rates in working-age adults and lower Medicaid and Medicare costs in the long run." Read more on prevention.

Fundraisers at U.S. Schools Too Often Sell Unhealthy Foods
Many public U.S. elementary schools ignore state and district policies banning unhealthy fundraisers, according to a study by researchers at the University of Illinois at Chicago. In the study, principals of 1,215 schools across the United States completed surveys on school food policies for the 2009-11 school years. Overall, only 39 percent of schools had nutritional restrictions on fundraisers, but schools within districts and states with strong policies were more than twice as likely to limit the sale of high-calorie and high-fat foods to raise money. Lindsay Turner, a researcher at the Institute for Health Research and Policy at the university and the lead author of the study, said “[i]t’s hard for schools to give up those financial resources, so that’s why it is essential to have alternative fundraising activities that don’t involve high-calorie products.” Turner ticked off alternatives suggested by the Center for Science in the Public Interest, including walk-a-thons and selling books, greeting cards, fruit, holiday decorations or wrapping paper. “This study puts fundraising on the radar as an issue that needs to be attended to in policy making,” said Turner. “There has been a lot of attention paid to competitive foods and beverages, and this is a really important piece of the entire picture of what’s going on in schools.” Read more on obesity.

The U.S. preterm birth rate dropped for the fifth consecutive year in 2011 to 11.7 percent, the lowest in a decade, according to the March of Dimes 2012 Premature Birth Report Cards. That improvement means not just healthier babies, but also potential savings of roughly $3 billion in health care and economic costs, says Jennifer Howse, PHD, March of Dimes president.

Howse says the improved rates can be attributed to an expansion of successful programs and interventions, including actions by state health officials in 48 states, the District of Columbia and Puerto Rico, who set goals to lower their preterm birth rates 8 percent by 2014 from their 2009 rate, based on a challenge issued in 2011 by the Association of State and Territorial Health Officers.

Preventing premature birth and, by extension, increasing the number of babies born healthy, is one focus of the March of Dimes first pregnancy book, Healthy Moms, Healthy Babies, just published a few weeks ago in celebration of the organization’s 75th anniversary.

In observance of the 75th anniversary, NewPublicHealth spoke with Edward R.B. McCabe, MD, PhD, Senior Vice President and Medical Director of by the March of Dimes Foundation, about the organization’s continuing efforts to reduce premature births in the United States.

NewPublicHealth: What are the current vital statistics on prematurity?

Dr. McCabe: Worldwide, 15 million babies are born prematurely each year and more than a million of them die. The United States has one of the highest preterm birth rates in the world. Despite these somber statistics, there is good news. The U.S. infant mortality—and preterm birth—rates are declining.

A recent National Center for Health Statistics (NCHS) report found that much of the decrease in the infant mortality rate can be accounted for by a decrease in preterm births. Preterm birth has declined for five consecutive years to 11.7 percent of all births, but still above the March of Dimes goal for 2020 of 9.6 percent. Overall, infant mortality declined for four consecutive years to less than 26,500 in 2009, the most recent year for which statistics are available, according to the NCHS.

Better Nutrition Advice Comes From Doctors Who Cook
At the “Healthy Kitchens, Healthy Lives – Caring for our Patients and Ourselves” conference presented by Harvard University and the Culinary Institute of America, health care professionals have been learning about both nutritional science and how to cook. The program was influenced by the idea that healthcare professionals practicing healthful behaviors—such as healthy eating, exercising, or wearing a seat belt—may be more likely to pass these same behaviors onto their patients.

A 2010 survey of 219 conference participants before the conference and 192 participants three months after found:

• 58 percent of healthcare professionals cooked their meals before the conference; 64% afterwards with reports of eating more whole grains, nuts and vegetables
• 46 percent said they could successfully advise an overweight patient on nutrition and lifestyle before the conference; 81% said they could afterwards

The researchers believe they “need enhanced educational efforts aimed at translating decades of nutrition science into practical strategies whereby healthy, affordable, easily prepared and delicious foods become the predominant elements of a person’s dietary lifestyle.” Read more on nutrition.

