Category Archives: Transportation
Improved Prevention and Treatment Decrease U.S. Stroke Deaths
Stroke deaths in the United States have declined dramatically in the last few decades because of improved prevention and treatment, according to a scientific statement published in Stroke, published by the American Heart Association. “The decline in stroke deaths is one of the greatest public health achievements of the 20th and 21st centuries,” said Daniel T. Lackland, DrPH, chair of the statement writing committee and professor of epidemiology at the Medical University of South Carolina, in Charleston, S.C. “The decline is real, not a statistical fluke or the result of more people dying of lung disease, the third leading cause of death,” said Lackland, who added that “although all groups showed improvement, there are still great racial and geographic disparities with stroke risks as well many people having strokes at young ages [and] we need to keep doing what works and to better target these programs to groups at higher risk.” Public health efforts that have helped lower stroke rates include hypertension control that started in the 1970s; smoking cessation programs; improved control of diabetes and high cholesterol levels; and improved stroke treatment options. Read more on prevention.
NHTSA Announces New Safety Efforts for Older Drivers
The National Highway Traffic Safety Administration (NHTSA) has announced a new strategic plan to help ensure the safety of older drivers and passengers. In 2012, according to NHTSA, more than 5,560 people over the age of 65 died, and 214,000 were injured in motor vehicle crashes. That’s a three percent increase in the number of fatalities and a 16 percent increase in the number of injuries from the previous year. In addition, since 2003 the population of older adults—defined as age 65 and older—has increased by 20 percent and the number of licensed older drivers increased by 21 percent, to 35 million licensed older drivers in 2012.
NHTSA has several new efforts in place to reduce these deaths and injuries:
- The agency is researching advanced vehicle technologies, including vehicle-to-vehicle communications, collision avoidance and crashworthiness that could help reduce the risk of death or injury to older occupants in the event of a crash. It is also considering adding a “silver” rating system, meaning cars with certain technologies might be preferable for older drivers.
- NHTSA will conduct studies to better understand the effects of age-related medical conditions, including dementia.
- NHTSA will continue public education efforts on functional changes that can impact driving, including vision, strength, flexibility and cognition.
Read more on transportation.
Poll: Parents Concerned Over Lack of Physical Activity During School Day
A recent poll conducted by the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation found that many parents are concerned about inadequate levels of physical education at schools. More than 1,300 parents of public school students were polled on a range of issues concerning education and health in the their child’s school, and one in four parents (25 percent) said their child’s school gives too little emphasis to physical education, compared with one in seven who say the same thing about reading and writing (14 percent) or math (15 percent). About three in 10 parents (28 percent) give a low grade (C, D or F) to their child’s school on providing enough time for physical education, while almost seven in 10 parents (68 percent) report that their child’s school does not provide daily physical education classes, a recommendation included in U.S. Centers for Disease Control and Prevention guidelines for schools. “In a period with a significant public debate about the content of educational reform, it is significant that many parents feel that more physical education is needed in the schools,” said Robert Blendon, ScD, Richard L. Menschel professor of Health Policy and Political Analysis at Harvard. Read more on education.
NHTSA: Motorcoaches, Large Buses to Require Seatbelts for All Passengers and Driver
New motorcoaches and large buses will be required to provide lap and shoulder seatbelts for all passengers and driver, under a new rule issued by the U.S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA). While the buses are an overall safe way to travel, the large numbers of people they carry and the high speeds at which they travel mean a single collision can lead to a significant number of injuries, according to NHTSA. An average of 7,934 riders are injured each year in motorcoaches, and an average of 21 passengers are killed. "Buckling up is the most effective way to prevent deaths and injuries in all vehicular crashes, including motorcoaches," said Federal Motor Carrier Safety Administrator Anne S. Ferro, in a release. "Requiring seat belts in new models is another strong step we are taking to reach an even higher level of safety for bus passengers." The rule will apply to buses with a gross vehicle weight rating (GVWR) greater than 26,000 pounds,) excluding transit buses and school buses. Read more on transportation.
