NewPublicHealth is partnering with Grassroots Change: Connecting for Better Health to share interviews, tools, and other resources on grassroots public health. The project of the Robert Wood Johnson Foundation Health Group supports grassroots leaders as they build and sustain public health movements at the local, state and national levels.

In this Q&A, conducted by Grassroots Change, Shannon Frattaroli, PhD, Associate Professor at the Johns Hopkins Bloomberg School of Public Health, Center for Injury Research and Policy, shares her perspective on grassroots power and the future of public health. Her research helps answer two critical questions: Why are grassroots movements so important; and what is a public health movement, anyway?

>> Frattaroli’s interview has been edited for NewPublicHealth. View the full interview at GrassrootsChange.net.

Grassroots Change: What do you see as the role of grassroots movements in public health?

Shannon Frattaroli: There’s tremendous potential. Public health at its core is about the public. The public should have a voice in public health, and grassroots movements are one way for that to happen. The public has been very engaged in policy issues or problems throughout the history of public health. When people get engaged and are strategic with regard to policy change, things can happen quickly. And change can happen in a way that feels more legitimate. I think it’s where we should be moving in the future.

GC: What does “grassroots movement” mean? How are grassroots health movements different from other types of advocacy?

NIH Grants $40M to Combat Racial, Ethnic Disparities in Stroke Risk
The National Institutes of Health (NIH) has awarded $40 million in grants over five years to help four research centers investigate and develop strategies to reduce the risk of stroke in racial and ethnic minorities. The funds come from NIH’s National Institute of Neurological Disorders and Stroke (NINDS). Racial and ethnic minorities are at higher risk than non-whites due to higher prevalence of cardiovascular risk factors, according to said Walter J. Koroshetz, MD, deputy director, NINDS. "A few of the grantees are working closely with at-risk populations to develop interventions that give people tools to achieve blood pressure control," he said. "These research efforts will give us the traction we need to control the greatest modifiable stroke risk factor. Together, the Stroke Prevention /Intervention Research Programs represent a much needed effort to address stroke disparities in the United States." Read more on stroke.

People With Congenital Heart Disease Need Physical Activity
A new scientific statement from the American Heart Association serves to remind health professionals and patients that regular physical activity is important for people with congenital heart disease and should be promoted. Congenital heart disease (heart structural problems existing since birth) impacts close to 1 million children and 1 million adults in the United States. Specifics of the new statement include:

• While some irregular heart beat conditions may require a restriction in physical activity, “for most, physical activity can be unlimited and should be strongly promoted.”
• Most patients with congenital heart disease are relatively sedentary.  But the physical, psychological and social health benefits of physical activity are important for this population which is at risk for exercise intolerance, obesity and other diseases. .
• These are general recommendations and physicians may have to tailor some specific guidelines for individual patients.

Read more on heart health.

DOT Announces Funds to Help Improve Road Safety on Tribal Lands
The U.S. Department of Transportation (DOT) has announced the availability of more than $8.6 million in Tribal Transportation Program Safety Funds from the Federal Highway Administration (FHWA). According to Transportation Secretary Ray LaHood, the funds will help improve roads on tribal lands, which have consistently ranked among the nation’s highest road fatality rates. DOT will hold a webinar on May 8 from 4-5 p.m. EDT to provide information on the grants to potential applicants. Find a link to the webinar here. Read more on transportation.

FDA Approves Plan B One-Step for Women 15 and Older
The U.S. Food and Drug Administration (FDA) has approved over-the-counter use of the Plan B One-Step emergency contraceptive for women age 15 years or older. The single dose pill previously required a prescription. “Research has shown that access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States,” said FDA Commissioner Margaret A. Hamburg, MD “The data reviewed by the agency demonstrated that women 15 years of age and older were able to understand how Plan B One-Step works, how to use it properly, and that it does not prevent the transmission of a sexually transmitted disease.” Last month a federal judge in New York ordered the FDA to make Plan B available to all women and/or make Plan B One-Step available “without age or point of sale restrictions,” according to an FDA release. Read more on teen pregnancy.

