‘Clean Your Plate’ Order Can Lead to Negative Results
The seemingly reasonable parental edict of “clean your plate” may in fact be counterproductive toward maintaining a healthy weight, according to a new study in the journal Pediatrics. The same can be true with instruction to eat less. Researchers found that restrictive instructions were more common with kids who were overweight and obese, while kids who weren’t overweight were more often linked to encouragement to finish meals. "In the 1950s, cleaning your plate meant something different,” said author Katie Loth, a registered dietician, doctoral candidate and research assistant at the University of Minnesota in Minneapolis. “Portion sizes have gotten bigger over time, and if you encourage kids to rely on environmental indicators, like how much food is on their plates or the time of day, they'll lose the ability to rely on internal cues to know whether they're hungry or full." About 17 percent of U.S. youth and adolescents are obese, according to the U.S. Centers for Disease Control and Prevention. Read more on obesity.

Study: Lack of Insurance Leading Cause of Difficulty for Young Adults with Asthma
Leaving high school and a lack of adult supervision are both factors that may explain the general decline in asthma control for young adults once they’re over the age of 18. However, the main cause is a loss of health insurance, according to a new study in the journal Pediatrics. Researchers found that those under 18 were more likely to utilize primate care and medications. On the other hand, those over age 18 were more likely to turn to emergency care and have difficulty getting costly treatments. While young adults are generally healthier than older adults, people with chronic conditions such as asthma still need to be sure to seek out proper treatment. "Young people with asthma need to work with their care providers to create transition plans from pediatric to adult care that take into account their medical and social history," said study leader Kao-Ping Chua, a staff physician in the division of emergency medicine at Boston Children's Hospital. Read more on access to health care.

China’s Bird Flu Outbreak Keeps Growing; 20 Dead, 105 Infected
China’s outbreak of H7N9 virus—a new strain of bird flu—continues to spread, with 20 people dead and 105 overall infected, according to Reuters. The World Health Organization is conducting field investigations into the infections and the public health response to the outbreak. Ho Pak-leung, an associate professor in the Department of Microbiology at the University of Hong Kong, recently British Medical Journal that this outbreak has already caused twice as many Chinese infections as the H5N1 strain did in about a decade. "H7N9 is much more transmissible to humans, and it's much more difficult to track down," he said. "We don't understand why it's so difficult to find." Read more on infectious disease. Also, read more on what you need to know about H7N9 on APHA's Get Ready blog.

Hookahs Not a Safe Alternative to Cigarettes
Despite the belief of many, smoking tobacco using a hookah is not a safe alternative to cigarettes, according to a new study in the American Association for Cancer Research’s Cancer Epidemiology, Biomarkers & Prevention. Hookah use produces higher levels of carbon monoxide and benzene, linked with heart or respiratory conditions and increased risk of leukemia, respectively. “People want to know if it is a lesser health risk if they switch from cigarettes to smoking a water pipe on a daily basis,” said UC San Francisco research chemist Peyton Jacob III, PhD. “We found that water-pipe smoking is not a safe alternative to cigarette smoking, nor is it likely to be an effective harm-reduction strategy.” The mix of toxins produced by a hookah is due to the combination of the two difference materials smoked, according to researcher Neal Benowitz, MD, of the San Francisco General Hospital and Trauma Center. “You’re basically burning a charcoal briquette on top of the tobacco,” Benowitz said, “and most of what you’re smoking is a moist fruit preparation, which is mixed with the tobacco. It smells good and it tastes good.” Read more on tobacco.

CDC: Number of U.S. Foodborne Illness Cases at a Standstill
After dropping for many years, the number of foodborne illnesses in the United States has apparently leveled out, according to a new study in the Morbidity and Mortality Weekly Report. About 48 million people—or one in six—suffer from a foodborne illness each year. The most common cause is salmonella. "It is still the case now that numbers were lower than they were back in the 1990s," said Robert Tauxe, MD, deputy director of the division of foodborne, waterborne and environmental diseases at the U.S. Centers for Disease Control and Prevention (CDC). "But right now we're just about where we were in 2006 to 2008, and we may need to identify additional ways to reduce contamination, as well as heightening awareness among consumers about the importance of thoroughly cooking and safely handling ground beef in their own homes." Read more on food safety.

