Prevention Matters

Over at the Senate Finance Committee, Republicans who have expended a lot of energy claiming that the federal government can't do anything right won a vote preserving $50 million a year for "abstinence-only" education programs. 

President Obama’s first budget eliminated federal funding for such programs, instead putting money into “evidence-based” teen pregnancy prevention programs. But now, writes The New Republic's Suzy Khimm, "the Finance Committee vote could mean that Bush’s legacy will continue well past Obama’s first term, funding the so-called Title V block grants to states through 2014."

Sen. Orrin Hatch (R-Utah), the sponsor of the amendment that won by a 12-11 vote, appeared to recognize the dichotomy inherent in his efforts.

"“My first choice would be to not have the federal government involved in any way in these types of education programs,” Hatch said in a press statement. “However, if the federal government is going to spend money on educating people about sexual decisions, the absence of an abstinence only education program has negative health consequences for our nation’s most vulnerable citizens.”

Khimm put it this way: "In other words, if the federal government is going to go there, we might as well pile on."

A 2007 survey of more than 2,000 teenagers carried out by a research company on behalf of Congress found that the half of the sample given abstinence-only education displayed exactly the same predilection for sex as those who had received conventional sex education in which contraception was discussed. Twenty-three states currently have rejected abstinence-only funds, even in the midst of a deep recession that has left states starving for funding.

Immediately after the Hatch amendment vote, the committee also voted 14-9 to approve an amendment sponsored by Finance Committee Chairman Max Baucus (D-Mont.) that supported a more comprehensive approach to sex education passed. The amendment will provide funding to a wide range of teen wellness programs, including those dealing with contraception and HIV/AIDS. Those funds will support abstinence education programs that are deemed “medically accurate and complete.”

If America is going to change health care, it's going to have to change diabetes. That's the conclusion of Dana Haza, senior director of the National Changing Diabetes® Program, in a column that appears in The Health Care Blog.   She uses some compelling facts to back up her assertion.

"While the rates of undiagnosed diabetes and pre-diabetes are alarming, studies show that type 2 diabetes can be significantly prevented, or at least delayed, by losing weight through diet and regular exercise," Haza writes. "But, even with evidence supporting prevention, our nation isn’t allocating adequate resources. In 2005, a study by the National Changing Diabetes® Program found that the federal government spent nearly $80 billion more on those with diabetes than those without the disease, and only $4 billion of that was spent on prevention and health promotion."

Partnership for Prevention President Robert J. Gould told National Journal that more science is needed to properly evaluate workplace wellness incentives that base employees' insurance rates on their individual health status.

Gould's comments were included in an article by Julie Kosterlitz on proposed legislation that lets employers offer workers discounts of as much as 50 percent for meeting specific health goals, such as smoking cessation, obesity, blood pressure and cholesterol. That would change a 1996 law that forbids discrimination by group health plans against workers based on their health status.

"Some leaders in the field of wellness and prevention have chosen not to endorse proposed legislation to change the 1996 law," Kosterlitz writes. 'We need more information before we can jump in and support this,'" said Rob Gould, president of Partnership for Prevention, an organization of businesses, nonprofits and governemnt agencies that advocate wellness. 'There are some case examples presented by companies, but it's not the kind of systematic evaluation' the group needs to satisfy its concerns.'"

Senate Majority Leader Harry Reid says the full Senate could begin debating a sweeping health- reform bill on the week of Oct. 12. That would require that Senators forego their traditional week-long Columbus Day recess. Reid's comments come as the Senate Finance Committee continues to work on its version of the health reform bill.

Soda taxes have been in the news a lot lately. On one side are public health experts who say that soda taxes could address our nation’s obesity problem. They cite the success tobacco taxes have had in reducing smoking rates and the relationship between soda consumption and body weight. An article in this month’s issue of the New England Journal of Medicine touts the health and economic benefits of taxing sugary drinks. The Institute of Medicine also recently released recommendations for local governments to combat childhood obesity that include implementing taxes to discourage consumption of foods with minimal nutritional value, which certainly include sugar-sweetened beverages.


Such taxes are also being discussed by policymakers. San Francisco’s mayor announced plans to introduce legislation this fall that will impose a fee on retailers selling sugary drinks, including soda. And President Obama was quoted as saying that soda taxes need to “be explored” as a way to reduce childhood obesity.

Not surprisingly, these proposed taxes are facing fierce opposition. This past Sunday’s Washington Post contains an opinion piece dispelling the 5 “myths” about soda taxes. Coca Cola’s CEO has weighed in on the issue calling a soda tax “socialist.” And anyone who reads a Sunday newspaper has surely seen the full-page ads run by Americans Against Food Taxes (aka, the beverage industry).

Opponents say that recent tax proposals aren’t large enough to impact obesity. That might be true, but they are missing the point. Drinking fewer sugary drinks has no downside (except possibly to the reduced profits of the beverage industry). These drinks push out healthier options like low-fat milk or water, and flood the body with excess calories that are rarely burned off and increase blood sugar levels. Teens consume the most soda and other sugary drinks, and are also historically price sensitive. Limiting their consumption of sugary drinks would cut their risk for obesity, diabetes, and cardiovascular disease, all costly health problems. And with states cutting essential programs and services, they should be looking to increase revenue wherever possible. Soda taxes seem like a win-win situation.


Alyson Hazen Kristensen, MPH

Senior Fellow & Program Officer
Partnership for Prevention

A San Francisco program that turns unused roadway areas into parks was named Partnership for Prevention's "Best Prevention Idea of the Week," while federal officials’ delay in informing schools about potentially tainted food was named “Worst Prevention Idea of the Week.”

The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.


