Disabled Adults Have Very High Rates of Emergency Room Use
A review of medical expenditure data by researchers at the National Institutes of Health finds that disabled adults account for a disproportionately high amount of annual emergency room (ER)  visits.

The study found that despite representing 17 percent of the working age U.S. population, adults with disabilities accounted for 39.2 percent of total emergency room visits. The researchers say the higher ER use is a problem not just because of the higher costs, but also because many disabled adults have non-urgent needs that are not met by the ER visits.

Recommendations to improve care for disabled adults include prevention and chronic condition management programs tailored for the functional limitations and service needs of people with disabilities, wider use of coordinated care systems for the disabled that provide case management, integration of psychosocial care and 24/7 access to medical assistance.

Read more on disability.

Change in Color of their Pills Keeps Some Patients from Taking Generic Drugs
A new study in JAMA Internal Medicine finds that some people stop taking their medicines when a generic becomes available if the color of the dispensed generic drug is different than the brand name drug they received previously.

The authors say the study shows the need for a reconsideration of the FDA’s current regulations that allow wide variation in the appearance of generic drugs.

Read more news about the Food and Drug Administration.

Mental Health Disorders Increase the Risk of Becoming a Victim of Domestic Violence
People diagnosed with mental illness are more likely than those who are not to be victims of domestic violence, according to a new study in PLoS One.

The researchers say the causality may run in both directions. Domestic violence can result in mental health problems and people with mental health problems are more likely to experience domestic violence. The researchers say studies they reviewed show that the link between domestic violence and mental health problems is a concern for both men and women.

Read more on mental health.

Following the shootings of 26 people, including twenty children, in Newtown earlier this month, three American Medical Association journals have published articles that take a hard look at gun violence in the United States.

• An article in the Journal of the American Medical Association looks at reduced funding in the last few years for gun injury prevention research, while increased funding for other types of injury prevention such as motor vehicle crashes, has resulted in fewer deaths.
• An essay in the Archives of Internal Medicine looks at guns as “weapons of mass destruction” and suggests strategies to reduce citizen casualties and mass shootings.
• Two contributors in the Archives of Pediatric and Adolescent Medicine write about the Florida law that prevents health care professionals from asking patients or families about firearms in the home.

 Bonus Links:

Read a blog post from the Network for Public Health Law on strategies that may help reduce mass shootings in the U.S. The author, Leila Barraza, JD, MPH, Deputy Director, Network for Public Health Law-Western Region, says that while increased mental health coverage and screenings and gun controls alone will likely not be enough to prevent mass shootings, “the public health law community will have a vital role to play as policies are created and evaluated.”

Read a recent NewPublicHealth interview with Jeffrey Swanson, PHD, a professor of psychiatry and behavioral sciences at Duke University School of Medicine, on how laws can help prevent gun violence.

APHA Supports Measures to Protect Against Gun Violence
The American Public Health Association (APHA) has expressed its strong support for action to protect our nation’s children and their families from the growing epidemic of gun violence. “Gun violence is one of the leading causes of preventable death in our country and we must take a comprehensive public health approach to addressing this growing crisis,” said APHA Executive Director Georges Benjamin, MD. “For too long, we as a nation have failed to take on this devastating problem in our communities, and we can wait no longer.” Key steps recommended by the APHA include:

• Adopting common sense gun control legislation (such as reinstating the federal ban on assault weapons and high-capacity magazines) and closing the “gun show loophole,” which exempts private sellers of firearms from conducting criminal background checks on buyers at gun shows.
• Expanding the collection and analysis of data related to gun violence and other violent deaths to better understand the causes and allow authorities to develop appropriate interventions to prevent such violence.
• Ensuring adequate funding for critical mental health services.

Read more on violence.

FDA Expands Use of Flu Drug for Kids Younger than 1 Year
The U.S. Food and Drug Administration (FDA) has expanded the approved use of Tamiiflu, a key drug used to treat influenza, for children as young as two weeks who have had flu symptoms for no longer than two days. Eight babies have already died of flu this season, so having an approved treatment is critical. Tamiflu was first approved in 1999 to treat adults. Its approved use was later expanded to treat children a year old and older as well as to prevent the flu in adults and in children a year old and older. The new approval is for treatment only, not for prevention of the flu. Vaccination with flu vaccine begins at six months of age, according to the CDC. Read more on flu.

