Prevention Matters

The current approach to prevention and control of chronic hepatitis B and hepatitis C is not working, says an Institute of Medicine study. It finds that as many as 5.3 million people in the United States have hepatitis B or C but most are unaware until they develop liver cancer or liver disease, researchers say. The report concludes that hepatitis is not widely recognized as a serious public health problem. As a result, viral hepatitis prevention, control and surveillance programs have inadequate resources.

In the national effort to lower health care costs by preventing chronic disease and hospitalizations, dentists may be an important part of the solution. A nationwide survey published in the January 2010 issue of the JADA (The Journal of the American Dental Association) reports that dentists would be willing to screen their patients for medical conditions such as cardiovascular disease and other chronic diseases when they come to the office for dental care. More than three-quarters of the 1,945 dentists who responded thought it was important for them to screen for hypertension, cardiovascular disease and diabetes, with a majority indicating they would be willing to check patients also for hepatitis and HIV.

The pediatrician wife of New Hampshire’s governor is backing legislation that would require the state’s schools to record children’s body mass index. Dr. Susan Lynch is a strong advocate for preventing and addressing childhood obesity, and says schools are a good place to screen children because not all have doctors to take the measurement. She believes that the measurement is more helpful than simply looking at a child’s weight to determine health risks of being under- or overweight.

E-cigarette merchants are wasting no time in taking advantage of a recent federal court ruling that says e-cigarettes are exempt from regulation by the Food and Drug Administration.
"Smoke Wherever You Want, Whenever You Want!" proclaims a website named "getsmartsmoker.com" that is the object of new mass e-mail marketing campaign. "Smokers can finally regain the freedom to smoke anywhere: bars, restaurants, planes, anywhere smoking has been banned."  Funny that the merchant would publish a quote about the smoking hazards of a product that they claim has none.

The ad also includes a quote from action movie hero/Calif. Gov./Arnold Schwarzenegger in which  he says that, while children under 18 should not be allowed access to e-cigs, "If adults want to purchase and consume these products with an understanding of the associated health risks, they should be able to do." It also includes a form that allows you to order a free (plus $9.95 shipping and handling) trial e-cigarette.

Surgeon General Regina M. Benjamin is calling for the establishment of a "new normal" in the war on obesity and overweight, in which the goals transcend the current fixation on numerical targets associated with weight or the body-mass index (BMI). Benjamin was joined by First Lady Michelle Obama and HHS Secretary Kathleen Sibelius in releasing her first official report, entitled The Surgeon General’s Vision for a Healthy and Fit Nation 2010.

"The real reward has to be something that people can feel and enjoy and celebrate," Benjamin writes. "That reward is invigorating, energizing, joyous health. It is a level of health that allows people to embrace each day and live their lives to the fullest—without disease, disability, or lost productivity."


Benjamin's report seeks to update, strengthen and expand the 2001 Surgeon General’s Call to Action on obesity and overweight issued by then-Surgeon General David Satcher. She identifies opportunities for prevention to make a difference in numerous settings - the home, the community, child care settings, schools, work sites and the medical community.

The first lady recently announced that she will launch a major initiative on childhood obesity in the next few weeks and has asked HHS to play a key role.

.

New York City public schools cut 4.6 billion calories and 422 million grams of fat a year from students’ diets by eliminating whole milk, a switch that districts are adopting in the U.S. fight against obesity. Whole milk was cut out in 2006, and fat-free chocolate milk replaced low-fat chocolate milk, according to a study that’s the first to measure how banning whole milk affects school nutrition. Students didn’t drink less of the healthier options, and average milk consumption increased 1.3 percent from 2004 to 2009, researchers said in the report published today by the U.S. Centers for Disease Control and Prevention.

Kudos to the San Francisco Chronicle's for noticing the prevention provisions in the health reform bills being worked out by Congress, and for realizing they are substantial.

