Category Archives: Obesity
HHS Moves to Strengthen Federal Background Checks for Gun Ownership
The U.S. Department of Health and Human Services (HHS) is taking steps to strengthen the federal background check system for the purchase of firearms by removing legal barriers under the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule that could stop states from reporting information to the National Instant Criminal Background Check System (NICS). The NICS is designed to ensure that felons, people convicted of domestic violence and people involuntarily committed to a mental institution cannot purchase firearms. A 2012 Government Accountability Office report found that 17 states had submitted fewer than 10 records of people prohibited from owning a firearm for mental health reasons. “There is a strong public safety need for this information to be accessible to the NICS, and some states are currently under-reporting or not reporting certain information to the NICS at all,” said HHS Secretary Kathleen Sebelius. “This proposed rulemaking is carefully balanced to protect and preserve individuals’ privacy interests, the patient-provider relationship, and the public’s health and safety.” Read more on mental health.
CDC: ‘Widespread’ Flu Activity in Almost Half of the Country
Half of the 50 U.S. states are already reporting influenza cases this season, according to the U.S. Centers for Disease Control and Prevention (CDC). The majority of the cases have been attributed to the H1N1 virus, which killed an estimated 284,000 people across 74 countries in 2009-2010. Almost half of the country has also classified flu activity as “widespread” this season. Texas, which on December 20 issued an “influenza health alert,” has already seen 25 deaths, according to health officials. "We are seeing a big uptick in disease in the past couple of weeks. The virus is all around the United States right now," said Joe Bresee, MD, chief of Epidemiology and Prevention in the CDC's Influenza Division, adding, "There is still a lot of season to come. If folks haven't been vaccinated, we recommend they do it now.” Read more on influenza.
Slower Eating Leads to Fewer Calories
Normal-weight individuals looking for methods to maintain their healthy weight should consider simply eating slower, according to a new study in the Journal of the Academy of Nutrition and Dietetics. Researchers found that both normal-weight and obese or overweight people who ate at relaxed, slow-speed conditions reported feeling less hungry afterward than they did after eating fast-paced meals. However, only the normal-weight study participants consumed “significantly” fewer calories during the slower meals, according to the researchers: 88 fewer calories, compared to 58 fewer calories for obese or overweight participants. Study author Meena Shah, a professor in the department of kinesiology at Texas Christian University, in Fort Worth, said one explanation for the findings could be that “slower eating allows people to better sense their feelings of hunger and fullness.” Read more on obesity.
NIH to Direct Additional $100M Toward Research in an HIV Cure
The National Institutes of Health (NIH) has announced plans to invest an additional $100 million over the next three fiscal years in research directed toward a cure for HIV. Over the past three decades, NIH-funded research has led to the development of more than 30 antiretroviral drugs and drug combinations targeting HIV. Anthony S. Fauci, MD, director of the NIH’s National Institute of Allergy and Infectious Diseases, said that growing knowledge about HIV, along with the development of new treatment strategies, makes the moment “ripe to pursue HIV cure research with vigor.” “Although the HIV/AIDS pandemic can theoretically be ended with a concerted and sustained scale-up of implementation of existing tools for HIV prevention and treatment, the development of a cure is critically important, as it may not be feasible for tens of millions of people living with HIV infection to access and adhere to a lifetime of antiretroviral therapy,” he said in a statement. Read more on HIV/AIDS.
Hong Kong Announces First Human Case of H7N9 Avian Flu
H7N9 avian flu appears to have spread from mainland China, with Hong Kong reporting its first human case of the deadly avian flu strain. A 36-year-old Indonesian domestic helper is in critical condition after travelling to Shenzhen and buying, slaughtering and eating an apparently infected chicken. Earlier this year a report of human infection in Shanghai was quickly followed by the confirmation of more than 100 cases. While closing down live poultry markets in the area caused the number of new cases to drop, the World Health Organization has confirmed a total of 139 cases and 45 deaths. Ko Wing-man, Hong Kong's secretary for food and health, said Hong Kong has raised its level of preparedness for an avian flu pandemic to "serious," and the city has suspended the importation of live chickens from certain Shenzhen farms as it also investigates its own stock. Read more on infectious disease.