Caffeine During Pregnancy Linked to Smaller, Later Newborns
Coffee and other caffeinated beverages consumed during pregnancy might increase the odds for low birth weight or an extended pregnancy, according to a new study in BMC Medicine. The study looked at about 60,000 pregnancies tracked by the Norwegian Institute of Public Health. Researchers found that caffeine from all sources was tied to a higher risk for reduced birth weight and that every 100 mg of caffeine consumed per day extended pregnancy by five hours. Caffeine from coffee extended pregnancy by eight hours. The World Health Organization advises women to limit their caffeine consumption to 300 mg a day during pregnancy, while the United States recommends a 200 mg daily limit. Read more on maternal and infant health.

CDC: Reductions in Some Types of Health Care-Associated Infections
Progress in the fight against certain bloodstream and surgical-site infections continues in hospitals in the United States, according to a U.S. Centers for Disease Control and Prevention (CDC) report. The report looked at data submitted to the National Healthcare Safety Network (NHSN), CDC’s infection tracking system. CDC reported a 41 percent reduction in central line-associated bloodstream infections since 2008 and a 17 percent reduction in surgical site infections since 2008. “The significant decrease in central line and surgical site infections means that thousands of patients avoid prolonged hospitalizations and the risk of dying in the hospital,” said Patrick Conway, chief medical officer of the Center for Medicare & Medicaid Services (CMS). The data indicates hospitals are making progress toward the goals established in 2008: 50 percent cut in central line-associated bloodstream infections and a 25 percent cut in surgical site infections in five years. Read more on injury prevention.

Folic Acid Supplements Early in Pregnancy May Reduce Risk of Autism by 40%
Prenatal folic acid supplements appear to reduce the risk for autistic spectrum disorders, according to a study in the Journal of the American Medical Association. The study included more than 85,000 babies born in Norway. Researchers noted prenatal eating habits of the mothers and followed up with families for three to ten years after birth to measure the development of autism spectrum disorders. A total of 270 cases were identified among the children in the study and a review by the researchers found that mothers who took folic acid supplements in early pregnancy had a 40 percent reduced risk of having children with autistic disorders. The researchers say that the timing of a mother’s intake of folic acid appears to be a critical factor. A child’s risk of autism was reduced only when the supplements were taken between 4 weeks before to 8 weeks after the start of pregnancy. Read more on maternal and infant health.

Prescription Drug Abuse Programs in Middle School Reduce Abuse Later in Life
A new study by researchers at the National Institutes of Health (NIH) found that middle school students from small towns and rural communities who were involved in community-based prevention programs were less likely to abuse prescription medications in late adolescence and young adulthood. The study was published in the American Journal of Public Health. According to the NIH, prescription drug abuse is one of the most serious public health problems in the United States.  In 2011, about 1.7 million people ages 12 to 25 abused a prescription drug for the first time, according to the National Survey on Drug Use and Health . “The intervention effects were comparable or even stronger for participants who had started misusing substances prior to the middle school interventions, suggesting that these programs also can be successful in higher-risk groups,” said Richard Spoth, PhD, of the Partnerships in Prevention Science Institute at Iowa State University and the lead author of the study. Those findings contrast with a recent study published by the Substance Abuse and Mental Health Administration that found that 12th grade dropouts have higher rates of cigarette, alcohol and illegal drug use. Read more on addiction.

New Study Shows Significant Health Benefits of Americans Reducing Their Sodium Intake
Hundreds of thousands of lives could be saved over 10 years if Americans reduced their sodium consumption to the levels recommended in federal guidelines, which would prevent many heart attacks and strokes, according to a new study by researchers at UC San Francisco, Harvard Medical School and Simon Fraser University in Canada. The study was published in the journal Hypertension. The study resulted from a workshop conducted by the U.S. Centers for Disease Control and Prevention which brought together scientists from the three universities. Each university group used different computer models to estimate the risk reduction of lowering sodium, but all found consistent, substantial benefits of reducing U.S. sodium consumption to a level close to the upper limit of the federal guideline of 2,300 mg/day.  According to the study, the overall average sodium consumption in the United States has been estimated at 3,500 mg/day, well above the upper limit of the level recommended by federal agencies and the Institute of Medicine. American men consume twice the recommended level on average. Read more on nutrition.

