In an effort to combat the growing epidemic of prescription drug abuse and overdose, the U.S. Food and Drug Administration (FDA) has approved a small, easy-to-use injector—similar to an EpiPen—that can be used to revive people who have stopped breathing or lost consciousness from an opioid drug overdose. The device, called Evzio, provides a single dose of naloxone, which is the standard treatment for opioid overdoses but up until now was mostly only available in hospitals and other medical settings.
The device, expected to be available starting this summer, will enable early intervention that increases the chances of survival. According to the National Center for Injury Prevention and Control , nationally, sales of prescription painkillers per capita have quadrupled since 1999—and the number of fatal poisonings due to prescription painkillers has also quadrupled.
The FDA’s approval comes at a critical time. In October of last year, Trust for America’s Health released a report that found that a very small number of states are implementing more than just a few promising strategies that have been identified to help combat the widespread drug abuse that continues to increase across the United States. The report, Prescription Drug Abuse: Strategies to Stop the Epidemic, which was funded by a grant from the Robert Wood Johnson Foundation, showed that only two states—New Mexico and Vermont—have implemented all ten strategies. TFAH also released an interactive tool with state-by-state prescription drug overdose death rates and state scores on the 10 key steps to curb abuse.
Carl R. Sullivan III, MD, director of the addictions program at West Virginia University, said the FDA’s approval of Evzio “is a big deal, and I hope [it] gets wide attention,” according to The New York Times. “It’s pretty simple: Having these things in the hands of people around drug addicts just makes sense because you’re going to prevent unnecessary mortality.”
Read the full story from The New York Times.
At this year’s Preparedness Summit, which met last week in Atlanta, the American Red Cross was a first-time partner for the annual event which brings together more than 1,000 preparedness experts from around the country.
“It was important for us to partner with the American Red Cross because they have a major role and responsibility in disasters,” said Jack Herrmann, the Summit chair and Chief of Public Health Preparedness at the National Association of County and City Health Officials (NACCHO), the lead partner for the Summit. “We felt that it was important that the public health and health care communities understand the Red Cross’ role and authority during a disaster and look for ways to foster and build partnerships [among] local health departments, state health departments and American Red Cross chapters across the country.”
Just prior to the Summit, NewPublicHealth conducted an interview by email with Russ Paulsen, Executive Director, Community Preparedness and Resilience Services of the American Red Cross.
NewPublicHealth: What are the key issues that communities should focus on now to get themselves better prepared for a disaster should it occur?
Russ Paulsen: Everyone has a role to play in getting communities better prepared for disasters.
As a first step, individuals, organizations and communities should understand the problem: What hazards are in their area? How likely are any of these hazards to become actual disasters? What have people already put in place to deal with them? Local Red Cross chapters can help with this assessment.
Once people understand the problem, the next step is to make a plan. Plan what to do in case you are separated from your family or household members during an emergency, and plan what to do if you must evacuate your home. Coordinate your household plan with your household members’ schools, daycare facilities, workplaces and with your community’s emergency plans.
HHS: Significant Improvement on Leading Health Indicators that Influence Reduction in Preventable Disease and Death
A new report from the U.S. Department of Health and Human Services (HHS), Healthy People 2020, finds that the country’s health is importing in more than half—14 of 26—of the critical measures known to have a major influence in reducing preventable disease and death. The Leading Health Indicators include categories such as access to care; maternal and child health; tobacco use; nutrition; and physical activity. “The Leading Health Indicators are intended to motivate action to improve the health of the whole population,” said Howard Koh, MD, Assistant Secretary for Health, in a release. “Today’s LHI Progress Report shows that we are doing just that.” Among the indicators that been met or are improving:
- Fewer adults smoking cigarettes
- Fewer children exposed to secondhand smoke
- More adults meeting physical activity targets
- Fewer adolescents using alcohol or illicit drugs
Read more on HHS.
