Category Archives: Recommended Reading
A new study published recently in the American Journal of Public Health finds that non-medical exemption laws for vaccines required for school or daycare admission have significantly impacted the vaccination rates of at least one disease. The researchers reviewed relevant laws and regulations for each year between 2001 and 2008 and rated them on their restrictiveness in granting exemptions. The study was funded by a grant from the Public Health Law Research program, a national program of the Robert Wood Johnson Foundation.
According to the study, state laws that make it difficult for children to be exempted from vaccines on religious or philosophical grounds could reduce the number of whooping cough cases, but did not have an impact on cases of measles, mumps, haemophilus influenza type B (Hib) or Hepatitis B.
“Our research shows that during the study period, if all states increased the restrictiveness of their non-medical exemption laws by one level, the number of U.S. whooping cough cases would decline by 1.14 percent, resulting in 171 fewer cases per year,” according to study author Y. Tony Yang, ScD, MPH, associate professor at the College of Health and Human Services at George Mason University.
The study found that the impact on whooping cough may be greater than for the other diseases studied simply because whooping cough affects more people. Researchers call this a “threshold effect,” which means laws may not have a significant impact unless they works to prevent a disease that affects a critical mass of people. During the study period, whooping cough was much more prevalent than the four other diseases studied—the average incidence rate for whooping cough was 18 per 100,000 individuals from 2001 to 2008. For Hib, Hepatitis B, measles, and mumps, the mean incidence rates were less than 1 per 100,000.
It was 10 years ago that the Institute of Medicine Committee on Assuring the Health of the Public in the 21st Century's released a report calling for an accreditation process for the nation’s public health departments. That recommendation led to the creation of the Public Health Accreditation Board (PHAB), which earlier this year named the first eleven departments to receive accreditation—there are now 22 accredited health departments.
Writing in a special issue of the Journal of Public Health Management and Practice that is dedicated to public health accreditation, Kaye Bender, PhD, RN, FAAN, and Carole Moehrle, BSN, RN, looked back on the first year, how the inaugural departments were selected and how they see accreditation changing the public health landscape moving forward. Bender is PHAB’s president and CEO, and Moehrle is chair of its executive committee.
“The first year of realizing the goal of accredited health departments has been outstanding, not only from the standpoint of reaching that goal but also from the perspective of experiencing firsthand what the public health community across this country can do when we all work together on a common goal,” they wrote in the article, PHAB: Reflections From the First Year of Accreditation. “As the next years unfold and accreditation changes with the inevitable changes in the public health practice environment, these initial days will long be remembered for establishing a sound foundation upon which to build.
Writing in the same issue, Pamela Russo, MD, MPH, and Paul Kuehnert, DNP, RN, in their commentary, Accreditation: A Lever for Transformation of Public Health Practice, discussed the role that the Robert Wood Johnson Foundation and other organizations played in making accreditation a success. Accreditation, they wrote, is a way for a public health department to demonstrate to its community that it’s committed to accountable, transparent and quality care.
“Those who have perceived health departments as simply administrative sites for a collection of miscellaneous services are beginning to recognize that accredited health departments are mission-driven organizations of excellence that are implementing strategic plans to improve and protect the health of their communities,” wrote Russo and Kuehnert. “Accreditation is rapidly proving itself to be a powerful lever for the transformation of public health practice.”
>>Bonus content: RWJF Senior Program Officer Pamela Russo recently sat down for an interview on the National Association of County & City Health Officials (NACCHO) podcast. Listen to Russo discuss how local partnerships can contribute to and improve community health.
Recommended Reading: ‘Retweet This’—Researchers See Rise in Use of Twitter to Share Scientific Journal Articles
The top two tweeted peer-reviewed science articles between 2010 and 2012 were about the effect of radiation on humans, according to a study published in the Journal of the Association for Information Science and Technology. Researchers reviewed 1.4 million articles to determine the most tweeted studies. Runners up in the top 15 of the most tweeted articles included studies on acne in teenagers and the link between physical activity and mortality rates. Nature, a highly regarded journal, received the most tweets: 13,430 Twitter mentions of 1,083 papers.
However, the researchers found that a retweet rate doesn’t necessarily correlate with a high rate of citations for an article in other studies, which is a standard measurement of significance for a scientific study. The most tweeted study—on genetic changes during radiation exposure—was tweeted 963 times but was cited in journals only nine times.
"The most popular scientific articles on Twitter stress health implications or have a humorous or surprising component. This suggests that articles having the broadest scientific impact do not have the widest distribution," said Stefanie Haustein, of the University of Montreal School of Library and Information Science, and a co-author of the study.