HUD Awards $26M to Convert Apartments to Assisted Living or Enhanced Service Senior Housing
The U.S. Department of Housing and Urban Development (HUD) has awarded $26 million in grants to the owners of multi-family housing developments in nine states to convert some or all of their apartments into assisted living or service-enriched environments for elderly residents. The funding is provided through HUD’s Assisted Living Conversion Program, which helps convert apartments into units that can accommodate the special needs of seniors who want to “age in place.” “We’re getting older as a nation and with that demographic shift, there is a growing demand for affordable housing that will allow our seniors to live independently in their own homes,” said Carol Galante, HUD’s Assistant Secretary for Housing and Federal Housing Commissioner. Read more on aging.

University of North Carolina Researchers Receive Grant to Develop Post-Disaster Recovery Benchmarks
Two University of North Carolina (UNC) researchers have received a U.S. Department of Homeland Security Grant to develop indicators of effectiveness for post-disaster recovery efforts. "This project is particularly important because it focuses on giving practitioners at the federal, state, and local levels the tools they need to measure how well a community is recovering from a disaster," said Jennifer Horney, PHD, research assistant professor of epidemiology and director of the UNC Center for Public Health Preparedness at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. The grant will be administered by the Coastal Hazards Center of Excellence at UNC. Read more on Hurricane Sandy.

As the nation grapples with last week’s school shooting in Connecticut, discussions across the nation are focused on how we can reduce gun-related violence and the devastation it causes. NewPublicHealth joins that conversation today, beginning with an interview with Jeffrey Swanson, PhD, a professor of psychiatry and behavioral sciences at Duke University School of Medicine. Swanson is a member of the Methods Core of the Public Health Law Research (PHLR) program at Temple University, a project of the Robert Wood Johnson Foundation. The researchers analyze the intersection of public health and law, selecting studies for funding and providing technical assistance and support to strengthen research on law and health.

>> Read a blog post by Scott Burris, director of PHLR, on developing new laws to increase the safety of having guns in society.

An article published last year by Dr. Swanson following the shooting of Congresswoman Gabrielle Giffords and eighteen other people in Tucson, Arizona, argued that homicides committed with guns against strangers by individuals with mental disorders occur far too infrequently to allow for explanatory statistical modeling and predictability. However, improving treatment access, continuity and adherence for people with serious mental illnesses can help prevent some violent episodes, according to Swanson.

NewPublicHealth spoke with Swanson a few days after the shooting in Newtown, Conn.

NewPublicHealth: What is the role of law and public health in efforts to prevent gun and other forms of violence?

Swanson: We need to think about gun violence as a public health problem. Homicide and suicide are the second- and third-leading causes of mortality in the U.S. population ages 15-34, and firearms are involved in most violent fatalities. In theory, the law should be an effective public health tool in trying to address the problem. Law can regulate what kinds of guns are available, where they can used, by whom, and even how they are stored. But since the U.S. Constitution protects a citizen’s basic right to possess a gun, the law can’t go too far in limiting legal access to guns in the population. That means we have to focus more on trying to identify dangerous people who should not have guns. That’s very complicated, because violence is complicated and so are people. The law could be used even more effectively, though, if we had better research evidence about what features of gun laws and policies work best to protect safety while safeguarding civil rights. That’s what we’re trying to do.

The Trust for America’s Health (TFAH) has released the 2012 edition of its Ready or Not? report. The annual report details and analyzes state and federal public health preparedness. This year’s entry focuses on emergency preparedness, looking at 10 indicators that help reveal the strengths and vulnerabilities in each state’s emergency preparedness status. TFAH’s hope is that policymakers, taxpayers and other groups can utilize the data to shore up their programs and policies—and help ensure they are ready to support public health in the event of a natural disaster or other emergency.

