FDA’s New Food Defense Tool Helps Stop Intentional Contamination
The U.S. Food and Drug Administration (FDA) has developed a new Food Defense Plan Builder tool to help owners and operators of food facilities create plans to minimize intentional contamination. While rare, intentional contamination, intentional contamination can be a serious public health problem. For example more than 40 people in Kansas became sick in 2009 when an employee put pesticide in salsa. Based on FDA’s food defense guidance documents, the tool uses a series of pointed questions to develop a customized food defense plan, including a vulnerability assessment; broad and focused mitigation strategies; and an action plan. Read more on food safety.

Text4baby Programs Gives Pregnant Women, Mothers Critical Information
The 2013 Text4baby State Enrollment Content will promote the mobile health tool while providing pregnant women with important information on their pregnancy and their child’s first year of life. By texting “BABY” (or “BEBE” for Spanish) to 511411, they will receive three free weekly text messages addressing issues such as labor signs and symptoms; prenatal care; developmental milestones; immunizations; nutrition; birth defect prevention; and safe sleep. The program is supported by more than 950 health departments, academic institutions, health plans, businesses and the U.S. Department of Health and Human Services. Under the contest, the states with the highest enrollment percentages will be recognized at the American Public Health Association Annual Meeting in Boston, Mass. in early November. Read more on maternal and infant health.

Citing High Cancer Risk, Angelina Jolie Undergoes Preventive Double Mastectomy
A mutated BRCA1 or BRCA2 gene makes a woman five times more likely to develop breast cancer in her life. On Tuesday in an op-ed in The New York Times, Angelina Jolie — who carries a “faulty” BRCA1 — announced she has undergone a double mastectomy to reduce her risk of developing the cancer. Her physicians had estimated an 87 percent risk of breast cancer and 50 percent risk of ovarian cancer. "I choose not to keep my story private because there are many women who do not know that they might be living under the shadow of cancer,” she wrote. “It is my hope that they, too, will be able to get gene tested." A woman with one of the faulty genes is at an average 60 percent risk of developing breast cancer; a woman without a mutated gene is at an average 12 percent risk. Today CNN anchor Zoraida Sambolin also announced she is getting a double mastectomy. Read more on cancer.

Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks. 

NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?

Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.

So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.

NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?

Doctors’ Knowledge of Lab Test Costs Reduces Unnecessary Testing
Knowing the cost of a laboratory tests makes doctors less inclined to order them for hospitalized patients, according to a new study in JAMA Internal Medicine. About $226 billion was wasted on unnecessary tests in 2011, according to the study from researchers at The Johns Hopkins University School of Medicine in Baltimore. Unnecessary tests also increase the risk of patient harm and false positives. "The rational approach to ordering tests is something we should all be interested in, and something—if we did better—that would save the system money and save the patients the horror of causing harm," said Leonard Feldman, MD, of Johns Hopkins. Read more on access to health care.

Mass. Study Shows Importance of Simplifying Health Insurance Benefits Options
Just six months before open enrollment for the Affordable Care Act’s health insurance marketplaces begins, a new study in the journal Health Affairs shows that some Massachusetts families who enrolled in unsubsidized Commonwealth Health Insurance Connector Authority plans experienced higher financial burdens due to health care costs. The study found that 38 percent saw financial burdens and 45 percent saw higher-than-expected out-of-pocket costs—indicating that lower-income families with increased health care needs and multiple children are at particular risk for higher costs. “Given the complexity of health insurance choices and consumers’ limited understanding of health insurance benefits, policy makers need to reach out and simplify information to promote optimal plan choices for the people,” wrote the study’s authors. Read more on community health.

CSPI Classifies Ginkgo Biloba as ‘Avoid’
The Center for Science in the Public Interest (CSPI) is now recommending people avoid Ginkgo biloba after a National Toxicology Program study linked it to liver cancer in mice and thyroid cancer in rats. The substance can be found in many dietary supplements, herbal teas and energy drinks. "Ginkgo has been used in recent years to let companies pretend that supplements or energy drinks with it confer some sort of benefit for memory or concentration," said CSPI executive director Michael F. Jacobson. "The evidence for those claims has been dubious, at best. The pretend benefits are now outweighed by the real risk of harm." The U.S. Food and Drug Administration has previously sent warning to drink manufacturers stating that the ingredient is not generally considered safe for food. Read more on nutrition.

