Category Archives: Transportation

May 27 2014
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Death by Walking: New Report Analyzes Road Dangers for Pedestrians

A 2012 report from the U.S. Centers for Disease Control and Prevention (CDC) found that walking is hands-down the most common exercise activity in the United States—which only makes a new report showing the high rate of pedestrian fatalities and injuries that much more alarming.

The report, Dangerous by Design 2014, released by the National Complete Streets Coalition, a program of advocacy group Smart Growth America, finds that more than 47,000 people were killed and close to 700,000 injured while walking in the United States between 2003 and 2012. The report also found that the rates have been rising in the last few years, and that the majority of deaths and injuries could have been prevented with safer street designs such as crosswalks and traffic signs.

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The report also ranks major U.S. metropolitan areas according to a Pedestrian Danger Index that assesses how safe pedestrians are while walking. The top four most dangerous cities—Orlando, Tampa, Jacksonville and Miami—are all in Florida and the other six are, in order, Memphis, Phoenix, Houston, Birmingham, Atlanta and Charlotte.

“We are allowing an epidemic of pedestrian fatalities, brought on by streets designed for speed and not safety, to take nearly 5,000 lives a year; a number that increased six percent between 2011 and 2012,” said Roger Millar, director of the National Complete Streets Coalition. “Not only is that number simply too high, but these deaths are easily prevented through policy, design and practice. State and local transportation leaders need to prioritize the implementation of Complete Streets policies that keep everyone safe.”

Complete Streets refer to “streets for everyone,” according to the Coalition, and are designed and operated to enable safe access for all users. People of all ages and abilities are able to safely move along and across streets in a community, regardless of how they are traveling. Complete Streets also make it easy to cross the street, walk to shops and bicycle to work, while allowing buses to run on time and making it safe for people to walk to and from train stations.

Rates of walking deaths and injuries are far higher for more vulnerable populations such as older adults, children and people of color, according to the report. For example, while just 12.6 percent of the total population is over age 65, that group accounts for nearly 21 percent of pedestrian fatalities nationwide.

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May 8 2014
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Streetcars: Is Desire Enough?

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This year, the County Health Rankings and Roadmaps, an annual report of the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, added some new measures, including transportation, to help track what communities can do to help improve population health. Researchers have found that more than three-quarters of workers drive to work alone and among them 33 percent drive longer than a half hour each way. Driving contributes to physical inactivity, obesity and air pollution.

One idea that has sprouted as an alternative to cars is actually a throwback: Streetcars. First introduced in the 1820s and drawn by horses on rails that let wagons move faster than they could on unpaved roads, many cities later added electricity by the 1920s to create early transit systems. They then added buses—and often faster underground rail lines—to transportation options as the 20th century continued, and then usually discontinuing the streetcar lines.

Planners say resurgence has come with plans to revitalize downtown areas as well as attract tourists, who often fly into town but then look for inexpensive and accessible ways to go from site to site. But funding, including grants from the U.S. Department of Transportation, is sometimes awarded for streetcars on the promise of using the lines as an inexpensive transit mode to get to and from work. An opinion piece in The New York Times last month proposed that idea for people who live in lower-income neighborhoods a mile or more from subway stations, which can be a deterrent to looking for higher-paying jobs outside of home neighborhoods.

But some researchers remain skeptical that streetcars will meet that and other promises made by some developers, including reducing car emissions and the need for parking spaces in cities. A study published last year in the Journal of Public Transportation by Jeffrey Brown, an associate professor in the Department of Urban and Regional Planning at Florida State University, said there is “a lack of information about how these investments [in streetcar lines] function as transportation modes as opposed to urban development tools.”

Brown said few streetcar rider surveys have been done, but where they have been ridership so far does not indicate they’re being used as a transportation option for work. A Memphis survey found that only 9 percent of streetcar rides transport workers between home and job, while 58 percent of bus rides are for transportation to work and back. And surveys of the Portland system, the heaviest used streetcar system in the United States, show that streetcar users tend to have higher incomes than users of the city’s other mass transit modes. 

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Apr 30 2014
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Public Health News Roundup: April 30

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Severe Weather Wreaking Havoc Across the U.S. Today
At least 35 people have been killed during severe weather in the past week in the South and Southwest. Severe weather, including significant flooding is expected to continue through much of the country today. Click here for today’s weather alerts for the entire United States from the National Weather Service.