Study: Amusement Rides Injure 4,000 U.S. Kids Annually
As the weather warms and families start to plan summer vacations, it’s important for parents to remember to use caution when selecting amusement park rides. More than 4,000 kids are injured on an amusement ride each year in the United States, according to researchers at the Center for Injury Research and Policy at the Research Institute at Nationwide Children's Hospital in Columbus, Ohio. Injuries sent about 93,000 children to emergency rooms between 1990 and 2010, with about 70 percent of those coming May through September. Researchers say the numbers demonstrate the need for standardized safety regulations. "Although the U.S. Consumer Product Safety Commission has jurisdiction over mobile rides, regulation of fixed-site rides is currently left to state or local governments, leading to a fragmented system," said senior author Gary Smith, MD, director of the Center for Injury Research and Policy, in a release. "A coordinated national system would help us prevent amusement-ride-related injuries through better injury surveillance and more consistent enforcement of standards." The study includes safety tips for parents. Read more on safety.

Prevention App Wins HHS Challenge
The winner of the a recent mobile app challenge from U.S. Department of Health and Human Services (HHS) Office of Disease Prevention and Health Promotion is the myfamily app developed by Lyfechannel, a company that translates evidence-based health behavior and adherence studies into mobile applications. App users can find prevention information and tips for each member of their family; create personal health alerts; and keep track of medical check-ups and vaccinations. HHS research shows that patients who are better engaged in their own health care have better health outcomes and that electronic tools can help them be better health consumers. Read more on prevention.

In recent years many bacteria have become resistant to drugs that commonly vanquished them, depleting a natural resource—antibiotics—that has saved millions of lives around the globe. Using these drugs only when necessary, and using the right drug for the right infection will help ensure that the medications are available and effective when they’re needed.

>>Watch a new, three-minute animated video that tells the story of how antibiotic-resistant “superbug” bacteria have become a serious public health threat that affects everyone. The video frames the problem uniquely: We must treat antibiotics as a natural resource that can be depleted with overuse, just like water, trees, and other resources on which we all depend. The video lays out specific steps that everyone – including doctors, hospitals, and consumers – can take to tackle the problem.

Extending the Cure (ETC), a project of the Center for Disease Dynamics, Economics & Policy based in Washington, D.C., and New Delhi, released the Superbugs video this week, along with a new report on trends in antibiotic resistance.

Last year, the organization also released research showing that certain types of bacteria responsible for causing urinary tract infections (UTIs) are becoming more difficult to treat with current antibiotics. ETC released the research via its online ResistanceMap, an online tool created to track changes in antibiotic drug use and resistance. A new, added feature of the ResistanceMap is ETC’s Drug Resistance Index, a way for non-experts to track changes in antibiotic effectiveness.

This research was funded by the Robert Wood Johnson Foundation. Urinary tract infections account for about 8.6 million visits to health care providers each year, according to the Centers for Disease Control and Prevention. More than half of U.S. women will get a UTI in their lifetime.

“Without proper antibiotic treatment, UTIs can turn into bloodstream infections, which are much more serious and can be life-threatening,” said Ramanan Laxminarayan, director of Extending the Cure (ETC). “These findings are especially disturbing because there are few new antibiotics to replace the ones that are becoming less effective,” says Laxminarayan. 

Read a previous NewPublicHealth interview with Ramanan Laxminarayan about ETC’s research and Drug Resistance Index.

USPSTF Recommends HIV Screening for All Americans 15-65
The U.S. Preventive Services Task Force (USPSTF) now recommends that all Americans ages 15 to 65 be screened for HIV, according to new guidelines appearing in the Annals of Internal Medicine. USPSTF’s previous 2005 guidelines recommended screening for only those people categorized as high-risk. The U.S. Centers for Disease Control and Prevention already recommends this course of action. "We do hope the fact that the guidelines are all very similar will provide an impetus for people to offer screening because it is a very critical public-health problem,” said task force member Douglas Owens, MD, a medical professor at Stanford University. Experts noted that the change will likely mean that testing will be covered as a preventive service under the Affordable Care Act. Read more on HIV/AIDS.

HUD’s $1.83B Plan Will Help Rebuild New Jersey, Prepare for Future Disasters
The U.S. Department of Housing and Urban Development’s (HUD) $1.83 billion New Jersey disaster recovery plan will help residents continue to recover from the damage caused by Hurricane Sandy and better prepare for future extreme weather events. “This infusion of federal funding will help New Jersey continue to recover from Superstorm Sandy and ensure that our state is rebuilt stronger and better prepared for future storms,” said Senator Frank Lautenberg (D-NJ). “Families that are rebuilding their homes, small businesses that are getting back on their feet, and communities that are repairing damaged public infrastructure will all benefit from this federal grant program.” The plan is funded through HUD’s Community Development Block Grant Program. The infrastructure restoration efforts will including elevating some homes to guard against future flooding. Read more on Hurricane Sandy.