Exercise, Healthy Eating Helps Keep Sleep Apnea in Check
The combination of exercise and healthy eating is a simple way to ease the effects of mild sleep apnea, according to a new study in JAMA Internal Medicine. The key is weight loss. Researchers “found obese study participants who went through a one-year lifestyle intervention were about half as likely to see their sleep apnea progress to more severe disease,” according to Reuters. "It usually takes at least a few years to progress from mild disease to the more severe disease, and mostly it's due to weight gain," said Henri Tuomilehto, MD, who led the new study at the Oivauni Sleep Clinic in Kuopio, Finland. "With these results, we can say that if we change our lifestyle…we really can stop the progression of sleep apnea.” Read more on obesity.

Doctors’ Knowledge of Lab Test Costs Reduces Unnecessary Testing
Knowing the cost of a laboratory tests makes doctors less inclined to order them for hospitalized patients, according to a new study in JAMA Internal Medicine. About $226 billion was wasted on unnecessary tests in 2011, according to the study from researchers at The Johns Hopkins University School of Medicine in Baltimore. Unnecessary tests also increase the risk of patient harm and false positives. "The rational approach to ordering tests is something we should all be interested in, and something—if we did better—that would save the system money and save the patients the horror of causing harm," said Leonard Feldman, MD, of Johns Hopkins. Read more on access to health care.

Mass. Study Shows Importance of Simplifying Health Insurance Benefits Options
Just six months before open enrollment for the Affordable Care Act’s health insurance marketplaces begins, a new study in the journal Health Affairs shows that some Massachusetts families who enrolled in unsubsidized Commonwealth Health Insurance Connector Authority plans experienced higher financial burdens due to health care costs. The study found that 38 percent saw financial burdens and 45 percent saw higher-than-expected out-of-pocket costs—indicating that lower-income families with increased health care needs and multiple children are at particular risk for higher costs. “Given the complexity of health insurance choices and consumers’ limited understanding of health insurance benefits, policy makers need to reach out and simplify information to promote optimal plan choices for the people,” wrote the study’s authors. Read more on community health.

CSPI Classifies Ginkgo Biloba as ‘Avoid’
The Center for Science in the Public Interest (CSPI) is now recommending people avoid Ginkgo biloba after a National Toxicology Program study linked it to liver cancer in mice and thyroid cancer in rats. The substance can be found in many dietary supplements, herbal teas and energy drinks. "Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks with it confer some sort of benefit for memory or concentration," said CSPI executive director Michael F. Jacobson. "The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm." The U.S. Food and Drug Administration has previously sent warning to drink manufacturers stating that the ingredient is not generally considered safe for food. Read more on nutrition.

CDC: Cutting Smoking in Subsidized Housing Would Save $521M Annually
Eliminating the ability to smoke in U.S. subsidized housing would save approximately $521 million each year in health care, renovation and fire-related costs, according to the U.S. Centers for Disease Control and Prevention (CDC). This includes public housing and rental assistance programs. Secondhand smoke can be especially problematic in multi-unit buildings with at-risk populations and smoking in common rooms. "Many of the more than 7 million Americans living in subsidized housing in the United States are children, the elderly or disabled," said Tim McAfee, MD, MPH, director of the Office on Smoking and Health at CDC. "These are people who are most sensitive to being exposed to secondhand smoke. This report shows that there are substantial financial benefits to implementing smoke-free policies, in addition to the health benefits those policies bring." Read more on tobacco.

HHS Campaign to Promote Breastfeeding by African American Mothers
The new It’s Only Natural public education campaign from the U.S. Department of Health and Human Services will work to raise awareness of the importance of breastfeeding among African American women, according to Surgeon General Regina M. Benjamin, MD, MBA. “One of the most highly effective preventive measures a mother can take to protect the health of her infant and herself is to breastfeed,” she said in a release. “By raising awareness, the success rate among mothers who want to breastfeed can be greatly improved through active support from their families, their friends and the community.” While overall 80 percent of U.S. women start out breastfeeding, that number is only 55 percent for African American women. The new campaign provides material specifically targeting African American women and giving them the information and encouragement they need to start and continue breastfeeding. Read more on maternal and health disparities.