Still, the researchers say the increase in tweets that include a link or description of scientific studies is important even if the rates don’t correlate with journal citations. For one thing, the number of scientific researchers on Twitter is still low and “the fact that more and more articles are tweeted [at all] is good news because it helps scientific communication [and] regardless of whether non-scientists are sending this information, it proves that science is an aspect of general culture,” said Vincent Larivière, PHD, a co-author of the study and professor at the University of Montreal, who holds the Canada Research Chair on the Transformation of Academic Communication.
Read the full study.
Beginning later next year, more than a million workers in New York City will have a brand new, health-promoting benefit: paid sick leave days that guarantee wages on a set number of days when they or a family member they care for is ill.
The new law, passed last June by the New York City Council and overriding an earlier veto by the mayor, begins to go into effect in April 2014. New York now joins San Francisco, Calif., Washington, D.C., Seattle, Wash., Portland, Ore., and the state of Connecticut in adopting at least some sick leave provisions.
Not every employee in New York City will get paid sick leave under the new law. The bill that passed the City Council initially applies only to businesses with 20 or more employees, who will be required to provide five paid sick days a year; that extends to companies with 15 or more employees beginning October 1, 2015. Smaller businesses and manufacturing firms are exempt from the paid leave provisions for now, though these workers will gain five days of unpaid sick leave, so they can take time off without fear of losing their jobs. Advocates hope to extend paid leave to cover those workers before long.
Advocates say paid sick leave is critical for smaller businesses, and especially for low wage earners. A survey by the Community Service Society (CSS) of New York found that half of low-income respondents said they have less than $500 to fall back on in case of an emergency, and according to CSS, without compensation for sick days, people are often forced to choose between caring for themselves or a loved one and heading to work.
A 2012 study in the American Journal of Public Health shows why the measure that is critical to individuals and families is equally crucial to society as a whole. The study found that lack of certain workplace policies, including paid sick leave, led to an additional 5 million cases of adult H1N1 (swine flu) during the 2009 outbreak.
Funding for much of CSS’s advocacy came through a County Health Rankings & Roadmaps grant to focus on four areas in two New York City boroughs, the Bronx and Brooklyn, that have very poor health rankings. The goal was to build support among small businesses, faith-based organizations and low-wage workers for passage of the ordinance through grassroots events, town halls, story collection and media coverage, as well as by encouraging partners and allies to include this policy as part of their policy agendas. The grant runs through November 2014 and CSS will be focusing its efforts, now that legislation has passed, on creating awareness and implementation of the new law.
NewPublicHealth recently spoke with Nancy Rankin, vice president for policy, research and advocacy at CSS about the new law and its impact.
NewPublicHealth: Key components of the legislation you advocated for passed. What’s next in your efforts on paid sick leave?
Nancy Rankin: We are continuing to work on this issue because we recognize that having a law pass is not the end of the story. We now need to do outreach to inform workers about their new rights and employers about their new requirements, because a new law requires compliance and it requires people to be aware of its provisions.
As colder weather begins to set in, a new story on the homeless from Atlantic Cities is particularly striking: According to the U.S. Department of Education, the number of homeless students in the United States has hit a record high number.
For the 2011 school year—the latest year for which the department has data—1,168,354 homeless children were enrolled in U.S. schools from nursery through 12th grade. Nationally, that is a 10 percent jump over the previous school year, and a whopping 72 percent increase since the recession began in 2008. More striking numbers: more than 40 states showed a rise in homelessness among kids and ten states saw the number of kids without a space to call their own rise more than 20 percent since 2008.
The lack of a safe home and limited access to health care leaves America’s homeless at especially high risk for a large number of health problems. According to a fact sheet from the National Health Care for the Homeless Council, “Without homes, people are exposed to the elements, disease, violence, unsanitary conditions, malnutrition, stress and addictive substances. Consequently, their rates of serious illnesses and injuries are three to six times the rates of other people. These conditions are frequently co-occurring, with a complex mix of severe physical, psychiatric, substance use and social problems.”
>>Bonus link: Continue reading even after the numbers jump out at you to learn about a ten year old girl, reported by the San Jose Mercury News, who rides a bus with her father in Santa Clara County, Calif., each night since the $70 monthly pass makes it an affordable option. The fact that the young girl is having “one of her best years so far in school,” according to her father, is all the more remarkable considering they have to get off and reboard that bus about every two hours.