Study: ‘Benign’ or ‘Healthy’ Obesity May Not Exist
Despite what some health professionals believe, “benign obesity” may not exist, according to a new study in the Annals of Internal Medicine. People who are overweight or obese without health issues such as high blood pressure, diabetes or other metabolic issues are still at increased risk of major health problems when compared with metabolically healthy, normal-weight people. The researchers looked at the results of eight studies covering more than 61,000 people, finding that in follow-ups of at least 10 years later the people who were overweight but without the risk factors were still at an increased risk of 24 percent for heart attack, stroke and even death. One explanation could be that these overweight people without the risk factors actually do have the risk factors, only at low levels that are difficult to detect, and that then become gradually worse. The results indicate that physicians should look at both body mass and metabolic tests when determining a patient’s health. Read more on obesity.
FDA Approves Vaccine for H5N1 Strain of Avian Flu
The U.S. Food and Drug Administration (FDA) has approved the first adjuvanted pandemic influenza vaccine for the prevention of the H5N1 strain of the avian flu, also known as bird flu. While most influenza A viruses do not infect people, H5N1 does and has demonstrated a 60 percent mortality rate when a person becomes infected. The U.S. Department of Health and Human Services has added the vaccine to the National Stockpile. “This vaccine could be used in the event that the H5N1 avian influenza virus develops the capability to spread efficiently from human to human, resulting in the rapid spread of disease across the globe,” said Karen Midthun, MD, director of the FDA’s Center for Biologics Evaluation and Research. “Vaccines are critical to protecting public health by helping to counter the transmission of influenza disease during a pandemic.” Read more on infectious diseases.
Study: Excessive Television Watching Equals Excess Weight in Kids
Children and teenagers who spend excessive amounts of time watching television or in front of other screens are also more inclined to be overweight or obese, according to a new study in the journal Pediatrics. Researchers analyzed data on nearly 8,000 boys and girls, ages 9-16, finding that each additional hour a day spent watching television was linked to a body mass index (BMI) scale increase of about 0.1 points, or about half a pound. Kids who watch television or play video/computer games are not only for the most part physically idle, but also more likely to snack. While many parents believe their kids spend a reasonable amount of time in front of screens, the reality is that most kids in the United States and Canada surpass the recommended daily limit of two hours. "We don't pay attention to the fact that it's half an hour here, half an hour there, an hour here, an hour there," said Mark Tremblay, director of Healthy Active Living and Obesity Research at the Children's Hospital of Eastern Ontario Research Institute in Ottawa, Canada, who was not a part of the study. Read more on obesity.
Study: One in 10 U.S. Kids has ADHD
About one in 10 U.S. children have attention-deficit/hyperactivity disorder (ADHD), according to a new study in the Journal of the American Academy of Child and Adolescent Psychiatry. A 2011 poll of more than 95,000 parents found 11 percent of kids ages 4-17 had ADHD, up from 9.5 percent in 2007. The number of kids on ADHD medication also climbed about 1 percent, with research showing that half the kids with ADHD are diagnosed before the age of 6. "This finding suggests that there are a large number of young children who could benefit from the early initiation of behavioral therapy, which is recommended as the first-line treatment for preschool children with ADHD," study author and U.S. Centers for Disease Control and Prevention (CDC) researcher Susanna Visser. The study also found that while the number of kids with ADHD is still climbing, it is no longer climbing as fast—the rate was increasing about 6 percent a year in the mid-2000s, but was only 4 percent a year from 2007 to 2011. Read more on pediatrics.
CDC Releases ‘Winnable Battles Progress Report 2010-2015’
The U.S. Centers for Disease Control and Prevention (CDC) has released its Winnable Battles Progress Report 2010-2015, which details the progress made in key areas where CDC has determined that progress is possible. The individual reports detail what’s been accomplished, and what still needs to be accomplished, to reach these goals by 2015. They include healthcare-associated infections; tobacco; nutrition, physical activity and obesity; food safety; motor vehicle safety; teen pregnancy; and HIV prevention. “By implementing the programs with the greatest potential impact, we are addressing Americans’ biggest health challenges while we try to get the most health bang for precious resources,” said CDC Director Tom Frieden, MD, MPH. Read more on the CDC.
