Category Archives: Recommended Reading
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.
A presentation at the recent American Public Health Association (APHA) annual meeting, held last week in Boston, reported on the Gun Shop Project. The program of the New Hampshire Firearm Safety Coalition shares guidelines on how to avoid selling or renting a firearm to a suicidal customer with gun advocates, gun shop owners, mental health professionals and public health professionals. The Gun Shop Project also encourages gun stores and firing ranges to display and distribute suicide prevention materials tailored to their customers
“The science shows us that not only is suicide the leading type of death from a firearm, but having a gun in the home increases the incidence of suicide, femicide [shooting a woman], and the likelihood that people in the community will be shot. Many mass shootings, like those at Sandy Hook Elementary School in Newtown, involve the suicide of the shooter,” said David Hemenway, who spoke about the Gun Shop Project at the APHA meeting. “One way to prevent the shootings may be to prevent the suicide.”
He is a member of the Project’s team as director of the Injury Control Center at the Harvard School of Public Health, as well as a recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research.
The ultimate goal of the coalition is to change social norms around gun use and to see the Gun Shop Project achieve results similar to the national effort to stop drunk driving.
“We want to work with the gun-owning community to create reasonable norms about when to get the guns out of the house,” Hemenway said. “If a neighbor is also a gun owner, for example, that neighbor could be asked to hold the firearms until another neighbor’s difficult period has passed. It’s the same idea as the ‘don’t let a friend drive drunk’ campaign. This can make a difference…”
Hemenway says the efforts of the Gun Shop Project are a growing national effort and partners include the U.S. Army, the American Foundation for Suicide Prevention and other groups working to reduce suicides by limiting access to lethal means at critical periods.
Read more about the Gun Shop Project.
In 2008, the U.S. Department of Veterans Affairs (VA) sent Army paratrooper Jeffrey Waggoner to an Oregon hospital to recover from an addiction to painkillers. However, once there they instead gave him a steady stream of medications, eventually releasing him for a weekend with 19 prescription drugs in hand. He was found dead of an overdose three hours later.
“As a parent, you’d want to know how this happened to your child,” said his father, Greg Waggoner, according to a new report from The Center for Investigative Reporting (CIR). “You send your child to a hospital to get well, not to die.”
In its investigation, CIR found that, post 9/11, the VA has increasingly been treating addictions with a variety of drugs, “feeding addictions and contributing to a fatal overdose rate among VA patients that is nearly double the national average.” Over the past dozen years, prescriptions for the four opiates hydrocodone, oxycodone, methadone and morphine have increased by 270 percent.
Waggoner’s weekend leave medications included 12 oxycodone pills.
As part of its investigation, CIR has created a comprehensive interactive tool that shows the VA systems with the highest prescription rates and allows users to search for information by region and system. The data is culled from CIR’s own research, as well as information from the VA and the U.S. Census Bureau.
Trust for America’s Health also recently released an interactive tool on the growing public health issue of prescription drug abuse—about 6.1 million Americans use or abuse prescription drugs. The tool allows users to search state-by-state prescription drug overdose death rates and find out how each scores on 10 key steps to curb abuse.
>>Read The Center for Investigative Reporting’s “VA’s opiate overload feeds veterans’ addictions, overdose deaths”
>>Read NewPublicHealth’s story, “New Report: Most States Not Implementing Enough Proven Strategies to Prevent Prescription Drug Abuse”
A story on the urbanwonk blog of The Atlantic Cities website finds that in Vienna, Austria, pilot projects are taking women’s home, work and elder care responsibilities into account in design planning. For example, surveys found that women—often with strollers in in tow—were more likely than men to use public transportation and needed some accommodating. They also found that after age nine boys were more likely than girls to use park space, perhaps because the girls felt fearful or outnumbered. A reengineering soon followed that brought girls into the parks. Austrian city planners have worked a lot of that data into other city construction, including a pilot apartment complex that includes onsite parks, doctor’s office, a pharmacy and a preschool.
A key concept? Assess needs first…and then plan the design.
>>Read the full article at The Atlantic Cities
>>Bonus Link: Read a NewPublicHealth post on creating safer urban biking opportunities for women
Have you heard the story about the Prevention and Public Health Fund? A “no” wouldn’t be surprising.
Have you heard the story about the almost 200,000 preventable deaths in the United States each year due to heart disease and stroke? Probably so.
The latter was big news last week, inspiring headlines and handwringing across the country. Men are twice as likely as women to die of preventable cardiovascular disease. Blacks are twice as likely as whites. Southerners are at far greater risk.
Most of the stories emphasized how all this unhealthy living is the result of unhealthy lifestyle choices. But is that the whole story?
“Largely absent from most of the stories covering the study was context—a hard look at the social and environmental conditions that help explain the findings—as well as some explanation of what it might take to really change things and prevent large numbers of needless deaths.” They also tended to suggest “that poor health is essentially a personal moral failing, while ignoring the vastly different realities that exist in different communities in this country.”
That’s the thesis of a recent Forbes opinion piece, which looks past the round number of “200,000” and other statistics detailed by the U.S. Centers for Disease Control and Prevention (CDC), and points attention to the very real obstacles to healthy living that far too many people face.
The CDC study also discussed the importance of addressing the economic and social determinants that influence the health of individuals and communities (though this went largely unacknowledged in most media accounts, according to the Forbes piece). The CDC pointed out strategies that help create conditions for healthier living, including policy changes that increase access to health care, that give people healthy local food options and that build walkable communities—changes that can only be made by communities, not individuals.
That brings us back to the Prevention and Public Health Fund. Created by the Affordable Care Act, the Fund’s grantees have spent the past three years doing all these things—helping states, cities and tribes create safer, healthier communities.
“That’s a story that needs to be told, with context.”
>>Read the full piece, “200,000 Preventable Deaths A Year: Numbers That Cry Out For Action -- And Better Reporting.”