New York Announces Companies Reducing their Sodium Content
Earlier this week, the city of New York announced that  21 companies met one or more of their voluntary commitments to reduce sodium content  in pre-packaged or restaurant foods. Those reductions were the result of the National Salt Reduction Initiative (NSRI), the first-ever nationwide partnership to reduce sodium in the U.S. food supply. The NSRI is a nationwide partnership of more than 90 city and state health authorities and organizations coordinated by New York City since 2009. The NSRI’s goal is to cut excess salt in packaged and restaurant foods by 25 percent over five years through voluntary corporate commitments. Support for the initiative has come from the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention, the W.K. Kellogg Foundation, the Robert Wood Johnson Foundation, the New York State Health Foundation and the National Association of County & City Health Officials. The project funding is administered by the Fund for Public Health in New York, a private non-profit organization that supports innovative initiatives of the New York City Department of Health and Mental Hygiene. Read more on prevention.

More Moms Are Breastfeeding
Across all groups, the percentage of mothers who start and continue breastfeeding is rising, according to a new report by the Centers for Disease Control and Prevention (CDC). From 2000 to 2008, the number of mothers who started breastfeeding increased more than 4 percentage points from 70.3 percent to 74.6 percent. And the number of mothers still breastfeeding at six months jumped nearly 10 percentage points, from 35 percent to nearly 45 percent.

The CDC also reports that gaps in breastfeeding rates between African American and white mothers have narrowed from 24 percentage points in 2000 to 16 percentage points in 2008. To help increase breastfeeding rates among African American mothers The CDC is funding Best-Fed Beginnings, which provides support to 89 hospitals, many serving minority and low-income populations, to improve hospital practices that support breastfeeding mothers. CDC has also recently awarded funds to six state health departments—Indiana, Michigan, New York, Massachusetts, California, and Washington—to develop community breastfeeding support systems in communities of color.

Read more on maternal and infant health.

Study: Nutrition Information for Fast Food Should Add Energy Expenditure Needed to Burn off the Calories
A study by researchers at the University Of North Carolina School of Public Health finds it would be useful to have nutritional labeling that describes real-time energy expenditure required to burn calories in fast foods. The study was published in the journal Appetite.

The researchers randomly assigned one of four types of menus to 800 study participants including 1) no nutritional information, 2) calorie information, 3) calorie information and minutes to walk to burn those calories, and 4) calorie information and miles to walk to burn those calories.

The researchers found a statistical difference in the number of calories ordered, based on menu type. An average of 1,020 calories were ordered from a menu with no nutritional information; an average of 927 calories from a menu with only calorie information; 916, from a menu with calorie information and statement of minutes one must walk to burn those calories; and 826, from a menu with calorie information and statement of number of miles to walk to burn the calories.

Read more on obesity.

New York City Reports Significant Increases in Prescription Opioid Overdoses
The rate of drug overdose from prescription opioids increased seven-fold in New York City over a 16-year period, especially among whites, according to a study by researchers at the Columbia University Mailman School of Public Health. The researchers say the study is one of the most comprehensive analyses of how the opioid epidemic has affected an urban area. 

The Food and Drug Administration held a hearing last week to discuss ways to limit prescription opioid misuse and recently issued draft recommendations for reformulating opioid oral pills to make it harder for people to crush them for snorting or injecting.

Read more on substance abuse.

Survey: Majority of Americans Support Stronger Gun Policies
The majority of Americans support all but four of 31 gun policies asked about in a recent survey by the Johns Hopkins Bloomberg School of Public Health. The policies are designed to reduce gun violence and include measures such as universal background checks (supported by 89 percent), banning the sale of military-style semiautomatic assault weapons (69 percent) and banning the sale of large-capacity ammunition magazines (68 percent). “This research indicates high support among Americans, including gun owners in many cases, for a wide range of policies aimed at reducing gun violence,” said study author Colleen Barry, PhD, MPP, an associate professor at the university. “These data indicate broad consensus among the American public in support of a comprehensive approach to reducing the staggering toll of gun violence in the United States.” Read more on violence.