Study: Americans Twice as Likely to Get Food Poisoning from Restaurants than at Home
Americans are twice as likely to get food poisoning from food at a restaurant than they are from food at home, according to a new study from the nonprofit Center for Science in the Public Interest (CSPI). The organization analyzed “solved” outbreaks over a ten-year period, finding that 1,610 outbreaks in restaurants sickened more than 28,000 people while 893 outbreaks linked to private homes sickened approximately 13,000 people. The study also determined that of the 104 outbreaks linked to milk, about 70 percent were caused by raw milk—meaning that while less than one percent of consumers drink raw milk, they account for 70 percent of the illnesses caused by milk-borne outbreaks. The researchers also expressed concern over the 42 percent drop in reported outbreaks from 2011 to 2012. "Underreporting of outbreaks has reached epidemic proportions," said CSPI food safety director Caroline Smith DeWaal. "Yet the details gleaned from outbreak investigations provide essential information so public health officials can shape food safety policy and make science-based recommendations to consumers. Despite the improvements in food safety policy in the past decade, far too many Americans still are getting sick, being hospitalized, or even dying due to contaminated food." Read more on food safety.
Study: Antipsychotic Medications for Foster Care Youth Remain High
Use of antipsychotic medications for unlabeled indications such as treatment for attention-deficit hyperactivity disorder (ADHD) is increasing among youth in foster care, according to a new study in the Journal of Adolescent Psychopharmacology. Researchers from the University of Maryland, Morgan State University and the Johns Hopkins Medical Institutions analyzed data on 266,590 youth ages 2-17 years and continuously enrolled in a mid-Atlantic state Medicaid program in 2006, finding that approximately one-third of the ADHD-diagnosed foster care youth included in the assessment received atypical antipsychotics. This study adds critical hard data to our understanding of a persistent and unacceptable trend in pediatric psychiatry," said Harold S. Koplewicz, MD, Editor-in-Chief of Journal of Child and Adolescent Psychopharmacology, and President, Child Mind Institute, in a release. "Our poorest, most vulnerable children, lacking access to evidence-based care, are receiving potentially harmful treatment with little oversight. The highlight of Burcu et al.'s paper for any reader should be the simple but necessary recommendations for antipsychotic prescribing and monitoring in these populations." Read more on prescription drugs.
On Friday, April 4, the Robert Wood Johnson Foundation held a First Friday Google+ Hangout to explore how the 2014 County Health Rankings can be used to move the needle toward healthy communities. Hosted by Susan Dentzer, RWJF senior policy advisor, the Hangout featured four panelists from various sectors working to improve the health of U.S. communities.
Marjorie Paloma, Senior Policy Advisor at the Foundation, provided viewers with an overview of the County Health Rankings and Roadmaps, explaining that the rankings continue to show that where we live matters to our health. The rankings allow each state to see how counties compare on a number of health factors, including housing, education, income and safety. The Rankings offer a look at health trends across the country in addition to county-level information. This year’s Rankings find that people who live in the least health communities are twice as likely to live shorter lives and that we are slowly seeing an uptick in the number of children living in poverty. However, there have been significant declines in smoking rates and violent crime.
“The Rankings really help us to see how we’re doing and also where we can improve on health,” said Paloma. “The Roadmaps are really a call to action. They are really helping to move communities from awareness to driving action.”
Paloma also highlighted the broad range of resources available through the County Health Rankings website for communities to find and develop health solutions.
According to Brian Smedley, Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies, the County Health Rankings is critical in understanding the importance of place as an upstream driver of health. Transportation, housing, opportunities for experience, quality of greenspace and more can be critical in determining the health of a community and the individuals who call it home. He explained that successful Roadmaps communities are ones that have built coalitions across different sectors and have health policy strategies that are local.
“We need to look at smaller geographic areas to see how neighborhoods affect health,” said Smedley. “A lens on place can be powerful in helping us to understand how we can reduce risks at the individual level and the community level.” He also offered additional tools for acquiring even finer cuts of data, such as Community Commons, local health departments and the U.S. Census Bureau.
Mary Lou Goeke, Executive Director, United Way of Santa Cruz County, offered a look at how the County Health Rankings and Roadmaps are used to improve health in Santa Cruz by shining a light on areas that need improvement and mobilizing the community to action. In particular, Goeke highlighted Santa Cruz’s efforts to reconcile a correlation between drinking rates and violent crime with the city’s new entertainment district. By using the data, the community was able to mitigate the potential harm of the entertainment district by implementing evidence-based practices to decrease drinking and crime.
“The County Health Rankings hold us accountable for things that aren’t working and encourages us to find new approaches,” said Goeke.