As smartphone technology becomes ever more ubiquitous and the dangers of tobacco become ever more apparent, it's not surprising that there are 414 quit-smoking apps available between iPhones and Androids, with Androids alone seeing about 700,000 downloads of these apps each month.
There's no question that these apps are in demand in the United States, where an estimated 11 million smokers own a smartphone and more than half of smokers in 2010 tried to quit.
The question is: Are they effective?
According to a new study in the American Journal of Preventive Medicine, the answer is too often "no," with many of the most popular apps failing to employ and advocate known and successful anti-tobacco strategies.
"Quit-smoking apps are an increasingly available tool for smokers," said lead author Lorien Abroms, ScD, an associate professor of Prevention and Community Health at the George Washington University School of Public Health and Health Services (SPHHS), according to Health Canal. "Yet our study suggests these apps have a long way to go to comply with practices that we know can help people stub out that last cigarette."
The study looked at the 50 top anti-smoking apps for both iPhones and Androids, analyzing their tactics on a number of fronts, including how well they aligned with guidelines from the U.S. Public Health Service on treating tobacco use. The review found serious issues with the apps' advice, especially concerning clinical practices. It found that:
- Most lacked basic advice on how to quit smoking and did not help people establish a "quit plan"
- None recommend calling a quit-line, which can more than double the chances of successfully quitting tobacco
- Fewer than one in 20 of the apps recommended medications, even though studies show how nicotine replacement therapy can help curb cravings
Taken together these, last two findings are especially troubling, as their pairing has been found to more than triple the chances of a person successfully breaking their nicotine addiction. One of the biggest takeaways from the study, according to Abroms, is that while quit-smoking apps can be important components of a larger plan to quit smoking, there might also be a simpler way to use those fancy smartphones.
"They should simply pick up their smartphone and call a quit-line now to get proven help on how to beat a tobacco addiction."
And the lack of adequate advice and guidance isn't limited to quit-smoking apps. A study by the IMS Institute for Healthcare Informatics found that while apps remain popular, they also remain limited.
"It clearly demonstrated that, to date, most efforts in app development have been in the overall wellness category with diet and exercise apps accounting for the majority available. An assessment finds that healthcare apps available today have both limited and simple functionality--the majority do little more than provide information.
Read the full story at Health Canal.
>>Bonus content: Read the previous NewPublicHealth post, "Public Health: There's An App For That"
>>Bonus link: Mobile Health and FDA Guidance
>>Bonus links: Here's a quick look at a few of the newest apps designed to improve public health in a variety of ways:
- My Health Apps offers a vast array of apps, sorted by categories such as "Mental Health," "Me and My Doctor" and "Staying Healthy"
- Hula, which helps people find STD testing, get the results on their phone and even share verified results
- My Fitness Pal, which combines guidance and community to help people lose weight
- Planned Parenthood offers a series of teen-focused apps on important issues such as birth control, condoms and even substance abuse
Today is Public Health Thank You Day 2013, when Research!America and other leading public health organizations recognize the public health professionals working to improve health where we all live, learn, work and play.
Among the biggest names in public health at the moment is Shiriki Kumanyika, PhD, MPH, a University of Pennsylvania professor who earlier this month became the president-elect of the American Public Health Association (APHA). In a recent Q&A on APHA’s Public Health Newswire blog, Kumanyika spoke about the overall landscape of public health and gave her thoughts on particular issues.
One of the big takeaways from the APHA annual meeting earlier this month—where she was named president-elect—was how APHA is shifting its focus to concentrate more on being an action- and goal-oriented organization, according to Kumanyika.
“We are going to be more convincing about the importance of a focus on prevention and wellness, while making better use of scientific evidence and creating a greater sense of urgency around health equity issues,” she said. “I think that, over time, this new positioning in the public arena will really enhance the sense of community among our thousands of diverse members, attract more members and align our combined efforts for greater overall impact.”
Kumanyika also has particular ideas on the greatest opportunities for improving health in African-American communities, especially when it comes to nutrition and obesity prevention. Not only are unhealthy foods too easily available in the average black community but, when compared to other communities, the situation is even more troubling, with black communities seeing more advertising for unhealthy food. The answer is targeted efforts to promote healthier alternatives.
However, she also noted how food and nutrition present their own particular public health obstacles.
“Food is a particularly complex area; we can’t treat it like tobacco and tell people to avoid it altogether. The changes we need are more complicated and will have huge implications across the spectrum from agriculture to environmental sustainability,” she said. “We have to make both a public health case and a business case for a healthier food supply and for marketing healthier foods and beverages. We have a tremendous opportunity to make progress that will change the food and health landscape for the population at large if we do our health diplomacy well.”