Among the key findings:

• 29 states cut funding for public health from FY 2010-11 to FY 2011-12
• 35 states and Washington, D.C. do not currently have climate change adaptation plans, which include planning for the health threats posed by extreme weather events
• 21 states have not been accredited by the Emergency Management Accreditation Program (EMAP)
• 13 state public health laboratories report they do not have sufficient capacity to work five, 12-hour days for six to eight weeks in response to an infectious disease outbreak, such as novel influenza A H1N1

This emphasis on analyzing emergency preparedness is especially meaningful now, with many in the Northeast still working to recover from the devastation of Hurricane Sandy. NewPublicHealth had been closely following public health’s role in responding to and recovering from Hurricane Sandy, and will continue to take an in-depth look at how this disaster continues to affect public health.

Here’s a look at some of the many ways NewPublicHealth has covered the intersection of public health and emergency preparedness:

Hurricane Sandy Recovery: New Jersey’s Health Commissioner Helms Response Roundtable
Just two weeks after Hurricane Sandy hit, the State of New Jersey held a Response Roundtable at the Jersey Shore University Medical Center in Neptune Township, N.J., to begin a review of the health department’s response to the storm. The site was an appropriate one: in the first few days of the Sandy, the medical center’s emergency room treated close to 2,000 patients with storm-related medical and mental health emergencies. A key roundtable participant was Nicole Lurie, the U.S. Department of Health and Human Services Assistant Secretary for Preparedness and Response. Leading the discussion was New Jersey’s Health Commissioner Mary E. O'Dowd.

Hookahs a Growing Public Health Concern in California
The increasing number of cafes and lounges featuring hookahs poses a public health risk for the state of California, according to state officials. Hookah use in California increased 40 percent from 2005 to 2008, according to 2011 state tobacco survey published in the American Journal of Public Health. While there is a perception that hookahs are safe than cigarettes, tobacco smoke from hookahs includes the carcinogens found in cigarette smoke, plus more carbon monoxide and extra carcinogens.  "There is a very, very concerning misperception about the use of hookahs among youth, thinking it's somehow safer. In fact, it puts you at the same risk," said Ron Chapman, MD, the state director of public health. Watch a video interview with Ron Chapman.

HHS: Child Abuse Cases Down, But Thousands Still Need Help
While the number of child abuse cases dropped for the fifth year in a row in 2011, there are still thousands of U.S. children in need of help, according to a new report from the U.S. Department of Health and Human Services' Administration for Children and Families. "We have made excellent progress over the past five years," said George Sheldon, acting assistant secretary of the administration, said in a release. "But what this report tells me is that we still have 681,000 children out there who need our help. We must continue coordination efforts among federal, state and local agencies to focus on child maltreatment prevention." About 11 percent of the abused children were physically or mentally disabled. In 2011, 1,570 died due to abuse or neglect. Read more on violence.

CDC Releases Tips on Staying Healthy During the Holiday Season
The U.S. Centers for Disease Control and Prevention has released Give the Gift of Health and Safety: Healthy Living Holiday Tips, a digital kit with advice on how to keep yourself, your friends and your family healthy during the holiday season. In addition to more obvious recommendation such as making sure all food is thoroughly cooked and not drinking and driving, there are also tips on how to stay warm (especially important for older adults), how to manage stress and how to travel safely. Read more on safety.

Study: Murder is Contagious and Can Spread Like Other Epidemics
Murder can be contagious and spread through communities like other epidemics, according to new research in the journal Justice Quarterly. Poorer neighborhoods are most susceptible, while communities that are diverse and immigrant-rich are least vulnerable. The research demonstrates a need—and a path—to prevent violence by combating risk factors. "For homicide, if you start trying to revitalize a community, are you going to stop a homicide that would have been committed tomorrow? Probably not," said study co-author April Zeoli, a criminal justice researcher at Michigan State University. "But you are maybe going to prevent homicides that would have been committed a year from now." Read more on violence.

Video on CPR Makes Dying Cancer Patients Less Likely to Want Aggressive End-of-life Care
Watching a three-minute video on CPR makes dying cancer patients less likely to opt for aggressive end-of-life care, according to a new study in the Journal of Clinical Oncology. The study found that 48 percent wanted CPR after being told about the procedure, while only 20 percent wanted it after viewing a demonstration and seeing what’s actually done during CPR. Angelo Volandes, MD, the study's lead author from Boston's Massachusetts General Hospital, said as they were dying of a terminal condition, procedures such as CPR only prolonged the dying process. “It's one of the most important issues in American medicine today,” Volandes said. “People are getting medical interventions that, if they had more knowledge, they would simply not want." Read more on cancer.