CDC: Pregnant Women Should Receive Pertussis Vaccine Booster
The U.S. Centers for Disease Control and Prevention (CDC) now recommends pregnant women should get a booster tetanus, diphtheria and pertussis (Tdap) vaccine to help protect their newborn children from whooping cough. The vaccine schedule for children has them receiving their first pertussis vaccine at two months of age and they are not fully protected until six months. Vaccinating pregnant women will protect them whooping cough and also allow them to pass on immune cells to their children, according to Reuters. "It turns out that immunity wanes pretty quickly," said H. Cody Meissner, MD, a pediatrician from the Tufts University School of Medicine in Boston. "Without boosting with each pregnancy, a mother's immunity will wane and she will have much less immunity to pass on to the baby." Read more on maternal and infant health.

Study: Eating Your Main Meal Earlier May Improve Weight Loss
Eating an earlier lunch may improve your chances to lose weight, according to a new study in the International Journal of Obesity. The study found people in a weight-loss program who consumed lunch after 3 p.m. lost about 25 percent less weight than those who ate earlier. Researchers were careful to note that the study was performed in Spain—where lunch is often the day’s main meal—so are unsure how the results would apply to countries such as the United States. Still, the findings back up the traditional advice to eat your larger meal earlier in the day. "This is the first large-scale, long-term study to show that it is an important factor in weight-loss success for overweight and obese individuals," senior researcher Frank Scheer, an assistant professor of medicine at Harvard Medical School. Read more on obesity.

This morning Scott Rhodes, PhD, MPH, a professor in the department of Social Sciences & Health Policy at Wake Forest University Health Sciences, presented a study on the impact of immigration enforcement on access to care among Latinos. The presentation came at a session on social and legal factors that affect health at the Public Health Law Research Program annual meeting. NewPublicHealth spoke with Rhodes about the study.

NewPublicHealth: You’ve been looking at immigration and found significant health care access issues in North Carolina?

Scott Rhodes: Yes, we’ve been working on Latino immigration issues for about ten years, but we hadn’t really looked at the role of immigration policy enforcement on access to care, specifically access to public health services among Latino immigrants. What we looked at in the research we presented at the PHLR annual meeting this morning were the limits that some of the policies pose, such as policies that allow police officers to start deportation processes with the Immigration and Customs Enforcement agency if they stop someone and find they are in the United States illegally. We wanted to know if those policies impact whether Latinos access public health services that they may need and what kind of impact that has on their health.

So, we did two things. We analyzed statewide county-level vital records data to look at the use of prenatal care services by Latinos across the state of North Carolina—pre- and post-implementation of one of the immigration policies that link police to the immigration service. And we also conducted focus groups and in-depth interviews with Latinos living in three counties in North Carolina in which the policy has been implemented, and then three counties in North Carolina where the policy was publicly rejected, to see whether there were some differences in perceptions about eligibility and about accessing and utilizing services.

NPH: And what did you find?

A study released this fall in the American Journal of Public Health looks at a critical evidence-based teen pregnancy prevention program led by the United Way of Greater Milwaukee. The United Way catalyzed critical partnerships between schools, community organizations and the Milwaukee Health Department to focus on the goal of reducing teen pregnancies.

In 2008, United Way of Greater Milwaukee, together with its partners, made a public commitment to reduce teen births among 15- to 17-year-olds by 46 percent by 2015. In October 2011, the City of Milwaukee and United Way announced the fourth consecutive yearly drop in the teen birth rate, by 13.5 percent, to its lowest level in decades. The current trend indicates that the partners are on track to reach their goal of 30 births per 1,000 (a 46 percent drop) by 2015.

Initiatives to support these goals include:

• Significant investments in programs through the Healthy Girls project that helps young people understand the consequences of teen pregnancy while also teaching them the skills needed to cope with social pressure to engage in sexual activity.
• A collaboration with the Medical College of Wisconsin and Children's Hospital of Wisconsin residents to develop content for a youth-focused, website, Baby Can Wait, with medically accurate and age-appropriate content on preventing pregnancy and promoting healthy relationships.
• United Way worked with Milwaukee Public Schools and other community leaders to revise human growth and development curriculum. Community members were given an opportunity to review the materials and make suggestions about content, and teachers received training in the new curriculum.

