Category Archives: Public Health

Mar 14 2014
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Readers Respond: Interpretation of Public Health Studies

Recently, we’ve been pleased to see increased engagement across a number of posts on NewPublicHealth, particularly from public health students. Reader comments have pointed a justly critical eye toward the way studies are often interpreted and presented. This level of conversation is critical to informing and bolstering NewPublicHealth’s coverage of public health news and issues.

We have compiled a handful of reader comments below, in an effort to continue the discussion.

  • Readers shared their opinions on a survey showing that Hispanic adults are not confident in their understanding of insurance terms:
    • “Although the concern of this study was the disparity between white literacy and non-white literacy, general focus should be placed on understanding for people in all racial categories. A lack of health literacy leads to many issues in health care, often resulting in ineffectiveness of care.” — Jessica H.
    • “The study regarding the lack of understanding of key insurance terms is interesting because while it specifically shows low-literacy levels in Hispanics, it points to a larger problem in America. Relative to this study, literacy levels were highest in Whites and lowest in Hispanics. Overall, the literacy levels were universally low. This is a problem because being unable to understand insurance terms would lead to less effective use of the insurance, or no insurance at all.” — Michael
  • Readers also questioned the validity of a study that found many parents support flu shots at school, based on concerns regarding data collection methods and information presentation biases:
    • “Regarding the study that found that many parents support flu shots at school: The survey used in this study was given in English, but it was found that people most likely to agree to have their children vaccinated in a school setting included parents of uninsured children...If children are not insured, it usually means the parents are not insured and have jobs that do not provide health benefits. Immigrants usually work these kinds of jobs, and probably do not speak English well. So, if the survey was only given in English, this could influence the results of the study...” — Brittany    
    • “Surveys aren’t the best method of collecting data. Secondly, the convenience portion, which includes vaccine beliefs and or skipping past vaccines greatly contributed to the unwillingness to consent...And this would create a high stated consent rate, due to parental preferences based on location...Lastly, although the author wrote this study with intentions of public health official’s consideration to this topic I would be concerned since this study is the first to provide this information and does however contain many biases.” — Cora Neville
    • “The article mentions that only parents who answered with a yes or not sure were asked follow up questions. If a parent answered no, was there a question that asked why they would not consent?...I think collecting data on those who declined the school-located vaccination would help future researchers find a way to get those parents who originally declined to consent.” — Shannen Mincey
  • Many people in the public health field have publicly weighed in on the U.S. Food and Drug Administration’s proposed changes to food labels, including NewPublicHealth readers:
    • I think some parts of this new regulation will be good for consumers while others will simply be a futile effort to help consumers eat better. For example, I believe adding “added sugars” to the label will be effective in identifying the bad sugar...One change that could be helpful for consumers would be to identify the types of fiber. Although the label includes total dietary fiber, this can be misleading to consumers who may not realize they are not getting nutritional value out of all of it.” — Jessica H.    
    • “Food labels need to be more understandable and consumer friendly. The Healthy People Campaign and health advocates, such as Michelle Obama want America to take responsibility for their health, yet the consumers have to dissect every food label to get a proper gauge of the nature of the food they’re consuming... On the same token, I think it is going to take a great deal of further research to determine what would be considered “better align[ed] with how much people really eat.’” — Vanessa Moses

Thank you to all our readers who have made their opinions known. Let’s keep these conversations going!

Mar 14 2014
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Public Health News Roundup: March 14

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Teens who Leave Gangs Still Face Consequences as Adults
A new study in the American Journal of Public Health finds that joining a gang during teen years has significant consequences in adulthood beyond criminal behavior, even after a person leaves the gang.

The study authors followed 808 fifth-grade students from 18 elementary schools in high-crime neighborhoods in Seattle, beginning in 1985. Participants were interviewed every year until the age of 18, then every three years until the age of 33.

Researchers used 23 risk factors, including poverty and associating with kids with problem behaviors, to calculate a child’s propensity for joining a gang, and then compared 173 youth who had joined a gang with 173 who did not but showed a similar propensity for doing so. The average age of joining a gang was just under 15 years old and the majority (60 percent) were in a gang for three years or less.

The study found that subjects between ages 27 and 33 who had joined a gang in adolescence were:

  • Nearly three times more likely to report committing a crime,
  • More than three times more likely to receive income from illegal sources
  • More than twice as likely to have been jailed in the previous year
  • Nearly three times more likely to have drug-abuse problems
  • Nearly twice as likely to say they were in poor health
  • Twice as likely to be receiving public assistanÎ
  • Half as likely to graduate from high school.

