Health care professionals who smoke often represent a significant obstacle to getting patients to stop smoking. Among registered nurses (RNs) in particular—whose population historically has a high percentage of smokers—smoking limits their ability to be strong advocates for cessation interventions. In 2003, Robert Wood Johnson Foundation (RWJF) grantee Linda Sarna, PhD, RN, FAAN, began a study at the UCLA School of Nursing to monitor smoking rates among health care professionals, with an emphasis on RNs. The study showed a significant drop in smoking rates among registered nurses and the results were featured in the January special issue of the Journal of American Medicine, which commemorated the 50th anniversary of the U.S. Surgeon General’s landmark report on the health consequences of smoking.
The UCLA study found that the proportion of registered nurses who smoke dropped by more than a third from 2003 to 2011. While RN smoking rates held relatively steady between 2003 and 2007, they fell from 11 percent in 2007 to 7 percent in 2011. The drop represents a 36 percent decrease in smoking rates among RNs—more than double the 13 percent decline among the general U.S. population during the same time period. The study also found that RNs were more likely to quit smoking than the general population.
Tobacco Free Nurses, an RWJF-funded national campaign led by Sarna and Stella Aguinaga Bialous, DrPH, RN, helped to reduce the prevalence of smoking among RNs. Founded in 2003, the nurse-led program aimed to dissuade nurses from smoking in order to prevent smoking-related health issues among RNs and their patients. Tobacco Free Nurses works by supporting smoking cessation efforts among nurses and nursing students; encouraging nurses to advocate for a smoke-free society; and giving nurses tobacco control resources to help patients with cessation efforts.
In addition to the significant decline among registered nurses, the UCLA study found that smoking rates also fell for most other health care professionals. However, licensed practical nurses (LPNs) did not see any significant decreases. Approximately 25 percent of the LPN population still smokes, which is the highest percentage of smokers among health care professionals.
>>Bonus Link: Learn more about the last 50 years of tobacco control in RWJF’s interactive timeline.
‘America Saves Week’ Promotes Health Financial Habits for Kids
Next Monday begins America Saves Week. Running through March 1, the week is an annual opportunity for organizations to promote good savings behavior for individuals and to urge people to assess their savings status. According to America Saves:
- Only 54 percent of Americans say they have a savings plan with specific goals.
- Only 43 percent of Americans say they have a spending plan that allows them to save enough money to achieve the goals of their savings plan.
- Only 66 percent of Americans have sufficient emergency funds for unexpected expenses like car repairs or a doctor’s visit.
The annual event places a special emphasis on helping people learn and adopt good savings behaviors while they’re young, with educators and youth organizations urging students to join as a Young America Saver on-line and open or add to an account at a local financial institution. “The importance of saving cannot be over-emphasized, as saving is one of the critical building blocks to financial success,” said Gail Cunningham, spokesperson for the National Foundation for Credit Counseling, one of the week’s participating organizations. “Financial stability cannot exist without a healthy savings account.” Read more on budgets.
Physical, Mental Effects of Bullying Can Compound Over Time
The negative physical and mental effects of bullying during youth can compound over time and follow someone into adulthood, according to a new study in the journal Pediatrics. Researchers analyzed data from the Healthy Passages study, which surveyed 4,297 students in Alabama, California and Texas about bullying. Approximately one-third reported being regularly bullied at some point. The study found that those who had been bullied in the past scored better on measures of physical and mental health than those who were still being bullied. Teens bullied throughout their school careers scored the worse. "I think this is overwhelming support for early interventions and immediate interventions and really advancing the science about interventions," Laura Bogart, from Boston Children's Hospital. Read more on violence.