Read the full interview on Public Health Newswire here.
Earlier this year, fans of the National Football League’s Seattle Seahawks set a record for outdoor stadium noise with a volume of 136.6 decibels. That record stood for a mere four weeks—the Kansas City Chiefs hit 137.5.
The fans revel in it—both records were set in part through the encouragement of fan organizations—and this record-seeking behavior is encouraged by teams and the league.
“Fans know they are going to a football game and not searching for a book at a library,” said Brian McCarthy, an NFL spokesman.
However, according to a recent story in The New York Times, such loud revelry at sporting events comes with severe costs for people’s hearing health. Elliott Berger, an acoustical engineer at 3M, said the average volume during an NFL game hovers at around 90 decibels. Considering the fact that an average NFL game lasts about three hours—and the National Institute for Occupational Safety and Health recommends limiting exposure to levels that high to 60 minutes—by going to football games people are putting themselves at serious risk for partial deafness and ringing, or even hyperacusis, an intolerance to sound that sometimes can cause pain.
While this may be alright (although very unhealthy) for the casual fans who only attend a few games per year, people who already have auditory problems are at substantial risk. And it’s something that even a simple set of earplugs or earmuffs can prevent.
“People think it’s cool or funny or whatever, but there is increasing evidence that if your ears are ringing, damage is happening,” said M. Charles Liberman, a professor of otology at Harvard Medical School and the director of a hearing research lab at the Massachusetts Eye and Ear Infirmary. “There’s something irreversible going on. It’s only going to worsen as you get older.”
Read the full story at The New York Times.
Implementation of the Affordable Care Act—and keeping future generations of Americans healthy or even healthy enough—will rely on an adequate supply of primary care physicians. That includes family physicians, pediatricians and internists who can help steer patients toward healthier lifestyles and effective treatments for chronic illnesses to help avoid both unnecessary complications and costs. However, the Association of American Medical Colleges predicts a shortfall of about 45,000 primary care doctors in the next decade, according to The Wall Street Journal. Many medical students have traditionally avoided primary care training in favor of specializing in fields such as dermatology and radiology because the pay is generally far higher. That matters especially these days, when many medical students leave school owing more than $150,000 for their training.
According to the article, in an effort to increase the number of doctors specializing in primary care, a number of medical schools have strengthened their primary care programs and at least 17 new medical schools have opened since 2005—some that have only primary care training programs. And some of the schools have been able to recruit effectively by building loan repayment programs into the program, especially if students commit to practicing in underserved areas following their training.
Colleen Christmas, director of the internal residency program at Johns Hopkins Bayview Medical Center, who is interviewed in the article, points out that a strategy of increasing the number of primary care doctors makes economic as well as population health sense. According to Christmas, a recent study by Johns Hopkins researchers showed that with each 1 percent increase in the proportion of primary-care physicians, an average city will have 503 fewer hospital admissions, almost 3,000 fewer emergency-room visits and 512 fewer surgeries annually.
Read the full story in The Wall Street Journal.
>>Bonus Link: Four months after Surgeon General Regina Benjamin left her post to return to academia and a medical practice, the White House has nominated Vivek Hallegere Murthy, co-founder and president of Doctors for America and a Boston-area physician, to take up that post.
Atlantic Cities recently reported on a ride sharing program called Lyft, which requires riders to join up and input credit card information to be eligible for the carpool-like rides. Lyft’s licensed drivers are pinged to pick up passengers whom the system tracks as headed in the same direction as other riders already in the car.
The article focuses on the "cool" factor, and the potential for building social relationships, making it a great solution for college kids or young adults looking for a safe way to get home on nights out—a critical public health service, particularly when research released earlier this year found that more than one-third of designated drivers end up drinking.
But another potential future use could be to help alleviate massive transportation challenges in rural areas, particularly for those with limited income or no access to a car for other reasons. One Department of Transportation study found, "Close to 40 percent of all rural counties are not served by rural transit, while another 28 percent have limited service. And, nearly 57 percent of the rural poor do not own a car, while 1 in every 14 households in rural America has no vehicle." In the future, perhaps ride sharing programs could catch on as a viable transportation option in rural towns far away from the neon lights.
>>Bonus Link: A second transportation article in Atlantic Cities this week finds that despite the growth in ridership of bike share programs across the country, PBSC, a Montreal-based major supplier of city bikeshare equipment and software faces major transportation woes. PBSC bike share customers include London, D.C. and Chicago, the city with the largest bike-share program in the nation.