Study: Women With Breast Cancer Should Get Mammograms Every 12 to 18 Months
Breast cancer patients should undergo mammograms every 12 to 18 months to determine whether their cancer has spread to the lymph nodes, according to a new study to be presented today at the annual meeting of the Radiological Society of North America. Study researcher Lilian Wang, MD, evaluated more than 300 women who were diagnosed with breast cancer because of a routine mammogram, dividing them into three groups based on their treatment history. She found that only 9 percent of the women who had 12- to 18-month intervals between mammograms saw their cancer spread to their lymph nodes; the rates were 21 percent for those who waited one-and-a-half to three years and 15 percent for those who waited three or more years. "If you catch someone with early stage cancer, they are going to need less extensive surgery, and maybe no chemo," said Laura Kruper, MD, director of the Cooper-Finkel Women's Health Center at the City of Hope Cancer Center, in Duarte, Calif., who was not a part of the study. "[The new study] adds more power behind the fact that we do need screening mammograms starting at age 40 and every year.” Read more on cancer.
FDA: Certain HeartStart AEDs May Not Work During Cardiac Emergencies
The U.S. Food and Drug Administration (FDA) announced yesterday that certain automated external defibrillator (AED) devices made by Philips Medical Systems may not function properly when needed. In a new safety communication, FDA revealed that the devices may not deliver the needed shock to restore normal heart rhythm during a cardiac emergency. “The FDA advises keeping all recalled HeartStart AEDs in service until you obtain a replacement from Philips Healthcare or another AED manufacturer, even if the device indicates it has detected an error during a self-test,” said Steve Silverman, director of the Office of Compliance in the FDA’s Center for Devices and Radiological Health. “Despite current manufacturing and performance problems, the FDA considers the benefits of attempting to use an AED in a cardiac arrest emergency greater than the risk of not attempting to use the defibrillator.” Read more on heart health.
Bithlo, Fla. is a town of 8,000 that is just 30 minutes outside Orlando and not much farther from the “happiest place on Earth” — but is beset by poverty, illiteracy, unemployment and toxic dumps that have infiltrated the drinking water. The water is so bad that it has eroded many residents’ teeth, making it that much harder for them to find jobs. Streets filled with trash, frequent road deaths and injuries from a lack of transportation options and safe places to walk, and dropping out before 10th grade were all the norm.
In just a short time, a collection of partners and volunteers have begun to reverse some of the decades-old problems Bithlo has faced. And earlier this week, the town that had been forgotten for almost a century was the scene of a hubbub of activity as hundreds of volunteers descended on the town to continue work on “Transformation Village,” Bithlo’s future main street, which will sport a combination library/coffee shop, schools, shops and many other services, all long missing from Bithlo.
Over the last few months, NewPublicHealth has reported on initiatives of the participating members of Stakeholder Health, formerly known as the Health Systems Learning Group. Stakeholder Health is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that share innovative practices aimed at improving health and economic viability of communities.
>>Read more on the Stakeholder Health effort to leverage health care systems to improve community health.
One of the Stakeholder Health members is the Adventist Health System, a not-for-profit health care system that has hospitals across the country. Recently, Adventist’s flagship health care provider, Florida Hospital in Orlando, began supporting United Global Outreach (UGO), a non-profit group aimed at building up communities in need, in their four-year-long effort to transform the town of Bithlo.
NewPublicHealth recently spoke with Tim McKinney, executive vice president of United Global Outreach, and Verbelee Neilsen-Swanson, vice president of community impact at Florida Hospital, about the partnerships and commitment that have gone into Bithlo’s transformation into a town that is looking forward to new housing stock, jobs, stores, better education and improved health outcomes for the its citizens.
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.
DOT and HUD Release Neighborhood Affordability Tool
The U.S. Departments of Housing and Transportation (HUD and DOT, respectively) have released a Location Affordability Portal, a new tool that lets users estimate housing and transportation costs for neighborhoods across the country.