Jill Birnbaum is an advocate for nutrition policy, tobacco control, and health care reform who has worked at the federal, state, and local levels. Her work began in Minnesota, and she now oversees state advocacy for the American Heart Association. Her grassroots experience, combined with her national role, gives her unique insights into public health policy at all levels of government. 

This is the first in a two-part interview conducted by Grassroots Change: Connecting for Better Health, a project of the Robert Wood Johnson Foundation Health Group. In part one, Jill shares her perspective on grassroots movements and the threat of preemption in the obesity prevention arena. Preemption can take away the ability of states and local communities to adopt innovative solutions to their own public health problems in a way that responds to each community’s unique needs.

>>View the original posting of this interview over at GrassrootsChange.net.
>>Read more on preemption and grassroots movement building.

Grassroots Change: What do you see as the impact of preemption in public health, especially in obesity prevention?

Jill Birnbaum: [Preemption] slows or even ends grassroots movements before they begin. It also drains our resources for future advocacy efforts. We leave it to the next generation of public health advocates to undo policy compromises that we make today. We’re still seeing that in a few states with tobacco, and anticipating the fights both at the federal and state levels that we might have to undo someday [in obesity prevention]. 

Preemption stifles innovation, and it also makes some assumptions that can be wrong. It assumes that we know everything today and that there’s nothing more that we have to learn tomorrow. That’s especially true in nutrition policy where science continues to evolve and policy needs to evolve along with the science. 

Preemption also has the effect of dividing the [public health] community when a small group of people, in some cases even a single individual or organization, negotiates away something that other people really want.

GC: Are the concerns about preemption in obesity prevention mostly about nutrition policy? There doesn’t seem to be a major effort to preempt local physical activity policies. 

Small Amounts of Daily Exercise Can Help Teens Quit Smoking
As little as 30 minutes of daily exercise can help kids quit smoking, according to a new study in the Journal of Adolescent Health. It can also help to reduce tobacco use. Researchers found that daily smokers were more likely to reduce or quit smoking if they combined a fitness program with a smoking cessation program, rather than just a cessation program alone. Every teen in the study smoked an average of half a pack of cigarettes each weekday and a full pack a day on weekends. And that was just one of the poor health habits of many of the participants. "It is not unusual for teenage smokers to engage in other unhealthy habits,” said author Kimberly Horn, associate dean for research at the George Washington University School of Public Health and Health Services. “Smoking and physical inactivity, for instance, often go hand in hand.” According to the U.S. Centers for Disease Control and Prevention, about 13 percent of Americans age 18 and under smoke tobacco. Read more on tobacco.

Study: Low Food Security, Exposure to Violence Closely Linked
There is a close correlation between low food security and exposure to violence, according to a new study in Public Health Nutrition. Researchers spoke with forty-four mothers of children age 3 and under who participated in public assistance programs, finding increased exposure to violence, which in turn increased the chance of negative mental health, an inability to continue school and an inability to make a living wage.  The violence included child abuse, neglect and rape. The study clearly demonstrates the need to consider and include violence prevention efforts when establishing policies to deal with hunger. Read more on violence.

Size of Parents’ Social Groups Can Affect Whether Kids are Vaccinated
What they hear from friends and the people in their social group may affect whether parents have their children vaccinated, according to a new study in the journal Pediatrics. Parents who were less likely to vaccinate were also more likely to have large social groups and rely on books, pamphlets and the Internet for information on vaccines. "I think that what needs to be done is that everybody needs to understand the importance of vaccines,” said Joseph Anthony Bocchini, Jr., MD, chairman of Pediatrics Medicine at Louisiana State University Health Sciences Center in Shreveport. “And they're not only important for the people who receive them but they're also important for the community." About 95 percent of kindergarten-aged children are appropriately vaccinated, according to the U.S. Centers for Disease Control and Prevention. Read more on vaccines.

Smoking in Youth-rated Movies Up Dramatically
Smoking scenes in youth-rated movies is back up to the same levels as about a decade ago, with approximately half of such movies in 2012 providing 14.8 billion “tobacco impressions,” according to a new study funded by Legacy. Tobacco impressions are calculated by multiplying incidents of tobacco use by the number of film tickets. From 2010 to 2012 alone the rate was up 169 percent; 2010 was an historic low for tobacco impressions. This trend is dangerous because of the way movies can influence youth behavior. "Increases in smoking imagery in the movies are discouraging," said Tom Frieden, MD, director of the U.S. Centers for Disease Control and Prevention. "Every day in the United States approximately 3,800 youth under 18 smoke their first cigarette, and approximately 1,000 become daily cigarette smokers. Reducing smoking and tobacco use in youth-oriented movies will help save lives, money, and years of suffering from completely preventable smoking-related chronic diseases." Read more on tobacco.