Study: One-third of Kids’ Calories from Schools, Stores, Fast Food Restaurants are ‘Empty Calories’
In the battle to improve nutrition for kids, parents need to look beyond just fast food restaurants and take a closer look at food from grocery stores and at schools. A new study in the Journal of the Academy of Nutrition and Dietetics found that roughly a third of the calories consumed from each of these three sources constituted “empty calories” coming from added sugar or solid fat. The 2010 Dietary Guidelines for Americans recommends between 8 and 19 percent of calories should be “empty” for both kids and adults; excessive empty calories can lead to weight gain and obesity. While all three sources offered high counts of empty calories, they did so for different reasons, demonstrating the need to tailor health efforts to meet their particular obstacles. "Our study found that 20 percent of pizza and 22 percent of high-fat milk consumed by kids are provided by schools, and 72 percent of sugar-sweetened beverages like sodas, fruit drinks, sports drinks and energy drinks consumed by kids are obtained from grocery stores," said study author Jennifer M. Poti, a doctoral candidate in nutritional epidemiology at the University of North Carolina at Chapel Hill. Read more on nutrition.
American Headache Society: New Guidelines on Treating Migraines, Limiting Unnecessary Treatments
The American Headache Society has issued new guidelines on how physicians can better treat patients with migraines while limiting unnecessary or even risky treatments. For example, because of their serious long-term risks, opiod painkillers such as OxyContin and Vicodin, as well as the barbiturate butalbital, should not be the first treatments prescribed. Also, CT scans should only be limited to non-emergency situations when possible, as MRIs are both able to diagnose more conditions and do not expose patients to radiation. "Our aim is to encourage doctors and patients to think carefully about medical care that can be harmful or unnecessary," said Elizabeth Loder, MD, president of the American Headache Society. "We didn't approach this with cost uppermost in mind. The goal is to help address the problems of low-value care." Approximately 12 percent of Americans are estimated to suffer from migraines. Read more on migraines.
Workplace Injuries Cost U.S. Healthcare System $13.1B in 2011
With nearly the highest injury rate of all U.S. industries, workplace injuries cost the U.S. healthcare system approximately $13.1 billion and more than 2 million lost workdays in 2011, according to a new study in the journal Professional Safety. “Healthcare worker injury rates are only less than outdoor wilderness professions, such as commercial loggers and fishermen. The injury rates are sky high," said report author Scott Harris, PhD, MSPH, the director of EHS advisory services for UL Workplace Health and Safety. The study found that 15.2 million employees were injured that year alone, with the most common injuries coming from slips, trips, falls, violence and chemical exposure; nurses experienced the highest rates. The report concluded that hospitals “would benefit from more rigorous and frequent inspections from the Occupational Safety and Health Administration.” Read more on injury prevention.
Even Healthy Overweight People at Increased Risk for Heart Disease
Even overweight people who are otherwise healthy are at increased risk for heart disease, according to a new study in JAMA Internal Medicine. Previous research indicated that higher-than-normal risk was linked to a collection of risk factors known as “metabolic syndrome,” including large waist circumference, high blood pressure, high triglycerides, low "good" cholesterol and diabetes. People have metabolic syndrome if they have at least three of the risk factors. However, in a study of 71,527 adults without heart problems, researchers determined that risk went up as weight went up, even if metabolic syndrome factors were absent. "Whether you call someone as having or not having metabolic syndrome as kind of a yes/no variable, is not helpful clinically and it doesn't make sense biologically," said Meir J. Stampfer, from the Harvard School of Public Health, according to Reuters. "It's basically just that the metabolic syndrome is waiting to happen to those people." Read more on obesity.
New Statin Guidelines Call For Greater Use
New guidelines from the American Heart Association and American College of Cardiology could dramatically increase the number of people taking cholesterol-lowering statins. The guidelines call for people to take statins if they already have heart disease, if their bad (LDL) cholesterol is extremely high (190 milligrams per deciliter of blood or more) or if they're middle-aged with type 2 diabetes. They also advise statins for people who are 40-75 years old with an estimated 10-year risk of heart disease of 7.5 percent or more. Previous guidelines had advised doctors to follow rigid clinical guidelines that trigger statin use when cholesterol levels reach a certain threshold. The new policy "suggests treatment should be individualized and that, depending on your risk, you may need a higher dose of a more potent statin than if your risk is lower," said Hector Medina, MD, a cardiologist at Scott & White Healthcare in Round Rock, Texas, according to HealthDay. Read more on heart health.