“Many consumers make the mistake of thinking they can afford to live in a certain neighborhood or region just because they can afford the rent or mortgage payment. Housing affordability encompasses much more than that,” said HUD Secretary Donovan. “The combined cost of housing and transportation consumes close to half of a working family’s monthly budget, and the [Portal] will help to better inform consumers, help them save money, and provide them with a broader perspective of their housing and transportation options.”
The new tool was developed with the input of real-estate industry professionals, academics, and staff from HUD and DOT, and uses statistical models that were developed from various sources that capture key neighborhood characteristics including population density, transit and job access, average number of commuters and distance of commutes, average household income and size, median selected monthly owner costs. and median gross rent. Read more on housing and transportation.
Health Index May Reduce Hospital Readmissions
A health risk score used during hospital stays using routine data from hospital electronic medical records may be able to identify patients at high risk of unplanned hospital readmission, according to a study published in Medical Care.
The score is calculated automatically using patient data such as vital signs, nursing assessments, skin condition, heart rhythms and laboratory tests. Lower Rothman Index scores (from a maximum of 100) indicate a higher risk of readmission. The study evaluated the ability of the Rothman Index to predict hospital readmission, based on data from more than 2,700 patients hospitalized during 2011. The researchers found that patients whom the Index calculated as being high risk for readmission were 2.5 times as likely to be readmitted within 30 days of discharge as patients calculated by the Index to be low risk.
About 20 percent of Medicare patients are readmitted to the hospital within 30 days of discharge, at an estimated cost of $17 billion per year, according to the study authors. Medicare has begun reducing payments by up to 2 percent for hospitals with high readmission rates. Read more on community health.
Rapid Flu Testing in the ER Leads to More Effective Treatment
Using rapid influenza tests to diagnose flu in patients who come to the emergency room results in fewer unnecessary antibiotics, increased prescriptions for antiviral medicines, and fewer additional lab tests compared to patients diagnosed with influenza without testing, according to a new study the Journal of the Pediatrics Infectious Diseases Society.
Among patients diagnosed with influenza without rapid testing, 23 percent of the emergency department visits included a prescription for antibiotics, which are not effective in to treat influenza because it is a viral infection. However, for patients who were diagnosed by rapid testing, only 11 percent of visits resulted in the patient getting antibiotics. Additional laboratory tests, including chest X-rays, blood tests, and urinalysis, were also ordered less frequently for patients whose influenza illness was diagnosed with a rapid test.
"While other studies have shown that physicians can accurately diagnose influenza without testing, our results suggest that using an influenza test increases diagnostic certainty and leads to the physician providing more specific and appropriate care,” says Anne J. Blaschke, MD, PhD, of the University of Utah School of Medicine, the study’s lead author. Read more on infectious disease.
The U.S. Department of Transportation’s (DOT) National Highway Traffic Safety Administration (NHTSA) has launched a new campaign that challenges parents to discuss with their teen drivers five practices that can prevent serious injuries and even deaths in the event of a crash:
- No cell phone use or texting while driving
- No extra passengers
- No speeding
- No alcohol
- No driving or riding without a seat belt
NHTSA data show motor vehicle crashes are the leading cause of death for teenagers 14-18 years-old in the United States. In 2011, 2,105 teen drivers were involved in fatal crashes. Of those teens involved in fatal crashes, 1,163 (55 percent) survived and 942 (45 percent) died in the crash.
"Safety is our highest priority, especially when it comes to teens, who are often our least experienced drivers," said DOT Secretary Anthony Foxx. "The ‘5 to Drive’ campaign gives parents and teens a simple, straightforward checklist that can help them talk about good driving skills and most importantly, prevent a tragedy before it happens."