U.S. Infant Mortality Rates Down; More Improvement Still Needed
Improvements in prenatal care and a reduction in elective deliveries helped cut the U.S. infant mortality rate by 12 percent from 2005 to 2011, according to a new study in the NCHS Data Brief. The National Center for Health Statistics (NCHS) said the rate was down to 6.05 deaths per 1,000 live births in 2011 from 6.87 in 2005. The rate of death from SIDS also dropped 20 percent over the period. Still, study author Marian MacDorman, PhD, an NCHS statistician, said more work is needed, noting that “preterm birth rates are much higher than in other countries, and the same is true with infant mortality" and that "[i]nfant mortality among blacks is about twice what it is for white women,” according to HealthDay. Jeffrey Biehler, MD, a pediatrician at Miami Children's Hospital, said that we "need to continue to advocate for prenatal care for every woman, and make sure they are educated so they know to seek care as early as possible and avoid smoking and alcohol and other things that put them and their babies at risk.” Read more on maternal and infant health.

CDC, SAMHSA and Red Cross Resources Help Individuals and Communities Cope with Disaster
Immediately after the explosions at the Boston Marathon yesterday, both the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) updated their crisis management resources and moved the information to the top of their home pages. CDC’s “Tips for Self Care” includes advice on dealing with stress and suggestions for connecting socially after a traumatic event, avoiding drugs and alcohol, as well as links to SAMHSA’s disaster distress helpline  which can be accessed by phone, text, twitter and Facebook. SAMHSA’s site also includes resources for students, parents, teachers, caregivers, children, first responders and health professionals.

Following the explosions, families and friends found that cell phone and in some cases even texting communication was jammed, making it difficult for people to know whereabouts of those involved in the explosion. The American Red Cross offers a free service called the Safe and Well website which is a central site for people in disaster areas in the United States to register their current status, and for their loved ones to access that information. The Red Cross says the site helps provide displaced families with relief and comfort during a stressful time. The site is easy to use:

• If you are currently being affected by a disaster somewhere in the United States, click List Myself as Safe and Well, enter your pre-disaster address and phone number, and select any of the standard message options.
• If you are concerned about a loved one in the United States, click Search Registrants and enter the person’s name and pre-disaster phone number OR address. If they have registered, you will be able to view the messages they have posted.

The site is available 24 hours a day, 365 days a year and is accessible in both English and Spanish. Read more on preparedness.

Mortality Rates Highest at Small Rural Hospitals
A new study by researchers at the Harvard School of Public Health (HSPH) finds that a failure to stay up to date in the treatments they provide may be a factor in climbing death rates at rural hospitals. The study appeared in the JAMA. The HSPH researchers reviewed data from small, rural hospitals that receive government reimbursements and are exempt from participation in national quality improvement programs. The researchers looked at data on 10 million Medicare patients who were admitted to these small rural hospitals or other hospitals with a heart attack, congestive heart failure, or pneumonia—and compared 30-day mortality rates for each of the three conditions over a nine-year period. While ten years ago, mortality rates for each of these conditions were about the same at hospitals, the researchers found that between 2002 and 2010, mortality rates at CAHs increased at a rate of 0.1% per year, while at non-CAHs they decreased 0.2% per year. By 2010, CAHs had higher overall mortality rates—13.3% versus 11.4% at non-CAHs. “Small rural hospitals are being left behind,” says Karen Joynt, MD, MPH, the lead author on the study. “By creating a separate category for these hospitals, we’ve really left them out of many of the advances in medical care over the past decade, and we need systems-level solutions to help improve healthcare in these rural areas.” Read more on health disparities.