Harvard Pilgrim Health Care Foundation’s work on childhood obesity is driven by one startling fact: one in three Massachusetts children are overweight or obese. To find out why, Executive Director Karen Voci and her colleagues went to the places where children learn and play—schools, after school programs and child care centers— and found that children were sitting for most of the day and foods were heavy on starch and sugar. With a limited budget, Voci and her team found opportunities and partners in Massachusetts, New Hampshire and Maine to improve childhood obesity rates.
“It’s hard to measure what you’re accomplishing,” said Voci at one session during the American Public Health Association (APHA) 2013 meeting. “These environments look and feel different, but it’s hard to capture this feeling in a meaningful statistic that can be used further down the road.”
As a result, most of the results shared focused on process and intermediate outcomes rather than actual health outcomes—for now—but the communities are optimistic that they’re moving in the right direction.
Voci underscored the importance of staying committed, noting that Harvard Pilgrim and its partners had been at this for years and they were in fact moving the needle. Session presenters shared successes from Massachusetts, New Hampshire and Maine.
Harvard Pilgrim partnered with the Massachusetts Department of Public Health and other foundations and businesses on the Mass in Motion initiative to combat childhood obesity in its home state. Led by their elected officials, 14 communities developed health improvement plans and received technical assistance to improve local food sources and increase physical activity. The multifaceted initiative included a “call to action” report, as well as a Governor’s Executive order establishing a nutrition standard for the food procured for the state of Massachusetts. In addition, the program implemented a body mass index (BMI) regulation that required schools to screen children’s BMI in order to identify potential issues early. The Department of Public Health worked within these communities to share information on physical activity and nutrition, all culminating in growth of the program to 52 communities in the state.
Communities in Eastern Massachusetts are showing concrete signs of progress on the childhood obesity front. Reports from this summer have shown that the obesity rate for the region’s children under six years of age has decreased by 21.4 percent—likely due in part to initiatives such as Mass in Motion, the Cambridge Healthy Children Task force and Shape Up Somerville.
CATCH Kids Club is an evidence-based, after-school environment that has been adopted by 117 sites in nine of New Hampshire’s ten counties. The CATCH program promotes exercise and healthy eating in elementary school children with a four-phased approach:
- Curriculum development
- Staff and booster training
- Staff support
- Environment and policy assessment
In the environment and policy assessment phase, CATCH found that 93 percent of participating after-school programs made four or more changes to improve children’s physical activity and healthy eating. In addition, most sites now offer programs that promote these goals between three and five times a week.
In Maine, the Let’s Go! 5210 Goes to School program offers resources to help schools create a culture of health. It aims to take the focus off of the highly charged weight management issue and shift it toward four simple and embraceable goals for each day:
- Eat 5 fruits and vegetables
- Limit screen time to 2 hours or less
- Get at least 1 hour of exercise
- Drink 0 sugary drinks
While each school decides which of these four goals it would like to adopt, they often end up promoting all four points of the program as time goes on. In fact, the 5210 initiative reaches children in all 16 Maine counties in schools, after school programs, early childhood education, doctors’ offices and more locations.
One of the key lessons learned was to engage busy school representatives at a level that made sense for them. “Don’t ask them to do something unrealistic,” said Torey Rogers of the Let’s Go! 5210 Goes to School Program and The Barbara Bush Children’s Hospital at Maine Medical Center.
Representatives from each of these programs offered insights and lessons learned when it comes to working with schools. When speaking with school representatives, organizations are often successful when they relate the goal back to the mission of schools: education. By highlighting the secondary benefits to attendance and active participation of students, organizations can engage teachers as partners in public health initiatives.
>>For more information on the successes of state and community efforts to reduce childhood obesity, view an interactive map on the signs of progress on childhood obesity.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
In 2012 alone, the fast food industry spent $4.6 billion to advertise mostly unhealthy products, with many of those ads specifically targeting children and teens. A new report, Fast Food FACTS 2013, examined 18 of the nation’s top fast-food restaurants, following up on a 2010 report to see how the food selection and advertising landscapes have changed. And while there have been some positive developments—healthier sides and beverages are available in most kids’ meals—the findings indicate there is still a very long way to go.