"There's a sleeper in both the House and Senate bills that could do more to promote health in the long run than any of the insurance we may - or may not - get," Lucy Johns, a health care planning and policy consultant in San Francisco, writes in a Chronicle column.

"Both bills address long-term disease prevention and health promotion with innovative strategies and startling amounts of funding," she writes. "The House appropriates $15.4 billion over five years, the Senate over $7 billion. This level of federal investment nibbles at the historic imbalance between spending for medical services and spending that averts the need for services in the first place.

Maryland may be the No. 1 state in the country when it comes to cigarette smuggling, according to Michigan's Mackinac Center for Public Policy, a pro-markets think tank. Mackinac researchers compared legal cigarette sales with each state's actual level of smoking as shown by federal health surveys.With next-door Virginia taxing smokes at only 30 cents a pack, the Mackinac center calculates, as many as half of all cigarettes consumed in Maryland these days are illegal.

Maryland's smokers and smugglers save $17 a carton by driving south and loading up the trunk; a vanful could yield smugglers profits of $5,000, even after splitting them with retailers. Tobacco-smuggling busts roughly tripled in the first fiscal year after Maryland's tax went from $1 to $2 a pack. They're on track to equal those levels again this year. The Baltimore Sun's Jay Hancock reports that some dealers are switching from heroin and cocaine to tobacco because it's easier and just as lucrative.

"Lawmakers hoped to increase revenue and discourage smoking when it raised the tax," says Hancock. "People who supported the tax increase cheer what looks like an amazing plunge in Maryland smoking. But But they're looking only at official figures"

Wonders never seem to cease these days in North Carolina, where Wake Forest University Baptist Medical Center has become the first hospital in the state to achieve statewide "gold star" status for its tobacco-cessation programs. The rating was issued by N.C. Prevention Partners, the advocacy group that successfully lobbied for every acute-care hospital in the state to become 100 percent tobacco free. The home of Winston and Salem became the first state to achieve the milestone.

However, a reporter with the Winston-Salem Journal popped by the main campus of Wake Forest Baptist and found that there's still work to be done to gain 100 percent compliance from employees, visitors and patients.

"About 35 people braved the blustery weather for a smoke around noon, primarily in public areas along the sidewalk, a covered city-bus stop or the Shell service station on Cloverdale Avenue that's yards away from the system's Comprehensive Cancer Center," writes Richard Craver.

Barry Levinson, the Academy Award-winning director of Diner and Rain Man, announced today from the Sundance Film Festival that he will direct a new documentary on America's burgeoning obesity crisis. The film is part of The Spotlight Initiative, a series of independent films with messages that make a positive difference in the world.  

"The evolution of the obesity crisis in America is a fascinating and compelling human story. It's the hidden enemy within our borders that no one talks about," said Mr. Levinson.

The CDC’s Advisory Committee on Immunization Practices has updated its 2010 Recommended Adult Immunization Schedule to include either of the FDA-approved human papillomavirus (HPV) vaccines for women ages 19 to 26 who have not been immunized previously against HPV. The updated recommendations appeared January 5 in the Annals of Internal Medicine.

According to the schedule, either of two recommended HPV vaccines would optimally be given to girls between the ages of 11 and 12, but women up to age 26 may benefit from “catch-up” vaccination. Both HPV vaccines are most effective when given before a woman becomes sexually active.

The summary of the latest data from the CDC's National Health Interview Survey could have been written by Charles Dickens - "it was the best of times and it was the worst of times."

In the first six months of 2009, the number of people working out was up by 4 percent over the same period in 2008. That six-month period also saw the highest portion of Americans getting seasonal flu vaccines, being tested for HIV, and quitting smoking since the data started being collected in 1997.

At the same time, however, more Americans than ever reported being obese, having Type 2 diabetes, asthma, or drinking too much. A record 7.2 percent of people in the U.S. "failed to obtain needed medical care" during that period, and the rate of uninsured people inched up to 15.1 percent. Meanwhile, U.S. spending on health care nearly doubled from $1.13 trillion in 1997 to an estimated $2.3 trillion in 2008.

