Category Archives: Substance Abuse
For the last several years, each incoming president of the Association of State and Territorial Health Officials (ASTHO) has introduced a President’s Challenge for the year of their presidency to focus attention on a critical national health issue. Previous challenges have included injury prevention, health equity and reducing the number of preterm births. This year, incoming ASTHO president Terry Cline, PhD, will focus his President’s Challenge on prescription drug abuse, a national public health crisis that results in tens of thousands of deaths each year.
>>Follow our ASTHO Annual Meeting coverage throughout the week.
Just before the ASTHO annual meeting began, NewPublicHealth spoke with Cline about the scope of the issue and steps Cline will introduce to help health officers collectively focus their attention on reducing this public health crisis.
NPH: Why have you chosen prescription drug abuse as your President’s Challenge?
Terry Cline: If you look at the trend lines in the United States, we’ve seen a very rapid increase in the number of deaths from the misuse of prescription drugs. We’ve also seen a huge increase in the number of children born with neonatal abstinence syndrome, which has actually tripled in the last decade. Prescription drug abuse has created an incredible burden on the health of people in the United States. Deaths are just one indicator; others include lost productivity, absenteeism and health care costs. Just using neonatal abstinence syndrome as an example, in 2000 the total hospital charges were about $190 million and in 2009, which is the last year we have that data, it was $720 million. Because in many states Medicaid pays for a large percentage of the births, in 2000 that amount was about $130 million out of the $190 million, and in 2009 it was $560 million of the $720 million. So that is becoming a larger and larger financial burden on states as well, and that does not include the long-term effects on babies.
The President’s Challenge will be looking at the absolute number—bringing down the number of deaths, which stand at more than 16,000 deaths per year. We’ve seen opioid deaths increase and continue every year over the last decade. And in most states now, the number of deaths from prescription drugs is actually greater than the number of deaths from automobile accidents, which has steadily gone down over the last decade. So, one is an example of a public health success; the decrease in motor vehicle deaths stems from a comprehensive approach and work with multiple sectors to bring that death rate down. The other, prescription drug deaths, is an alarming increase. My hope is that with the President’s Challenge, we can really increase awareness and leverage public health agencies across the country to mobilize around this issue.
Antibiotic-resistant Infections on the Rise; Threat Called "Urgent"
Antibiotic-resistant infections sicken more than two million Americans each year, killing more than 23,000 in the process, according to a new study from the U.S. Centers for Disease Control and Prevention (CDC). The report ranked the threats according to seven factors, including health impact, economic impact, how common the infection is and how easily it is spread. It classified carbapenem-resistant Enterobacteriaceae (CRE), drug-resistant gonorrhea, and Clostridium difficile as “urgent." C. difficile alone causes about 250,000 hospitalizations and at least 14,000 deaths each year. Excessive antibiotic use is the number one cause of the increase in antibiotic-resistant infections, with as many as 50 percent of prescriptions either not needed or prescribed inappropriately. “Every time antibiotics are used in any setting, bacteria evolve by developing resistance. This process can happen with alarming speed,” said Steve Solomon, MD, director of CDC’s Office of Antimicrobial Resistance. “These drugs are a precious, limited resource—the more we use antibiotics today, the less likely we are to have effective antibiotics tomorrow.” Antibiotic-resistant infections also add as much as $20 billion in excess direct health care costs and account for as much as $35 billion in lost economic productivity. Read more on prescription drugs.
Survey: Nearly 80 Percent of College Students Oppose Concealed Handguns on Campus
Nearly 80 percent of the students in 15 Midwestern colleges and universities oppose allowing concealed handguns on their campuses, according to a new study in the Journal of American College Health. Ball State University researchers surveyed 1,649 undergraduate students, finding 78 percent were against the handguns and would not apply for a permit if they were legal. “Firearm morbidity and mortality are major public health problems that significantly impact our society,” said study co-author Jagdish Khubchandani, a member of Ball State’s Global Health Institute and a community health education professor in the university's Department of Physiology and Health Science. “The issue of allowing people to carry concealed weapons at universities and colleges around the U.S. has been raised several times in recent years. This is in spite of the fact that almost four of every five students are not in favor of allowing guns on campus.”
The study also found that:
- About 16 percent of undergraduate students own a firearm and 20 percent witnessed a crime on their campus that involved firearms
- About 79 percent of students would not feel safe if faculty, students and visitors carried concealed handguns on campus
- About 66 percent did not feel that carrying a gun would make them less likely to be troubled by others
- Most students also believed that allowing concealed carry guns would increase the rate of fatal suicides and homicides on campus
Read more on violence.