Detailed findings from the report, which was supported by a grant from the Robert Wood Johnson Foundation, will be presented today at the American Public Health Association’s (APHA) annual meeting in Boston.
>>Read more on the Fast Food FACTS 2013 report.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders, hearing from attendees on the ground and providing updates from sessions, with a focus on building a culture of health. Follow the coverage here.
NewPublicHealth spoke with Jennifer Harris, the Yale Rudd Center for Food Policy & Obesity’s director of marketing initiatives and lead author of the report, and Marlene Schwartz, the Center’s director, about their findings and how fast food advertising continues to impact our nation’s youth.
NewPublicHealth: Has any progress been made in the nutritional quality of fast food kids' meals?
Jennifer Harris: There have been a lot of changes in kids’ meals over the past three years and a lot of it has been good. Most of the restaurants have added healthy sides and healthy beverages to their kids’ meals. Now it’s possible to get a fairly healthy kids’ meal at most of the restaurants we looked at. But the problem is it’s kind of like finding a needle in a haystack. Almost all of the meals they offer are high in fat, sugar or sodium.
Marlene Schwartz: The odds of you getting the healthy combination when you go are extraordinarily low. For every healthy combination, there are roughly 250 unhealthy combinations.
HPV Vaccines Less Effective in African-American Women than in White Women
Perhaps because of their lower participation rates in clinical trials, African-American women are less likely to benefit from available human papillomavirus (HPV) vaccines that guard against cervical cancer, according to new findings presented at the 12th annual International Conference on Frontiers in Cancer Prevention Research. The two most popular vaccines in use protect against infection by HPV 16 and HPV 18, which are responsible for about 70 percent of cervical cancers. However, these two subtypes are half as likely to be found in black women as they are in white women. Researchers found that the most common infections for white women are from subtypes 16, 18, 56, 39 and 66; the most common for black women are 33, 35, 58 and 68. "Since African-American women don't seem to be getting the same subtypes of HPV with the same frequency, the vaccines aren't helping all women equally," said study author Adriana Vidal, Ph.D., assistant professor of obstetrics and gynecology at Duke University School of Medicine. Read more on health disparities.
San Francisco Proposes Tax on Soda, Other Sugary Beverages
In an effort to curb the growing rate of obesity and obesity-related health issues, a San Francisco, California city supervisor has proposed a ballot measure that would impose a 2-cents-per-ounce tax on soda and other sugary beverages with at least 25 calories per ounce. This would be the first and strongest such city measure in the country, amounting to an additional 24 cents for a normal 12-ounce can of soda. Supervisor Scott Wiener said the tax proceeds, which he estimates would be $30 million annually, would go toward physical education and healthy lunch programs in city schools, as well as city parks, recreation programs and community health organizations. The California cities of Richmond and El Monte last year failed to enact similar taxes. A ballot measure requires a two-thirds majority to pass. "We know that this will be a long road," said Wiener. "This type of proposal has occurred in other cities and the beverage industry always comes out full guns blaring, so we're going to need to pull together to make sure that this wins." Read more on obesity.
Study: Young Cancer Patients at Increased Risk for Suicide
The stress of a cancer diagnosis means that teens and young adults who are diagnosed should be carefully monitored for behavior changes and other issues that could be a sign of suicidal thoughts, according to a new study in the Annals of Oncology. While there is an elevated risk of suicide for cancer patients of all ages, “because adolescents and young adults are still developing their coping strategies for stress, they may be more affected than adults when facing major adversity such as a cancer diagnosis," said lead researcher Donghao Lu, from the department of medical epidemiology and biostatistics at the Karolinska Institute in Stockholm, Sweden. Lu and his team found that Swedes ages 15-30 with a cancer diagnosis were at a 60 percent greater risk of suicide or attempted suicide, compared to people in the same age group but without cancer; in the first year after the diagnosis the risk was 150 percent higher. Lu said the findings indicate the need for greater communication and cooperation among medical professionals, psychological professionals, family members and social workers. Read more on cancer.