In recent months, the organizers of the Vancouver 2010 Winter Olympic Games have promised the competition would be a smoke-free world event. Now, it seems, at the request of a few VIP smokestacks, the health-promoting policy has been suddenly changed, and 25 smoking areas will be established at the Games. These designated areas will be for high-ranking officials only, not spectators, who must exit the security perimeter to light up.

Some are criticizing the treatment of paying spectators as second-class citizens by reserving the privilege of toxic tobacco self-pollution (without leaving the premises) exclusively for the "special people." But the bigger issue is the fact that the organizers reneged on what was touted as the first completely smoke-free Olympics.

Why did they back down? The answer: because “it was requested.” Big whoop. I say stick to your non-smoking guns. Most states in the U.S. are smoke free, as are scores of major cities around the world. And more than 20 entire countries have committed themselves to disease prevention by doing the same.

Hello, is this the Vancouver Olympic Games? I’m “requesting” that you send a message to the world that smoke-free is the new norm. These are the World Games, the smoke-free World Games (or so we had been led to believe). It has been proven all over the world that people, even important people, will get used to it. They may even like the clean air.

David Zauche
Managing Senior Fellow and Senior Program Officer
Partnership for Prevention

A study finding that cutting salt intake is as beneficial as smoking cessation was named “Best Prevention Idea of the Week,” while the proliferation of counterfeit condoms from China was named “Worst Prevention Idea of the Week.”

The Best/Worst awards are announced weekly in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are voted on by the Partnership for Prevention staff, based upon nominees from the staff as well as the general public. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders working to make evidence-based disease prevention and health promotion a national priority. More information is available online at www.prevent.org.


BEST


Study Finds Cutting Salt as Good as Quitting Smoking
http://www.webmd.com/hypertension-high-blood-pressure/news/20100122/cutting-salt-as-good-as-quitting-smoking

A new study finds that cutting U.S. salt intake by just half a teaspoon a day would prevent up to 92,000 deaths, 99,000 heart attacks and 66,000 strokes -- a benefit as big as smoking cessation. The prediction, based on computer models using real clinical data, to predict the effects of small reductions in salt intake, was published in the Jan. 20 online issue of the New England Journal of Medicine. "The [heart] benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels," says Kirsten Bibbins-Domingo, PhD. The average U.S. man currently gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.


WORST

Counterfeit Condoms are China's Latest Knockoff Scandal
http://www.latimes.com/news/nation-and-world/la-fg-china-condoms21-2010jan21,0,3174579.story

Health officials warn that inferior contraceptives can spread the diseases they are supposed to protect against. Some of the brand-name knockoffs have reached the U.S. It's China's latest knockoff scandal -- inferior contraceptives that health officials say provide little protection and may in fact spread infectious diseases, tarnishing the axiom that condoms mean safe sex.

While concern continues to mount over childhood obesity, it turns out that mothers in the U.S. are giving birth to lighter babies, and no one is quite sure why. The data, published Thursday in the Journal of Obstetrics and Gynecology, showed a 1% increase in the number of the lowest-weight babies and suggested the birth-weight decline didn't stop in 2005. The trend is potentially troubling, since low-birth-weight babies are at higher risk for a host of health problems.

At the same time, researchers also found a 2% decrease in the number of babies considered large—those over the 90th percentile of weight for gestational age. That's considered positive, since large babies can experience more birth trauma and cause more birth injury to the mother.

Cutting U.S. salt intake by just half a teaspoon a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. The prediction, based on computer models using real clinical data,  to predict the effects of small reductions in salt intake, was published in the Jan. 20 online issue of the New England Journal of Medicine.

"The [ heart] benefits of reduced salt intake are on par with the benefits of population-wide reductions in tobacco use, obesity, and cholesterol levels," says Kirsten Bibbins-Domingo, PhD. The average U.S. man currently gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.

