Category Archives: Access to Health Care

Oct 17 2013
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Public Health News Roundup: October 17

Electronic Laboratory Reporting Increasing
Federal agencies are reopening today after a 16 day shutdown and public health updates such as FluView from the Centers for Disease Control and Prevention are expected to come back online within the new few days. CDC’s last news release before the shutdown was on the increasing capability of laboratories to report findings to local and state health agencies electronically. The report was published in the most recent issue of Morbidity and Mortality Weekly Report (MMWR).

According to CDC, the number of state and local health departments receiving electronic reports from laboratories has more than doubled since 2005, however, progress is still needed. The MMWR report shows that only about a quarter of the nation’s labs are reporting electronically and that electronic reporting lags for some diseases behind others. For example, 76 percent of reportable lab results for general communicable diseases were sent electronically, compared to 53 percent of HIV results and 63 percent of results for sexually transmitted diseases. Read more on infectious disease.

District Laws and Policies Reduce Sugary Foods and Drinks at School Parties
Schools with a district policy or state law discouraging sugary foods and beverages were 2.5 times more likely to restrict those foods at school parties than were schools with no such policy or law, according to a new study published online in the Journal of Nutrition Education and Behavior.

Researchers at the University of Illinois at Chicago School of Public Health examined the linkages between state laws, district, and school-level policies for classroom birthday and holiday parties through surveys of more than 1,999 schools in 47 states.

About half the schools had either no restrictions or left the decision to teachers; one-third had school-wide policies discouraging sugary items; and fewer than 10 percent actually banned sweets during holiday parties or did not allow parties.

The study was supported by the Robert Wood Johnson Foundation. Read more on nutrition.

Children of Same Sex Marriages Less Likely to be Covered by Health Insurance
Children with same sex parents are less likely to have private health insurance than children with married opposite-sex parents, according to a recent study in Pediatrics. Using data from the 2008-2010 American Community Survey on children aged 0-17 years, the researchers found that 78 percent of children with married opposite-sex parents had private health insurance coverage, compared to 63 percent of children with same-sex fathers and 68 percent of those with same-sex mothers.

However, in states with legal same-sex marriage or civil unions, or in states that allowed second-parent adoptions, the disparities in private health insurance was lower for children of same-sex parents, suggesting that children of gay and lesbian households benefited from these policies. The American Academy of Pediatrics endorsed same-sex marriage in March. Read more on access to health care.

Oct 16 2013
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Public Health News Roundup: October 15

American Heart Association: Doctors Should Routinely Ask About Physical Activity
A new scientific statement from the American Heart Association says that doctors should evaluate their patients’ physical activity habits as routinely as checking blood pressure and other risk factors for cardiovascular diseases. The statement was published in the journal Circulation.

The statement says that an exercise checkup should cover types, frequency, duration and intensity of physical activity at work, home and during leisure time.

The American Heart Association recommends at least 30 minutes of moderate-intensity aerobic activity five days a week or more, or at least 20 minutes of vigorous aerobic activity three days a week or more and moderate- to high-intensity muscle strengthening at least two days a week. Read more on heart health.

People with Mental Health Problems More Likely to be Uninsured
A new University of Minnesota study published in Health Affairs finds that people with mental health problems are more likely to be uninsured and rely on public insurance than people without mental health problems. The study reviewed national insurance coverage rates from 1999 to 2010. The study authors say the implementation of the Affordable Care Act will give many more people with mental health problems access to health insurance – particularly in states such as Minnesota that have that have opted to expand their Medicaid programs. The researchers also say that people with mental health problems on public insurance have better access to care and lower cost barriers than the uninsured or those with private health insurance coverage.
 
Kathleen Rowan, the lead author of the study and a doctoral student in health services research, policy, and administration at the University of Minnesota School of Public, says, “unfortunately, most persons with mental illness do not receive needed care due in part to a lack of health insurance coverage and the cost of treatment.” Read more on mental health.