NewPublicHealth caught up with Nicole Angresano, Vice President at United Way of Greater Milwaukee, to get her take on the program’s successes and what other communities can learn from them.

NewPublicHealth: What is different about this effort to focus on teen pregnancy for your community?

New Report Finds Underage Drinking in all States
More than a quarter of Americans who are legally too young to drink are doing so anyway, according to a new report issued today by the Substance Abuse and Mental Health Services Administration (SAMHSA). The report says there has been progress in reducing the extent of underage drinking in recent years, especially among youth ages 17 and younger, but that the rates of underage drinking “are still unacceptably high.” Over 25 percent of people ages 12-20 report drinking in the month before they were surveyed, and 8.7 percent of them purchased their own alcohol the last time they drank. “Underage drinking should not be a normal part of growing up. It’s a serious and persistent public health problem that puts our young people and our communities in danger,” says SAMHSA Administrator Pamela S. Hyde. “Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death.” All 50 states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21. Find resources to prevent and treat underage drinking here. Read more on addiction.

Helmets Can Save Lives on the Slopes
Wearing a helmet while skiing or snowboarding can prevent injuries and reduce injury severity, according to a review article of 16 published studies in the Journal of Trauma and Acute Care Surgery. About 600,000 skiing and snowboarding injuries occur each year, according to reporting by Johns Hopkins researchers who wrote the new report. Up to 20 percent of those are head injuries, and 22 percent of those head injuries are severe enough to cause loss of consciousness, concussion or more serious injuries. Read more on injury prevention.

Study: Low-Level Air Pollution Impacts Fetal Growth
Exposure to low levels of air pollution seems to have a small effect on fetal growth, according to a study in the Puget Sound area by the University of Washington Schools of Public Health and Medicine and the Seattle Children’s Research Institute. The study looked at more than 367,000 births between 1997 and 2005 in the four-county Puget Sound region, including metropolitan areas Seattle and Tacoma, and estimated prenatal exposure to traffic-related air pollutants such as nitrogen oxide. The researchers found associations between increased levels of nitrogen dioxide exposures and an increased risk of small-for-gestational-age birth. Health problems for low birth weight babies can include decreased oxygen levels and low blood sugar, according to the researchers. Read more on maternal and infant health.

Study: Medicare Patients More Likely to Have Repeated Tests
Older adults on Medicare are more likely to have heart, lung, stomach or bladder tests repeated within three years, according to a new study in the Archives of Internal Medicine. "What we were struck by is just how commonly these tests are being repeated," said H. Gilbert Welch, MD, from the Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire. "Either these patients continually develop new problems or there are doctors who routinely repeat tests." Excessive testing can lead to unnecessary costs and treatments, Welch said. Read more on access to health care.

Use of Discontinued Meds Shows Need for Electronic Updates to Pharmacies
Even though the treatments are complete, some pharmacists continue to fill prescriptions for patients, which can unintentionally cause health issues ranging from nausea or lightheadedness to low blood pressure or allergic reactions, according to a study in the Annals of Internal Medicine. Researchers found that about 12 percent of discontinued medications caused harm, which demonstrates the need to electronically alert pharmacies when a medication is prescription is discontinued, said Adrienne Allen, MD, associate medical director of quality, safety and risk at the Boston-area North Shore Physicians Group."Future research should focus on evaluating methods of improving communication between providers and pharmacies to better reconcile medication lists, as well as explore strategies to improve patient knowledge and awareness of their medication regimen." Read more on prescription drugs.

Link Between Antibiotic Use During Pregnancy, Asthma in Children
Antibiotic use during pregnancy increases the chance that a child will have asthma, according to a new study in The Journal of Pediatrics. Researchers concluded the children were 17 percent more likely to be hospitalized for the breathing disorder. "We speculate that mothers' use of antibiotics changes the balance of natural bacteria, which is transmitted to the newborn, and that such unbalanced bacteria in early life impact on the immune maturation in the newborn," said Hans Bisgaard, MD, a professor at the University of Copenhagen. The findings support previous research linking antibiotics to asthma. Read more on maternal and infant health.