‘Bath Salts’ Drugs Led to 23,000 ER Visits in 2011
The use of “bath salts” drugs accounted for almost 23,000 emergency department visits in the United States in 2011, according to a new report from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The report is the first national study to analyze the link between the street drugs and emergency department visits. "Although bath salts drugs are sometimes claimed to be 'legal highs' or are promoted with labels to mask their real purpose, they can be extremely dangerous when used," said Elinore McCance-Katz, MD, SAMHSA's chief medical officer. The drugs can cause heart problems, high blood pressure, seizures, addiction, suicidal thoughts, psychosis and even death. About two-thirds of the visits also involved at least one other drug, with 15 percent of the visits also being linked to marijuana or synthetic forms of marijuana. There were approximately 2.5 million U.S. emergency department visits linked to drug misuse or abuse in 2011. Read more on substance abuse.
It’s been more than forty years since a U.S. vice presidential candidate, Senator Thomas Eagleton, was forced to withdraw his name from the ticket after it was revealed he’d been treated for depression. Medical science and understanding have come a long way since then. Still, for many there is still a stigma surrounding mental illness—a stigma that can leave people, already hurting, feeling even more alone.
This is a clear and major public health issue which dramatically reduces the likelihood that someone with a mental health condition will seek out and have access to effective health care and social services. In fact, only 38 percent of U.S. adults with diagnosable mental illnesses receive the treatment they need. The numbers are even worse for children and adolescents, with less than 20 percent getting treatment.
September is Suicide Prevention Month and Sept. 10 is the 11th-annual World Suicide Prevention Day. This year’s theme is “Stigma: A Major Barrier for Suicide Prevention.” Suicide is one of the top ten leading causes of death in the United States—with more than 38,000 deaths each year—and many of those people suffered in silence rather than reaching out to loved ones and available avenues of help.
As part of the collective effort to combat this barrier to full and compassionate care, the American Psychiatric Association (APA) is working to raise awareness so that people with mental illnesses and substance use disorders can feel more confident in seeking treatment, just as anyone with most any other medical concern would be.
APA’s new Public Service Advertisements (PSAs) series, called “A Healthy Minds Minute,” features a number of celebrities and prominent figures calling for equal access to quality care and insurance coverage for people with mental illness and substance use disorders. Below is a video with Former Congressman Patrick Kennedy.
>>Watch the APA’s “A Healthy Minds Minute” online video series.
Three Cases of Dengue Fever Reported in Florida
The Florida Department of Health is reporting three confirmed cases of Dengue Fever in Central Florida. Dengue Fever is an infectious disease transmitted by mosquitoes. While common in Africa, it’s very rare in the United States. The health department has reported that the three patients have not traveled internationally recently, and that they likely contracted the disease from mosquitoes in their home state. The last case of Dengue Fever in Central Florida was in 2011. Symptoms of Dengue Fever, which is treated with supportive care and can in some cases lead to death, include high fever, headache, rash and joint pain.
The Wall Street Journal recently reported on a severe outbreak of Dengue Fever in Southeast Asia that has been especially harsh this year because of an early rainy season, higher than average temperatures and the fact that the virus has mutated in some cases into a more severe version of the disease. Travelers to the region who become infected risk carrying the virus to their home countries, where the virus can spread if an infected person is bitten by a mosquito that then bites other humans.
Guidelines issued by the Florida Department of Health for mosquito control are effective for other diseases transmitted by mosquitoes, including West Nile Virus and some forms of encephalitis, which both have been seen this summer in the United States. The guidelines include:
- Drain water from garbage cans, house gutters, buckets, pool covers, coolers, toys, flower pots or any other containers where sprinkler or rain water has collected.
- Discard old tires, drums, bottles, cans, pots and pans, broken appliances and other items that aren't being used.
- Empty and clean birdbaths and pet's water bowls that are kept outside at least once or twice a week.
- Protect boats and vehicles from rain with tarps that don’t accumulate water.
Read more on infectious disease.