AAP Recommends Precautions to Prevent High Rate of ACL Injuries in children
The American Academy of Pediatrics (AAP) issued a report yesterday on preventing and treating knee injuries in kids. According to the AAP, pediatricians have been seeing an increase in the last twenty years in tears to the anterior cruciate ligament (ACL) which provides stability for the knee as more kids—in particular girls—play sports. According to the AAP, research shows that specific types of physical training can reduce the risk of ACL injury by as much as 72 percent and the Academy now recommends strengthening exercises to reduce athletes’ risks of being injured, and encourages coaches and school sports programs to learn about the programs. The AAP is also advising that surgeries be done by trained surgeons using less-invasive surgery techniques that protect the developing growth plates in kids and teenagers.

According to the AAP, the effects of an ACL tear can be long-lasting and impactful beyond an end to playing a sport. Injured athletes who leave a sport and its social network can experience depression, and time away from school for treatments can impact academic performance. And research shows that athletes with ACL injuries are up to 10 times more likely to develop early-onset degenerative knee osteoarthritis and chronic pain. Read more on injury prevention.

NHTSA Awards Grants to Reduce Pedestrian Deaths
The National Highway Traffic Safety Administration (NHTSA) today announced that Louisville, Philadelphia and New York City will receive grants totaling over $1 million for public education and enforcement initiatives to improve pedestrian safety. The new grants are part of the Department’s Everyone Is a Pedestrian campaign to help communities reduce the rising number of pedestrian deaths and injuries that occurred from 2009 through 2012.

According to NHTSA, the three winners are among the cities with some of the highest rates of pedestrian fatalities nationwide:

  • Louisville was awarded $307,000 and will use the funds to create a pedestrian education program for school-aged children and create safe walking routes for senior citizens. In addition, the funds will be used to conduct law enforcement training and crosswalk enforcement activities. In Louisville, a total of six pedestrians were killed in motor vehicle crashes during 2012, representing 10 percent of the city’s total traffic fatalities.
  • Philadelphia was awarded $525,000 and will use the funds to address pedestrian safety in downtown areas by increasing police visibility and ticketing during high risk hours in 20 high-crash locations. The grant will also be used for marketing to reach pedestrians in these areas and to train officers on pedestrian safety. In Philadelphia, a total of 31 pedestrians were killed in motor vehicle crashes during 2012, representing 29 percent of the city’s total traffic fatalities.
  • New York City was awarded $805,801 and will use the funds to address speeding drivers and drivers who do not yield to pedestrians in crosswalks. The city will work on reaching the demographic most likely to be in pedestrian crashes—young men—through social media and enforcement activities in high-crash areas. In New York City, a total of 127 pedestrians were killed in motor vehicle crashes during 2012, representing 47 percent of the city’s total traffic fatalities.

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Apr 23 2014
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NewPublicHealth Q&A: Kathleen Hoke, Network for Public Health Law

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Earlier this month U.S. Department of Transportation Secretary Anthony Foxx kicked off April’s National Distracted Driving Awareness Month by announcing the department’s first-ever national advertising campaign and law enforcement crackdown in states with distracted driving bans. That effort ended last week, but through individual interactions with drivers by law enforcement and through ads on television, radio and online, the effort raised attention to the dangers—and penalties—of distracted driving, according to the National Highway Traffic Safety Administration (NHTSA.) According to NHTSA 3,328 people were killed and an estimated 421,000 were injured in distraction-related crashes in 2012, the latest year for which data is available.

"This campaign puts distracted driving on par with our efforts to fight drunk driving or to encourage seatbelt use," said Foxx.

According to NHTSA, the national campaign built upon the success of federally funded distracted driving state demonstration programs in California and Delaware, “Phone in One Hand, Ticket in the Other.” Over three enforcement waves, California police issued more than 10,700 tickets for violations involving drivers talking or texting on cell phones, and Delaware police issued more than 6,200 tickets. Observed hand-held cell phone use dropped by approximately a third at each program site, from 4.1 percent to 2.7 percent in California, and from 4.5 percent to 3.0 percent in Delaware.