Online Tool Helps Family, Friends Determine Whether an Older Driver is Safe
A new free online tool can help family members and caregivers of drivers age 65 and older determine whether they’re safe to continue going out on the roads. The Fitness-to-Drive Screening Measure questionnaire, developed by researchers at the University of Florida (UF), provides a rating profile, recommendations on how to move forward and links to an array of resources. Sherrilene Classen, PhD, MPH, an associate professor of occupational therapy at the UF College of Public Health and Health Professions and the tool’s lead developer, said it’s designed to give a realistic assessment of the driving abilities without requiring an on-the-road evaluation. “We know from our research and others’ that drivers do not give valid self-reports,” said Classen, “Most everybody thinks they are driving better than they actually are. Because we don’t have the evaluators to assess the 36 million older adults who may potentially at some stage require a driving evaluation, we went to the next-best step, which is involving their caregivers or family members.” Read more on aging.

Study Links Breakfast Cereal, Healthier BMIs for Kids
Helping kids maintain a low BMI could be as simple as giving them cereal for breakfast, according to a new study in the Journal of the Academy of Nutrition and Dietetics. The study found that children who had cereal for breakfast four out of nine mornings were in the 95th percentile for BMI; kids who had cereal every day were in the 65th percentile. Researchers say the study shows the ability to combat childhood obesity by making breakfast cereal available to low-income kids; one in four U.S. kids live in a “food insecure household,” according to lead author Lana Frantzen, PhD. "(Cereal) is an excellent breakfast choice, it's simple, and gets those essential nutrients that children need, especially low income minority children," she said. Read more on obesity.

Smaller, Frequent Meals Help Kids Keep Weight Off
Smaller, more frequent meals can help kids ward of overeating and obesity, according to several new studies in the journal Pediatrics. One study found that simply using smaller dishware—thus forcing smaller portions—meant kids ate less; they found that adult-sized dishware led first-graders to take 90 calories more of food. Researchers also found kids who ate more often were 22 less likely to be overweight. "The results are very interesting and confirm our expectations that the impact of plate size on adults in the laboratory also apply to children," said Thomas Robinson, MD, a childhood obesity researcher at Stanford University, according to Reuters. "This study provides very important preliminary evidence that using smaller dishware may help reduce children's energy intakes." Read more on obesity.

Low-calorie Drinks Increasingly Popular for Kids
While sugary drinks remain popular, low-calories drinks are also gaining more and more consumers, according to a new study in the journal Pediatric Obesity. Researchers at the University of North Caroline (UNC) found both that consumption of calories from sweetened drinks was down and consumer of low-calorie drinks was up over a 10-year period. The findings were especially significant for kids. "The food industry is trying many ways to reduce the caloric content of foods and beverages," said Barry M. Popkin, PhD, W.R. Kenan Jr. Distinguished Professor of Nutrition at UNC's Gillings School of Global Public Health. "We are increasingly seeing them replace caloric sweeteners with low-calorie sweeteners. This trend has particularly emerged in the last three to four years as U.S. concern about obesity, diabetes and other complications of consuming excessive sugary high-calorie beverages has increased." Read more on nutrition.

Missed, Delayed Mammograms Increase Death Risk for Older Women
Older women with misses or delayed mammograms are significantly more likely to die from breast cancer, according to new research to be presented at the annual meeting of the American Association for Cancer Research. Researchers found “that 23 percent of women who had their last mammogram five or more years before being diagnosed with breast cancer had advanced cancer, compared with 20 percent of those who had a mammogram six months to a year before their diagnosis,” according to HealthDay. Increased time between mammograms also significantly increased the risk of death from cancer for women age 75 and older. Researchers said more study is needed to examine the connection. "It is possible that the differences in the relationship between screening interval and [death] in older versus younger women may be related to the more aggressive nature of the tumors in younger women, which might obliterate the effects of more screening,” said Michael Simon, MD, leader of the breast multidisciplinary team at the Barbara Ann Karmanos Cancer Institute in Detroit. “Other reasons may include differences in cancer treatment, information that was not available for this [group] of women.” Read more on cancer.

While this is the first year that the American Public Health Association has used “return on investment” as the theme for National Public Health Week, which runs through April 7, it’s far from the first time that public health practitioners have made the case to policymakers that the work of public health can save lives and money.

