Prevention Matters

The newly-established FDA tobacco advisory panel has the opportunity to take a bold step and ban menthol cigarettes. Menthol cigarettes are popular with young smokers -- 62 percent of middle-school smokers begin with menthol cigarettes. And, about 75 percent of African American smokers use menthol brands. These two groups are heavily targeted by tobacco companies, which says menthol cigarettes are no more dangerous than other cigarettes. But, Congress and the FDA had no problem banning other favors like chocolate and clove. What’s the big deal here? How about $18 billion dollars a year? The tobacco industry won’t give up on menthol without a strong fight. Health advocates need to continue to make the case for a ban.

Read the Washington Post article on menthol - "FDA panel mulls putting limits on menthol cigarettes".

Diane Canova
Vice President, Policy and Programs

The passage of a health reform bill that emphasizes prevention and wellness was named the “Best Prevention Idea of the Week,” while reduced life expectancy due to preventable risk factors was named the “Worst Prevention Idea of the Week."

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

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Obama Signs Historic Health Reform Law, Steps Up Focus on Prevention and Wellness

On March 23, 2010, President Barack Obama signed the health care bill into law. The new federal health reform law (HR 3590) includes many provisions aimed at disease prevention and promoting healthy lifestyles. The law creates a $15 billion fund for programs designed to promote prevention and wellness, such as efforts to address obesity and to help patients manage chronic diseases. The law also establishes a National Prevention, Health Promotion and Public Health Council to coordinate federal efforts to promote healthy living. In addition, the health care reform law:

• Eliminates copayments for Medicare and Medicaid beneficiaries receiving preventive services;
• Increases reimbursement rates for physicians who offer certain preventive services;
• Provides grants to small business for establishing wellness programs and incentives for employers to offer workers as much as 50% off their premiums for participating in such programs; and
• Requires chain restaurants and vending machines to disclose nutritional information.

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Four Preventable Risk Factors Reduce Life Expectancy in U.S. and Lead to Health Disparities

A new study led by researchers from the Harvard School of Public Health (HSPH) in collaboration with researchers from the Institute for Health Metrics and Evaluation at the University of Washington estimates that smoking, high blood pressure, elevated blood glucose and overweight and obesity currently reduce life expectancy in the U.S. by 4.9 years in men and 4.1 years in women. It is the first study to look at the effects of those four preventable risk factors on life expectancy in the whole nation.

Two new studies exemplify the need for alcohol abuse prevention to take on a heightened focus for public health practitioners, healthcare providers, and policymakers. According to a new national survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA), more than a quarter of youth aged 12-20 (27.6 percent) drank alcohol in the past month. Underage drinking rates are as high as 40 percent in some states—especially in New England and the upper Midwest. The study also found that nationwide, almost 9 percent of underage drinkers were able to purchase their own alcohol the last time they drank. In an effort to combat this growing epidemic, SAMHSA and the Ad Council launched a new series of national PSAs to encourage parents to talk to their children about drinking alcohol at an early age.

Another study, which appears in the April issue of the Journal of the American Dietetic Association, finds that the more people drink, the worse their food choices. The study found that as alcohol consumption rose, fruit consumption declined and caloric intake increased among men and women. "This finding raises questions about whether the combination of alcohol misuse and poor diet might interact to further increase health risks," said NIAAA acting director Kenneth R. Warren.

Christianne Johnson
Program Manager, Partnership for Prevention

The announcement by PepsiCo that it plans to remove sugary drinks from schools worldwide was named the “Best Prevention Idea of the Week,” while women in Wales smoking during their pregnancy has been named the “Worst Prevention Idea of the Week.”

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

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PepsiCo to stop selling sugary drinks from schools worldwide by 2012

PepsiCo plans to remove sugary drinks from schools worldwide, following the success of programs in the U.S. aimed at cutting down on childhood obesity. The company said last Tuesday it will remove full-calorie, sweetened drinks from schools in more than 200 countries by 2012, marking the first such move by a major soft drink producer.

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One in five women in Wales smoke while pregnant


Wales has the highest rates of women who smoke during their pregnancy in the UK, shocking figures revealed. Despite the social taboo, the figures from anti-smoking charity ASH Wales show one-in-five women continue to smoke throughout pregnancy. Midwives said many young women are smoking while pregnant because they believe they will have smaller “doll-like” babies.