High Resting Heart Rate Indicates Increased Risk of Early Death
Faster than normal heart rates—even in men who exercise—could indicate a higher risk of early death, according to a new study in the journal Heart. While previous studies have shown a connection between heart rate and life expectancy, this study looked specifically at whether that was also true for healthy people who got regular exercise; the results indicate that resting heart rate is a risk factor independent of other health markers. Each 10-beat-per-minute resting heart rate increase corresponded to a 16 percent increase in the likelihood of death. Gregg Fonarow, MD, a professor of cardiology at the University of California, Los Angeles, said there are ways to improve resting hear rate. "Increasing physical activity and decreasing periods of sitting can lower heart rate and lower cardiovascular risk," he said, adding that stopping smoking can also lower heart rate. Read more on heart health.

Small Amounts of Daily Exercise Can Help Teens Quit Smoking
As little as 30 minutes of daily exercise can help kids quit smoking, according to a new study in the Journal of Adolescent Health. It can also help to reduce tobacco use. Researchers found that daily smokers were more likely to reduce or quit smoking if they combined a fitness program with a smoking cessation program, rather than just a cessation program alone. Every teen in the study smoked an average of half a pack of cigarettes each weekday and a full pack a day on weekends. And that was just one of the poor health habits of many of the participants. "It is not unusual for teenage smokers to engage in other unhealthy habits,” said author Kimberly Horn, associate dean for research at the George Washington University School of Public Health and Health Services. “Smoking and physical inactivity, for instance, often go hand in hand.” According to the U.S. Centers for Disease Control and Prevention, about 13 percent of Americans age 18 and under smoke tobacco. Read more on tobacco.

Study: Low Food Security, Exposure to Violence Closely Linked
There is a close correlation between low food security and exposure to violence, according to a new study in Public Health Nutrition. Researchers spoke with forty-four mothers of children age 3 and under who participated in public assistance programs, finding increased exposure to violence, which in turn increased the chance of negative mental health, an inability to continue school and an inability to make a living wage.  The violence included child abuse, neglect and rape. The study clearly demonstrates the need to consider and include violence prevention efforts when establishing policies to deal with hunger. Read more on violence.

Size of Parents’ Social Groups Can Affect Whether Kids are Vaccinated
What they hear from friends and the people in their social group may affect whether parents have their children vaccinated, according to a new study in the journal Pediatrics. Parents who were less likely to vaccinate were also more likely to have large social groups and rely on books, pamphlets and the Internet for information on vaccines. "I think that what needs to be done is that everybody needs to understand the importance of vaccines,” said Joseph Anthony Bocchini, Jr., MD, chairman of Pediatrics Medicine at Louisiana State University Health Sciences Center in Shreveport. “And they're not only important for the people who receive them but they're also important for the community." About 95 percent of kindergarten-aged children are appropriately vaccinated, according to the U.S. Centers for Disease Control and Prevention. Read more on vaccines.

Experts Debate Expected Changes to ADHD Diagnosis
Medical experts are at odds as to what to ultimately expect from the predicted changes to the diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5 will be released in May by the American Psychiatric Association. The broadened criteria should increase the number of people diagnosed with ADHD in part by expanding the age time frame for the onset of symptoms. "In the current version, it's seven years,” James Norcross, MD, a child and adolescent psychiatrist at the University of Texas Southwestern Medical Center at Dallas. “That will be changed to 12 years in the DSM-5, which may make things easier for adults and adolescents, because they'll be able to better recall some of the challenges that may have occurred." Norcross said the changes are positive overall. However, Allen Frances, MD, chair of the task force for the DSM-4 and former chair of psychiatry at Duke University School of Medicine in Durham, N.C., worries the new criteria will serve to increase the unnecessary use of stimulant medications. "We're already overdiagnosing ADHD,” he said. “Almost 20 percent of teen boys get the diagnosis of ADHD, and about 10 percent of boys are on stimulant drugs. We don't need to make it easier to diagnose ADHD.” Read more on mental health.