The study was funded by the National Institute on Drug Abuse the Robert Wood Johnson Foundation, and the National Institute on Mental Health.

Read more on poverty

Stroke Survivors May Lose a Month of Healthy Life for Every 15-Minute Delay in Treatment
Every 15-minute delay in delivering a clot-busting drug after stroke takes away about a month of a healthy life for stroke survivors, according to a new study in the journal Stroke. Researchers at the University of Melbourne in Australia analyzed data from clot-busting trials and applied the time to efficacy to over 2,000 stroke cases in Australia and Finland to calculate what the patient outcomes would have been if they had been treated faster or slower. They found that for every minute the treatment could be delivered faster, patients gained an average 1.8 days of extra healthy life. The researchers also found that while all patients benefited from faster treatment, younger patients with longer life expectancies gained more than older patients

Read more on access to health care

One in Five Older Americans Take Medications that Work Against Each Other
More than 20 percent of older Americans take Medicines that work at odds with each other, and in some cases the medication being used for one condition can actually make the other condition worse, according to a new study in the online journal PLUS One by researchers at Oregon State University and the Yale School of Medicine. The study was conducted by researchers from OSU and Yale with 5,815 community-living adults over a two year period.  

“Many physicians are aware of these concerns but there isn’t much information available on what to do about it,” says David Lee, an assistant professor in the Oregon State University/Oregon Health & Science University College of Pharmacy. “As a result,” says Lee, “right now we’re probably treating too many conditions with too many medications. There may be times it’s best to just focus on the most serious health problem, rather than use a drug to treat a different condition that could make the more serious health problem even worse.”

The chronic conditions in which competing therapies are common include coronary artery disease, diabetes, COPD, dementia, heart failure, hypertension, high cholesterol and osteoarthritis and others.

Read more on prescription drugs

Mar 13 2014
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Public Health News Roundup: March 13

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Hypertension Often Untreated in U.S. Hispanic Community
A new study in the American Journal of Hypertension finds that there is too little recognition and control of hypertension among the Hispanic population of the United States.

The new data comes from the Hispanic Community Health Study/Study of Latino, a longitudinal study of 16,415 Hispanics/Latinos, ages 18 to 74 years from four communities in the U.S. (Bronx, Chicago, Miami, and San Diego). Measures including hypertension levels and whether patients were on hypertension medications were collected between 2008 and 2011 and then followed up last year.

The study also found that the prevalence of hypertension in the Hispanic community increased with age, and was highest among those with Cuban, Puerto Rican, and Dominican backgrounds.

Read more on heart health.

USDA Funds News Childhood Obesity Prevention Programs at Three Universities
The National Institute of Food and Agriculture of the U.S. Department of Agriculture has given grants to childhood obesity prevention projects at three U.S. universities:

  • University of Tennessee, Knoxville, Tenn. for "Get Fruved:" A peer-led, train-the-trainer social marketing intervention to increase fruit and vegetable intake and prevent childhood obesity
  • Tufts University, Boston, Mass., for a “kids-only" retail coupon study to promote healthy snack options among adolescents in convenience stores.
  • Winston-Salem State University, Winston-Salem, N.C., for a program works with 10-12 year-old children from low income families.

Read more on obesity.

Almost Half of U.S. Population Lives in Jurisdictions that Strengthened Gun Laws in 2013
Fifteen states and the District of Columbia strengthened their gun laws in the year following the Newtown school shooting, according to a new review from the Johns Hopkins University press, Updated Evidence and Policy Developments on Reducing Gun Violence in America.

Among the changes in the last year was legislation at the state level to reduce intimate partner violence offenders’ access to firearms.

Read more on injury prevention.

Feb 12 2014
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Public Health News Roundup: February 12

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.

Feb 11 2014
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Local Health Departments in 2013: Budget and Job Cuts; Social Media and QI Increases

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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.

Read More

Feb 7 2014
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Faces of Public Health: Dennis Andrulis

Dennis Andrulis

In January 2008, the Texas Health Institute received support from the Joint Center for Political and Economic Studies, a policy think tank with a particular focus on people of color, to track progress on efforts to advance racial and health equity through provisions of the Affordable Care Act (ACA). Shortly after the ACA became law, new support from the W.K. Kellogg Foundation and the California Endowment has led to a series of four reports that have assessed how well the law has been implemented in a way that addresses racial and ethnic health equity across five topic areas:

  • Health insurance and exchanges;
  • Health care safety net;
  • Workforce support and diversity;
  • Data, research and quality; and
  • Public health and prevention.