At Partnership we focus much on issues and policies affecting prevention which, happily, are significant components of the recently passed health reform legislation. But beyond the details of specific provisions we must pause to give credit to the work of the House Speaker, Nancy Pelosi of California, who made possible -- comprehensive health reform – when many “political experts” thought the task was impossible.

There will be many commentators who will dissect the Speaker’s leadership style and seek to explain the nature of her success. But I am interested and impressed more by the substance of what she has achieved and the philosophy that guided her efforts.

Before the final vote last night on passage of HR 3590, the “Patient Protection and Affordable Care Act” the Speaker entered the well of the House and delivered a final call to action on behalf of the American people. Her words, powerfully delivered, came at the conclusion of seemingly bitter and contentious legislative process.

The Speaker spoke of the legislation’s passage as an “historic moment” that would lead to healthier lives.

She said “we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege.”

She spoke of a letter sent to President Obama from the late Edward Kennedy who wrote ‘At stake are not just the details of policy but…the character of our country.’

The Speaker’s words evoked the best of American values. They captured, better than any Committee report or legislative history, why passage of the legislation was a duty, and important, not just to individual families but to moving us closer to the Founding Father’s goal of a more perfect union.

I commend the reading of the full text of the Speaker’s Remarks.

Ripley Forbes
Director, Government Affairs
Partnership for Prevention


Statement on the floor of the US House of Representatives by Speaker Nancy Pelosi, on passage of HR 3590, the “Patient Protection and Affordable Care Act.” (March 21, 2010):


“Thank you, my colleagues. Thank you, Mr. Speaker. I thank the gentleman for yielding. I thank all of you for bringing us to this moment.

“It is with great humility and with great pride that we tonight will make history for our country and progress for the American people. [Applause] Just think—we will be joining those who established Social Security, Medicare, and now tonight health care for all Americans. [Applause]

“In doing so, we will honor the vows of our founders, who in the Declaration of Independence said that we are ‘endowed by our Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness.’ This legislation will lead to healthier lives, more liberty to pursue hopes and dreams and happiness for the American people. This is an American proposal that honors the traditions of our country. [Applause]

“We would not be here tonight, for sure, without the extraordinary leadership and vision of President Barack Obama. [Applause] We thank him for his unwavering commitment to health care for all Americans.

“And this began over a year ago under his leadership in the American Recovery and Reinvestment Act, where we had very significant investments in science, technology, and innovation for health care reform. It continued in the President’s budget a few months later, a budget which was a statement of our national values, which allocated resources that were part of our value system. And in a way that stabilized our economy, created jobs, lowered taxes for the middle class and did so, and reduced the deficit, and did so in a way that had pillars of investment, including education and health care reform—health care reform and education, equal opportunity for the American people. [Applause]

“And this legislation tonight, if I had one word to describe it would be ‘opportunity,’ with its investments in education and health care as a continuation of the President’s budget. We all know, and it has been said over and over again, that our economy needs something new, a jolt. And I believe that this legislation will unleash tremendous entrepreneurial power into our economy. Imagine a society and an economy where a person could change jobs without losing health insurance, where they could be self-employed or start a small business. Imagine an economy where people could follow their passions and their talent without having to worry that their children would not have health insurance, that if they had a child with diabetes who was bipolar or pre-existing medical condition in their family, that they would be job-locked. Under this bill, their entrepreneurial spirit will be unleashed. [Applause]

“We all know, we all know that the present health care system and insurance system, health insurance system in our country is unsustainable. We simply cannot afford it. It simply does not work for enough people in terms of delivery of service and it is bankrupting the country with the upward spiral of increasing medical costs.