Study: STD Education Should Start Early
Prevention of sexually transmitted diseases (STDs) is about more than safe sex education—it’s also about established a stable home life early on that encourages responsible behavior, according to a new study in the Journal of Adolescent Health. "Kids don't engage in risky behaviors in a vacuum. There are environmental opportunities that have to be created," said study lead author Marina Epstein, of the University of Washington. Using data on approximately 2,000 Seattle-area participants, researchers determined that about one-third of those who became sexually active before age 15 had an STD, compared with 16 percent of those who started having sex at a later age. They also found that having more sexual partners and having sex after drinking alcohol or using drugs were tied to greater incidence of STDs. Epstein said funding for programs that emphasize abstinence until marriage would be better spend on preparing kids to make health and responsible choices. "We already have good programs that have been shown to be effective at improving parent-child relationships and intervening with at-risk youth," Epstein said. "We should use our prevention dollars on programs that we know work and that show effects on a range of behaviors, including risky sex practices." Read more on sexual health.
A recent essay by columnist Nicholas Kristof of The New York Times looked at a critical problem faced by jails across the country, which often double as behavioral health treatment centers. For many inmates, mental health problems have been the significant factor in committing a crime, with some even purposely flouting the law in the hopes of getting into jail where they can get free treatment. As a result, the United States has a national inmate population where half of all male inmates and three quarters of all female inmates have a behavioral health condition.
Solutions are beginning to emerge, though critical problems remain. At a recent health initiatives forum convened by the National Association of Counties and held in San Diego, county health officials talked about the promise of the Affordable Care Act, which will allow jail health specialists to help enroll inmates in coverage in advance of their discharge to help continue care—behavioral and physical—outside of jail.
Read the full column here.
>>Bonus Link: Read NewPublicHealth’s coverage of the recent NACo Health Initiatives Forum.
Study: Increasing Young Men’s Knowledge of Emergency Contraception Could Increase Access, Use
Increasing young men’s knowledge of emergency contraception could increase access to the drug and help prevent unwanted pregnancies, according to a new study in Journal of Family Planning and Reproductive Health Care. Emergency contraception, commonly known as "the morning after pill," prevents pregnancy after unprotected sex or when other methods of contraception fail. Nine U.S. states allow pharmacists to dispense emergency contraception without a prescription under certain conditions. The study gauged the knowledge of 101 males and 97 females ages 18 to in 2008 and 2009. "About half of the women understood basic facts about emergency contraception, how you get it, how you use it, and the fact that male partners were also able to buy it over-the-counter for their female partners," said Sheree Schrager, a member of the study team and a researcher at Children's Hospital Los Angeles, California. “But young men had significantly lower knowledge then the young women did, and this is an opportunity for providers to reach out to young men in the hopes of reaching more young women to use emergency contraception.” According to the researchers, unplanned pregnancies are more common in poor communities, where there are also greater health and economic consequences. Read more on sexual health.
U.S., Global Partners to Joint in Prevention, Detection and Response to Infectious Disease
The United States has joined with 26 countries and other global partners to, over the next five years, work to prevent, detect and effectively respond to naturally occurring, accidental and intentional infectious disease threats. Additional partners in the Global Health Security Agenda include the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE). “While we have made great progress in fighting and treating diseases, biological threats can emerge anywhere, travel quickly, and take lives,” said Lisa Monaco, Assistant to the President for Homeland Security and Counterterrorism. “The recent outbreaks of H7N9 influenza and Middle East Respiratory Syndrome are reminders of the need to step up our efforts as a global community. The Global Health Security Agenda is about accelerating progress toward a world safe and secure from infectious disease threats.” The U.S. Centers for Disease Control and Prevention (CDC) has pledged $40 million in FY 2014 to advancing Global Health Security Agenda objectives, and its FY 2015 budget will include an additional $45 million to prevent avoidable catastrophes, detect threats early and mobilize effective responses to contain outbreaks. Read more on global health.