The list of precautions matches the top causes of death in teen crashes:
- In 2011, over half of the teen occupants of passenger vehicles who died in crashes were unrestrained
- Speeding was a factor in 35 percent of fatal crashes involving a teen driver
- Twelve percent of teen drivers involved in fatal crashes were distracted at the time
- In 2011, 505 people nationwide died in crashes in which drivers ages 14-18 years had alcohol in their systems, despite the fact that all states have Zero Tolerance Laws for drinking under age 21
NHTSA research also finds that peer pressure is a contributing factor in teen crash deaths. When the teen driver in a fatal crash was not wearing a seat belt, almost four-fifths of that driver’s teen passengers were also unrestrained. And a teenage driver was 2.5 times more likely to engage in risky behaviors when driving with one teenage passenger, but three times more likely when driving with multiple teenager passengers.
Additional NHTSA research found that poor decisions among teen drivers can lead to crashes and fatalities at any time of the day, but that they were most frequent between 3 p.m. and 8 p.m., and remained high until midnight.
>>Bonus Link: NHTSA provides a wealth of resources on safe driving for teens.
GAO Recommends FDA Set Schedules for Decisions on New Tobacco Products
The General Accounting Office issued a report yesterday recommending that the U.S. Food and Drug Administration (FDA) establish performance measures for the Center for Tobacco Products that include time frames for making decisions on the approval of new tobacco product submissions. The FDA has had authority over tobacco for more than four years, but a backlog remains on new tobacco products the agency must approve. New tobacco products applications submitted to the agency include devices that may deliver less nicotine to people who smoke. In a response to a draft of the GAO report, the FDA noted that the GAO report recognized that “the length of time from the end of jurisdiction review to the end of completeness review decreased from 8 months in FY2011 to 2 months in FY2012. This constitutes considerable progress and is a reflection of CTP’s ongoing commitment to shortening review times.” Read more on tobacco.
American Heart Association: Unlock School Gates
A new policy statement from the American Heart Association (AHA), published in the American Journal of Public Health, says school districts can increase physical activity among children and young adults by opening playgrounds, gyms and playing fields to the community outside of school hours, especially in low-income areas. AHA recommends that school districts enter shared-use agreements with community organizations to allow supervised activities such as sports leagues and unsupervised playing on school grounds. When previously locked schoolyards in two lower-income communities in New Orleans were opened and activities supervised, children’s outdoor physical activity was 84 percent higher than in a community with closed schoolyards, according to research cited in the statement. A U.S. Centers for Disease Control and Prevention survey finds that 61.6 percent of 800 school districts surveyed have a formal agreement for use of their facilities. Increasing shared use agreements is a key goal of Voices for Healthy Kids, a collaboration of the American Heart Association and the Robert Wood Johnson Foundation to reverse the current levels of childhood obesity by 2015. Read more on physical activity.
DOT Announces Funding to Improve Transit Safety and Preparedness
The U.S. Department of Transportation has announced the availability of $29 million in research funds for innovative projects to help transit agencies strengthen operational safety; better withstand natural disasters and other emergencies; and improve emergency response capabilities. “For the first time in FTA’s history, we’re calling on the transit industry, the private sector, universities and others to work with us to develop and implement innovative solutions…bringing transit facilities into a state of good repair,” said Federal Transit Administration (FTA) head Peter Rogoff. “This will translate into real-world improvements…ranging from reducing transit-related injuries to making transit systems less vulnerable to flooding and severe weather.” Funding proposals will be considered in three areas: operational safety; resiliency; and all-hazards emergency response and recovery. Read more on transportation.
Although the overall traffic death rate is dropping, the number of pedestrians and bicyclists killed by distracted drivers in the United States is climbing, according to a new study in Public Health Reports.
Researchers utilized the Fatality Analysis Reporting System to find crashes on public roads from 2005 to 2010 that led to at least one death, finding that pedestrian deaths jumped to 500 from 347. The number of bicyclist deaths rose to 73 from 56, with a peak of 77 in 2008. They also found that distracted drivers were three times more likely to hit pedestrians on road shoulders and 1.6 times more likely to hit them in marked crosswalks.