“The best action that we can take on behalf of America’s family budgets and on behalf of the federal budget, is to pass health care reform. [Applause]


“The best action we can take to strengthen Medicare and improve care and benefits for our seniors is to pass this legislation tonight, pass health care reform. [Applause]

“The best action we can do to create jobs and strengthen our economic security is pass health care reform. [Applause]

“The best action we can take to keep America competitive, ignite innovation, again unleash entrepreneurial spirit is to pass health care reform. [Applause]

“With this action tonight, with this health care reform, 32 million more Americans will have health care insurance. And those who have insurance now will be spared being at the mercy of the health insurance industry with their obscene increases in premiums, their rescinding of policies at the time of illness, their cutting off of policies even if you have been fully paying but become sick, the list goes on and on about the health care reforms that are in this legislation: insure 32 million more people, make it more affordable for the middle class, end insurance company discrimination based on pre-existing conditions, improve care and benefits under Medicare, and extending Medicare’s solvency for almost a decade, creating a healthier America through prevention, through wellness and innovation, create 4 million jobs in the life of the bill and doing all of that by saving the taxpayer $1.3 trillion dollars. [Applause.]

“Another Speaker, Tip O’Neill once said: ‘All politics is local.’ And I say to you tonight that when it comes to health care for all Americans, ‘All politics is personal.’

“It’s personal for the family that wrote to me who had to choose between buying groceries and seeing a doctor. It’s personal to the family who was refused coverage because their child had a pre-existing condition — no coverage, the child got worse, sicker. It’s personal for women — after we pass this bill, being a woman will no longer be a pre-existing medical condition. [Applause.]

“It’s personal for a senior gentleman whom I met in Michigan, who told me about his wife who had been bed-ridden for 16 years. He told me he didn’t know how he was going to be able to pay his medical bills. As I said to you before, I saw a grown man cry. He was worried that he might lose his home — that they might lose their home because of his medical bills and he didn’t know how he was going to pay them. And most of all, he was too embarrassed to tell his children and ask them for help. How many times have you heard a story like that?

“And it’s personal for millions of families who’ve gone into bankruptcy under the weight of rising health care costs. In fact, many, many, many — a high percentage of bankruptcies in our country are caused by medical bills that people cannot pay. And it’s personal for 45,000 Americans and their — families who have lost a loved one each year because they didn’t and couldn’t get health insurance.

"That is why we’re proud and also humbled today to act with the support of millions of Americans who recognize the urgency of passing health care reform. And more than 350 organizations, representing Americans of every age, every background, every part of the country, who have endorsed this legislation. Our coalition ranges from the AARP, who said that our legislation ‘improves efforts to crack down on fraud and waste in Medicare, strengthening Medicare for today’s seniors and future generations.’ I repeat: ‘Improves efforts to crack down on fraud and waste in Medicare, strengthening the program for today’s and future generations of seniors.’ To the American Medical Association, the Catholic Health Association, the United Medical — the United Methodist Church, and Voices of America’s Children. From A to Z — they are sending a clear message to Members of Congress: Say yes to health care reform. [Applause.]

“We have also reached this historic moment because of the extraordinary leadership and hard work and dedication of all the Members of Congress, but I want to especially recognize our esteemed Chairs — Mr. Waxman, Mr. Rangel, Mr. Levin, Mr. Miller, Mr. Spratt, Ms. Slaughter — for bringing this bill to the floor today. Let us acknowledge them. [Applause.]

“And I want to acknowledge the staff of the committees and of the leadership — they have done a remarkable job — dazzling us with their knowledge and their know-how. [Applause.] I would like to thank on my own staff: Amy Rosenbaum, Wendell Primus, and Arshi Siddiqui.

“And now, I want to just close by saying this. It would not be possible to talk about health care without acknowledging the great leadership of Senator Edward Kennedy, who made health care his life’s work. [Applause.]

“In a letter to President Obama before he passed away — he left the letter to be read after he died. Senator Kennedy wrote that: ‘Access to health care is the great unfinished business of our society.’ That is until today. [Applause.]

“After more than a year of debate, and by the way, the legislation that will go forth from here has over 200 Republican amendments, and while it may not get Republican votes and be bipartisan in that respect, it is bipartisan in having over 200 Republican amendments. [Applause.]

“After a year of debate and hearing the calls of millions of Americans, we have come to this historic moment. Today, we have the opportunity to complete the great unfinished business of our society and pass health insurance reform for all Americans that is a right and not a privilege. [Applause.]

“In that same letter to the President, Senator Kennedy wrote, what is ‘at stake’ he said, ‘At stake are not just the details of policy but…the character of our country.’