Early Obesity Dramatically Increases Men’s Risk of Poor Health, Death
Obesity in the early 20’s can dramatically increased a man’s chance of suffering from serious health problems or even dying by the age of 55, according to a new study in the journal BMJ Open. A study tracking Danish men found that approximately half of the participants who were obese at the age of 22 had developed diabetes, developed high blood pressure, had a heart attack, had a stroke, or experienced blood clots or died by age 55. Men of a normal weight at age 22 saw only a 20 percent risk of developing these problems by age 55. Each unit increase in body mass index raised the risk of heart attack by 5 percent; high blood pressure and clots by 10 percent; and diabetes by 20 percent. In the United States approximately 35.7 percent of adults and 17 percent of children are obese, according to the U. S. Centers for Disease Control and Prevention. Read more on obesity.

Survey: Many Americans Still Unaware of or Confused About the Affordable Care Act
Signup for the Affordable Care Act (ACA) Health Insurance Marketplace begins in October, but a new poll from the Kaiser Family Foundation finds that many Americans are still confused about the law, which will require virtually all Americans to sign up for health insurance coverage that will take effect January 1, 2014.

Key poll findings include:

• More than 40 percent of Americans aren’t aware that the ACA is the law of the land.
• Of those who aren’t aware that the ACA is now law, 12 percent think the law was repealed by Congress and 7 percent think the law was overturned by the Supreme Court.
• About half of the respondents said they did not have enough information about the health reform law to understand how it will impact their family.

The poll findings also showed that people who are currently uninsured and those in low-income households were the most likely groups to say they did not understand how the ACA benefits them and their families. Read more on access to health care.

Past Decade's Poor Economy Drove Health Declines
More than a decade of research points to the negative impact of the austerity that accompanies a flagging economy on the population's health, according to Reuters. The studies will be detailed in a new book to be released by an interesting research pairing including a political economist from Oxford University and a professor of medicine and epidemiology at Standford University. the researchers say more than 10,000 suicides and up to a million cases of depression have been diagnosed during what they call the "Great Recession" and its accompanying austerity across Europe and North America. For example, more than five million Americans have lost access to health care during the latest recession. Researchers also tie cuts in governmental public health programs to excess disease rates. "In Greece, moves like cutting HIV prevention budgets have coincided with rates of the AIDS-causing virus rising by more than 200 percent since 2011—driven in part by increasing drug abuse in the context of a 50 percent youth unemployment rate," according to the Reuters article. Read more on poverty and health.

What Influences Kids to Smoke (or Not to) Changes Over Time
Peer pressure may have a bigger influence on middle school-aged kids in starting to smoke, but that influence may wane as they get older. On the other hand, researchers said parents seem to remain influential over their children's smoking behavior throughout high school, as reported by HealthDay. Researchers looked at data from  the Midwestern Prevention Project, the longest-running substance abuse prevention, randomized controlled trial in the United States, which includes 1,000 teens. Read more on tobacco use. 

Facebook Could Help Predict, Track and Map Obesity
The higher the percentage of people in a city, town or neighborhood with Facebook interests suggesting a healthy, active lifestyle, the lower that area's obesity rate, according to a new study. At the same time, areas with a large percentage of Facebook users with television-related interests tend to have higher rates of obesity. The study was conducted by Boston Children's Hospital researchers comparing geotagged Facebook user data with data from national and New York City-focused health surveys. 

"Online social networks like Facebook represent a new high-value, low-cost data stream for looking at health at a population level," said study author John Brownstein, PhD, from the Boston Children's Hospital Informatics Program. "The tight correlation between Facebook users' interests and obesity data suggest that this kind of social network analysis could help generate real-time estimates of obesity levels in an area, help target public health campaigns that would promote healthy behavior change, and assess the success of those campaigns." The study was published in PLOS ONE. Read more on obesity.

Mammography Rates Remained Steady After Change in Guidelines
The proportion of women undergoing screening for breast cancer every year did not change after U.S. Preventive Services Task Force released recommendations saying there wasn't enough evidence to support routine mammograms for women in their 40s, according to a new study published in the journal Cancer. In 2009, the Task Force changed their recommendations to state that women aged 50 to 74 should have a mammogram every other year, and screenings for women under age 50 should be evaluated by each woman with her doctor, according to individual risk factors. "When there are conflicting versions of guidelines, providers may err on the side of screening," said David Howard, a health policy researcher from Emory University in Atlanta, in an interview with Reuters. Read more on cancer.