Currently 43 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands ban text messaging for drivers of all ages; 12 states, Washington, D.C., Puerto Rico, Guam and the U.S. Virgin Islands prohibit drivers of all ages from using hand-held cell phones while driving; and 37 states and D.C. ban cell phone use by new drivers.

More state campaigns are expected to be launched, according to NHTSA. To find out more about the ability of public health laws such as laws aimed at reducing distracted driving to improve health and save lives, NewPublicHealth recently spoke with Kathleen Hoke, director of the Network for Public Health Law, Eastern Region. The Network is a program of the Robert Wood Johnson Foundation.

NewPublicHealth: In his announcement of the campaign, Secretary Foxx said that the national distracted driving reduction efforts show how public health laws can be transformative. What public health does this build on? Could this have been done if there hadn’t been a history of using laws to help improve the public’s health?

Kathleen Hoke: I think there is kind of a cycle that we see in public health using law to effectuate improvements in public health, particularly injury prevention. I know we can’t think today that there was a time that children weren’t in car seats, but there was. And what happened was there was an education campaign much like the Department of Transportation’s current campaign that was all about encouraging folks to put their children in safety seats. The law took it to a certain level, so we went from roughly 20 percent of people putting their kids in car seats to maybe 60 percent of people putting their kids in car seats.

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Apr 1 2014
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Public Health News Roundup: April 1

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NHTSA: Rear Cameras for All New Cars by May 2018
All new vehicles under 10,000 pounds will be required to have rear visibility technology—or rear cameras—by May 2018, according to a new rule issued by the U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA). According to NHTSA, the technology significantly reduces injuries and fatalities due to backover incidents; there are an average of 210 deaths and 15,000 injuries each year caused by such incidents, with children under age 5 accounting for 31 percent and adults ages 70 and older accounting for 26 percent. "Safety is our highest priority, and we are committed to protecting the most vulnerable victims of backover accidents — our children and seniors," said U.S. Transportation Secretary Anthony Foxx. "As a father, I can only imagine how heart wrenching these types of accidents can be for families, but we hope that today's rule will serve as a significant step toward reducing these tragic accidents." Read more on injury prevention.

Study: Diet of Fruit, Vegetables Linked to Reduced Risk of Death
Diets heavy on fruits and vegetables can reduce the risk of death at any age by as much as 42 percent, according to a new study in the Journal of Epidemiology and Community Health. Using data on the eating habits of more than 65,000 people in England from 2011 to 2013, researchers determined that the risk of death was reduced by 36 percent with five to seven portions, 29 percent with three to five portions and 14 percent with one to three portions. More specifically, they also determined that eating seven or more portions of fruits and vegetables reduced the risk of death from heart disease by 31 percent and the risk of death from cancer by 25 percent. "We all know that eating fruit and vegetables is healthy, but the size of the effect is staggering," study author Oyinlola Oyebode, at the department of epidemiology and public health of University College London, in a release. "Vegetables have a larger effect than fruit, but fruit still makes a real difference. If you're happy to snack on carrots or other vegetables, then that is a great choice but if you fancy something sweeter, a banana or any fruit will also do you good.” Read more on nutrition.

Affordable Care Act Expected to Hit Goal of Coverage for 7 Million
Despite a glitch-filled rollout of HealthCare.gov that allowed few people to enroll over the first month, the Affordable Care Act and its online portals appear to be on track to meet the original goal of enrolling 7 million people by its deadline of yesterday, March 31, according to Obama administration officials. More than 6 million had signed up for health care coverage as of last week and the run up to the deadline saw a surge that should put the total over 7 million. The administration also recently announced an extension of the enrollment deadline for Americans who had attempted to sign up for coverage but were impeded by technological problems. Read more on the Affordable Care Act.

Mar 25 2014
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Public Health News Roundup: March 25

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Overweight Teens Should Start Healthy Eating by Cutting Down on Salt
Overweight or obese teenagers who eat lots of salty foods shows signs of faster cell aging, according to research presented at the American Heart Association’s Epidemiology & Prevention/Nutrition, Physical Activity & Metabolism Scientific Sessions 2014. Previous research found that protective ends on chromosomes (telomeres) naturally shorten with age, but the process is accelerated by smoking, lack of physical activity and high body fat. This study is the first to examine the impact of sodium intake on telomere length.