To learn more about the reports’ findings, NewPublicHealth recently talked with Dennis Andrulis, PhD, MPH, the Senior Research Scientist at the Texas Health Institute and an Associate Professor at the University of Texas School of Public Health.

NewPublicHealth:  How have the reports produced by the Texas Health Institute helped advance what we know about the ability of the Affordable Care Act to advance health equity?

Dennis Andrulis: The reports have provided an update of the progress, or lack thereof, in implementing race, ethnicity, language and equity provisions in the law. Did Congress appropriate dollars to support these provisions? If so, did the appropriations match the original requests and will they continue in future years?

The result is we have mapped out what we believe is a comprehensive overview of about 60 provisions related to health equity. Additionally, we have reported on the content and shape of related new initiatives, innovations, program support and other health care efforts.

NPH: What are some short-term and long-term efforts that your work indicated will help improve some health disparities?

Dennis Andrulis: First we need to have accurate and well-disseminated information about what’s in the law and the opportunities to change disparities that it provides.

Read More

Feb 7 2014
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Public Health News Roundup: February 7

Decrease in Pediatric Antibiotic Leveling Off 
The number of children taking antibiotics has decreased over the past decade, but that decrease has stalled in recent years in certain age groups and geographic locations, according to a study in Pediatrics. Researchers reviewed pharmacy and outpatient claims over a 10-year period (2000 to 2010) in three health plans located in three different geographic locations to determine the number of antibiotics dispensed each year for children ages 3 months to 18 years. Although the overall antibiotic-dispensing rate in each age group and health plan was lower in 2009-2010 than in 2000-2001, the rate of decline in antibiotic use has slowed. The highest rate of antibiotic use was in children age 3 months to less than 24 months of age in all years of the study.

The study authors say the previous downward trend in antibiotic use in children may have reached a plateau, and continued improvements in judicious antibiotic dispensing are needed. Read more on pediatrics.

NHTSA Gives Okay for Vehicle to Vehicle Communication to Help Prevent Crashes
The National Highway Traffic Safety Administration has announced that it will begin taking steps to allow vehicle-to-vehicle (V2V) communication technology for light vehicles, which will allow vehicles to "talk" to each other and ultimately avoid many crashes by exchanging basic safety data, such as speed and position, ten times per second.

The safety applications currently being developed provide warnings to drivers so that they can prevent imminent collisions, but do not automatically operate any vehicle systems, such as braking or steering, although NHTSA is also considering future actions on active safety technologies that rely on on-board sensors.

V2V communications can provide the vehicle and driver with 360-degree situational awareness to address additional crash situations — including those, for example, in which a driver needs to decide if it is safe to pass on a two-lane road (potential head-on collision), make a left turn across the path of oncoming traffic, or in which a vehicle approaching at an intersection appears to be on a collision course. In those situations, V2V communications can detect threats hundreds of yards from other vehicles that cannot be seen, often in situations in which on-board sensors alone cannot detect the threat. Read more on transportation.

Many Hospital ICUs Don't Follow Infection Prevention Rules
While most hospitals have evidence-based guidelines in place to prevent health care-associated infections in intensive care units (ICUs), clinicians often fail to follow them according to new research from the Columbia University School of Nursing published in the American Journal of Infection Control. The study, on over 1600 ICUs, found lax compliance in intensive care units where patients are more likely to be treated with devices linked to preventable infections – such as central lines, urinary catheters and ventilators.

The study focused on three of the most common preventable infections — central line-associated bloodstream infections, ventilator-associated pneumonia, and catheter-associated urinary tract infections and determined that despite decades of research, establishing best practices for prevention of these infections, approximately one in 10 hospitals lack checklists to prevent bloodstream infections, and one in four lack checklists to help avoid pneumonia in ventilator patients, and that in hospitals with checklists, they are followed only about half of the time.

Health care-associated infections kill an estimated 100,000 Americans a year and result in over $30 billion in excess medical costs, according to the Centers for Disease Control and Prevention. Read more on injury prevention.

Feb 5 2014
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Pulling the Plug on the Tobacco “Power Wall”: CVS Pharmacies to Stop Selling Tobacco

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The announcement by CVS Caremark this morning that it will stop selling cigarettes and other tobacco products at its more than 7,600 CVS pharmacy stores across the United States by October 1, 2014, does more than just end an outlet for smokers. It also removes a highly effective marketing tactic from those stores, the tobacco "power wall," which is aimed at enticing current and would-be smokers—especially children and teens—to smoke.  