“Americans will look back on this day as one which we honored the character of our country and honored our commitment to our nation’s founders for a commitment to ‘life, liberty, and the pursuit of happiness.’

“As our colleague John Lewis has said, ‘We may not have chosen the time, but the time has chosen us.’ We have been given this opportunity. I urge our — an opportunity — stay right up there with again, Social Security, Medicare, health care for all Americans. I urge my colleagues in joining together in passing health insurance reform — making history, making progress, and restoring the American dream.

“I urge an aye vote. Thank you.”

Two new studies published in the March issue of the Archives of Dermatology might give us reason to trade in that slogan for “time to pay the piper”.

Referring to non-melanoma skin cancer: "We are dealing with a problem that is not going away," said Dr. Howard Rogers, a dermatologist in Norwich, Conn., and lead author of one of the studies. "The number has kept going up and up at a rate of 4.2 percent every year, on average, from 1992 to 2006," he said. One study found that one in five 70-year-olds has been treated for non-melanoma skin cancer.

As the baby-oiled sun worshippers grow older, they have a high probability of getting basal cell or squamous cell carcinoma. These non-melanoma skin cancers are not usually fatal, but can be disfiguring and can matastasize. "This is only going to get worse," said Dr. Suephy Chen, an associate professor of dermatology at Emory University School of Medicine in Atlanta. "Our population is aging. Those people who grew up in the 1970s and 1980s when there was not a big sun-protection message out there are now coming into their 50s and 60s and are starting to develop skin cancers."

Dermatologists suggest these practices to better your odds against skin cancer: apply broad-spectrum sunscreen liberally and often, wear hats and other protective clothing when out in the sun, avoid sun exposure when the sun's rays are the strongest -- between 10 a.m. and 3 p.m., and never using tanning beds. “It's especially important to take these steps with children and teens (to the extent they will listen)”, Rogers said. “Skin cancer is turning up in younger and younger patients”. In the past week or so, he removed non-melanoma cancer off the cheek of a 17-year-old boy and removed a melanoma from an 18-year-old girl.

Because skin cancer is one of the most preventable diseases Americans face, Partnership for Prevention underscores these health recommendations. With over one million new diagnoses predicted in 2010, affecting more people than all other cancers combined, the time is now to use sense in the sun.

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

The study showing that giving flu shots to children protects a whole community from disease was named the “Best Prevention Idea of the Week,” while pregnant women skimping on fruit and vegetables and gaining too much weight has been named the “Worst Prevention Idea of the Week.”

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

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Flu Shots in Children Can Help Community

An unusual study done in 49 remote Hutterite farming colonies in western Canada has provided the surest proof yet that giving flu shots to schoolchildren protects a whole community from the disease. Although previous studies have demonstrated what scientists call “herd immunity,” none have been so incontrovertible, because they were done in less isolated places with more sources of flu passing through. Also, only one other study, done 42 years ago, immunized over 80 percent of a community’s children, as this one did. Success repeated in many separate communities with very high vaccination rates implies that the shots themselves — rather than luck, viral mutations, hand-washing or any other factor — were the crucial protective element.

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Pregnant Women Falling Short On Nutrition

Pregnant women are skimping on fruit and vegetables and gaining too much weight, according to a new Australian study. The research, in the journal Nutrition & Dietetics published by Wiley-Blackwell, found that expectant mothers are eating less than half the recommended servings of fruit and vegetables. And at least one in three put on more than the recommended weight gain for pregnancy.

An interesting article published in yesterday's issue of the Daily Women's Health Policy Report discusses the shift in birth patterns happening quickly in the U.S.

Births to minority women in the U.S. soon could surpass births to white women, according to a study published recently in the journal Population and Development Review, the New York Times reports.

In the 12 months leading up to July 2008, minorities accounted for 48% of all U.S. births. According to demographers, the 50% benchmark possibly could be reached this year and almost certainly will be reached within two years. This represents a sizeable demographic shift since 1990, when non-Hispanic whites accounted for almost two-thirds of births.

The Census Bureau estimates that minorities will make up the majority of the U.S. population within 30 years and a majority of all U.S. residents under age 18 within 10 years.