CDC: States with Indoor Tanning Laws See Far Less Use by Female High School Students
States with indoor tanning laws—especially those requiring parental permission or setting age restrictions—see lower rates of indoor tanning by female high school students, according to a new study in the American Journal of Public Health. The study was conducted by the U.S. Centers for Disease Control and Prevention. Studies have connected the increased exposure to ultraviolet radiation from indoor tanning to increased risk of melanoma; each year the United States sees 60,000 new melanoma diagnoses and approximately 3.5 million treatments for nonmelanoma skin cancer. The study determined that the odds of female students engaging in indoor tanning in states with any indoor tanning laws were 30 percent less than those in states without such laws, and that the odds in states with systems access, parental permission and age restriction laws were 42 percent less than those in states without any laws. “State indoor tanning laws, especially age restrictions, may be effective in reducing indoor tanning among our nation’s youth,” said Gery Guy, PhD, health economist and the study’s lead author. “We need to address the harms of indoor tanning, especially among children. Indoor tanning laws can be part of a comprehensive effort to prevent skin cancers and change social norms around tanned skin.” Read more on cancer.
Looking for powerful ways to save I love you?
- Send ecards reminding those you love to get a flu shot, make a preparedness plan and wash their hands, courtesy of the American Public Health Association.
- Learn about your own—and loved one’s—risk of heart disease and stroke.
- One in ten teens reports being physically hurt by a boyfriend or girlfriend. Find out how to help prevent teen dating violence.
- Learn the signs of heart attack, stroke and cardiac arrest.
Read more on heart health.
American Society of Clinical Oncology Weighs in on Mammography
In response to a study published this week in the British Medical Journal which called into question the benefit of mammography, the American Society of Clinical Oncology (ASCO) issued a statement today saying that because mammography is similar to many other tests that can detect a condition that may never cause harm, the benefits of screening are likely to be greater for women who are at increased risk of developing breast cancer based on factors such as age and family history, than for women at average risk. It also stated no single study should be used to change screening policy and that all women should be encouraged to speak with their doctors about their personal risk for breast cancer, as well as the potential benefits and harms of mammography screening. ASCO and other cancer advocacy and women’s health groups have announced that they will be monitoring additional mammography studies now being conducted, and the American Cancer Society is expected to release new mammography recommendations later this year. Read more on cancer.
NHTSA Announces New Mandatory Label to Help Owners Instantly Identify Recall Mailings
The U.S. Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) today announced that starting February 18, all manufacturers must use a distinctive label on the agency’s required mailings that notify owners of recalled vehicles or equipment.
The requirement was introduced to help owners instantly distinguish important recall notices arriving in their mailboxes from other mail and hopefully avoid mistakenly discarding the safety notices. NHTSA has also just launched the SaferCar app for Android devices that will provide information for car owners and shoppers, including recalls and safety performance. There is already a SaferCar app for iPhone, iPad and iPod Touch users. Other safety notification options from NHTSA include:
- Register Your Cars, Tires and Car Seats: Receive NHTSA email notifications when there is a recall by the federal government. There is no way to locate or notify individual owners of car seats or tires if the product is not registered with the manufacturer or NHTSA.
Check for Open Recalls on Used Cars: Verify with the previous owner or dealer whether a used car has been fixed by using www.safercar.gov, which provides a general search tool to help consumers identify recalls that may affect their vehicle.
Read more on transportation.
“Building a culture of health means recognizing that while Americans’ economic, geographic, or social circumstances may differ, we all aspire to lead the best lives that we can,” wrote Robert Wood Johnson Foundation president and CEO Risa Lavizzo-Mourrey, MD, MBA in her 2014 President’s Message, released earlier this week. Laying out the plans for achieving those goals, Lavizzo-Mourrey added: “for the Foundation, it also means informing the dialogue and building demand for health by pursuing new partnerships, creating new networks to build momentum, and standing on the shoulders of others also striving to make America a healthier nation.”