Study: Research to Delay Aging is a Better Investment Than Cancer, Heart Disease Research
A new study in current issue of Health Affairs finds that research to delay aging and the infirmities of old age would produce better health and economic returns than advances in some fatal diseases such as cancer or heart disease.

The study found that even modest gains in the scientific understanding of how to slow the aging process would result in an additional 5 percent of adults over the age of 65 remaining healthy rather than disabled every year from 2030 to 2060, or 11.7 million more healthy adults over age 65 remaining healthy by 2060.

The analysis was conducted by scientists from a consortium of research centers. “Even a marginal success in slowing aging is going to have a huge impact on health and quality of life. This is a fundamentally new approach to public health that would attack the underlying risk factors for all fatal and disabling diseases,” said S. Jay Olshansky, professor of epidemiology at the UIC School of Public Health and one of the study’s authors. “We need to begin the research now. We don’t know which mechanisms are going to work to actually delay aging, and there are probably a variety of ways this could be accomplished, but we need to decide now that this is worth pursuing.” Read more on aging.

Oct 15 2013
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Public Health News Roundup: October 15

Even Low Levels of Air Pollution Tied to Low Birth Weights
Even low levels of pollution can increase the risk of low-birth weight babies, according to a new study in The Lancet Respiratory Medicine. Researchers analyzed data on more than 74,000 women in 12 European countries, finding that all types of air pollution were linked to both increased risk of low birth weights and smaller average head circumference at birth.  The determined that every increase of 5 micrograms per cubic meter (mcg/m3) of fine particulate matter also increases the risk of low birth weight by 18 percent. The European Union’s current regulations call for a limit of 25 mcg/m3, but the study found the risk is still there at limits below this threshold; lowering it to the World Health Organization's guideline of 10 mcg/m3 could prevent as many as 22 percent of the cases. "Our findings suggest that a substantial proportion of cases of low birth weight at term could be prevented in Europe if urban air pollution—particularly fine particulate matter—was reduced," said lead author Marie Pedersen, MD, from the Centre for Research in Environmental Epidemiology in Barcelona, Spain. Read more on infant and maternal health.

Regular Exercise Can Boost Sperm Count, Improve Odds of Conception
Regular exercise—especially done outdoors—may boost a man’s sperm count and improve the odds of conception, according to a new study to be presented at the International Federation of Fertility Societies and the American Society for Reproductive Medicine in Boston. Researchers found that men who spent about an hour a day exercising had a 48 percent higher concentration than men who spent less than one hour a week exercising. The study also found clear associations between higher sperm counts and time spent either outdoors or lifting weights. Possible explanations include higher vitamin D levels in men who spent time outdoors in the sunshine and the increased testosterone levels and insulin sensitivity that come with lifting weights. Also, contradicting popular conceptions, the study found no link between caffeine and alcohol and decreased fertility. Read more on sexual health.

Study: Hospital CEO Salaries Tied to Patient Satisfaction, Not Quality of Care
Hospital CEO salaries tend to be higher at hospitals with high patient satisfaction ratings, and does not seem on average to be linked to either their quality of care nor the benefits they offer to their communities, according to a new study in JAMA Internal Medicine. "I was hoping I'd see even some modest relationship with quality performance," said lead researcher Ashish Jha, MD. "I think we were a little disappointed." Researchers at the Harvard School of Public Health analyzed data on 1,877 CEOs from 2,681 private, non-profit hospitals across the country, finding an average salary of $596,000; those in the lowest 10 percent earned about $118,000 and those in the highest earned about $1.7 million. While many different factors account for the wide range, Jha said the growing emphasis on improving quality measures suggests that the quality of care should be a factor when determining executive salaries. "If you're going to ask doctors and nurses to be accountable, if you're going to ask patients to be accountable…then I think we should make sure that everybody's in, and that senior managers of hospitals also have a stake in insuring high-quality care." Read more on access to health care.