In the study, 766 people ages 14-18 were divided into the lowest or highest half of reported sodium intake. Low-intake teens consumed an average 2,388 mg/day, compared with 4,142 mg/day in the high-intake group. Both groups consumed far more than the 1,500 mg/day maximum (about 2/3 teaspoon of salt) recommended by the American Heart Association. After adjusting for several factors that influence telomere length, researchers found that in overweight/obese teens, telomeres were significantly shorter with high-sodium intake. In normal weight teens, telomeres were not significantly different with high-sodium intake.

“Even in these relatively healthy young people, we can already see the effect of high sodium intake, suggesting that high sodium intake and obesity may act synergistically to accelerate cellular aging,” said Haidong Zhu, MD, PhD, lead author of the study and assistant professor of pediatrics at Medical College of Georgia, Georgia Regents University in Augusta, Ga. “Lowering sodium intake may be an easier first step than losing weight for overweight young people who want to lower their risk of heart disease. The majority of sodium in the diet comes from processed foods, so parents can help by cooking fresh meals more often and by offering fresh fruit rather than potato chips for a snack.” Read more on heart health.

DOT Awards Grants to Improve Transportation for American Indian and Alaska Native Tribes
The U.S. Department of Transportation is awarding $5 million to 42 American Indian and Alaska Native tribes in 19 states for projects to improve transit service, in addition to $25 million in funds announced recently to help improve public transit service on rural tribal lands and better connect tribal members and other residents with jobs, education, and other opportunities.

“We fully recognize that residents on tribal lands and in surrounding communities often face significant transportation challenges, as many cannot afford to own a vehicle, or fill the tank, and yet must travel long distances to reach basic services,” said Federal Transit Administration head Therese McMillan. “We want to ensure that everyone who needs a ride to earn a paycheck, attend school, see the doctor, or buy groceries has that opportunity.” Read more on transportation.

Health Providers Should Prescribe Sleep for People with Metabolic Disorders
A new study in The Lancet Diabetes & Endocrinology finds that insufficient or disturbed sleep is associated with metabolic disorders such as type 2 diabetes and obesity, and addressing poor quality sleep should be a target for the prevention—and even treatment—of the disorders. According to the study authors, addressing some types of sleep disturbance—such as sleep apnea—may have a directly beneficial effect on patients' metabolic health, but a far more common problem is people simply not getting enough sleep, particularly due to the increased use of devices such as tablets and online games. The authors say that early studies are starting to provide evidence that there is a direct causal link between loss of sleep and the body's ability to metabolize glucose, control food intake, and maintain its energy balance. Read more on obesity.

Feb 14 2014
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Public Health News Roundup: February 14

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Public Health Wants to be Your Valentine

Looking for powerful ways to save I love you?

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American Society of Clinical Oncology Weighs in on Mammography
In response to a study published this week in the British Medical Journal which called into question the benefit of mammography, the American Society of Clinical Oncology (ASCO) issued a statement today saying that because mammography is similar to many other tests that can detect a condition that may never cause harm, the benefits of screening are likely to be greater for women who are at increased risk of developing breast cancer based on factors such as age and family history, than for women at average risk. It also stated no single study should be used to change screening policy and that all women should be encouraged to speak with their doctors about their personal risk for breast cancer, as well as the potential benefits and harms of mammography screening. ASCO and other cancer advocacy and women’s health groups have announced that they will be monitoring additional mammography studies now being conducted, and the American Cancer Society is expected to release new mammography recommendations later this year. Read more on cancer.

NHTSA Announces New Mandatory Label to Help Owners Instantly Identify Recall Mailings
The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) today announced that starting February 18, all manufacturers must use a distinctive label on the agency’s required mailings that notify owners of recalled vehicles or equipment.

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The requirement was introduced to help owners instantly distinguish important recall notices arriving in their mailboxes from other mail and hopefully avoid mistakenly discarding the safety notices. NHTSA has also just launched the SaferCar app for Android devices that will provide information for car owners and shoppers, including recalls and safety performance. There is already a SaferCar app for iPhone, iPad and iPod Touch users. Other safety notification options from NHTSA include:

  • Register Your Cars, Tires and Car Seats: Receive NHTSA email notifications when there is a recall by the federal government. There is no way to locate or notify individual owners of car seats or tires if the product is not registered with the manufacturer or NHTSA.
    Check for Open Recalls on Used Cars: Verify with the previous owner or dealer whether a used car has been fixed by using www.safercar.gov, which provides a general search tool to help consumers identify recalls that may affect their vehicle.