BEST

SF PROGRAM TRANSFORMS PAVEMENT INTO PARKS
http://arieff.blogs.nytimes.com/2009/09/22/pavement-to-parks/?emc=eta1

San Francisco’s “Pavement to Parks” program creates green spaces where people can walk and be active by reclaiming excess roadway, through the use of simple and low-cost design interventions. A pro bono designer works on each park (there are 12 scheduled to be finished through 2010; three have just been completed) with the mandate of using materials the city already has to maximize greenery and “transform a sea of asphalt.”

WORST

U.S. DELAYED TELLING SCHOOLS ABOUT FOOD RECALLS
http://www.msnbc.msn.com/id/32989396/ns/health-kids_and_parenting/?ocid=twitter/from/ET

The federal government failed to inform schools of recalls of suspected tainted food products, potentially putting millions of schoolchildren at risk of food poisoning over the last two years, a government investigation has concluded. The recalled foods included salmonella-tainted peanut products linked to the deaths of at least nine people, said the report, which was completed last month by the Government Accountability Office, the investigative arm of Congress.

From the Schwitzer health news blog: This week's edition of the BMJ publishes a study, an analysis and an editorial all showing that there isn't enough evidence to support population-wide prostate screening with the PSA blood test. (Subscription required to access full text of all of these.)

A coalition of physician organizations and other groups recommends doctor-patient conversations about weight loss and improved clinical approaches as ways to reverse the nation's obesity epidemic. These and other suggestions were issued Sept. 9 by the Strategies to Overcome and Prevent Obesity Alliance. The coalition said the recommendations should be included in health system reform legislation being debated on Capitol Hill.

New York City's City Planning Commission unanimously approved a proposal to encourage the establishment of new supermarkets in areas where fresh produce is scarce and where poverty, obesity and diabetes run high. As described by the New York Times' Diane Cardwell, the proposal would offer zoning and tax incentives to spur the development of full-service grocery stores that devote a certain amount of space to fresh produce, meats, dairy and other perishables.

Health insurers aren't getting the return on investment that they want to see when they cover clinical treatments for pediatric obesity. That's one reason there is a shortage of programs in that area, according to Roberta Clarke, an associate professor in Boston University's Health Sector Management Program who just closed down one of the few pediatric obesity treatment clinics in New England.

"With families changing their insurance plans on average every three years, the insurers reasoned that by the time one of (our) children avoided diabetes or other obesity-related health problems due to the program intervention, that child would no longer be covered by that insurer," Clarke writes in a Boston Globe column. "Therefore, the insurer would lose its investment in making that child less obese."

Starting midday today and continuing through Thursday, the "Healthy Kids, Healthy Futures" conference in Washington, DC, will feature live reporting via liveblogging and Twitter. This will include interviews with speakers including Agriculture Secretary Tom Vilsack, guest posts and more. Organizers will be using Twitter to cover the event at the hashtag #hkhf09.

The two-day conference, Healthy Kids, Healthy Future, will convene children’s health and early education experts, Administration officials, scholars, public health officials and early care program administrators to address these questions and more. Other speakers include Martha Coven, Director of the White House Office of Mobility and Opportunities; Joe Thompson, MD, MPH, Robert Wood Johnson Foundation Center to Prevent Childhood Obesity.

The event is hosted by Nemours, one of the nation’s leading pediatric health systems, the Robert Wood Johnson Foundation Center to Prevent Childhood Obesity, the Centers for Disease Control and Prevention, and the Maternal and Child Health Bureau, with support from the Altarum Institute.

Tom Vilsack, Secretary, U.S. Dept. of Agriculture (keynote); Martha Coven, Director of the White House Office of Mobility and Opportunities; Joe Thompson, MD, MPH, Robert Wood Johnson Foundation Center to Prevent Childhood Obesity

As of today, September 22, 2009, candy and fruit-flavored cigarettes are illegal.
The FDA has begun to implement the new Family Smoking Prevention and Tobacco Control Act that gives the FDA broad authority to regulate the manufacture and sale of tobacco products.

Given the appeal of candy-like flavors to children, the FDA recognized the importance of quickly reducing access to tobacco products that were appealing to children. FDA Commissioner Margaret Hamburg stated that “almost 90 percent of adult smokers started smoking as teenagers. These flavored cigarettes are a gateway for many children and young adults to become regular smokers.”

Companies that violate the ban are subject to FDA enforcement actions. The new ban does not apply to menthol cigarettes and other flavored tobacco products, but the FDA is looking additional ways to regulate these products.

You can access a link to the FDA flavored tobacco web site at: www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/FlavoredTobacco/default.htm


Diane M. Canova
Managing Senior Fellow
& Senior Program Officer

Senate Finance Committee Chairman Max Baucus (D-MT) has amended his version of the health reform bill to add a $200 million program to help small businesses establish wellness programs. The funding would allow the Secretary of Health and Human Services to make grants for up to five years to businesses with less 100 than full and/or part-time employees (to provide access to comprehensive, evidence-based workplace wellness programs.

Qualifying programs will include the following components to help employees make healthier choices: health awareness (such as health education, preventive screenings and health risk assessments), employee engagement (such as mechanisms to encourage employee participation), behavioral change (elements proven to help alter unhealthy lifestyles such as counseling, seminars, on-line programs, self help materials) and supportive environment (such as creating on-site policies that encourage health lifestyles, health eating, physical activity and mental health).

Grant money from this amendment would only be available for employers that are not already providing qualified wellness programs.

Conservative columnist Morton Kondracke calls for a "war on diabetes" similar to Nixon's "war on cancer" 30 years ago.

"The reason for a war on diabetes is that, like some cancers, Type 2 diabetes — the most prevalent type — is heavily a “lifestyle disease” resulting from overeating and lack of activity. Therefore, it’s preventable," Kondrake says.