The study found that although immigration has declined, other variables are contributing to the racial and ethnic shift. The Times reports that these factors include a decline in the number of non-Hispanic white and black children; white and Asian birth rates that are below replacement levels, which magnifies the impact of higher Hispanic birth rates and immigration; and a declining number of non-Hispanic white women who are of child-bearing age (Roberts, New York Times, 3/11).

From: National Partnership for Women and Families, Daily Women's Health Policy Report, March 15, 2010

Have tobacco companies stopped advertising their products to children? A five-year study published March 15, 2010 in the journal Pediatrics found that nearly half of teenage girls participating in the study could name their favorite cigarette ad. This in spite of U.S. government advertising restrictions required by the 1998 Big Tobacco settlement agreement. This study is the fifth installment of a nationally representative sample of teenagers that was designed to assess whether cigarette ads run after the tobacco settlement had any effect on adolescents.

“These are the same people that brought us Joe Camel, a very big campaign with multiple different components," said study author John Pierce, a professor of family and preventive medicine and director of the Cancer Prevention and Control Program at the Moores Cancer Center at the University of California, San Diego. "Now it seems like what they're doing is trying a campaign, and then when people complain, they change and do something else."

The controversy surrounds Camel No. 9 whose ads featured a pink camel and a sub-brand of cigarettes called Stiletto. In addition to the very feminine ads placed in such magazines as Glamour and Vogue, the campaign also featured promotional giveaways, including flavored lip balm, purses and cell phone jewelry.

"This article presents credible evidence that the Camel No. 9 cigarette advertising campaign has targeted underaged girls," the researchers wrote.

R.J. Reynolds stands by its claim that Camel No. 9’s advertisements were not designed to attract teenagers.

David Zauche
Managing Senior Fellow & Senior Program Officer, Partnership for Prevention

“Herd immunity” is one of the most important concepts behind vaccination – the idea that once a certain percentage of the population is vaccinated against a particular illness, the entire population will be protected even if not everyone has been vaccinated. While the concept has often been demonstrated, it has been hard to prove, but an innovative study published in the Journal of the American Medical Association provides such proof.

In a study funded by the American and Canadian governments, scientists from several Canadian universities and St. Jude’s Children’s Research Hospital in Tennessee conducted their research in 49 remote Hutterite farming colonies in western Canada. The Hutterites have similar roots to the Amish and live in small, isolated communities, making them perfect subjects for this research.

In 25 of the colonies, all children ages 3 to 15 received seasonal flu shots. In 24 other colonies, the same age children received the hepatitis A vaccine instead. In the colonies without the flu vaccine, more than 10 percent of the population had seasonal flu during that year’s flu season; less than 5 percent of the population in the vaccinated colonies did. This translates to a 60 percent “protective effect” for the whole community and suggests that giving flu shots only to children would still protect the elderly, even if they were not directly vaccinated.

While CDC recommends directly vaccinating high-risk individuals, such as the elderly, and has moved to recommending universal vaccination for the recent H1N1 epidemic, this study provides important evidence for the existence of herd immunity and supports the practice of vaccinating children to prevent further spread of influenza in the population.

Rebecca Barson
Consultant, Partnership for Prevention

Yesterday, the Robert Wood Johnson Foundation launched a new interactive map that provides the latest data on tobacco policies by state. Using information courtesy of the Americans for Nonsmokers’ Rights and the Campaign for Tobacco-Free Kids, the map focuses on three different aspects of tobacco policy: 1) smoke-free laws; 2) cigarette tax rates; and 3) tobacco control spending. “Users will be able to see whether a state is ahead or behind the curve in protecting and promoting health,” says Michelle Larkin, J.D., M.S., R.N., leader of RWJF’s Public Health Team.

With its array of colors and pop-up menus, the map points out that Rhode Island and Connecticut have the highest tax rates in the U.S.--$3.46 and $3.00, respectively. The map also shows that North Dakota is the only state that spends 100% or more of state funding for tobacco control relative to the Centers for Disease Control and Prevention recommendations.