Hurricane Sandy Rebuilding Task Force Releases Report, Recommendations
The Hurricane Sandy Rebuilding Task Force yesterday released its Rebuilding Strategy designed to be a model on how communities can prepare for and respond to extreme weather events. It also includes recommendations on how to continue to help area rebuild from the devastation of Hurricane Sandy. “This Rebuilding Strategy will protect families, small businesses and communities across the region, and the taxpayers’ investment in them, from the risks posed by sea level rise and more extreme weather events – risks that are made worse by the reality of a changing climate,” according to U.S. Department of Housing and Urban Development (HUD) Secretary Shaun Donovan, who chairs the task force. The goals include aligning federal funding with local rebuilding visions; cutting red tape and getting assistance to families, businesses and communities efficiently and effectively; and coordinating the efforts of the federal, state and local governments, with a region-wide approach to rebuilding. Read more on Hurricane Sandy.
Survey: Hispanic Teens More Likely Than White, Black Teens to Abuse Drugs
Hispanic teens are more likely than their white and black counterparts to abuse both legal and illegal drugs, according to a new report, The Partnership Attitude Tracking Study 2012: Hispanic Teens and Hispanic Parents. A survey found that about 54 percent of Hispanic teens had used an illicit drug; 43 percent of white teens and 45 of black teens reported using an illicit drug in the same survey. At the heart of the issue could be that Hispanic teens on average view the drugs as less harmful, said Sean Clarkin, director of strategy and programs at The Partnership at Drugfree.org. "They see drug use among their peers and in their community, and the messages they are not getting from their parents—these all may be contributing to this feeling that drug use is normal," he said. The key to improving on these troubling rates is improved guidance an education on the dangers of drug abuse. Read more on substance abuse.
CDC: Excessive Alcohol Consumption Costs States Billions
Excessive alcohol use cost states and the District of Columbia a median of $2.9 billion in 2006. On a state by state basis, those costs range from a low of $420 million in North Dakota to a high of $32 billion in California, according to the U.S. Centers for Disease Control and Prevention (CDC). Binge drinking—five or more drinks for men or four or more drinks for women—was responsible for about 70 percent of that; an estimated 18 percent of U.S. adults report binge drinking. “Excessive alcohol use has devastating impacts on individuals, families, communities, and the economy,” said CDC Director Tom Frieden, MD, MPH. “In addition to injury, illness, disease, and death, it costs our society billions of dollars through reduced work productivity, increased criminal justice expenses, and higher healthcare costs. Effective prevention programs can support people in making wise choices about drinking alcohol.” Read more on alcohol.
Poll: After Jolie’s Mastectomy, More Women Inclined to Discuss Issue with Doctors
In the wake of actress Angelina Jolie’s announcement that she underwent a preventative double mastectomy, more women have decided to seek medical advice on that procedure or ovary removal, according to a new poll from HealthDay. The survey found that 86 percent of women knew about Jolie’s decision and 5 percent would speak with their own doctors about the issue. That translates to about 6 million U.S. women. Jolie’s decision was made because she carries a mutation in a gene called BRCA1, which increases her risk of developing breast cancer to about 60 percent and her risk of developing ovarian cancer to as much as 40 percent. The U.S. averages are 12 percent for breast cancer and 1.4 percent for ovarian cancer. Still, doctors stress that genetic testing is only recommended for women deemed at “high risk,” which includes those with a personal history or a strong family history of breast or ovarian cancers. The American Cancer Society (ACS) Board of Directors has stated that "only very strong clinical and/or pathologic indications warrant doing this type of preventive operation," and ACS says the procedure is not 100 percent effective. Read more on cancer.
Stimulant-related ER Visits Up 300 Percent for Younger Adults
Emergency department visits due to central nervous system (CNS) stimulants rose by about 300 percent for younger adults from 2005 to 2011, according to a new report from the Substance Abuse and Mental Health Services Administration (SAMHSA). There were 22,949 such visits in 2011, with about 30 percent of the visits also involving alcohol. There were also about 1.24 million visits related to the nonmedical use of pharmaceuticals. “Nonmedical use of any drug, even an over-the-counter drug, can be dangerous, but these CNS stimulants can potentially cause significant and lasting harm, including heart problems and addiction,” said SAMHSA Chief Medical Officer Elinore F. McCance-Katz, MD, PhD. “We must raise awareness of this public health risk and do everything possible to prevent it.” Nonmedical use of CNS prescription drugs—which include those used to treat attention deficit/hyperactivity disorder—is linked to heart and blood vessel problems, as well as drug abuse or dependence. When paired with alcohol they can increase the risk of alcohol poisoning or alcohol-related injuries. Read more on substance abuse.