A column in BizTimes.com says worksite wellness programs "are showing a significant return on investment among companies across the U.S." Well City Milwaukee's Janet McMahon specifically cites the following programs:

• Johnson & Johnson's Healthy People program, which saves an estimated $9 to $10 million per year from reduced medical utilization and lower administrative expenses.
• Citibank's comprehensive health management program, which demonstrates for every dollar invested in programming activities, $4.56 to $4.73 was saved in reduced health care costs.
• Union Pacific Railroad's medical self-care program, which shows a cost savings of $2.78 for every dollar invested by reducing inappropriate emergency room and outpatient visits.
• Robert W. Baird & Co. Inc. in Millwauke, which launched its wellness program in 2006. In the past three years, Baird's health care cost trend has decreased from 13 percent per year to 7 percent per year, and it is expected to be lower in 2010 as well. In addition, preventable health risks, which are closely associated with health care costs, have decreased for Baird employees.

Local health departments—the public agencies that work on-the-ground to safeguard their communities against the H1N1 flu virus and other threats to public health—sustained accelerated job losses during the first half of 2009, a new survey shows. Because of budget-related cuts, city, county, and other local health departments eliminated 8,000 staff positions between January and June, according to a survey conducted by the National Association of County and City Health Officials (NACCHO).

This loss compounds the disappearance of 7,000 positions in 2008, determined by a previous NACCHO survey, the results of which were announced in January. Departments lost more jobs in the first six months of 2009 than in all of 2008.

Thirteen key aspects of cardiovascular disease prevention are identified as performance measures in a new, comprehensive set of detailed steps to help healthcare providers reduce patients’ risk for heart problems. The performance measures, developed by a joint task force of the American College of Cardiology and the American Heart Association, are simultaneously published in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.
The 13 measures are:

• lifestyle/risk factor screening
• dietary intake counseling
• physical activity counseling
• smoking/tobacco use assessment
• smoking/tobacco cessation
• weight and body fat assessment
• weight management
• blood pressure measurement
• blood pressure control
• blood lipid measurement
• blood lipid therapy and control
• estimation of a patient’s global risk for developing heart disease
• aspirin use in at-risk patients

Dr. John Clarke of Baldwin, New York, rapped his way to victory in the Department of Health and Human Service's flu prevention PSA contest. HHS Secretary Kathleen Sebelius announced that Clarke's "H1N1 Rap" was named the winner after a tally of more than 50,000 v0tes from more than 200 entries from across the country.

Americans were called to create a 15, 30, or 60 second video promoting good hygienic practices and submit this video over YouTube. This video was to inform people about the flu and motivate them to take steps that help prevent the spread of the flu. The winner received $2500 in cash and will be featured on national television.

A panel of 12 video communication and public health experts determined the top 10 entries. These were put on the HHS YouTube Channel and put to a public vote. Over 50 thousand votes were cast in the 18 days that voting was open, and these votes determined the overall winner.

Heart attack rates fall 17% within a year after smoking bans take effect, according to two recent analyses of laws in the USA, Canada and Europe. One analysis, which included 13 studies, appears in Circulation: Journal of the American Heart Association. A second analysis, which considered 11 studies, appears in the Journal of the American College of Cardiology.

In a column in the Los Angeles Times, former Senate Republican Leader Bill Friest says true health reform has to emphasize behavior-changing wellness programs.

"The major determinants of health are not doctors, hospitals, universal insurance, public plans and expanded health services," says Frist, who is also a heart surgeon. "Much more significant is behavior -- things such as diet, exercise, smoking and drinking -- basic education and socioeconomic status. So if the goal is to make us healthier, to lower the burden and thus the societal costs of disease, policymakers in Washington must actively promote health and wellness. And the way to do that is by providing incentives for the implementation and sustained use of employer-backed wellness programs. "

Frist said prevention has been written off as costly due to reports like one that appeared recently in Health Affairs subtitled: "An Overwhelming Percentage of Preventive Interventions Add More to Medical Costs Than They Save."

"The key word is 'interventions,'" Frist says. "Think about it: Having more people getting more health screenings, mammograms, pap smears and colonoscopies has to cost more money.While we want such services to be widely available, reform that concentrates merely on offering more of those things isn't the way to fix what ails the nation.

"Instead, we need a system that concentrates on keeping us well, so we need less "healthcare" and fewer "preventive interventions" in the first place."

The Centers for Disease Control and Prevention has launched a three-month text messaging campaign pilot to share important, timely health information on the H1N1 virus directly to users.
To subscribe to the pilot, text HEALTH to 87000. Once you sign up for this pilot, you will be asked a few questions and begin receiving short health tips from CDC. Subscribers can expect to receive about three health messages a week during the three-month pilot. Standard text messaging rates will apply. You can opt out at any time by simply replying HEALTH QUIT.

The U.S. Chamber of Commerce is offering companies new guidelines for coping with the H1N1 swine flu pandemic amid concerns that employers could face crippling absenteeism as the U.S. flu season takes hold. The 16-page guide, entitled "It's Not Flu as Usual: An H1N1 Business Preparedness Guide," offers scenarios in which more than 10 percent of staff are too sick to come to work on any given day over the course of several months to a year.

On Tuesday, Sept. 22, the U.S. Food and Drug Administration (FDA) will start enforcing a ban on candy, fruit and other flavored cigarettes, which is one of the first provisions of the new federal law allowing the FDA to regulate tobacco products. Mike Meyers over at Campaign for Tobacco Free Kids reports that some tobacco companies may already be preparing to try to circumvent the ban.