Katie Loovis, Director of U.S. Partnerships and Stakeholder Engagement, GlaxoSmithKline, explained how her company uses the rankings to shape its philanthropic efforts across the country. In the past few years, GlaxoSmithKline employees have overwhelming expressed support for the company to improve health in communities.
“If you want to improve health in your community, you have to know where you’re starting,” said Loovis. “The rankings do just that.” GlaxoSmithKline relies on the roadmaps to help highlight which interventions have the science to back them up and to identify which nonprofits to partner with in their target communities.
In addition, Loovis encourages local health departments and non-profits to reach out to local businesses directly and invite them to get involved in the solutions.
Each year during the first week of April, the American Public Health Association (APHA) hosts National Public Health Week, an opportunity to help communities across the United States highlight issues that are critical to improving the health of the nation. This year’s theme is “Public Health: Start Here”—entry points for making us a healthier nation. Each day this week has its own theme and NewPublicHeatlth will have a post about each one:
- Monday, April 7: Be healthy from the start. From maternal health and school nutrition to emergency preparedness, public health starts at home. Let us show you around. (Read a previous NewPublicHealth post, County Health Rankings — Nurse-Family Partnership: Q&A with Elly Yost, about how Rockingham County, N.C. is working to improve maternal health.)
- Tuesday, April 8: Don't panic. Disaster preparedness starts with community-wide commitment and action. We're here to help you weather the unexpected.
- Wednesday, April 9: Get out ahead. Prevention is now a nationwide priority. Let us show you where you fit in.
- Thursday, April 10: Eat well. The system that keeps our nation's food safe and healthy is complex. We can guide you through the choices.
- Friday, April 11: Be the healthiest nation in one generation. Best practices for community health come from around the globe.
In observance of National Public Health Week, NewPublicHealth spoke with Georges Benjamin, MD, executive director of the American Public Health Association about National Public Health Week 2014.
NewPublicHealth: Tell us about the 2014 National Public Health Week.
Georges Benjamin: We have an overarching theme, and it’s “Public Health: Start Here.” The intent is to get people to “just do it.” Often all of us have a tendency to kind of ruminate over what we want to do to improve the public’s health, and what we’re trying to emphasize this year is that there is enormous opportunity for people just to get up and do it. The evidence base is there, the opportunity is there, and so we’re just getting people to start improving their health.
We have five themes for the week. Monday is around early health such as maternal and child health; school nutrition; and conversations at home about how to make every family healthier. Tuesday is focused on emergency preparedness and disaster preparedness. On Wednesday we’ll be on prevention, including clinical and community preventive health services. Thursday’s focus is on eating well with a focus on the nutritional aspects of health. And Friday we look at becoming the healthiest nation in just one generation. Like the Robert Wood Johnson Foundation, the American Public Health Association is focused on a creating a culture of health and creating a healthy environment for everyone.
CDC Identifies Rare U.S. Case of Lassa Fever
A severe viral disease common in West Africa has been confirmed in a person returning to the United States from the region, according to the U.S. Centers for Disease Control and Prevention (CDC) and the Minnesota Department of Health (MDH). The patient was admitted to a Minnesota hospital for Lassa fever on March 31, with the CDC confirming diagnosis on April 3 and the patient now recovering and in stable condition. The last case of Lassa fever in the United States, of which there have been seven confirmed and all related to travel, was in Pennsylvania in 2010. The virus is not transmitted through direct contact with a sick person’s blood of bodily fluids and cannot by transmitted by casual contact; there are up to 300,000 cases and 5,000 deaths each year in West Africa. “This imported case is a reminder that we are all connected by international travel. A disease anywhere can appear anywhere else in the world within hours,” said CDC Director Tom Frieden, MD, MPH. Read more on infectious disease.
Public Health Officials in Developing Countries Use Social Marketing to Promote Health Behaviors
Public health officials in developing countries are successfully using social marketing strategies to educate people about the importance of behaviors related to water and sanitation, according to a new study in the journal Social Science & Medicine. In a systematic review of 32 studies, researchers led by W. Douglas Evans, PhD, a professor of prevention and community health at Milken Institute School of Public Health at the George Washington University, looked at how public health officials utilized social marketing tools such as door-to-door visits and public education campaigns for school children to promote behaviors such as regular hand washing and water purification. Read more on global health.