Sep 26 2013
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Public Health News Roundup: September 26

Average Monthly Cost of Mid-tier Insurance Under Affordable Care Act Estimated at $328
The average monthly cost of a mid-tier health insurance plan under the Affordable Care Act will be $328, and government subsidies will also help reduce that cost for most Americans, according to a new report from the U.S. Department of Health and Human Services. The health exchanges open for enrollment next week and the federal government hopes to enroll as many as 7 million people within the first year. The cost varies from state to state, with Minnesota projected to have the least expensive plan at $192 per month and Wyoming projected to have the highest at $516. Read more on access to health care.

NIH Initiative Will Help Move Science from the Laboratories to the Commercial Sector
The U.S. National Institutes of Health (NIH) has awarded $31.5 million in grants to establish three inaugural NIH Centers for Accelerated Innovations that will work to improve how basic science discoveries move from laboratories to commercial products. The Centers are funded by NIH’s National Heart, Lung and Blood Institute (NHLBI) and will focus on technologies to improve the diagnosis, treatment, management and prevention of heart, lung, blood and sleep disorders and diseases. “These centers essentially will offer a one-stop shop to accelerate the translation of early-stage technologies for further development by the private sector and ultimate commercialization,” said Gary H. Gibbons, MD, director of NHLBI. As a result, the public will gain access sooner to new biomedical products that improve human health while also benefiting from the economic growth associated with the creation of new companies and the expansion of existing ones.” Read more on research.

‘Cycling’ Drugs Could Help Combat Antibiotic-resistant Bacteria
“Cycling” between antibiotics may extend their life and effectiveness, while also enabling doctors to stay ahead of drug-resistant bacteria, according to a new study in the journal Science Translational Medicine. "You cycle between drugs that have reciprocal sensitivities," said study co-author Morten Sommer, a lead researcher with the Novo Nordisk Foundation Center for Biosustainability at the Technical University of Denmark. "If you become resistant to drug A, you will become more sensitive to drug B. That way, you can cycle between drug A and drug B without increasing resistance in the long term.” With the increased use—and overuse—of antibiotics, antibiotic-resistant bacteria are becoming an increasingly serious public health problem, leading researchers and health care professionals in search of new ways to combat the problem. More than 2 million people are made ill and more than 23,000 people die every year in the United States due to antibiotic-resistant infections, according to the U.S. Centers for Disease Control and Prevention. Read more on prescription drugs.

Sep 19 2013
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Public Health News Roundup: September 19

Confusing ‘Sell-by’ and ‘Best-before’ Labeling Leads to Billions of Pounds of Wasted Food
Inconsistent “sell-by” and “best-before” dates on package labels lead Americans to needlessly discard billions of pounds of food every year, according to a new study by Harvard Law School and the Natural Resources Defense Council. The labels are meant to inform retailers about a food product’s peak freshness. "The labeling system is aimed at helping consumers understand freshness, but it fails—they think it's about safety. And (consumers) are wasting money and wasting food because of this misunderstanding," said co-author Emily Broad Lieb, who led the report from the Harvard Law School's Food Law and Policy Clinic. The study recommends that “sell-by” dates be reconfigured so as to be invisible to consumers, that a uniform label system is created and that technology-based “smart labels” be used more often. "Under the current patchwork of state and federal laws, consumers are left in the lurch, forced to decipher the differences between 'sell-by' and 'best if used by,' and too often food is either thrown out prematurely, or families wind up consuming dangerous or spoiled food," said Congresswoman Nita Lowey (D-NY), in a release. Read more on food safety.

Study: Hospitals that Perform the Most Surgeries Also Have Lowest Readmission Rates
A new study from the New England Journal of Medicine indicates that the higher quality of care during a surgical procedure, the lower the likelihood of the patient being readmitted for additional surgery. It also found that hospitals that performed the most procedures also, on average, delivered a higher quality of care. In a review of about 480,000 patients discharged from more than 3,000 U.S. hospitals, the researchers found that one in seven were readmitted within 30 days, with the hospitals that did the most procedures having both the lowest readmission rates and the lowest death rates. Hospitals with the most surgeries had readmission rates of about 12.7 percent, compared to 16.8 percent for hospitals with the fewest procedures. "If hospitals performing very few surgeries do not have the volume required to create highly reliable care systems despite their best quality-improvement efforts, perhaps they should not be performing them," said Don Goldmann, MD, chief medical and scientific officer of the Institute for Healthcare Improvement in Boston, who was not involved in the study. "This is a provocative suggestion and deserves careful consideration before being implemented." Read more on access to health care.