The Foundation’s wide-ranging plans to “inform the dialogue” included a plenary talk by Mark McClellan, co-chair of the RWJF Commission to Build a Healthier America, and a former head of both the Food and Drug Administration and the Centers for Medicare and Medicaid Services. McClellan spoke at the AcademyHealth National Health Policy Conference in Washington, D.C., last week — less than a month after the release of the Commission’s 2014 report.
“To become healthier and reduce the growth of public and private spending on medical care, we must create a seismic shift in how we approach health and the actions we take,” said McClellan, “As a country, we need to expand our focus to address how to stay healthy in the first place.”
McClellan told a very attentive audience that critical needed changes include:
- Improve opportunities [for people] to make healthy decisions where we live, learn, work and play
- Improve access to a good education, jobs and health care
- Work across sectors, collaborating to improve the health of all Americans
- Make investing in America’s youngest children a high priority
- Fundamentally change how we revitalize neighborhoods, fully integrating health into community development
- Adopt new health “vital signs” to assess non-medical indicators for health such as jobs, income, housing, transportation and access to healthy food.
- Create incentives tied to reimbursement for health professionals and health care institutions to address non-medical factors that affect health.
McClellan cited two examples of organizations that are addressing issues beyond healthcare in order to improve health:
- Health Leads, a national health care organization, enables physicians and other health professionals to systematically screen patients for food, heat, and other basic resources that patients need to be healthy and “prescribe” these resources for patients.
- The Medical-Legal Partnership program removes legal barriers that impede health for low-income populations by integrating legal professionals into the care team. These volunteers intervene with landlords, social service agencies, and others to address health-harming conditions ranging from lack of utilities to bedbugs to mold in rental properties.
- Read Risa Lavizzo-Mourrey’s President’s Message
- Read the report of the 2014 Commission to Build a Healthier America
SAMHSA Disaster Distress Helpline Open 24/7 to Help People Impacted by the Severe Weather
The Substance Abuse and Mental Health Administration (SAMHSA) issued a bulletin yesterday to remind public health officials and the community that its Disaster Distress Helpline (1-800-985-5990) can provide immediate counseling to anyone who needs help in dealing with the damage caused by the winter storms in the Mid-Atlantic and Southern states. The helpline is a 24 hours-a-day, seven-days-a-week resource that responds to people who need crisis counseling after experiencing a natural or man-made disaster or tragedy. The helpline immediately connects callers to trained professionals from the closest crisis counseling center; helpline staff provide confidential counseling, referrals and other needed support services. Assistance is available in several languages. The helpline can also be accessed by texting TalkWithUs to 66746, by going here and by TTY for deaf and hearing impaired at 1-800-846-8517. Read more on disasters.
Well-Child Visits Linked to More than 700,000 Cases of Flu-Like Illness
A recent study in Infection Control and Hospital Epidemiology links well-child doctor appointments for annual exams and vaccinations with an increased risk of flu-like illnesses in children and family members within two weeks of the visit. This risk translates to more than 700,000 potentially avoidable illnesses each year, costing more than $490 million annually, according to the researchers.
"Well child visits are critically important. However, our results demonstrate that healthcare professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics [and] more attention should be paid to these guidelines by healthcare professionals, patients, and their families," said Phil Polgreen, MD, MPH, lead author of the study.
The researchers used data from the Agency for Healthcare Research and Quality's (AHRQ) Medical Expenditure Panel Survey to examine the health care trends of 84,595 families collected from 1996-2008. After controlling for factors including the presence of other children, insurance and demographics, the authors found that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points. A commentary in the journal on the study also pointed out the likelihood of some unnecessary antibiotics being prescribed for some of the illnesses.
"Even with interventions, such as the restricted use of communal toys or separate sick and well-child waiting areas, if hand-hygiene compliance is poor and potentially infectious patients are not wearing masks, preventable infections will continue to occur," said Polgreen. Read more on infectious disease.