"For example, Kretek International Inc., which imports Djarum-brand tobacco products from Indonesia and is the nation’s top distributor of clove-flavored cigarettes, has introduced clove cigars that look and, according to news reports, taste like its clove cigarettes.," Meyers says.

Tobacco companies have a long history of using flavors to attract kids, and survey data show that youth smokers are much more likely to use these flavored products. In a recent letter to the industry, the FDA warned that it will take aggressive action against attempts to evade the new law, noting that the ban "applies to all tobacco products that meet the definition of a “cigarette” in section 900(3) of the Act even if they are not labeled as “cigarettes” or are labeled as cigars or as some other product."

UPDATE 9/22/09:

The FDA has launched a web site dedicated to flavored tobacco products. You can access a link to the FDA flavored tobacco web site at: www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/FlavoredTobacco/default.htm <http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/FlavoredTobacco/default.htm> or from the main FDA tobacco products web page at: www.fda.gov/tobaccoproducts <http://www.fda.gov/tobaccoproducts> .

Middle-aged male smokers with high blood pressure and raised cholesterol levels face dying about 10 years before healthier counterparts, a study warns. The UK study, published in in the British Medical Journal, looked at more than 19,000 civil servants aged 40-69 and traced what happened to them 38 years later.

A first-of-its-kind study released definitively links soda consumption and an obesity epidemic. Using interviews with 43,000 adults and 4,000 adolescents in California, the UCLA Center for Health Policy Research analyzed the correlation between soft drink consumption and weight. It found that adults who drink at least one soda or sugar-sweetened energy drink a day are 27 percent more likely to be overweight or obese. For children, the risk of obesity soars 60 percent with each daily serving of soda or sugary beverage.

The percentage of Americans without major heart disease risk factors rose during the 1980s and 1990s, but our health is declining again, a new study shows. The number of people with obesity, diabetes, and high blood pressure is increasing, even though the percentage of smokers is still heading south, according to the study published in Circulation: Journal of the American Heart Association.

Hairdressers have a higher risk of cancer than the general population, according to a new study published in the International Journal of Epidemiology. Authors of the study say improved ventilation systems in the hairdresser salons and implementation of hygiene measures aimed at mitigating exposure to potential carcinogens at work may reduce the risk.

Ever rent a car with the unpleasant lingering odor of stale cigarettes? Well, that could be a thing of the past. Beginning October 1, all Avis and Budget rental vehicles in the United States and Canada will be smoke-free. This is big!

With the advent of smoke-free restaurants and hotels, business analysts complained that customers would go elsewhere and business would decline. Hasn’t happened. Non-smokers have become loyal supporters of smoke-free environments and business establishments that have enacted smoke-free policies. Let’s prove the naysayers wrong in this case too. Smoke-free car rentals can be a popular and healthier alternative.

Kudos to the Avis Budget Group for recognizing not only the unpleasantness of tobacco smoke residue and odors, but also for discouraging smoking in a small closed environment. People’s health and dry cleaning bills will both be positively impacted.

To ensure compliance with the new smoke-free policy, Avis and Budget have new inspection processes and will assess cleaning fees if tobacco odor or residue is detected in returned vehicles. And, these vehicles will be taken out of the rental fleet until thoroughly cleaned and odor-free again.


Diane M. Canova, JD
Managing Senior Fellow
& Senior Program Officer

Policymakers and federal bean-counters don't always apply the same standards to prevention that they apply to medical treatment. Partnership for Prevention Executive VP Corinne G. Husten, MD, MPH expounded on this long-running concern in a recent interview on "Radio Health Journal."

"When someone comes in with chest pain, we don’t say, 'Oh, is it going to save money if we do an angiogram and a bypass or put them on beta blockers?' Husten asked. "We know we just need to treat them, they’re sick.

But somehow with prevention, instead of saying 'this is important and we need to do it because our goal is to have the healthiest people we can have because we value it,'" she added " … sometimes it seems like it’s only worth doing if it saves money. I would argue that it really is the wrong question, or if we ask that question we should ask it of all our treatment services as well the prevention services."

Husten's views were echoed by Dr. George Miller, a fellow at the Altera Institute.

"I think where there has sometimes been a difficulty is that we don’t expect treatments to save money; we would like them to be worth what we spend for them," Miller said. "Whereas there has been occasionally this view that prevention isn’t worth doing unless it’s actually cost saving, which is a much more stringent standard than being cost-effective.

"I believe that’s too harsh a requirement to put on it," he said. "I think prevention has other benefits besides saving money that ought to be taken into account in deciding which preventive measures to adopt."

Partnership for Prevention today said it was encouraged by a new initiative at the U.S. Department of Health and Human Services in which economic stimulus funds will be used to reduce risk factors associated with the leading causes of preventable death.

“Tobacco use, poor nutrition and lack of physical activity are driving the overwhelming majority of preventable deaths and chronic illnesses in the United States,” said Partnership President/CEO Robert J. Gould. “Investing in high-impact approaches to reduce these risk factors should yield a handsome return for the country, not only in terms of improved health but also in improved productivity and an improved economy.”

The Centers for Disease Control and Prevention announce the release of $373 million from the American Recovery and Reinvestment Act of 2009 to fund the first part of a new $650 million public health initiative named “Communities Putting Prevention to Work.” The initial $373 million will fund competitive grants awarded to communities to support evidence-based prevention strategies for youths and adults and to promote partnerships across communities and sectors.

Funds will be awarded for projects in two categories: Obesity/Physical Activity/Nutrition and Tobacco Control/Cessation. Approximately 30-40 community awardees will be selected for the initiative. Awards for both categories will vary with size of jurisdiction and the needs of communities. Size of the grants varies from $500,000-$1 million for tribal applicants to $10 million-$20 million for large cities.