HHS ‘Meaningful Consent’ Website to Help Providers, Patients Understands EHR Sharing
As electronic health records (EHRs) become more common, a new website from the U.S. Department of Health and Human Services (HHS) will help health care providers and patients determine exactly how they want their electronic patient health information shared. Meaningful Consent will address issues such as the laws and policies related to the health information exchange (HIE). It also includes strategies and tools for providers, certain health information organizations and other implementers of health information technology. The site also provides background, lessons learned, videos and customizable tools from the HHS Office of the National Coordinator for Health Information Technology’s eConsent pilot project, which tested the use of tablet computers to provide patients with better information on EHRs. Read more on technology.

Sep 16 2013
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Public Health News Roundup: September 16

U.S. Youth Exercise, Diet Improved Over Past Decade
Exercise and dietary habits of U.S. kids and teenagers seems to have improved over the past decade, according to a new study in the journal Pediatrics. The study found that from 2001-2002 to 2009-2010, the average number of days per week being physically active for at least 60 minutes for sixth through tenth graders climbed from 4.3 to 4.5; the days eating breakfast before school climbed from 3 to 3.3; and hours per day watching television dropped from 3.1 to 2.4. The findings suggest that it takes time for public health efforts to translate into behavioral changes. "I would like to believe that all the public health efforts focusing on increasing physical activity and increasing fruit and vegetable consumption are having an effect, because that seems to be a pattern," said Ronald Iannotti, study author from the University of Massachusetts Boston. "The fact that (obesity) is leveling off, that's a surprise and a major change from the steady increase that we've seen over time.” Read more on pediatrics.

Study: Kids of Same-sex Couples Less Likely to Have Private Health Insurance
Children of same-sex parents are less likely to have private health insurance, although the rates improve in states that recognize same-sex marriages or unions, according to a new study in the journal Pediatrics. Approximately two-thirds of U.S. youth with same-sex parents have private health insurance, compared to approximately 78 percent of U.S. youth with married heterosexual parents. When accounting for additional factors such as parental incomes and education level, researchers determined that youth living with same-sex parents were as much as 45 percent less likely to have private health insurance than were youth living with married heterosexual parents. The findings indicate yet another public health benefit of same-sex marriage, as access to health insurance directly affects a child’s health; previous studies have shown a connection between legal unions and improved mental health for gay and lesbian adults. A likely cause for the disparity is the fact that employers have not had to extend coverage to an employee’s same-sex partner or that employee’s children. "I think we are going to see more and more research like this that shows how marriage-equality laws have far-reaching health consequences," said Richard Wight, a researcher at the University of California, Los Angeles, who was not a part of the study. Read more on LGBT issues.

HHS: $67M for Expanded Preventive and Primary Care for 130,000 Americans
The U.S. Department of Health and Human Services (HHS) has awarded approximately $67 million for the creation of 32 new health service delivery sites to expand access to individuals, families and communities across the country. The sites will provide improved preventive and primary health care to more than 130,000 people. Another $48 million will go toward the approximately 1,200 existing centers. “Health centers have a proven track record of success in providing high quality health care to those who need it most,” said HHS Secretary Kathleen Sebelius. “New health center sites in some of the neediest communities in the country will provide access to health care for individuals and families who otherwise may have lacked access to high quality, affordable and comprehensive primary care services.” Read more on access to health care.

Sep 12 2013
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Recommended Reading: Giving Context to ‘200,000 Preventable’ Cardiovascular Deaths

Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.

Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.

The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.

Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?

“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”

That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.

The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.

That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.

“That’s a story that needs to be told, with context.”