FDA Releases Violations on Several Dozen Compounding Pharmacies
Yesterday the U.S. Food and Drug Administration (FDA) released a list of violation reports for 28 of the 31 drug compounding pharmacies it’s inspected since April. The safety of drugs produced at compounding pharmacies came into question last year after the Framingham, Massachusetts-based New England Compounding Center was linked to a meningitis outbreak that caused 39 deaths and 656 cases of illness in 19 states. Found violations range from “inappropriate clothing for sterile drug processing to insufficient testing for contaminants,” according to Reuters. Still, FDA reiterated its stance that it needs more increased regulatory authority when it comes to compounding facilities. Last month Commissioner Margaret A. Hamburg, MD, proposed the FDA be given greater authority to oversee high-risk sterile compounding facilities that distribute drug products in advance of or without receiving a prescription. Read more on prescription drugs.

USPSTF: Limit Oral Cancer Screenings to Patients with Signs, Symptoms
Primary care physicians should limit oral cancer screenings to adult patients who actually show signs or symptoms of the condition, according to new draft recommendations from the U.S. Preventive Services Task Force (USPSTF). "The evidence shows that it is difficult to detect oral cancer and that the evidence is not clear whether oral cancer screening improves long-term health outcomes among the general adult population or among high-risk groups," said Jessica Herzstein, MD. "We need more high-quality research on whether screening tests can accurately detect oral cancer and if screening adults for oral cancer in primary care settings improves health outcomes." Tobacco and alcohol are both major risk factors for oral cancer. The task force also recommended physicians take into account patient wishes, medical histories and other expert opinions when making decisions. Read more on cancer.

FDA Budget Includes Funds for Food, Medical Product Safety Improvements
The U.S. Food and Drug Administration’s (FDA) requested $4.7 billion budget will include funds to support the Food Safety Modernization Act and to help ensure the safety of medical products. However, the budget will also include a $15 million cut related to human drug, biologics and medical device programs. “Our budget increases are targeted to strategic areas that will benefit patients and consumers and overall strengthen our economy,” said Margaret A. Hamburg, M.D., Commissioner of Food and Drugs. “Through the good work of the FDA, Americans will receive life-saving medicines approved as fast as or faster than anywhere in the world, confidence in the medical products they rely on daily, and a food supply that is among the safest in the world.” Read more on food safety.

Study: No Link Between Fertility Drugs, Increased Ovarian Cancer Risk
There is no link between fertility drugs and an increased risk of ovarian cancer, according to a new study in the journal Fertility and Sterility. While previous studies have suggested a connection, Albert Asante, MD, lead author of the study and a clinical fellow in the division of reproductive endocrinology at the Mayo Clinic, said the results show that “women who need to use fertility drugs to get pregnant should not worry about using these fertility drugs." The study looked at the medical information of approximately 1,900 women who participated in an ovarian cancer study at the Mayo Clinic. Approximately 13 out of every 100,000 women will develop ovarian cancer in their lives. Read more on cancer.

Unemployment Stress Can Lead to Severe Cardiovascular Troubles
The stress and anxiety of unemployment can cause both immediate and long-lasting cardiovascular problems. There’s even a possibility of something called “broken heart syndrome.” "In a very stressful situation, you can actually get a severe release of adrenaline and sympathetic nerve discharges that cause the heart to beat irregularly," said John Higgins, MD, a sports cardiologist at the University of Texas Health Science Center in Houston, according to HealthDay. In the most severe cases this can lead to heart attack. However, Kavitha Chinnaiyan, MD, director of cardiac imaging at Beaumont Hospital in Royal Oak, Mich., said steps can be taken to reduce the damage. "We know from studies that behaviors such as meditation, yoga and tai chi work specifically to reduce our response to stress," she said, noting that meditation in particular “helps you see your choices and have a clearer perspective of what to do next. Stress may still be around us, but meditation gives us a better ability to cope with it." Learn more on the connection between stable employment and health in an INFOGRAPHIC.

Smoking in Youth-rated Movies Up Dramatically
Smoking scenes in youth-rated movies is back up to the same levels as about a decade ago, with approximately half of such movies in 2012 providing 14.8 billion “tobacco impressions,” according to a new study funded by Legacy. Tobacco impressions are calculated by multiplying incidents of tobacco use by the number of film tickets. From 2010 to 2012 alone the rate was up 169 percent; 2010 was an historic low for tobacco impressions. This trend is dangerous because of the way movies can influence youth behavior. "Increases in smoking imagery in the movies are discouraging," said Tom Frieden, MD, director of the U.S. Centers for Disease Control and Prevention. "Every day in the United States approximately 3,800 youth under 18 smoke their first cigarette, and approximately 1,000 become daily cigarette smokers. Reducing smoking and tobacco use in youth-oriented movies will help save lives, money, and years of suffering from completely preventable smoking-related chronic diseases." Read more on tobacco.