Partnership for Prevention had urged Congress to include disease prevention and health promotion projects in the economic stimulus bill, and had also encouraged HHS to invest those funds in high-impact, evidence-based approaches to reduce the major risk factors. Communities that wish to apply for awards can find more information at www.grants.gov.

An additional $277 million will be made available in the coming weeks to states, territories, and other organizations and networks to support and extend the reach and impact of the community projects. The deadlines for the state, territory, and other prevention projects that are part of the Communities Putting Prevention to Work initiative will be announced soon.

Congress has given the Food and Drug Administration broad powers to regulate tobacco. So how should they go about regulating it? The FDA recently received oral testimony from non-profit groups across the nation. Partnership for Prevention threw in our two cents' worth as noted below:

• FDA needs to develop strong regulations that will prevent the abusive practices of the tobacco industry, such as the targeting of children and the manipulation of the product to make it more addictive.
• Partnership encourages the FDA to be as aggressive as possible in developing public health actions under your new authority regarding the retail environment, warning labels, packaging, advertising restrictions and other key provisions.
• New warning labels should be large, very graphic and explicit in nature, and prominently feature the 1-800 Quit Now number on all tobacco products and advertising. We encourage the FDA to learn from other countries that have implemented strong warning labels.
• We support the development of strong metrics for measuring impact. FDA will also need real-time monitoring systems so you quickly know the intended and unintended consequences of the regulations that are put in place. FDA needs to be assured that the tobacco industry is not circumventing the intent of the new rules.
• Partnership also encourages FDA to view these regulations as dynamic – FDA should operate on the assumption that changes in the regulations will be needed as new information is received about the impact, or lack of impact, of their regulatory actions.
• Proven harm reduction efforts (that is, preventing tobacco use and helping current tobacco users quit) must be a high priority. FDA must ensure that progress in reducing tobacco use accelerates, not slows, as a result of regulation.
• Finally, FDA regulation alone is not the “solution” to the tobacco problem in our country. We hope that FDA will work collaboratively with other Federal agencies and tobacco control partners. It is also critical that FDA make clear in all its work that this regulatory authority does not negate nor diminish the importance of comprehensive, well-funded national and state tobacco prevention and control programs.
  
  Thank you for the opportunity to comment.

A community prevention program that cut teen drinking by more than a third was named Partnership for Prevention's "Best Prevention Idea of the Week," while low reimbursement rates for vaccines that are forcing doctors to opt out of offering them was named “Worst Prevention Idea of the Week.”

The Best/Worst Idea awards are a regular feature of Prevention Matters , the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.


BEST

Community Prevention System Cuts Teen Binge Drinking Rate by More Than A Third
http://ow.ly/oPO4

Rates of binge drinking were 37 percent lower among eighth-grade students in communities in seven states that used a prevention system designed to reduce drug use and delinquent behavior compared to teenagers in communities that did not use the system. Eighth graders in the towns that offered the Communities That Care prevention system also had significantly lower levels of alcohol and smokeless tobacco use and engaged in fewer delinquent behaviors. Under the program, each town assesses the risk factors that contribute to local drug use and delinquency and select two to five of them as their top priorities. They were then given information about scientifically tested programs that addressed each of their priority risk factors, selected programs they would use, and were trained in implementation.


WORST

Rising Vaccine Costs Force Doctors to Slash Vaccines Use
http://money.cnn.com/2009/09/08/news/economy/health_care_vaccinations/index.htm?cnn=yes

CNN recently reported that the nation’s pediatricians are increasingly not offering vaccines because their costs have risen above the reimbursement offered by most insurers. For example, one doctor says the chicken pox vaccine runs about $115, but insurers only cover between $68 to $83 of that. “It's not clear exactly how widespread vaccine cutbacks are, but in a recent industry survey, 5% of pediatricians and 11% of physicians indicated that they're seriously considering no longer offering immunizations,” CNN reported.

Paul Hipp, a musician and contributor to The Huffington Post, has posted a music video to YouTube celebrating the U.S.'s status among health systems as ranked by the WHO. Today, "We're Number 37!" sits at the #10 spot among YouTube music videos (Why do I suddenly feel like Casey Kasem?).

An FDA advisory committee voted to recommend approval of the vaccine Gardasil for males ages 9 to 26 to prevent genital warts. The FDA advisory committee ruled 7 to 0, with one abstaining vote, that Gardasil's clinical trial data support the vaccine's effectiveness at preventing genital warts in males ages 9 to 26. And in a 7 to 1 vote, the advisory committee ruled that the data show Gardasil to be safe for males in that age range.

Each year, about 200 out of 100,000 males are newly diagnosed with genital warts, according to background information cited by the FDA. Penile cancer and anal cancer are much rarer.
Gardasil already has FDA approval for use in females ages 9 to 26. In females, HPV can cause cervical cancer.

A new survey shows that most U.S. businesses are concerned that swine flu will have a negative effect on business if cases are widespread and severe this fall and winter. Most companies said they could handle some swine flu absenteeism, but not without major problems if a lot of workers were affected.

For instance, 73% of participants said their company could avoid severe operational problems if 20% of their workers were absent for two weeks. But if a third of their employees were out for that long, only 44% of companies said they could handle that without having severe operational problems, and only 33% were as confident about their ability to cope if half of their workers were out for two weeks.

The two most recent Surgeons General say obesity in the U.S. has reached "the tipping point" and urged policymakers to take action. Drs. Richard H. Camona and David Satcher helped to release new policy recomendations from the Strategies to Overcome and Prevent (STOP) Obesity Alliance to address obesity and the chronic diseases associated with it.