>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”

Sep 9 2013
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Low-Income Housing in the Bronx Gets Healthy and Green

file Via Verde offers green, healthy low-income housing. (Image credit: David Sundberg/Esto)

In the 1970s and 80s, residents of the Bronx, one of New York City’s five boroughs, were so anxious to leave the crime-ridden area that many residential and commercial buildings—once majestic and architecturally rich—were torched and empty for decades. Now fifty years later there’s a waiting list of thousands for Via Verde, a new low- and middle-income Bronx housing complex that opened last year. Many features set the complex apart from almost any other housing development in the United States, including an emphasis on greenery from almost every vantage point of the building. This helps create a calming and beautiful atmosphere for the residents, many of whom grew up in crowded housing projects where any nearby parks were usually too dangerous to enjoy.

Why is housing important for health? A lack of affordable rental housing can push more tenants into substandard or overcrowded living situations. Living in unaffordable housing also leaves fewer resources for the things that can keep a family healthy, such as healthy food or preventative health care. Low-income housing also has a reputation for being unhealthy, and for good reason—more than 6 million housing units in the U.S. have deficiencies such as lead paint hazards; allergens, dampness and mold that can trigger asthma; and unsafe structural issues that can cause falls and other injuries. Via Verde and other similar efforts seek to change all that, with housing that is not only affordable but also safe, healthy and even environmentally sound and sustainable (which in turn also saves on costs).

The design for Via Verde was the winner of a 2006 competition hosted by the New York City Department of Housing Preservation and Development; the New York Chapter of the American Institute of Architects; the New York State Energy Research and Development Authority (NYSERDA); and the Enterprise Foundation. It was New York City’s first juried design competition for affordable and sustainable housing.

Read more

Aug 29 2013
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Public Health News Roundup: August 29

Women with Midwives Less Likely to Have Complicated, Premature Births
Pregnant women cared for by midwives are less likely to have complicated or premature births, according to a new review of 13 studies by The Cochrane Library. The analysis found that women with midwives were 23 percent less likely have premature births and 19 percent less likely to lose the fetus before 24 weeks. Such pregnancies are also linked to fewer epidurals, episiotomies and the use of instruments such as forceps or vacuums during delivery. Lead author Jane Sandall, professor of social science and women's health in the Division of Women's Health of King's College London, said the next step is to determine exactly why this is the case. "For example, whether it is the model of care itself where midwives are in a position to pick up problems and get the right specialist input as early as possible, or whether a relationship where a women knows and trusts her midwife leads to a better outcome," said Sandall, according to Reuters. Read more on maternal and infant health.

Survey: Large U.S. Employers to Pay 7 Percent More on Health Benefits in 2014
Large U.S. employers estimated the cost of providing health care benefits to their employees will rise 7 percent in 2014, according to a new survey from the National Business Group on Health. The organization is a non-profit association of more than 265 large employers. The survey also found that some employers are interested in the possibility of health insurance exchanges for certain populations, as well as that more companies intend to offer consumer-directed health plans as their only options. This would be the third consecutive year that employers have budgeted for an increase of 7 percent. While this means rates have been kept “stable,” employers are still looking at ways to engage workers in health management and healthy lifestyles that would also help lower costs. “Rising health care costs remain a serious concern for U.S. employers,” said Helen Darling, President and CEO of the National Business Group on Health. Read more on access to health care.

More than 8.5 Million U.S. Adults Use Prescription Sleep Aids
More than 8.5 million U.S. adults took a prescription sleep aid in the past month, according to a new report from the U.S. Centers for Disease Control and Prevention (CDC). As many as 70 million U.S. adults suffer from a sleeping disorder. The report found that the rates of use increases with age, that about 5 percent of women over the age of 20 utilized the medications, that about 3.1 percent of men over the age of 20 utilized the medications and that the higher a person’s level of education, the less likely they were to take the drugs. Report coauthor Yinong Chong, an epidemiologist at the CDC's National Center for Health Statistics, said the rate of usage climbed only about 1 percent from 1999 to 2010. Jordan Josephson, MD, a nasal and endoscopic sinus surgeon at Lenox Hill Hospital in New York City, said the report findings were not surprising. "More accurate diagnosis and better education has led more people to seek treatment for these disorders, which affect them in every aspect of their lives," he said. "For those people who suffer from fatigue and/or daytime somnolence—being tired and feeling sleepy—it is important for them to seek treatment from a board-certified sleep specialist.” However, the U.S. Food and Drug Administration has also lately been taking a closer look at the effects of sleep aids—which recent evidence shows can last into the following day—and plans to have manufacturers perform more extensive tests on the drugs. Read more on prescription drugs.