In his latest budget proposal, New York Gov. David Paterson has proposed a tax on sugared drinks that would amount to about a penny an ounce. According to The Wall Street Journal's Jacob Goldstein, "the basic argument is that taxing soda and other sugared drinks would be a way to fight obesity while raising money to fund health care (the money raised by the proposed tax in New York would go into an existing pool that funds some of the state’s health expenses)."

The proposed tax (explained on  p. 130 of this PDF) would be levied on drinks "that contain more than ten calories per eight ounces, such as soda, sports drinks, ‘energy’ drinks, colas, fruit or vegetable drinks containing less than 70% natural fruit or vegetable juice, and bottled coffee or tea. Milk, milk products, milk substitutes, dietary aids, and infant formula would be exempt."

A new survey from the Kaiser Family Foundation finds that kids spend more than 71/2 hours a day with electronic media, up from about six hours in 1999.

Most young people have a cellphone and an iPod — and nearly one in three own a laptop computer."Heavy media users" - those who consume more than 16 hours of media content in a typical day, are more likely to have bad grades, more likely to be "often sad or unhappy," less likely to get along well with their parents and twice as likely to "get into trouble a lot." Even so, heavy users were more likely to say they have "a lot of friends."

Michelle Obama says she will launch a major initiative in February to combat the problem of childhood obesity. She mentioned the upcoming effort at a meeting of the U.S. Conference of Mayors, saying she wanted "to put in place commonsense initiatives and solutions that empower families and communities to make healthy decisions for their kids."

Under the initiative, she says, the federal government will work with local officials and leaders in the foundation, business and non-profit sectors to increase the number of schools that serve nutritious food, provide more opportunities for kids to be physically active and give more communities access to affordable healthy food.

The “Vitality Project” in Albert Lea, Minn., was named “Best Prevention Idea of the Week,” while a noted Canadian psychiatrist who touts the benefits of smoking was awarded the honor of “Worst Prevention Idea of the Week.”

The “Best/Worst” awards are given by “Prevention Matters,” the blog of Partnership for Prevention. Nominees are suggested by Partnership staff and the general public, and voted on by the staff.. Partnership for Prevention is a non-profit organization of business, nonprofit, and government leaders working to make evidence-based disease prevention and health promotion a national priority. For more information about Partnership for Prevention, go to www.prevent.org

BEST

“Vitality Project” Makes a Difference in Minnesota Community
http://www.aarpmagazine.org/health/minnesota_miracle.html

The results are in on the “AARP/Blue Zones Vitality Project,” sponsored by the United Health Foundation, a program to help the residents of Albert Lea, Minnesota, eat better, become more active, and connect with one another. By the time the Vitality Project ended in October 2009 a total of 3,464 residents of all ages had participated. The life expectancy of the 786 residents who took the Vitality Compass before and after rose by an average of 2.9 years. Two-thirds of locally owned restaurants added life-extending foods to their menus, from berries to broccoli, and 35 businesses pledged to make their workplaces healthier by offering more nutritious catering menus and vending machine choices, and substituting fruit for doughnuts. Residents participated in 15 Vitality Project initiatives ranging from "walking school buses" to healthy cooking classes.


WORST

Canadian Doc Touts Benefits of Smoking
http://www.cjad.com/news/565/1049474

The former president of the Psychiatric Association of Quebec believes there are benefits to smoking and, as such, society shouldn't be treating smokers as outcasts. In his new book. Dr. Jean-Jacques Bourque points to the therapeutic benefits of smoking, calling it a stress reliever for the depressed and anxious. As for actual health benefits, he cites the fact smokers are less likely to suffer from Alzheimer's and Parkinsons disease. A smoker himself, the doctor also suggests non-smokers should show a little more compassion towards smokers instead of sending them outside to have a puff. Bourque's position is outlined in a new book to be published soon.

The national economic burden of diabetes has reached $218 billion, according to a study in Health Affairs. The authors have created a Cost of Diabetes Model that combines information from peer-reviewed literature, analyses of national survey and medical claims databases, and government statistics.