"We’ve reached the tipping point on obesity in the United States,” said Carmona, who is now STOP's Health and Wellness Chairperson and President of Canyon Ranch Institute. “Obesity now impacts every aspect of our lives, including the future of our health care system. Health reform that directly addresses obesity will save lives, save money, and improve the health and well-being of every American.”

“When I served as Surgeon General, obesity was a problem of epidemic proportions,” said Satcher, who released the 2001 Surgeon General’s Call to Action To Prevent and Decrease Overweight and Obesity. “Today, we are in a state of emergency when it comes to obesity. The issues underpinning obesity are too complex and widespread for any one institution to effectively address it alone. Until we collaborate to address obesity through meaningful, population-based policies and programs, our nation will continue to be crippled by obesity and the chronic diseases it causes.”

The Centers for Disease Control and Prevention (CDC) will award grants to help 22 states and four Indian tribes establish colorectal screening programs for the uninsured.

The grants, which range from $300,000 to $1.1 million, will be used to establish programs aimed at screening low-income patients between the ages of 50 and 64. States would have the option of selecting one of three common procedures for the screening program but also could use the funds for outreach, follow-up care or data collection, according to the CDC.

This post is a week or so late, but it's too good to ignore.

Syndicated columnist Charles Krauthammer recently created a stir in prevention circles with a column entitled "Prevention saves money? Nonsense. It adds to health costs." Out on the hustings, it inspired a letter to the Press of Atlantic City from Dr. Franklin X. Loeb, a pediatrician from Smithville, NJ.

"The sad fact is that before "prevention," nearly 50 percent of American children died of or were crippled by 'the diseases of childhood,'" Loeb wrote. "Doctors in Third World countries have had the questionable privilege of seeing far too many such kids. That is why, when asked what kind of help they could best use, almost without hesitation, their response is 'preventative measures.'

"Who knows? Krauthammer, with articles like this, might be able to persuade the bobble-headed czars now accumulating around the White House to eliminate preventative measures entirely. What would it cost to treat all of those kids with polio?"

Competing demands on parents' time can compromise food choices for themselves and their children, says a new study in the September/October issue of the Journal of Nutrition Education and Behavior. Findings suggest that better work conditions may be associated with more positive strategies such as more home-prepared meals, eating with the family, keeping healthful food at work, and less meal skipping.

Fathers who worked long hours or had nonstandard hours and schedules were more likely to use take-out meals, miss family meals, purchase prepared entrees, and eat while working. Mothers purchased restaurant meals or prepared entrees or missed breakfast. Job security, satisfaction, and food access were also associated with gender-specific strategies. About a quarter of mothers and fathers said they did not have access to healthful, reasonably priced, and/or good-tasting food at or near work.

Former HHS Secretary Tommy Thompson says prevention "tops the list" of health reform policies that Americans feel are worth the investment. Thompson offered his assessment in a column written for the Huffington Post.

"The question is what policies under consideration do the vast majority of Americans view as being "worth" the investment -- not just tomorrow, but today," he writes.

"The answer that tops the list is prevention. Americans are literally sick of a health care system that doesn't improve health, but instead waits until we get sick before it springs into action. That's why policies that will reorient our system to emphasize prevention is an idea that ranks at the top of what Americans want in health reform -- well above ideas that get a lot more attention from politicians and the media. In fact, according to a recent Trust for America's Health survey, Americans rated prevention as the top priority in health reform, above providing tax credits to small businesses and prohibiting health insurers from denying coverage based on health status.

"In this highly politicized debate, it's important to note that a vast majority (88%) of voters -- Republicans and Democrats alike -- favor such an approach to reform, according to a recent survey by bipartisan pollsters Celinda Lake and Bill McInturff. For instance, there is strong bipartisan support for policies that make it easier for Americans with chronic disease to appropriately manage their conditions and prevent complications -- such as eliminating co-pays and deductibles for treatments for chronic illness -- which are a part of current reform proposals."

The Boston Globe reports how local schools are boosting the physical activity of its students at recess to help curb childhood obesity, and in the process are discovering some unintended benefits.

Conservatory Lab Charter School and other elementary schools around the area are bringing in leaders — often college athletes — to organize more vigorous recess activities like kickball, tag and Hula-Hooping.

“Now there is zero inactivity and almost zero incidents of discipline problems on the playground,” says Annie Sevelius, codirector at Conservatory Lab. “We hardly have any fights. Before, there were skirmishes, arguing, grabbing, and trash-talking.”

President Obama hinted he could support a "sin tax" on fizzy drinks to help lower high rates of US obesity, but admitted it would be an uphill battle against corporate and economic interests.

Over at www.disruptivewomen.net, Glenna Crooks has a powerful take on what she calls the "unsettling debate" over whether prevention will cost the government money.

"Yes, prevention will cost more health dollars," says Crooks, who is founder and President of Strategic Health Policy International, Inc. "Let’s get over it and move on – and beyond – that."

"...Regardless of what transpires in health reform debates, I hope that policy makers will realize that health – though valuable in-and-of itself – is an instrument of bigger goals," she writes.

"I hope they will not set their sights too low and act as if it’s all-and-only about cutting costs. I hope they will see that a healthy population is a productive one and in this economy that’s exactly what we need: people who are capable of managing the stresses of these modern times, who can work more productively and work longer to bring this nation – and the world – forward to its full potential of peace and prosperity for all."

Crooks says she offered similar advice in an August 2001 speech at an international conference on resistant pathogens. The reaction from conferees, she says, was "stunning." Many in the audience came to her afterwards in tears and talked about how she had touched them.

"It was then that I realized how weary we all are of working our best to shave another cent from the health care dollar and how much we all wanted a higher purpose for our work," she says.