Latest HIV Vaccine Study Halted
The National Institutes of Health halted a study testing an experimental HIV vaccine after an independent review board found the vaccine did not prevent HIV infection and did not reduce the amount of HIV in the blood. The trial, started in 2009, is the latest in a series of failed HIV vaccine trials, according to Reuters. The halted study included more than 2,500 volunteers in 19 U.S. cities. Study populations included men who have sex with men and transgender people who have sex with men. Read more on HIV.

CDC's Food Safety Report Card: Some Foodborne Illnesses Spiked in 2012
The Centers for Disease Control and Prevention (CDC) recently released the "nation’s annual food safety report card," and it shows that 2012 rates of infections from two types of foodborne bacteria—campylobacter and Vibrio—have increased significantly when compared to a baseline period of 2006-2008, while rates of most others have not changed during the same period. The data are part of the Foodborne Diseases Active Surveillance Network report. Campylobacter infections have been linked to tranmission in many foods, including poultry, raw milk and produce. These infections were at their highest level since 2000, up 14 percent since 2006-2008. Vibrio infections, often associated with raw shellfish, were up 43 percent.

“The U.S. food supply remains one of the safest in the world,” said CDC Director Tom Frieden, MD, MPH. “However, some foodborne diseases continue to pose a challenge. We have the ability, through investments in emerging technologies, to identify outbreaks even more quickly and implement interventions even faster to protect people from the dangers posed by contaminated food.” Read more on food safety.

Study: Single Can of Sugary Soda Can Increase Diabetes Risk 22 Percent
Drinking even a single 12-ounce can of sugary soda once a day can up the risk of diabetes by 22 percent, according to a new study out of Imperial College London. Researchers looked at the data of approximately 350,000 European residents. "Given the increase in sweet beverage consumption in Europe, clear messages on the unhealthy effect of these drinks should be given to the population," said study leader Dora Romaguera, according to Reuters. Previous studies have also shown a link between sugary drinks and increased risk of obesity and type 2 diabetes, which affects approximately 310 million people, according to the World Health Organization. Read more on diabetes.

Teen Years in the ‘Stroke Belt’ Ups Risk of Stroke Later in Life
Growing up as a teenager in the U.S. “stroke belt”—an area in the country’s southeast—can increase the risk of stroke later in life by as much as 17 percent, according to a new study in the journal Neurology. Risk factors including high blood pressure and diabetes are only partially responsible for the increase risk. "Many social and behavioral risk factors, such as smoking, are set in place during the teenage years, and teens are more exposed to external influences and gain the knowledge to challenge or reaffirm their childhood habits and lifestyle," said study author Virginia Howard, with the School of Public Health at the University of Alabama at Birmingham, in a release. Across all age groups the risk was double for black Americans when compared to white Americans. Researchers were careful to note that the findings do not demonstration causation. Read more on strokes.

Poultry Probably Source of China’s New Bird Flu Strain
Researchers believe that poultry-to-human transmission from “wet” markets is likely responsible for the new H7N9 bird flu strain that has killed 22 people in China and infected more than 100. Wet markets sell and immediately slaughter poultry. So far the strain does not seem to pass easily between people, so the researchers feel relatively confident that closing the markets and slaughtering the birds will control the outbreak. “Overall, the evidence, in terms of epidemiology and virology, suggests that it is a pure poultry to human transmission, and that controlling [the epidemic in humans] will therefore depend on controlling the epidemic in poultry,” said Kwok-Yung Yuen of the University of Hong Kong, according to MSNBC. The findings were published in the journal Lancet. Read more on infectious disease.

New York City Moves to Ban Cigarette Sales to People Under 21
A bill introduced to the New York City Council would ban cigarette sales to anyone under the age of 21. The current age limit is 18. "Too many adult smokers begin this deadly habit before age 21," City Council Speaker Christine Quinn said. "By delaying our city's children and young adults access to lethal tobacco products, we're decreasing the likelihood they ever start smoking, and thus, creating a healthier city." Though not introduced by Mayor Michael Bloomberg, he does support the bill. New York City also has the highest taxes on cigarettes of any U.S. city, with a city tax of $1.50 on top of a state tax of $4.35. Read more on tobacco.