Online Tool Helps Family, Friends Determine Whether an Older Driver is Safe
A new free online tool can help family members and caregivers of drivers age 65 and older determine whether they’re safe to continue going out on the roads. The Fitness-to-Drive Screening Measure questionnaire, developed by researchers at the University of Florida (UF), provides a rating profile, recommendations on how to move forward and links to an array of resources. Sherrilene Classen, PhD, MPH, an associate professor of occupational therapy at the UF College of Public Health and Health Professions and the tool’s lead developer, said it’s designed to give a realistic assessment of the driving abilities without requiring an on-the-road evaluation. “We know from our research and others’ that drivers do not give valid self-reports,” said Classen, “Most everybody thinks they are driving better than they actually are. Because we don’t have the evaluators to assess the 36 million older adults who may potentially at some stage require a driving evaluation, we went to the next-best step, which is involving their caregivers or family members.” Read more on aging.

Study Links Breakfast Cereal, Healthier BMIs for Kids
Helping kids maintain a low BMI could be as simple as giving them cereal for breakfast, according to a new study in the Journal of the Academy of Nutrition and Dietetics. The study found that children who had cereal for breakfast four out of nine mornings were in the 95th percentile for BMI; kids who had cereal every day were in the 65th percentile. Researchers say the study shows the ability to combat childhood obesity by making breakfast cereal available to low-income kids; one in four U.S. kids live in a “food insecure household,” according to lead author Lana Frantzen, PhD. "(Cereal) is an excellent breakfast choice, it's simple, and gets those essential nutrients that children need, especially low income minority children," she said. Read more on obesity.

Hospital-based Quality Improvement Programs Cut Early Elective Deliveries
Elective early term deliveries are down significantly in part due to multistate, hospital-based quality improvement programs, according to a new study in the journal Obstetrics & Gynecology. Labor inductions and Cesarean sections without a medical reason were down 83 percent from 27.8 percent to only 4.8 percent over a one-year program at 25 hospitals. Early term babies are at increased risk of a host of medical problems and even death, according to the March of Dimes. “Reducing unnecessary early deliveries to less than five percent in these hospitals means that more babies stayed in the womb longer, which is so important for their growth and development,” said Edward R.B. McCabe, MD, medical director of the March of Dimes. Read more on maternal and infant health.

Study: School Lunch Standards Help Kids Maintain Healthy Weight
States with strict school lunch standards may be helping students maintain healthier weights, according to a new study in JAMA Pediatrics. The U.S. Department of Agriculture’s National School Lunch Program standards include maximums calories for lunches and the serving of only skim or reduced-fat milk. Depending on grade level, school lunches are between 550 and 850 calories. The preliminary findings help refute the concern that students would simply compensate with unhealthy snacks, according to Daniel Taber, MD, lead author from the Institute for Health Research and Policy at the University of Illinois at Chicago. Nutritionist Marion Nestle of New York University said that this “is important work and should stimulate government agencies to take a closer look at what they might do to make the food environment a lot healthier for children and adults.” Read more on obesity.

CDC: Many Skipping Medications to Save on High Health Care Costs
Lack of insurance and other factors are leading many Americans to request cheaper medications or even skip taking prescribed drugs, according to a new report from the U.S. Centers for Disease Control and Prevention. "Adults who do not take prescription medication as prescribed have been shown to have poorer health status and increased emergency room use, hospitalizations and cardiovascular events," said Robin Cohen of the NCHS's Division of Health Interview Statistics. About 20 percent of U.S. patients ages 18 to 64 requested cheaper medications from their health care providers; the uninsured in that group was also twice as likely—23 percent total—as those ages 65 and older to simply skip the medications entirely. Read more on prescription drugs.

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