The Washington Post printed the following letter from Partnership President/CEO Robert J. Gould in its Sept. 8 edition:

"It's bad enough that in the debate over health reform, the media's only interest regarding disease prevention and health promotion seems to revolve around the question of whether prevention will save enough money to pay for the health-reform bill. But the Sept. 1 news story "Study Raises Questions About Cost Savings From Preventive Care" seemed to go further by implying that the country should fund highly effective programs for controlling diabetes only if they save money.

"The fact is, while some preventive measures save money, almost all of them provide real value in that they offer more health benefits per dollar spent than many medical treatments do. While this may not pay the freight for health reform, it will help our country stretch its health-care dollar.

"That is indeed worth something. And, oh yes, prevention measures also help people live longer and healthier lives. Isn't that what our health-care system is supposed to be about?"

Congrats to the University of Louisville!

On November 19, 2009, the University of Louisville will begin its transition toward becoming a smoke-free campus. While some smoking areas will be designated temporarily, the campus will go entirely smoke free in June, 2010. Congratulations to president, Dr. James Ramsey, and the university leadership for making what must have been a difficult decision. Bucking the powerful tobacco industry and facing down disgruntled smoking student and university workers are no easy tasks. You did the right thing!

Tobacco use costs our nation more than $150 billion annually. Smoking is the leading cause of preventable death. Yet, there is hope – if tobacco users quit by age 30, their life expectancy is comparable to that of non-smokers. And, stopping tobacco use at any age can bring improved health.

Along with instituting a smoking ban, I encourage the University to make comprehensive cessation counseling, quitlines and medications available to all employees and students. Smoking cessation treatment is one of the highest ranked preventive health services – very positive health impact and cost effective.

I’m very proud of my alma mater and encourage all campuses throughout the United States to become smoke-free.

Diane M. Canova, JD
Managing Senior Fellow
& Senior Program Officer

Living without a car in an area populated by fast food restaurants may make your weight climb, according to a study cited by the Los Angeles Times' Jeannine Stein. The study, which appears in the September issue of the Journal of Urban Health, Using information on 2,156 adults from the Los Angeles Family and Neighborhood Study database, researchers looked at connections between body mass index, the concentration of restaurants in a neighborhood, and whether or not someone owned a car.

"Car owners on average weighed 8.5 pounds more than those who didn't own cars," Stein writes. "But non-car owners who lived in neighborhoods with a high concentration of fast food restaurants weighed 12 pounds more than non-car owners in areas without fast food restaurants, and 2.7 pounds more than those who owned cars and lived in areas with many fast food restaurants.

"Those who weighed the least didn't own a car and lived in areas without any fast food restaurants," she concludes.

When college-town bars offer special prices on drinks, the result is an increase in drunk college students. That's the conclusion of recent research, and it didn't come from the "Univeristy of DUH!"

Alcohol researchers from the University of Florida and San Diego State University decided to study the relationship between drink specials and the quantity of alcohol consumed. According to the New York Times' Tara Parker-Pope, they were spurred by long-time claims from bar owners that special drink prices attract more people to the bar, but don't result in people drinking more.

The researchers collectied data on 495 men and 309 women leaving seven bars near a university campus. The bar patrons were given breath alcohol concentration tests and also told researchers what they drank and spent during their time at the bar. For every $1.40 hike in drink price, the bar goer was 30 percent less likely to leave the bar legally drunk.

The findings will be published in the November issue of Alcoholism: Clinical and Experimental Research.

James Pinkerton, Schwartz Senior Fellow at the New America Foundation has pinned a insightful blog noting that “with all the hand-wringing over the details of paying for health care, we’ve lost sight of the fact that any good effort to reform health reform care should actually try to improve the health of Americans.”

His posting takes on critics on the left and right who say prevention doesn’t work or doesn’t save money. Pinkerton rightly sees prevention as an investment that reflects a core purpose of a health care system; to maintain and restore a population to health.

“As Washington debates the minutiae of health care dollars and cents, we’re missing what’s clearly common sense. Better health is a good thing; it would be worth investing in even if it didn’t save money. But it’s clear that lots of prevention efforts have the added bonus that they do save money.”

And Pinkerton credits the science behind his opinion. “The research shows that starting early--like way before someone has advanced diabetes or late-stage lung cancer--is critical not only to the survival of the patient, but also to the biggest monetary savings. Targeting these problems means helping people quit smoking, eat more nutritiously, and get more exercise, which often don’t even involve going to the doctor’s office. The New York Academy of Medicine has identified dozens of low-cost programs around the country that have shown real results in reducing smoking rates, limiting diabetes, improving nutrition, and increasing exercise, which then in turn reduce rates of disease.”

For those of us who believe prevention saves much more than money, Pinkerton’s commentary is a refreshing break from the naysayers who seem, with apologies Oscar Wilde, to know the price of everything but the value of nothing.

Ripley Forbes
Director, Legislative & Policy Advocacy
Partnership for Prevention

After The Washington Post buried the news from his recent study under a pile of all-too-typical blather about whether prevention measures will save enough to pay for the health reform bill, Michael O'Grady wrote a column for Roll Call outlining his proposal to change rules for scoring federal health care spending in a way that addresses prevention more realistically.

"Fighting chronic disease is costly and hard," writes O'Grady, a senior fellow at the University of Chicago's National Opinion Research Center. "However, we do not have to make it look more costly than it really is."

O'Grady cites findings from the National Institutes of Health that an intensive diabetes management program only begins to yield lower spending on diabetes treatment and complications after about eight years, with the bulk of the reductions occurring between years 10 and 20. The result, he says, is that the Congressional Budget Office's current scoring system, which only “scores,” the cost reductions achieved in the first 10 years of a program, "underestimates the longer term economic benefits associated with aggressive diabetes management programs."