Depression, Anxiety Linked to Poor Diabetes Management
Depression and anxiety can be significant impediments to proper management of diabetes, according to a new study in the journal BioMed Central. Researchers from The University of Texas School of Public Health examined 500 Mexican-American adults from the Cameron County Hispanic Cohort in Brownsville, Texas, each of whom had been diagnosed diabetes and were taking medication for diabetes. Each t was interviewed about symptoms of depression and anxiety, and researchers also took measurements for body mass index (BMI), waist circumference, physical activity, fasting glucose and average blood sugar levels over time. “Unfortunately, greater depression and anxiety are associated with higher BMI and greater waist circumference, both indicators of obesity, as well as engaging in less physical activity and having less favorable indicators of glycemic control,” said Darla Kendzor, PhD, principal investigator and assistant professor at the School of Public Health Dallas Regional Campus, part of The University of Texas Health Science Center at Houston. Eighty one percent of Mexican-Americans are obese or overweight nationwide, with a nationwide diabetes rate of 16.3 that climbs to 30 percent for those who live along the U.S.-Mexico border. Read more on obesity.
Behavioral health was a frequent topic at this year’s Preparedness Summit in Atlanta for both presenters and attendees, who focus on helping people cope with stress during a disaster as well as on mental health conditions which can be exacerbated by the stress of an emergency. Thomas Bornemann, EdD, has been the director of mental health programs at the Carter Center in Atlanta since 2002. The Carter Center is the philanthropic foundation of former president Jimmy Carter and his wife, and focuses primarily on peace and health initiatives globally and in the United States.
NewPublicHealth spoke with Bornemann about the Center’s mental health programs and challenges that lie ahead. We spoke with Bornemann several days before the shooting this week at Fort Hood.
NewPublicHealth: What are the key mental health projects underway at the Carter Center?
Thomas Bornemann: We’re involved in a number of issues at the local level, national level and globally. One of our major global programs is a program in Liberia, West Africa, where we’ve been working on scaling up services in this post-conflict, low-income country. We are in our fourth year of five, and we’re providing three services: We’re training mental health workers because their mental health system was decimated after the war; we have helped them develop a national mental health policy plan and a national mental health law that will go to the legislature for approval this year we hope; and we’ve been working on the issues of stigma and discrimination against people with mental illnesses and helping to develop support for family caregivers who provide the lion’s share of the care.
In the United States we’ve been working for years on Mrs. Carter’s number one healthy policy priority, which has been the implementation of mental health parity legislation which passed in 2008. The U.S. Department of Health and Human Services has been working on final regulations since then which spell out the terms and conditions of parity. We’ve been working on monitoring that through the years, and we were very proud that in November Secretary Kathleen Sebelius came here to announce the release of the regulations out of respect for Mrs. Carter’s long commitment to parity legislation. We’ll continue to monitor the parity efforts as they become implemented through the Affordable Care Act.
CDC: Calls to Poison Centers for E-Cigarettes Has Jumped Dramatically Since 2010
Calls to poison centers involving e-cigarette liquids containing nicotine jumped from just one per month in September 2010 to 215 per month in February 2014, according to a new U.S. Centers for Disease Control and Prevention (CDC) study in the Morbidity and Mortality Weekly Report. There was no similar increase for conventional cigarettes. The study found that 51.1 percent of the e-cigarette calls involved children under age 5 and about 42 percent involved people ages 20 and older. “This report raises another red flag about e-cigarettes—the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, MD, MPH, in a release. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.” Read more on the FDA.
HHS Draft Report Would Strengthen Innovative Health IT, Help Patients
The U.S. Department of Health and Human Services (HHS) has released a draft report that includes a proposed strategy for a health information technology (health IT) framework to help promote product innovation while also ensuring patent protections and avoiding regulatory duplication. The congressionally mandated report was developed by the U.S. Food and Drug Administration in consultation with HHS’ Office of the National Coordinator for Health IT (ONC) and the Federal Communications Commission (FCC). “The diverse and rapidly developing industry of health information technology requires a thoughtful, flexible approach,” said HHS Secretary Kathleen Sebelius. “This proposed strategy is designed to promote innovation and provide technology to consumers and health care providers while maintaining patient safety.” Improved health IT could help lead to greater prevention of medical errors; reductions in unnecessary tests; increased patient engagement; and faster identifications of and response to public health threats and emergencies. Read more on technology.