NIH Study Seeks to Improve Asthma Therapy for African-Americans
A new study by researchers at the National Heart Lung and Blood Institute, a division of the U.S. National Institutes of Health, is enrolling about 500 African-American children and adults with asthma in a multi-center clinical trial to assess how they react to therapies and to explore the role of genetics in determining the response to asthma treatment. The study will be conducted at 30 sites in 14 states, and its goal is to determine the best approach for asthma management in African-Americans, who suffer much higher rates of serious asthma attacks, hospitalizations and asthma-related deaths than whites. “While national asthma guidelines provide recommendations for all patients with asthma, it is possible that, compared with other groups, African-Americans respond differently to asthma medications,” said Michael Wechsler, MD, principal investigator for the study and professor of medicine at National Jewish Health in Denver. “Our study is designed to specifically address how asthma should be managed in African-American asthma patients, both adults and children.” Read more on health disparities.
FEMA Issues Advisories as Severe Weather Hits Parts of the U.S.
The Federal Emergency Management Agency (FEMA) has begun issuing advisories for states across the Southern United States expected to be impacted by severe weather.
According to the National Weather Service, a major winter storm is impacting the South and Southeast ahead of moving up the Eastern Seaboard on Wednesday.
FEMA is encouraging both residents and visitors in the track of the storms to follow the instructions of state, local and tribal officials, and monitor NOAA Weather Radio and their local news for updates and directions provided by local officials. Residents can find trusted sources for weather and preparedness information via Twitter on FEMA’s social hub.
Weather Emergency Alerts (WEA) are currently being sent directly to many cell phones on participating wireless carrier networks. These alerts are sent by public safety offices such as the National Weather Service about imminent threats like severe weather. They look like a text message and show the type and time of the alert, any action you should take and the agency issuing the alert. Check your cellular carrier to determine if your phone or wireless device is WEA-enabled. Read more on preparedness.
Dozens of Bills Introduced in Recent Years to Increase School Vaccine Exemptions
From 2009 to 2012, 36 bills were introduced in 18 states to change school immunization mandates, with the majority aimed at expanding exemptions, according to a recent review in JAMA by researchers from Emory University. None of the bills passed, but the researchers say continued efforts to change state vaccine rules are concerning. Among 36 bills introduced, 15 contained no administrative requirements, seven bills had one or two administrative requirements, and the remaining 14 contained between up to five administrative requirements in order for parents to exempt their children from school vaccine rules in a given state.
"Exemptions to school immunization requirements continue to be an issue for discussion and debate in many state legislatures," according to the study authors. Read more on vaccines.
Being in a Good Mood Can Lead to Safer Sex
HIV-positive men are more likely to have save sex when their mood improves, according to a new study by researchers at the Mailman School of Public Health at Columbia University. The study, published in the journal Psychology, included 106 sexually active, HIV-positive men who have sex with men who completed weekly surveys over six weeks that asked about their sexual behavior, depression, and wellbeing during the prior week. Overall, 66 percent of study participants reported having unprotected intercourse in the prior two months; 81 percent had multiple partners. Three-quarters of the study participants were black and Latino men, a group disproportionately affected by HIV.
The researchers found that the men who reported an increase in their wellbeing in a given week were more likely to have safe sex (66%), while those who reported higher-than-usual levels of depression were more likely to engage in the risk behaviors (69%). The researchers are now studying potential interventions that might help address risky behaviors during depressive phases. Read more on sexual health.
Job loss at local health departments continues unabated, according to the 2013 edition of the National Association of County and City Health Officials (NACCHO) Profile of Local health Departments. The total number of employees in local health departments has fallen to 162,000 last year from 190,000 in 2008.
However, the report also highlights program gains:
- Nearly half of health departments not yet accredited plan to apply, have submitted a formal application or have submitted a statement of intent to apply for public health accreditation from the Public Health Accreditation Board.
- The percentage of local health departments who have completed the three key accreditation prerequisites — community health assessment, community health improvement plans and an agency-wide strategic plan — has grown from 20 percent in 2010 to 30 percent in 2013.