Most retail food and sundry stores include the colorful display walls, which are usually designed by tobacco companies who also often provide financial incentives to store owners to keep the walls stocked. A report, updated in 2012, by the  Center for Public Health and Tobacco Policy which is funded by the New York State and Vermont departments of Health, says the power walls “are highly engineered by tobacco companies to maximize visual intrusiveness and instigate impulse purchases.” The report adds that the walls “function as a subtle kind of advertising, conveying the message that cigarettes are popular and desirable."

 

file Tobacco "power wall" in a pharmacy, alongside tobacco cessation aids

A 2006 study in the journal Heath Education Research  found that “[t]he presence of cigarette displays at the point-of-sale... has adverse effects on students’ perceptions about ease of access to cigarettes and brand recall, both factors that increase the risk of taking up smoking.”

And, according to a November report on point of sale displays by the Campaign for Tobacco-Free Kids, exposure to point of sale tobacco product displays “influences youth smoking, promotes the social acceptability of tobacco products, increases impulse tobacco purchases and undermines quitting attempts.”

While San Francisco and a few other cities have passed laws that ban cigarette sales in pharmacies, and the advocacy group Americans for Nonsmokers' Rights is working to expand that ban, no U.S. jurisdictions have ended displays of tobacco products  according to tobacco control legal experts, generally because of concern that they might be sued by tobacco companies claiming an infringement of the companies’ right to commercial free speech under the U.S. Constitution. Recently, tobacco control legal experts have said tobacco company suits likely have less merit since the 2009 law giving regulation of most U.S. tobacco products to the Food and Drug Administration.

But tobacco control advocates hope other major pharmcies will follow the CVS example, since leveraging the power of private companies to support a culture of health may be a far more effective way to bring down those walls.

>>Read a statement by Robert Wood Johnson Foundation president Risa Lavizzo Mourey on the CVS Caremark decision to stop selling cigarettes in its stores.

Dec 30 2013
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Helping Working Families Find Homes They Can Afford

The U.S. Department of Housing and Urban Development (HUD) recently posted an interview with Teresa Bainton, director of the New York Multifamily HUB, which manages multifamily housing programs in the Northeast. Bainton’s job puts her in constant contact with families, veterans, seniors, developers, elected officials and building owners and managers. Bainton says the work, though so rewarding, is especially challenging in the Northeast, where housing prices are often higher than average costs for the rest of the United States.

>>Read the full interview.

Dec 30 2013
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Public Health News Roundup: December 30

More Than One Million People Now Enrolled for Health Insurance Coverage under the Affordable Care Act
The Centers for Medicare and Medicaid Services (CMS), which administers the health insurance provisions of the Affordable Care Act (ACA) reported late last week that more than one million people have now enrolled for coverage under the ACA.

CMS also reported that December enrollment as of December 27 was seven times that of October and November. Open enrollment will continue through March, with rolling dates for first day of coverage. Read more on the Affordable Care Act.

U.S. Flu Cases on the Rise
The Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported last week that rates of flu are on the rise in the United States, with the 2009 H1N1 virus the predominant strain. The good news is that this year’s flu vaccine is protective against H1N1.

According to CIDRAP, officials from the Centers for Disease Control and Prevention have said that the 2009 H1N1 virus has a greater impact on younger adults and older children than seasonal flu strains typically do.

The numbers of U.S. flu cases are usually highest January through March, which means that people who have not had flu shots yet still have time to protect themselves. Full immunity from the vaccine can take up to two weeks from the time of the injection. Use the CDC’s Flu Vaccine Finder to find a flu shot in your neighborhood. Read more on outbreaks.

New Orleans Health Commissioner to become Federal Health IT Administrator
New Orleans Health Commissioner Karen DeSalvo, MD, has been appointed the new National Coordinator for Health Information Technology (IT), replacing Farzad Mostashari, who left the position earlier this year. In a memo to employees of the U.S. Department of Health and Human Services (HHS), which oversees the office of the National Coordinator, HHS Secretary Kathleen Sebelius noted that Dr. DeSalvo boosted the use of health IT as "a cornerstone of [New Orleans’s] primary care efforts and a key part of the city's policy development, public health initiatives and emergency preparedness." Dr. DeSalvo will begin her post in mid-January. Under Dr. DeSalvo's leadership, New Orleans also received the inaugural Robert Wood Johnson Foundation Roadmaps to Health Prize.