Read more on transportation.

Feb 7 2014
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Public Health News Roundup: February 7

Decrease in Pediatric Antibiotic Leveling Off 
The number of children taking antibiotics has decreased over the past decade, but that decrease has stalled in recent years in certain age groups and geographic locations, according to a study in Pediatrics. Researchers reviewed pharmacy and outpatient claims over a 10-year period (2000 to 2010) in three health plans located in three different geographic locations to determine the number of antibiotics dispensed each year for children ages 3 months to 18 years. Although the overall antibiotic-dispensing rate in each age group and health plan was lower in 2009-2010 than in 2000-2001, the rate of decline in antibiotic use has slowed. The highest rate of antibiotic use was in children age 3 months to less than 24 months of age in all years of the study.

The study authors say the previous downward trend in antibiotic use in children may have reached a plateau, and continued improvements in judicious antibiotic dispensing are needed. Read more on pediatrics.

NHTSA Gives Okay for Vehicle to Vehicle Communication to Help Prevent Crashes
The National Highway Traffic Safety Administration has announced that it will begin taking steps to allow vehicle-to-vehicle (V2V) communication technology for light vehicles, which will allow vehicles to "talk" to each other and ultimately avoid many crashes by exchanging basic safety data, such as speed and position, ten times per second.

The safety applications currently being developed provide warnings to drivers so that they can prevent imminent collisions, but do not automatically operate any vehicle systems, such as braking or steering, although NHTSA is also considering future actions on active safety technologies that rely on on-board sensors.

V2V communications can provide the vehicle and driver with 360-degree situational awareness to address additional crash situations — including those, for example, in which a driver needs to decide if it is safe to pass on a two-lane road (potential head-on collision), make a left turn across the path of oncoming traffic, or in which a vehicle approaching at an intersection appears to be on a collision course. In those situations, V2V communications can detect threats hundreds of yards from other vehicles that cannot be seen, often in situations in which on-board sensors alone cannot detect the threat. Read more on transportation.

Many Hospital ICUs Don't Follow Infection Prevention Rules
While most hospitals have evidence-based guidelines in place to prevent health care-associated infections in intensive care units (ICUs), clinicians often fail to follow them according to new research from the Columbia University School of Nursing published in the American Journal of Infection Control. The study, on over 1600 ICUs, found lax compliance in intensive care units where patients are more likely to be treated with devices linked to preventable infections – such as central lines, urinary catheters and ventilators.

The study focused on three of the most common preventable infections — central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections and determined that despite decades of research, establishing best practices for prevention of these infections, approximately one in 10 hospitals lack checklists to prevent bloodstream infections, and one in four lack checklists to help avoid pneumonia in ventilator patients, and that in hospitals with checklists, they are followed only about half of the time.

Health care-associated infections kill an estimated 100,000 Americans a year and result in over $30 billion in excess medical costs, according to the Centers for Disease Control and Prevention. Read more on injury prevention.

Jan 29 2014
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Public Health News Roundup: January 29

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NIDA Releases Resources on Identifying, Treating Teen Drug Abuse
As part of the annual National Drug Facts Week, the National Institute on Drug Abuse (NIDA) has released a collection of resources to help parents, health care providers and substance abuse treatment specialists identify teens at risk and help those struggling with drug abuse. The new resources include:

  • Thirteen principles to consider in treating adolescent substance use disorders
  • Frequently asked questions about adolescent drug use
  • Settings in which adolescent drug abuse treatment most often occurs
  • Evidence-based approaches to treating adolescent substance use disorders
  • The role of the family and medical professionals in identifying teen substance use and supporting treatment and recovery.

“Because critical brain circuits are still developing during the teen years, this age group is particularly susceptible to drug abuse and addiction,” said NIDA Director Nora D. Volkow, MD. “These new resources are based on recent research that has greatly advanced our understanding of the unique treatment needs of the adolescent.” Currently only 10 percent of adolescents ages 12 to 17 who need substance abuse treatment receive it, according to the 2012 National Survey on Drug Use and Health.  Read more on substance abuse.