“The problem is that pedestrians and cyclists have little protection on the roadways,” said study author Fernando Wilson, PhD, associate professor in the College of Public Health at the University of Nebraska Medical Center, adding, “Evidence suggests that separating non-motorized travel from motorized travel, through bike lanes or other redevelopment efforts, could greatly reduce deaths.”
The study’s authors concluded that new and better policies are needed to stop this growing public health problem. They hope that the findings—particularly the demographic findings—can help advocates and policymakers determine exactly what these policies should be.
For example, the pedestrian victims are more likely to be:
- Older than 65
- Physically impaired
- On the road shoulder
- Hit during the day
Bicyclist victims are more likely to be:
- Riding in the morning
- On the road shoulder
- In a rural area
The study was funded by the Robert Wood Johnson Foundation’s Public Health Law Research program.
A key panel discussion during the National Health Impact Assessment (HIA) meeting will be on perspectives on health impact assessments with policymakers. Ahead of the meeting, NewPublicHealth spoke with State Representative Denise Provost (D), of Somerville, Mass., who will be one of the panel members.
NewPublicHealth: How does it value governing, communities and population health by factoring health into policies made in other sectors?
Denise Provost: Governance should always take consideration of health. Legislators should actually embrace the first principle of the Hippocratic Oath, which is “first do no harm.” Sometimes by action or inaction we, as a nation, have pursued policies which we’ve discovered are not so good for health. Some are market forces that end up being reinforced by the actions of government. Looking out for the health impact on the population needs to be part of the long-term view of what we do. The particular discipline of looking at health through a health impact assessment is valuable for government because policy makers are often disparaged by scientists for governing by anecdote and that’s a real danger in the absence of quantitative analysis based on peer reviewed studies. The HIAs I’ve seen employ that kind of methodology.
The value of HIAs to communities is that they will in the long term—and even in the short- or middle-term—enjoy better health and fewer negative health effects from government decisions or government failure to reign in market forces that result in conditions that cause bad health as part of their business model.
NPH: Can you give us examples of HIAs in your community that have been innovative and beneficial?
Provost: We’re still in early days with HIAs but one, as contemplated by our 2009 transportation reform bill, has some fairly groundbreaking language in it that requires our secretaries of transportation, health and the environment to convene regularly and look at healthy transportation projects very broadly. They’re also charged with developing tools such as HIAs for use in the evaluation of transportation projects.
Despite decades of outreach around car seat safety, car crashes remain the number one cause of death for children under the age of 12, according to the U.S. National Highway and Traffic Safety Administration (NHTSA). The numbers from the U.S. Centers for Disease Control and Prevention (CDC) are also stark and troubling: more than 1,200 U.S. children ages 14 years and younger died in motor vehicle crashes in 2010, and approximately 171,000 were injured.
What makes these statistics even more tragic is the fact that many of these deaths and injuries are preventable by following these simple edicts—put kids in the right seat and use it the right way. In fact, NHTSA has identified child seat safety restraints as the most effective way to protect young children in motor vehicle crashes.
Child safety seats reduce the risk of death in passenger cars by 71 percent for infants and by 54 percent for kids ages 1 to 4, according to the CDC. For children ages 4 to 8, booster seats cut the risk of serious injury by 45 percent.
This week is Child Passenger Safety Week. It also marks the launch of the new BuckleUpForLife.org, Cincinnati Children’s and Toyota’s community-based safety program designed to educate families on critical safety behaviors and provide child car seats to families in need.
The website features the “Making Safety a Snap” online tool—a series of quick questions and videos that demonstrate exactly how parents and caregivers can make sure their child has the right safety seat and is using it properly.
You can follow a live Buckle Up for Life Twitter Q&A starting at 2 p.m. today. Use the hashtag #BuckleUpforLife to join the discussion and have your child car seats questions answered by their experts.