- Facebook use has grown from 20 percent in 2010 to 44 percent last year.
- Twitter use has grown from 13 percent in 2010 to 18 percent last year.
- YouTube use has grown from 6 percent in 2010 to 12 percent last year.
- In 2013, 56 percent of local health departments were engaged in some type of quality improvement (QI) activity, up from 45 percent in 2010.
AHA Releases Stroke Prevention Guidelines for Women
For the first time, the American Heart Association (AHA) has released stroke prevention guidelines for women. The guidelines outline stroke risks unique to women and provide evidence-based recommendations on how best to treat them, including:
- Women with a history of high blood pressure before pregnancy should be considered for low-dose aspirin and/or calcium supplement therapy to lower preeclampsia risks.
- Women who have preeclampsia have twice the risk of stroke and a four-fold risk of high blood pressure later in life. Therefore, preeclampsia should be recognized as a risk factor well after pregnancy, and other risk factors such as smoking, high cholesterol, and obesity in these women should be treated early.
- Pregnant women with moderately high blood pressure (150-159 mmHg/100-109 mmHg) should be considered for blood pressure medication; expectant mothers with severe high blood pressure (160/110 mmHg or above) should be treated.
- Women should be screened for high blood pressure before taking birth control pills because the combination raises stroke risks.
- Women who have migraine headaches with aura should stop smoking to avoid higher stroke risks.
- Women over age 75 should be screened for atrial fibrillation risks; a risk factor for stroke.
Read more on prevention.
New Study Predicts Flu Severity
Researchers at St. Jude Children’s Research Hospital in Memphis say flu patients, regardless of age, who have elevated levels of three particular immune system regulators, called cytokines, early in the infection were more likely to develop severe flu symptoms and to be hospitalized than patients with lower levels of the same regulators. Study participants ranged in age from 3 weeks to 71 years.
The study, published in the American Journal of Respiratory and Critical Care Medicine, found that cytokine levels early in the infection were predictive of flu-related complications regardless of patient age, flu strain, the ability of the virus to replicate and other factors. The cytokines studied help to regulate inflammation caused by the body’s immune response to the flu until antibodies and T cells take over. Patients with the elevated cytokines seem to develop airway distress as a reaction to the immune response, a development separate from the effects of the flu virus. “We need to explore targeted therapies to address this problem separately from efforts to clear the virus, says study author Paul Thomas, PhD, an assistant member of the St. Jude Department of Immunology. Read more on flu.
Community Health Worker Model Can Reduce Hospital Readmissions
A new study in JAMA Internal Medicine reports on a community health worker (CHW) program developed at the University of Pennsylvania School of Medicine that hired people from the local community to help discharged patients navigate the health care system and address key health barriers, such as housing instability or food insecurity. The study found that the intervention improved patient experiences and health outcomes and reduced hospital readmissions.
The Penn team tested the model in a randomized trial with 446 hospitalized patients who were either uninsured or on Medicaid, and lived in low-income communities in which more than 30 percent of the population lived below the Federal Poverty Level. More than one-third of all readmissions to the hospitals participating in the study come from a five-zip code region. Patients in the trial received support from CHWs hired for traits such as empathy and active listening. The CHWs connected during a patient's hospital stay and continued after they were discharged to help with issues including scheduling doctor appointments, accessing medications, or finding child care or shelter. The control group received routine hospital care, medication reconciliation, written discharge instructions, and prescriptions from the hospital. The CHW group had a 52 percent greater chance of seeing a primary care physician within two weeks after being discharged from the hospital and scores measuring a patient's confidence in managing their own care in the future more than doubled in the CHW group. While the two groups had similar rates of at least one hospital readmission (15 percent vs 13.6 percent), the CHW group was less likely to have multiple readmissions (2 percent vs 6 percent in the control group). Read more on health disparities.