"It is time the CBO uses the best available epidemiologic models as well as actuarial and economic models when predicting costs associated with disease interventions," he says. "...Overlooking the cost reductions associated with fewer kidney transplants, dialysis, heart attacks, strokes, blindness and amputations resulting from interventions pioneered by the NIH and CDC because they occur outside a 10-year budget window is harmful to the health of our economy and our people."

CNN reports on the workplace wellness program at Quest Diagnostics, a Virginia company whose "Healthy Quest" program saves $4.80 for every dollar invested in it.

"Healthy Quest is designed to focus on health issues that 'drive a lot of costs, and drive a lot of lost productivity,' like obesity, smoking and stress, [Steve Burton, vice president of health and wellness services at Quest Diagnostics] said." Since its inception, "the company has benefited from lower health care costs, fewer sick days and more satisfied employees," he said.

College classes are starting and another cohort of students is arriving on campus. Some of them will pack on the so-called "freshman 15"—the extra pounds gained during college that can last a lifetime.

It’s been assumed this rapid weight gain is related to sitting in the all-you-can-eat cafeteria on campus having long philosophical conversations. Research from the University of Minnesota, School of Public Health indicates that heavy drinking is associated with weight gain during college years in complex ways.

Among 3206 Minnesota college students, binge drinking was associated with a 7 to 32% increase in a wide variety of unhealthy eating behaviors--infrequent breakfast consumption, eating few fruit and vegetables, high fast food consumption, unhealthy weight control behaviors, and some sedentary behavior. These associations held throughout the college years.　

The study authors wonder if health messages are inadvertently competing with each other. Perhaps healthy eating messages do not fully account for ways a campus drinking context influences eating and, on the flip side, that the adage to never drink on an empty stomach may subtly contribute to weight gain. Now that’s food (and drink) for thought.

Susan Maloney
Managing Senior Fellow
& Senior Program Officer

Any school-age child in New York City can get a free swine flu vaccination under Mayor Michael Bloomberg's plan to contain the deadly virus this fall and winter.

Bloomberg and other city officials were set to announce the multi-pronged strategy later Tuesday to fight a second, more serious wave of the virus that sickened hundreds of thousands, many in schools.

Other elements of the city's plan include tracking influenza at emergency rooms and posting that and other data on a new flu Web site. The city will also produce a daily report on public school absenteeism and schools reporting five or more cases of flu-like illness.

One of the biggest concerns fueled by the obesity epidemic is what will be the long-term health implications of a generation of children that have high levels of obesity and overweight. Spanish researchers provide some insight in a study that found overweight and obese kids as young as 12 are showing early signs of heart disease.

Scientists in Barcelona analysed 80 obese and overweight kids with an average age of 12 and compared them with 60 lean youngsters. They found that larger kids had higher cholesterol and blood pressure, as well as more signs of pre-diabetes.

The Health Affairs website offers a study that explores alternative methods of projecting federal health care spending that incorporates actual clinical information.

The study was prepared by Elbert Huang and Anirban Basu, assistant professors of medicine at the University of Chicago School of Medicine; Michael O'Grady, senior fellow at National Opinion Research Center at the University of Chicago; and James Capretta, a principal of Civic Enterprises LLC in Washington, D.C.

"Current federal cost projection methods are constrained by ten-year cost estimates, which capture increases in near-term intervention costs but not changes in long-term costs," they write. "Current methods also cannot easily capture the cost implications of changes in disease progression. Type 2 diabetes is a prime example of a chronic illness with long-term health and cost consequences."

“I’m trying to show (the Congressional Budget Office) that there are other ways to do this, as we face these new challenges from the epidemic of chronic illness,” O'Grady told the Washington Post. “They’re used to thinking like economists. And their friends at Health and Human Services are used to thinking like actuaries. But there’s this third way, which is epidemiological, which shows us how a disease progresses over time.”

A new report from the Institute of Medicine and National Research Council outlines strategies that local government officials can use to tackle the childhood obesity epidemic in their communities. They include zoning restrictions on fast-food restaurants near schools and playgrounds, community policing to improve safety around public recreational sites, requirements that publicly run after-school programs limit video game and TV time, and taxes on high-calorie, low-nutrient foods and drinks.

The report highlights several examples of ways that officials have promoted healthier lifestyles in communities ranging from big cities to small towns. It also recommends starting points that could help officials initiate childhood obesity prevention plans tailored to their jurisdictions' resources and needs.

The ink is barely dry on the law giving the Food and Drug Administration (FDA) regulatory authority over tobacco products. The specific tobacco rules haven’t even been written yet. That hasn’t stopped R.J. Reynolds, Lorillard and other tobacco companies from filing a lawsuit challenging the new law. The lawsuit, filed in tobacco-friendly Kentucky, seeks to overturn significant portions of the Family Smoking Prevention and Tobacco Control Act dealing with tobacco product advertising, marketing and labeling.

The language of the Act was carefully drafted to stay within the boundaries of the First Amendment and to meet the objective of saving thousands of lives otherwise lost to smoking and other tobacco use. The advertising and marketing restrictions had a test run in 1996 as part of the FDA Tobacco Rule that was cleared by the US Department of Justice. Obviously, the tobacco companies are just “blowing smoke” as they have been for decades – choosing to ignore the suffering, disease and death they have caused children, adults and families throughout the United States and around the world.

Let’s not let the tobacco companies have the last say on this critical issue. Let your voice be heard that strong regulations protecting all Americans are long overdue. The FDA is accepting comments on the new regulations until September 29, 2009. Go to www.regulations.gov to support the call for strong regulatory protections on all tobacco products.


Diane Canova
Managing Senior Fellow
& Senior Program Officer