Study: Distracted Walking may be as Dangerous as Distracted Driving
Distracted walking due to cell phone may be just as dangerous as distracted driving due to texting or talking on the phone. The devices divert the attention of pedestrians and increase the chance they will be hit by a car or otherwise injured. "Texters are not looking before they cross the street, they are not crossing with the light, they are walking more slowly and they are not looking at traffic,” said Beth Ebel, MD, lead researcher and director of the Harborview Injury Prevention and Research Center at the University of Washington in Seattle. They are putting themselves at risk; they are putting the car that hits them at risk." Ebel said the research demonstrates the need for pedestrians to exercise better judgment about when to use electronic devices. The new study appears in the journal Injury Prevention. Read more on injury prevention.

The Institute of Medicine and the Avon Foundation for Women issued the “Ending Violence @ Home App Challenge” to encourage powerful communication through technologies such as social media and mobile apps to help end worldwide suffering caused by domestic violence.  Four winners of the App challenge were chosen from 19 submissions that came in from across nine countries. The four were chosen based on their innovation, design, potential impact, and ability to integrate evidence-based information and usability in different settings. IOM President Harvey Fineberg stated in a release, “I am very impressed with the level of creativity demonstrated by the winning products, which can make a real difference to abused individuals.”  

The top prize of $10,000 was awarded to Wisdom of the Children (Çocuktan Al Haberi), a Turkish group that developed a website to encourage individuals to see that change can start with a simple shift in how we talk to each other. The website encourages families to take old Turkish expressions that condone violence and reinforce traditional gender norms, and turn them into more positive sayings. For example, the traditional saying from the region, “don't spare a baby from your wife's belly and rod from her back,” was changed to “don't spare soup from a women's belly and sunscreen from her back.” Web visitors are encouraged to create their own new, positive, health-reinforcing sayings with their children.

>>Read more about the app challenge.

A host of sessions focused on health equity at this year’s American Public Health Association meeting. Panel topics varied greatly, from the effects of health inequity on education outcomes to creative marketing strategies for reaching vulnerable populations; but overall, a few key themes emerged:

• Health inequities must be addressed as locally as possible
• Prevention is crucial
• Organizations must strive for greater diversity, especially in leadership
• In fiscal crunches, health equity requires creativity and commitment

Read more about these themes below.

Inequities in health must be assessed and addressed on a local level, whether by region, city, neighborhood or even block-by-block.

The California Endowment started the conversation by covering the conference halls with images from their Health Happens Here campaign, which draws attention to the vast differences in life expectancy that can exist from one zip code to the next. [Read more in a Q&A with California Endowment president Robert Ross.]

Last week at the American Public Health Association (APHA) annual meeting, a number of presenters took on an important, but often overlooked topic in the public health world: violence. Violence is often primarily considered a criminal justice or public safety issue, but there is a growing movement of public health practitioners that recognize that the health of vulnerable communities cannot be improved without first stopping shootings and killings.

When violence is present in a community, it impacts the physical, mental and emotional health of all residents. Violence also often prevents other positive changes from taking place. According to Greta Massetti from the Centers for Disease Control and Prevention, the current economic impact of youth violence is an estimated $14.1 billion in combined costs from medical care and work loss.

During the APHA meeting, speakers from organizations such as Cure Violence, UNITY and the Centers for Disease Control and Prevention discussed the latest research and strategies to prevent disease.

Treating violence as a disease

For many vulnerable communities, violence is the most pressing health issue. For children growing up in violent communities, the health impact is more than just the physical threat. As Benita Tsao from Urban Networks to Increase Thriving Youth (UNITY) pointed out, growing up in a community plagued by violence can often feel like being in a war zone.  That constant fear results in real health consequences, as evidenced by the increasing number of children who have grown up surrounded by violence and are now showing signs of chronic traumatic stress disorder. Experiencing ongoing trauma impacts young people’s physical, mental and emotional development, and has the ripple effect of making it harder to focus and succeed in school.