Study: Fewer Cases of Smoking on TV Screens May Be Tied to Overall Drop in U.S. Smoking Rates
Fewer scenes of cigarette use in prime-time television shows may be linked to an overall reduction in the U.S. smoking rate, according to a new study in the journal Tobacco Control. Analyzing 1,800 hours of popular U.S. prime-time dramas broadcast between 1955 and 2010, researchers from the Annenberg Public Policy Center at the University of Pennsylvania in Philadelphia determined that scenes involving cigarette use on such shows fell from nearly five scenes per hour of programming (excluding commercials) in 1961 to about 0.3 scenes per hour in 2010. Based on this data they concluded that one less depiction of smoking per hour over two years of prime-time programming was associated with an overall drop of almost two packs of cigarettes, or 38.5 cigarettes, a year for every adult. The new findings support previous research showing that seeing other people smoke prompts cigarette cravings in adult smokers. Read more on tobacco.
Disaster experts at this week’s Preparedness Summit underscored the importance of meeting the specific needs of children and young adults in a disaster, who often react not only to their own response to a crisis but also to how adults around them are responding and dealing with the situation.
The Federal Emergency Management Agency (FEMA) has a program called Teen CERT (Community Emergency Response Team) which teaches readiness and response skills and includes practice and exercises. A California fourteen-year-old Teen CERT member, for example, has 17,000 Twitter followers for a weekly feed she updates with disaster preparedness tips.
Teen CERT Training takes 20-30 hours; more if teens are also certified in CPR, First Aid and the use of automatic defibrillators. Training includes:
- Keeping the teen volunteer safe while helping others
- Identifying and anticipate hazards
- Reducing fire hazards in the home and workplace
- Using fire extinguishers to put out small fires
- Assisting emergency responders
- Conducting light search and rescue
- Setting up medical treatment areas
- Applying basic first aid techniques and helping reduce survivor stress
Teen CERT members are also eligible for community credits which many high schools require for graduation.
And Columbia University’s National Center for Disaster Preparedness spearheads a program called SHOREline, which has a pilot program at five high schools in the Gulf Coast. Students work on organizational and leadership skills; meet and practice preparedness drills with local and national experts; and attend youth preparedness summits, said David Abramson, PHD, MPH, the deputy director of the Center who spoke about the SHOREline program at the Preparedness Summit this morning.
Abramson told attendees about the work of one group of SHOREline members at a Gulf Coast high school who took the lead on a disaster recently when a student at the school was killed by in a shooting. Seeing that the school had not planned a memorial service, the students raised $500 and bought all the helium balloons they could find for a service they planned and carried out that Abramson said was very critical for community recovery.
At the start of the 2014 Preparedness Summit meeting this week in Atlanta, Summit chair Jack Herrmann took a moment to remember the lives lost in the mudslide in Washington State last week and took note of the many public health workers who left their communities to help in the rescue and recovery. Since then, two more major disasters have occurred—the earthquake and tsunami waves in Chile and the shooting yesterday at Fort Hood. Conversations about those events, and other events back home that need the attention of public health staff even while they are on travel at a preparedness conference, can be heard in the hallways during breaks in the sessions as people who train for such disasters mourn the losses and offer their assistance.
Tom Hipper, Public Health Planner at the Center for Public Health Readiness and Communication at Drexel University in Philadelphia, had some advice for communications by public health departments not involved in a disaster earlier this week. Hipper advises delaying planned, non-urgent communication and sending out empathetic messages about the disasters which can help build community and resilience and give people a chance to become involved by expressing and sharing their sentiments. Hipper says empathetic communication can be a bonding experience and lets people know that others will be thinking about and trying to help them in the event of an emergency in their community.
In addition, says Hipper, while previously people outside a disaster area could often only help by donating money, they can now also be “digital volunteers” by posting and retweeting accurate information from credible sources about a disaster to let people impacted by an emergency know they’re not alone.
The Center maintains and updates a list of important preparedness resources.
>> Bonus Content: Read a previous NewPublicHealth Q&A with Jonathan Woodson on the U.S. Department of Defense’s overall approach to wellness and prevention for military, veterans and their families as part of our National Prevention Strategy series.