Just a few metro stops can mean the difference between an extra five to ten years added to your lifespan. Using new city maps, the Commission to Build a Healthier America, which reconvened recently after a four year hiatus, is illustrating the dramatic disparity between the life expectancies of communities mere miles away from each other. Where we live, learn, work and play can have a greater impact on our health than we realize.
For too many people, making healthy choices can be difficult because the barriers in their communities are too high—poor access to affordable healthy foods and limited opportunities for exercise, for example. The focus for the Commission’s 2013 deliberations will be on how to increase opportunities for low-income populations to make healthier choices.
The two maps of the Washington, D.C. area and New Orleans help to quantify the differences between living in certain parts of the region versus others.
Living in Northern Virginia’s Fairfax and Arlington Counties instead of the nearby District of Columbia, a distance of no more than 14 miles, can mean about six or seven more years in life expectancy. The same disparity exists between babies born at the end of the Washington Metropolitan Transit Authority’s (known as the Metro) Red Line in Montgomery County—ranked second out of 24 counties in the County Health Rankings, metrics developed by the Robert Wood Johnson Foundation and the University of Wisconsin to show the health of different counties—and those born and living at the end of the Metro’s Blue Line in Prince George’s County, which ranked 17th in the County Health Rankings.
“We know PSA campaigns can make a big impact; that they can improve people’s lives.”
The Advertising (Ad) Council has just launched a new version of its digital distribution platform, PSA Central, which is geared toward PSA directors and media outlets, but is also valuable for anyone who wants to share the messages including educators and public health practitioners. The site offers easy access to video, print, radio, online, mobile and outdoor media public service advertisements that range from bullying prevention to food safety education.
Public Service Advertisements (PSAs) may actually date back to the civil war when newspapers offered free advertising space to the U.S. government to advertise bonds whose revenues were used to pay for the war effort. These days, PSAs are much more likely to be public safety messages such as a United Kingdom video PSA, downloaded over 2 million times on YouTube, reminding people just why they should buckle up in a car. And more importantly, these efforts are being measured and tracked to show impact on health behavior change and health outcomes, such as the Ad Council’s drunk driving prevention campaign that has encouraged 70 percent of Americans to take action to stop a friend from driving drunk.
NewPublicHealth recently spoke with Peggy Conlon, president and CEO of the Ad Council, about the public health messages PSAs can convey and how new media has expanded their reach.
NewPublicHealth: How have PSAs evolved over the years?
Peggy Conlon: PSAs have evolved quite a bit. The Ad Council is 71 years old and back in the earliest days PSAs were seen in newspapers and heard over the radio. Since then they have been showcased on just about all media platforms. In the 90s we were introduced to the Internet and everything changed forever. The Internet added another new dimension to our ability, in a very tangible and personal way, to engage communities around social issues.
NPH: What are some of the most effective and iconic campaigns in public service advertising?
CDC Issues First Comprehensive Report on Children’s Mental Health in the United States
As many as one in five American children under the age of 17 has a diagnosable mental disorder according to a new report from the Centers for Disease Control and Prevention. The report is the first expansive report on children's mental health ever done by the U.S. government and looked at six conditions:
- attention-deficit/hyperactivity disorder (ADHD)
- behavioral or conduct disorders
- mood and anxiety disorders
- autism spectrum disorders
- substance abuse
- Tourette syndrome
The most common disorder for children age 3 through 17 is ADHD (7 percent) followed by behavioral or conduct problems (3.5 percent), anxiety (3 percent), depression (2 percent), and autism spectrum disorders (1 percent).
Five percent of teens reported abusing or being dependent on illegal drugs, 4 percent abused alcohol and 3 percent reported smoking cigarettes regularly. Boys were more likely than girls to have the disorders. Read more on mental health.
New PSAs Help Parents Talk to Younger Kids about the Dangers of Underage Drinking
“Talk. They Hear You,” is a new national public service announcement (PSA) campaign from the Substance Abuse and Mental Health Services Administration (SAMHSA) to empower parents to talk to children as young as nine about the dangers of underage drinking. SAMHSA research shows that more than a quarter of American youth engage in underage drinking, and though there has been progress in reducing the extent of underage drinking in recent years, particularly among those aged 17 and younger, the rates of underage drinking are still unacceptably high, according to SAMHSA. A report from late last year shows that 26.6 percent of 12-20 year-olds report drinking in the month before they were surveyed and 8.7 percent of them purchased their own alcohol the last time they drank, despite the fact that all fifty states and the District of Columbia currently have laws prohibiting the purchase and use of alcoholic beverages by anyone under age 21.