Study: Erratic Bedtimes Linked to Kids’ Behavior Problems
Children with erratic bedtimes also exhibit more behavior problems at home and at school, according to a new study in the journal Pediatrics. Researchers analyzed date on more than 10,000 children who were part of long-term sleep studies, finding that kids without a regular bedtime scored worse on a measure of behavior problems including acting unhappy, getting into fights and being inconsiderate. "If you are constantly changing the amounts of sleep you get or the different times you go to bed, it's likely to mess up your body clock," said study leader Yvonne Kelly, from University College London. "That has all sorts of impacts on how your body is able to work the following day," Kelly, from University College London.” However, the researchers also found that when a child went from no set bedtime to a scheduled bedtime, their behavior improved. Read more on pediatrics.
Overweight Teens at Increased Risk of Later Esophageal Cancer
People who are overweight or obese as teens have nearly twice the risk of developing esophageal cancer later in life when compared to their peers with healthy weights, according to a new study in the journal Cancer. The study also found that social status, economic status and education levels can all be factors in the development of gastric cancers; poor teens are at twice the risk of developing stomach cancer, as are teens with nine years of fewer of education. The study included more than 1 million male Israeli teens. "We look at obesity as dangerous from cardiovascular aspects at ages 40 and over, but here we can see that it has effects much earlier," said study author Zohar Levi, MD, of the Rabin Medical Center in Israel. However, the study did not prove cause-and-effect, so further research is needed to determine whether losing weight or gaining higher social or economic status later in life can reduce the risks. Read more on cancer.
USDA: California Plants Linked to Salmonella Can Stay Open
After making “immediate substantive changes to their slaughter and processing,” three California poultry processing plants tied to a salmonella outbreak in 17 states will remain open, the U.S. Department of Agriculture (USDA) has determined. The plants will implement new food safety controls and the USDA will monitor the plants products for the next three months. The outbreak has sickened 278 people since May; the normal hospitalization rate is about 20 percent, but antibiotic resistance means about 42 percent of the people sickened in this outbreak were hospitalized. Read more on food safety.
Study: Top Athletes Endorse Junk Food More Often Than Healthy Food
A new study of professional athletes’ food and beverage endorsements found that more often than not their paid support is given to products that are energy-dense and nutrient-poor, according to a new study in the journal Pediatrics. The study looked at 512 brands endorsed by 100 different athletes, finding that “Seventy-nine percent of the 62 food products in athlete-endorsed advertisements were energy-dense” and “93.4% of the 46 advertised beverages had 100% of calories from added sugar.” Denver Broncos player Peyton Manning and Miami Heat player LeBron James had the most endorsements for the energy-dense, nutrient-poor food and beverages. "I hope this paper inspires some reflection on the part of America's athletes and professional sports leagues, as well as all other celebrities for that matter,” said Center for Science in the Public Interest Executive Director Michael F. Jacobson, in a statement. Read more on nutrition.
U.S. Task Force Recommends Against Blood Pressure Screening for Kids, Teens
Despite recommendations from several expert groups, the U.S. Preventive Services Task Force is not recommending that health care professionals respond to the growing obesity crisis by screening children and teens for high blood pressure. The panel concluded that more study into the issue is needed, and that in the mean time there are other, known avenues toward lowering youth obesity and improving cardiovascular health. "We don't know if lowering blood pressure in youth leads to improved cardiovascular health in adulthood,” said panel member Kirsten Bibbins-Domingo, MD. “We also don't know the long-term benefits and harms for children and adolescents who initiate blood pressure medications when they are young. While there is much we don't know, we do know that eating a healthy diet, being active, and maintaining a normal weight are ways children and teens can improve their cardiovascular health." Read more on heart health.
Study: Tobacco Advertisements Connecting with Young Kids in Many Low-, Middle-income Countries
The global pervasiveness of tobacco advertisements means that most very young children in many low-and middle-income countries are familiar with cigarette brands, and nearly 70 percent of kids ages 5 and 6 can identify at least one cigarette logo, according to a new study in the journal Pediatrics. The study is from the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health. The findings demonstrate the significant steps countries and public health organizations still need to take to limit the influence of tobacco ads. “Evidence-based strategies exist to reduce the ability of tobacco companies to market their products to children, such as implementing and enforcing bans on tobacco advertising, promotion and sponsorship,” said Joanna Cohen, PhD, co-author of the study and director on the institute. “Putting large picture warnings on the front and back of cigarette packs and requiring plain and standardized packaging, as Australia has done, also helps to reduce the attractiveness of cigarette packs among young children.” Read more on global health.