Study: Public Transit Drivers Distracted an Estimated 39 Percent of their Time on the Road
Public transit bus drivers spend an estimated 39 percent of their time on the road distracted, according to a new study in the journal Traffic Injury Prevention. Researchers in the Department of Epidemiology at the University of Alabama at Birmingham observed and recorded distraction behaviors for three months, then compared them by route characteristics. Interactions with other passengers are the most common source of distraction. Drivers younger than 30 or older than 50, on city streets or highways, or who were driving more than 20 passengers were the most likely to be distracted. Researchers concluded that more needs to be done to educate drivers on the hazards of distracted driving and ways to avoid distractions. Read more on transportation.

Improved Education on Subsidies, Medicaid Could Reduce Number of Uninsured U.S. Adults
The number of U.S. adults who are uninsured could be significantly reduced with improved education on available subsidies and Medicaid expansion, according to the new quarterly Health Reform Monitoring Survey, conducted by Urban Institute researchers with funding from the Robert Wood Johnson Foundation and the Ford Foundation. The survey found that 39.3 percent of uninsured adults expect to have health insurance in 2014, and that four in 10 adults who expect to remain uninsured also think they will have to pay some sort of penalty. Read more on access to health care.

Jan 27 2014
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Public Health News Roundup: January 27

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Study: 20 U.S. Children Hospitalized for Gunshots Each Day
Each day approximately 20 children across the United States are hospitalized for a firearm injury, with more than 6 percent—or about one child a day—ultimately dying, according to a new study in the journal Pediatrics. Researchers from the Yale School of Medicine analyzed health records for 2009, finding a total of 7,391 hospitalizations and 453 deaths for children and adolescents younger than age 20. While most hospitalizations were for assault, for children younger than age 10 the cause was unintentional or accidental injury approximately 75 percent of the time. Firearm injuries can require extensive follow-up treatment, including rehabilitation; home health care; hospital readmission from delayed effects of the injury; and mental health or social services. "These data highlight the toll of gun-related injuries that extends beyond high-profile cases, and those children and adolescents who die before being hospitalized,” said John Leventhal, MD. “Pediatricians and other health care providers can play an important role in preventing these injuries through counseling about firearm safety, including safe storage.” Read more on violence.

Study: Integrating Vegetation into Transportation Planning Improve Air Quality, Public Health Overall
The strategic integration of trees, plants and other vegetation into transportation planning may have a positive effect on air quality specifically and public health overall, according to a new article from the U.S. Environmental Protection Agency, the U.S. Forest Service and other organizations. The study, which appeared in TR News Magazine, looked at short-term and long-term methods to reduce human exposure to pollutants along major transportation corridors. “Properly designed and managed roadside vegetation can help us breathe a little easier,” said Greg McPherson, PhD, research forester at the U.S. Forest Service’s Pacific Southwest Research Station. “Besides reducing pollutants in the air, these buffers can protect water quality, store carbon, cool urban heat islands and soften views along our streetscapes. They are essential components of green infrastructure in cities and towns.” Read more on transportation.

Quality Improvement Initiative Sees Significant Improvement in Teen Asthma Management
A quality improvement initiative from the Cincinnati Children's Hospital Medical Center has proven to significantly improve asthma outcomes for teenagers, a notoriously difficult demographic to help due to overall poor adherence to treatment. The study appeared in the journal Pediatrics. The researchers focused their efforts on 322 primary care patients with asthma, of which only about 10 percent had optimally well-controlled asthma. Starting in 2007, that percentage grew to 30 percent by 2009 and remained steady through the study’s end in 2011. The researchers also saw patient confidence in the ability to manage their asthma climb from 70 percent to 85 percent. "We were able to achieve sustained improvement in patients whose chronic asthma is not well-controlled by implementing a package of chronic care interventions,” said Maria Britto, MD, director of the Center for Innovation in Chronic Disease Care at Cincinnati Children's and senior author of the study. “These included standardized and evidence-based care; self-management support, such as self-monitoring by using diaries and journals; care coordination and active outreach among healthcare providers; linking these teens to community resources; and following-up with patients whose chronic asthma is not well-controlled." Read more on pediatrics.