“Even though drinking is often glamorized, the truth is that underage drinking can lead to poor academic performance, sexual assault, injury, and even death,” said said SAMHSA Administrator Pamela S. Hyde.
The goal of the new PSA is to help parents start a conversation about alcohol before their children become teenagers. Read more on addiction.
Advocacy Groups Petition FDA to Ban Menthol Flavored Cigarettes
In response to a Citizen Petition by close to twenty health and tobacco control advocacy groups, the Food and Drug Administration has opened a docket for public comment on banning menthol in cigarettes. In 2009, according to the Tobacco Control Legal Consortium, the lead group on the petition, Congress banned all flavors in cigarettes except menthol, and directed the FDA to decide whether continued sale of menthol cigarettes is “appropriate for public health." According to the petition, menthol cigarettes are the source of addiction for nearly half of all teen smokers. Read more on tobacco.
Harvard Study: Public Supports Policy Interventions to Reduce Disease Burden
A survey by the Harvard School of Public Health finds that the public greatly supports government action with the goals of changing lifestyle choices that can lead to obesity, diabetes and other non-communicable diseases. However, the survey found that people are less likely to support actions that seem intrusive or coercive. The survey was published in Health Affairs. In a second poll from the Harvard School of Public Health, National Public Radio and the Robert Wood Johnson Foundation, researchers found a large gap between parents’ perceptions of their children’s weight and expert definitions. According to the parents, 15 percent of children are a little or very overweight; national data suggest more than twice as many, or 32 percent of all children, are overweight or obese. Read more on obesity.
Is Facebook Biased Against Older People?
Researchers at the Yale School of Public Health reviewed publicly available Facebook pages and found that many sites created by younger people often included negative age stereotypes. Some even suggested (possibly in jest) that older people should be killed. One Facebook group description, for example, stated that anyone “over the age of 69 should immediately face a firing squad.”
“Facebook has the potential to create new connections between the generations,” says Becca Levy, the lead author of the study. “Instead, it may have created new obstacles.” The study was published in The Gerontologist. Read more on aging.
Drug Use and Mental Health Issues Linked to Dropping Out of College
Marijuana and other illegal drug use, as well as mental health problems, are associated with an increased likelihood of dropping out of college, according to research from the University of Maryland School of Public Health. The research was part of the College Life Study, a longitudinal prospective study of health-risk behaviors among 1,253 college students between 17-19 years old, who were interviewed annually for four years, beginning with their first year of college. The study was published online in the Journal of Studies on Alcohol and Drugs. Read more on substance abuse.
Certain Alcohol Brands Dominate Underage Drinking
A small number of alcohol brands in particular are most popular with underage drinkers, according to a new study in Alcoholism: Clinical & Experimental Research. About 27.9 percent of underage youth reporting they’d had Bud Light in the past 30 days, making it the most used. Smirnoff Malt Beverages and Budweiser were second and third. “Importantly, this report paves the way for subsequent studies to explore the association between exposure to alcohol advertising and marketing efforts and drinking behavior in young people,” said study author David Jernigan, PhD, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health. Read more on alcohol.
Report: Informational Tools Help Men Make Better Prostate Health Decisions
Decision-making aids help men make better—and more informed—decisions about prostate screenings, according to a new report in JAMA Internal Medicine. Researchers found the aids help the men weigh different possible outcomes, such as catching extra cancers, possibly reducing their risk of death or avoiding unpleasant side effects. As many as one in four family physicians regular perform prostate screenings without first getting a patient’s permission, according to Reuters. The U.S. Preventive Services Task Force recommends against prostate-specific antigen tests for men who are not at high-risk. Read more on cancer.
Study: Kids Treated for ADHD Still Show Serious Symptoms
As many as 90 percent of kids who are treated for attention-deficit/hyperactivity disorder (ADHD) still show serious symptoms after six years, indicating the chronic condition requires advancements in long-term behavioral and pharmacological treatments, according to a new study in the Journal of the American Academy of Child & Adolescent Psychiatry. The study did not look into issues such as whether medications were ineffective or not taken as prescribed. "Our study was not designed to answer these questions, but whatever the reason may be, it is worrisome that children with ADHD, even when treated with medication, continue to experience symptoms, and what we need to find out is why that is and how we can do better," said lead investigator Mark Riddle, MD, a pediatric psychiatrist at the Johns Hopkins Children's Center. ADHD causes difficulty in concentration, restlessness, hyperactivity and impulsive behavior. Read more on mental health.