For 2007, they calculated that the national economic burden of diabetes and pre-diabetes was a staggering $218 billion, which included $153 billion in medical costs and $65 billion in reduced productivity.  This translated to approximately $700 per person. The $65 billion estimated productivity loss associated with diabetes came from higher levels of absenteeism, working at less than capacity, and early mortality.

“The burden of diabetes to society is even higher when one considers intangible costs from reduced quality of life…underscore[ing] the urgency to better understand the cost-mitigation potential of prevention and treatment strategies,” the authors wrote.  They said the study shows that lifestyle changes (diet and exercise) can help delay or prevent the onset of diabetes.

According to the American Diabetes Association, nearly 17.5 million people were diagnosed with that disease in 2007; another 6.3 million adults are living with undiagnosed diabetes.

A Health Affairs article reviews the evidence on workplace wellness programs and concludes that the medical savings outweigh the costs for employers.

The authors conducted a critical review of more than 100 existing peer-reviewed analyses of employee wellness programs, many of which use health risk assessments and focus on obesity and smoking, the top two causes of preventable death in the United States. They found that these initiatives save employers money both through reduced health costs for their employees and reduced absenteeism.  For every dollar spent on wellness programs, about $3.27 was saved in medical costs and $2.37 was saved in reduced workplace absenteeism.

Partnership for Prevention sent a letter to congressional negotiators on the health reform bill urging them to maintain the independence and expertise of the federal task forces for clinical and community prevention services. The House and Senate bills both have provisions that would change the role and structure of the US Preventive Services Task Force and the Community Preventive Services Task Force.

"It is vital that  each body continue to offer unbiased, objective recommendations that can inform physicians, public health officials, and other health professionals about the quality of evidence of clinical and community services," Partnership President/CEO Robert J. Gould wrote Sen. Tom Harkin, D-Iowa, and Sen. Henry Waxman, D-Calif.

"...To maintain this scientific independence, it is absolutely essential that task force members have the necessary training and expertise to fulfill their primary responsibility: the review of scientific evidence related to the effectiveness of clinical and community preventive services and applying this evidence to decision-making.

"Any other qualifications for appointment, such as expertise in employer health or school health or clinical experience, should be a supplemental qualification and not an alternative..." he concluded.

U.S. District Judge Richard Leon today ruled that the U.S. Food and Drug Administration may not regulate electronic cigarettes as drugs or medical devices.

"This case appears to be yet another example of FDA's aggressive efforts to regulate recreational tobacco products as drugs or devices," Judge Leon said in his ruling. He added the FDA's "tenacious drive to maximize its regulatory power has resulted in its advocacy of an interpretation of the relevant law that I find, at first blush, to be unreasonable and unacceptable."

The FDA has seized shipments of e-cigarettes, saying the electronic cigarettes were essentially drugs or devices that were being imported without FDA approval.

Meanwhile, California Attorney General Jerry Brown has filed suit seeking to halt the sale of one company's electronic cigarettes in the state, saying they contain dangerous chemicals and are being marketed to children.
Brown says Florida-based Smoking Everywhere Inc., a leading manufacturer of e-cigarettes, has no evidence to back up claims their product is safe.

"One third of American adults are now obese. In fact, one-third of Americans adults are now one-half of American adults."

- Steven Colbert, "The Colbert Report"

An influential East Tennessee doctor suggests that, while his state is successful in getting federal transportation funds, it fails to address transportation challenges in a comprehensive way that address health-related concerns.

"The right kind of streets allow kids to burn those calories by bicycle, foot or skateboard to school, recreation, social engagements and the like," Dr. Anthony DeLucia, a member of the faculty at East Tennessee State University and former chairman of the American Lung Association, wrote in an op-ed published in the Johnson City Herald. "For our growing senior population, some of whom cannot drive, a complete street and sidewalk system with amenities like crosswalks, raised medians, trees, fountains and benches is a thing of beauty and utility."