Aug 21 2013
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Public Health News Roundup: August 21

Kaiser Family Foundation Finds Modest Increase for Family’s Share of Employer-Sponsored Health Insurance
Annual premiums for employer-sponsored family health coverage reached $16,351 this year, up 4 percent from last year, with workers on average paying $4,565 toward the cost of their coverage, according to a new Kaiser Family Foundation survey of more than 2,000 employers. That rise is moderate by historical standards according to the survey; since 2003, premiums have increased 80 percent, nearly three times as fast as wages (31 percent) and inflation (27 percent).

The survey also found that large deductibles of at least $1,000 are common in employer-sponsored plans, especially for employees at smaller firms. This year, 38 percent of all covered workers face such a deductible. At small firms, 58 percent of covered workers now face deductibles of at least $1,000, including nearly a third (31 percent) who face deductibles of at least $2,000, up from 12 percent in 2008.

Additional findings of the survey:

  • Nearly all large employers (at least 200 workers) offer at least one wellness program and more than a third (36 percent) of large employers who offer them also provide some kind of financial incentive for workers to participate, such as lower premiums or a lower deductible, receiving a larger contribution to a tax-preferred savings account, or gift cards, cash or other direct financial incentives.
  • Among large firms offering health benefits, more than half (55 percent) offer some kind of biometric screenings to measure workers' health risks. Of these, 11 percent reward or penalize workers financially based on whether they achieve specific biometric outcomes.

"This will be an important issue to watch next year, as employers [under the Affordable Care Act can] ask workers to pay more because of their lifestyles and health conditions," said Kaiser Vice President Gary Claxton, the study's lead investigator and director of the Foundation's Health Care Marketplace Project.

Read more on access to health care.

CDC: $75.8M to Help Health Departments Prepare for, Respond to Infectious Diseases
The U.S. Centers for Disease Control and Prevention (CDC) has awarded approximately $75.8 million in grants to help state, territorial and certain local health departments prepare for—and respond quickly to—an array of infectious diseases. The grants are through the Epidemiology and Laboratory Capacity for Infectious Diseases Cooperative Agreement. They will go to such critical areas as surveillance, detection, and outbreak response efforts in infectious disease areas such as foodborne diseases, influenza and healthcare-associated infections. “With many infectious diseases first identified at the local level, this funding ensures that state health departments are able to effectively prevent, detect and respond to such public health threats,” said Beth P. Bell, MD, MPH, director of CDC’s National Center for Emerging and Zoonotic Infectious Diseases.” Read more on infectious diseases.

Study: Quitting Smoking Even After Becoming Pregnant Reduces Risk, Complications of Low Birth Weight
While women who quit smoking right before or right after becoming pregnant will on average gain more pregnancy-related weight, and are also less likely to have babies who are born small, according to a new study in the journal Obstetrics and Gynecology. Low birth weight increases the risk for infections; breathing and respiratory disorders; delayed growth and social development; and learning disabilities. Other studies have also linked smoking during pregnancy to premature birth, birth defects and stillbirth. "The big thing to get out of this study is that quitting early in pregnancy is as helpful in respect to the birth weight of your baby as never having smoked while you were pregnant," said Amber Samuel, MD, a maternal-fetal medicine expert at Emory University School of Medicine in Atlanta. "I think that can be an inspiration to moms who are looking to make a change in their lives." Read more on maternal and infant health.