Research on the impact of public health services includes the critical fact that spending just $10 per person in programs aimed at smoking cessation, improved nutrition and better physical fitness could save the nation more than $16 billion a year, according to the Trust for America’s Health. That’s a nearly $6 return for every $1 spent.

Over the last two years, NewPublicHealth has reported frequently on the value of investing in public health. Some of our favorite ROI articles, reports and other resources include:

• >>UPDATE: Trust for America's Health released Investing in America's Health: A State-by-State Look at Public Health Funding and Key Health Facts today. The report examine public health funding and key health facts in states around the country, finding inadequate and cut funding and wide variation in health outcomes by state and county.
  
• Making the Case for Prevention: A Q&A with James S. Marks, Senior Vice President, Robert Wood Johnson Foundation, about the great potential for investing in prevention.
  
• National Prevention Resources Starter Guide:
  A collection of resources that showcase how different fields can work together and take action to prioritize prevention.
  
• Strategies to Move from Sick Care to Health Care: The  Trust for America's Health identifies high-impact steps that the nation can take to prioritize prevention and improve Americans' health.
• Workplace Wellness Perspectives: A Q&A with two very different businesses—one big, one small; one academic, one industrial—on creating healthier workplaces.
• Employers Join Community Health Movement: A Q&A with Trust for America’s Health and the National Business Coalition on Health about the critical role of employers in community prevention efforts.
• Stories of the value of investing in prevention from Wyandotte County, Kan., and Hernando, Miss.

>>Read more on the value of prevention from RWJF.org.

Every two weeks the Agency for Health Care Research and Quality (AHRQ) releases an Innovations Exchange newsletter in order to share innovative health practices from around the country that can be adapted by other communities. The Innovations Exchange supports the Agency's mission to improve the quality of health care and reduce disparities.

The current issue focuses on school-based programs for youth at risk. According to AHRQ, many adolescents—particularly those in minority and low-income communities—lack access to health information, preventive care, and clinical services, leaving them at risk for untreated physical and mental health issues. School-based health care delivery, according to AHRQ, can improve access to care and address the needs of this vulnerable population. 

The featured innovations for at risk youth include:

• A school-based program to reduce type 2 diabetes risk factors for children and young adults;
• An inner city school district's reproductive health services model;
• A school-based health center that improved access to mental health services, particularly for minorities.

The newsletter also features quality tools that schools can use to support HIV and STD prevention programs in schools and to facilitate school-based preventive, mental health, nutrition, and oral health services.

>>Read the latest issue of the AHRQ Innovations Exchange.

Study: Most Intend to Comply With Mandatory Hurricane Evacuation
Most residents of areas most likely to be hit by hurricanes—no matter their income level—intend to comply with mandatory evacuation orders, according to a new study in the journal Disaster Medicine and Public Health Preparedness. Researchers at The University of Texas School of Public Health did find variations with other demographic differences, such as age, ethnicity and education level. The findings indicate that disaster preparedness should focus more on how to best evacuate the most vulnerable residents, which could include targeted messaging and education. Read more on preparedness.

Breath Test May Identify People Prone to Obesity
A breath test that measures bacterial overgrowth in the stomach could be used to determine whether a person will become overweight, according to a new study in the Journal of Clinical Endocrinology & Metabolism. Researchers found that higher levels of methane and hydrogen from the bacteria Methanobrevibacter smithii were associated with higher BMIs and more body fat. Overgrowth of “bad” bacteria can also lead to bloating, constipation and diarrhea. While noting that obesity is “not a one-size-fits-all disease," study author Ruchi Mathur, MD, director of the outpatient diabetes treatment center at Cedars-Sinai Medical Center in Los Angeles, said this could help identify people who would respond best to particular weight loss methods. Read more on obesity.

Study Finds Most Major Restaurants Post Accurate Nutrition Info
A new study from Consumer Reports found that most major chain restaurants post accurate nutritional information about their food. Shoppers purchased and tested 17 menu items from restaurants and fast-food chains, comparing the results for each item to the same items purchased at other restaurants in the chain. They determined that only two items had higher fat or calorie content than advertised: Olive Garden’s Lasagna Primavera with Grilled Chicken and Outback Steakhouse’s Chicken on the Barbie. “We found that you can usually trust the figures you see,” said editor Leslie Ware. “On average, most of them were telling the truth.” The U.S. Food and Drug Administration is slated to release new regulations regarding nutrition labeling later this year. Read more on nutrition.