"Instead, we have provided an illusory and one-dimensional economic stimulus," he writes. "In transportation policy, 'my way or the highway' literally means 'my way is the highway.' We need a fresh look at policy, funding and accountability that addresses the challenges of local metropolitan planning organizations, state departments of transportation and the Federal Highway Administration."

Americans now feel that it is as important for businesses to engage in health as it is for them to engage in the environment, says one of the folks who produced Edelman's "Health Engagement Pulse" survey.

"In essence, health is becoming the new/next green," Nancy Turrett, Edelman's President for Health, told The Health Care Blog's Matthew Holt. However, Turrett warns the business community, consumers think only one in ten Americans think business is doing an excellent or very good job at ANY of these.


"The social contract that business of all stripes has with society is fortunately -- ironically in light of the financial/ethical come-uppance of the past 18 months -- top of mind for many business leaders.  It's a great time to enlighten them about the health engagement business imperative -- minds and strategic plans are more open now that I’ve seen in my 25 years communicating and engaging in health.

New Yorkers’ efforts to curb salt use and the widespread presence of bacteria linked to feces at soda fountains were named the Best and Worst Prevention Ideas of the week.

The “Best/Worst” awards are given by “Prevention Matters,” the blog of Partnership for Prevention. Nominees are suggested by Partnership staff and the general public, and voted on by the staff. For more information about Partnership for Prevention, go to www.prevent.org .


BEST


NYC Seeks National Effort to Curb Salt Use

New York City officials plan to unveil a broad new health initiative aimed at encouraging food manufacturers and restaurant chains across the country to curtail the amount of salt in their products. The plan, for which the city claims support from health agencies in other cities and states, sets a goal of reducing the amount of salt in packaged and restaurant food by 25 percent over the next five years. Public health experts say that would reduce the incidence of high blood pressure and should help prevent some of the strokes and heart attacks associated with that condition. The plan is voluntary for food companies and involves no legislation. It allows companies to cut salt gradually over five years so the change is not so noticeable to consumers.


WORST

Bacteria Linked to Feces Found on Soda Fountains

A team of microbiologists from Hollins University found that 48% of the sodas they tested from fast food soda fountains had coliform bacteria. Coliform is typically fecal in origin. On top of that, the study found that most of the bacteria were resistant to antibiotics. The team tested 90 beverages from 30 fountains, and published their findings in the International Journal of Food Microbiology.

Do we really know what works best when it comes to health promotion? And when we learn what works, are we making sure others know, also? These are some of the questions we explore in this podcast with Michel O'Donnell, PhD, editor of the American Journal of Health Promotion. O'Donnel is also program chair of a March 15 conference on "The Art and Science of Health Promotion," where noted experts will also be addressing these questions. To listen to this podcast click on the media player below. If you don't see a media player below, click here.

The health benefits Americans have gained by reducing their tobacco use are becoming "outweighed" by the negative effects of our growing obesity epidemic, according to a new study. The study, led by Susan Stewart of Harvard University, forecasts the life expectancy for a nationally representative 18-year-old assuming that recent trends in smoking and weight gain continued for the next decade or so.

While continued declines in cigarette smoking would increase the life expectancy of the18-year-old by 0.31 years by 2020, continued increases in BMI would cut life expectancy by 1.02 years over the same period of time. That's an overall net loss in life expectancy 0.71 years.

The week between Christmas and New Year's Day is a peak time for movie theater attendance and, according to one group, the most recent crop of holiday releases gave tobacco use considerable exposure. Scenesmoking.org, project that routinely rates movies on the extent and type of their tobacco-related content, gave its worst rating - the "black lung" - to five of the top 10 releases on the week of Dec. 28.