Insurance Authorization Delays Trap Psychiatric Patients in ERs
Thousands of hours of physician time is lost each year caring for emergency department patients in need of psychiatric care, but waiting for insurance authorization to be admitted into the hospital, according to a letter to be published in the May issue of Annals of Emergency Medicine. Researchers found that about half of authorizations were completed in less than 20 minutes, but 10 percent took at least an hour. About 2.5 million people are admitted to hospitals for psychiatric care each year. "Psychiatric care is really the poor stepchild in the world of insurance coverage," said lead author Amy Funkenstein, MD, of Brown University in Providence, R.I.. "Insurance carriers reimburse poorly and as a consequence, hospitals often have inadequate resources for patients who urgently need this care. The situation is so dire that ERs are now being designed and configured to house psychiatric patients awaiting placement as inpatients. These patients deserve better." Read more on mental health.

Report Finds Positive, Negative News on U.S. Air Quality
Areas across the country have seen a mix in terms of improvement of air quality over the past decade, according to a new report from the American Lung Association (ALA). "The long-term trend is positive and headed to much cleaner air," said author Janice Nolen, ALA's assistant vice president of national policy and advocacy. "[However], there is an uptick in some areas that are a concern and some areas where the problem remains very, very serious." Approximately half of the 25 most polluted cities in 2000 saw improvements in air quality, with the others seeing declines. And some of the “improved” cities still were highly polluted, such as Los Angeles and Bakersfield, Calif. Houston, Dallas, Oklahoma City, Cincinnati, New York City and Washington, D.C. were the other cities with the highest levels of ozone. Overall, the report found that 132 million people were living in 254 counties with unhealthy levels of ozone or particle pollution. Read more on environment.

Supreme Court Lets FDA Move Forward with Graphic Cigarette Warnings and Other Tobacco Regulations
The Supreme Court yesterday announced that it will not hear the tobacco industry's appeal of a March 2012 ruling by the U.S. Court of Appeals for the Sixth Circuit on graphic cigarette warnings and several other tobacco regulations. That decision allows the U.S. Food and Drug Administration (FDA) to move forward in developing graphic cigarette warnings allowed by a 2009 law that gave the FDA sweeping new authority over tobacco, and other recent court rulings.

The 2009 law requires graphic warnings that cover the top half of the front and back of cigarette packs and 20 percent of cigarette ads. According to the Campaign for Tobacco-Free Kids (CTFK), a tobacco control advocacy group based in Washington, D.C., the graphic warnings are needed to better inform Americans about the deadly consequences of smoking. According to CTFK, the current, text-only warnings which are printed on the side of cigarette packs haven’t been updated since 1984 and often go unnoticed.

The appeals court ruling also upheld other key provisions of the law that:

• Tobacco companies are prohibited from making health claims about tobacco products without FDA review
• Several forms of tobacco marketing that appeal to children would be banned, including brand name sponsorships; tobacco-branded merchandise such as caps and t-shirts; and free samples of tobacco products
• Tobacco companies are prohibited from making statements implying that a tobacco product is safer because it is regulated by the FDA.

In a statement released yesterday, CTFK Executive Director Susan Liss said: “The FDA should move forward aggressively to reduce the death and disease caused by tobacco use, which is the nation's number one cause of preventable death.” Read more on tobacco.

Task Force Finds Insufficient Evidence for Universal Suicide Risk Screenings
While the U.S. Preventive Services Task Force’s latest draft guidelines stated that there is not enough evidence to support universal screening to identify people at risk of suicide, it’s still critical for health care professionals to be wary of certain signs, said David Grossman, MD, MPH, a member of the Task Force. "Although we did not find enough evidence to say ‘here are the right questions and tools to find the people who may be at risk for suicide,' doctors should be screening for depression and alcohol abuse disorders in their primary care population," he said. Top risk factors include depression and alcohol abuse. There are approximately 37,000 cases of suicide in the United States each year. Read more on mental health.

Poll: Nearly 1 in 4 High School Students Have Abused Prescription Meds
Approximately 24 percent of high school students have abused prescription drugs, according to a new poll from by Partnership at Drugfree.org. With about 5 million kids admitting to the medication abuse, the rate is up 33 percent since 2008. About 13 percent say they’ve experimented with Ritalin or Adderall, both of which are used to treat attention-deficit/hyperactivity disorder. At the heart of the problem is the misconception by both kids and parents that misusing prescription drugs is not as dangerous as taking other drugs. "The key here is that kids and often their parents are buying into the myth and misunderstanding that prescription drug abuse is a safer way to get high, a safer alternative to street drugs, and that they can control it," said said Steve Pasierb, president and CEO at the Partnership organization. "And it's very important to note that, on this, kids and parents are in the same place. Kids say that they don't think that their parents are going to be upset if they know about this, and parents are essentially saying the same thing." Read more on prescription drugs.