"Avatar," "Sherlock Holmes," "The Blind Side," "Nine," and "Did You Hear about the Morgans?" all received "black lung ratings. There was apparently no middle ground for movie-makers, as the rest of the top 10 were deemed "pink lung" movies, which are the group's highest rating. The "pink lung" movies included "Alvin and the Chipmunks: The Squeakque," "It's Complicated," "Up in the Air," "The Princess and the Frog," and "Invictus."

Scenesmoking.org is a project of Breathe California of Sacramento-Emigrant Trails.

The North Carolina smoking ban was only one of many public health laws that took effect across the country on Jan. 1.  Some other examples:


- California became the first state to ban restaurants' use of trans fats in cooking. Initially, restaurants won’t be able to use “oil, shortening, or margarine containing specified trans fats.” In 2011, the bill will expand to prohibit restaurants from serving “any food containing artificial trans fat.” Certain exceptions will apply, and some school cafeterias will be exempt.



- A ban on texting while driving took effect in New Hampshire, Oregon and Illinois. That brings the number of states that ban the practice to 19, according to the Governors Highway Safety Association.

- Illinois Cancer laws.. A new Illinois law requires health class curricula to include information on cancer risk factors, prevention and early detection. 2010 also brings new cancer screenings as a component of Illinois school sports physicals.

- Retailers may only sell cigarettes that extinguish themselves if left unattended, thanks to laws passed in  Arkansas, Texas, Alabama, Florida, Georgia, Michigan, Missouri, Nebraska, New Mexico, North Carolina, South Carolina, Tennessee and Virginia. Fire-safe cigarette laws will also take effect in Mississippi, Ohio and South Dakota by the first week of 2011. Wyoming is the only state that hasn't passed such a law, according to the Coalition for Fire-Safe Cigarettes.

- A new Arkansas law requires health insurance policies to cover prostate cancer screenings and treatment for men at least 40 years old.

- A new law in Maryland requires the provision of substance abuse benefits to people under the Maryland Medical Assistance Program.


- In Texas, teens who use tanning beds must be accompanied by an adult or bring signed permission slips, while new college students who want to live on campus must prove they have been vaccinated against bacterial meningitis.

- A Tennessee law seeks to help prevent the accidental or intentional poisoning of people, pets and other animals as a result of ingesting antifreeze or engine coolants. The law requires manufacturers to add a bittering agent. Without it, antifreeze has a sweet aroma and flavor.Ethylene glycol, a key ingredient in antifreeze, is toxic to humans and animals.

- Illinois health care institutions are banned from flushing medications into public sewer systems or septic systems, except those in intravenous fluids, syringes and transdermal patches. designed to reduce the amount of prescription medications found in local water supplies.

- Wisconsin will start work on an environmental quality  protocol for schools.  A new law requires the Department of Public Instruction (DPI) to convene a task force to develop a model management plan for indoor environmental quality in public and private schools.

- Oregon will require children under age 16 to wear a seat belt on any ATV or vehicle on public property, and will increase the fine for people riding a motorcycle without a helmet to $720.

• In Texas, smoke detectors will need to be able to alert a hearing-impaired person if requested by a tenant. 

Anybody else notice that a recent Arctic blast hit the mid-Atlantic region just about the same time that the statewide smoking ban in North Carolina restaurants and bars took effect on Jan. 1?  Is it a sign that perhaps another place with an even warmer climate froze over? Given that North Carolina is the country's largest tobacco-producing state, few probably would be surprised.

"Even as recently as a decade ago, this was unthinkable," Ferrel Guillory, a professor and political expert at UNC Chapel Hill, told the Charlotte Observer. The new law imposes a fine of up to $50 for smoking inside bars and restaurants and $200 for business owners who permit smoking.

Some bars and restaurants have expanded their patio options to allow smoking outdoors, while others are getting around the ban by choosing to operate as a private club. But others embraced the change enthusiastically. “We expect a 15 to 20 percent increase in business,” Doug Jones, who owns Fishers Grille in downtown Greensboro, told the Greensboro News-Record. “We’ve had people say they’d bring their families if it weren’t for the smoke.”