Brandi Robinson
Program Associate, Partnership for Prevention

As the nation waits for the House of Representatives to pass health reform legislation, the US Senate took action yesterday to approve S. 1147, legislation to prevent tobacco smuggling and ensure the collection of all tobacco taxes. The vote on the bill, the “Prevent All Cigarette Trafficking Act of 2009 ” (PACT) was unanimous. Welcome news indeed since in recent months finding unanimity on any issue in the US Senate has been a tough task.

During Senate debate, chief sponsor Senator Herb Kohl of Wisconsin told fellow Senators: “Without innovative enforcement methods, law enforcement will not be able to effectively address the growing challenges facing them today. The PACT Act sets out to do just that by empowering states to go after out-of-state sellers who are violating their tax laws in Federal court.”

Kohl added that “the bill will keep tobacco out of the hands of kids…The PACT Act contains a strong age verification section that will prevent online sales of cigarettes by requiring sellers to use a method of shipment that includes a signature and photo ID check upon delivery.” The PACT Act also gives state and local governments direct rights to enforce the Act against illegal Internet sellers in federal court (while protecting State and Tribal sovereignty and immunity rights).

Partnership believes the most important impact of the legislation is closing a loophole that has allowed Internet tobacco sales to circumvent the payment of State sales taxes. Once the bill becomes law States will be free to increase their tobacco excise taxes without fear that out-of-state tobacco sellers can circumvent state tax requirements by selling cigarettes on the Internet.

The House bill HR 1676, passed back in May of 2009 on a vote of 397-11. The options ahead are for the House to either accept the Senate bill as passed or develop an amendment resolving minor differences between the two versions of the legislation. Given overwhelming support for the legislation there is reason to be hopeful final action will be completed so it can be forwarded to the President for his signature this Spring.

Ripley Forbes, Director, Government Affairs
Partnership for Prevention

US Surgeon General, Regina Benjamin told Congress yesterday that obesity “may dramatically impact the quality and longevity of life for an entire generation of children.” In forceful testimony before the Senate Committee on Health, Education and Pensions, Benjamin noted “the prevalence of obesity has increased dramatically in the United States, tripling among children and doubling among adults. Today, two-thirds of adults and nearly one in three children are overweight or obese.” She explained that from 1980 to 2008, obesity among adults rose from 13.4% to 34.3% and among children, rates rose from 5% to 17%.

The solution isn’t easy or quick but it is obvious and encouraging that the Obama administration is engaged. The Surgeon General explained that last month the President established a new Task Force on Childhood Obesity and charged it with reviewing all Federal programs dealing with child nutrition and physical activity and developing a national action plan. The National Action Plan is scheduled to be completed by May 9. Perhaps no less important, is the very visible role and support to this effort being given by First Lady Michelle Obama and her commitment to end “childhood obesity within a generation.” Her “Let’s Move” campaign is being supported by an innovative series of new web-based tools including the next generation Food Pyramid and USDA’s Food Environmental Atlas. These projects will help families make healthier food and physical activity choices and better understand national and local trends on food decisions.

Benjamin concluded her testimony with a simple but powerful message. “Instead of bombarding people with lists of what not to do, we need to empower them with what to do to promote health. Healthy eating and physical activity should be something all Americans want to do, not something they feel they have to do. We need to encourage people to take up activities that they enjoy, like swimming, dancing, or biking. We need to show them how healthy foods can be affordable, accessible, and delicious.”

Sage advice from the nation’s Family Doctor.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

Earlier this week, the research article, “Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index (ABI)”, was published in JAMA. The goal of the study was to determine if daily aspirin reduced the risk of heart attack and stroke in patients with a low ABI, a quick and inexpensive way to establish risk for these events, and no other risk factors. Researchers hoped to show that the ABI could identify asymptomatic higher risk individuals that could benefit from preventive treatments, such as aspirin use.

The researchers found that aspirin was not effective in preventing first heart attack, stroke, or other cardiovascular events for individuals with low ABI and an absence of other risk factors. However, due to the fact that ABI was the only indicator used when determining risk, the study population was ultimately found to be at very low risk for heart attack and stroke. According to current guidelines, this low risk group would not be encouraged to use aspirin. So the study may actually say more about ABI or the range of ABI as a screening tool for cardiovascular risk than aspirin for primary prevention of cardiovascular events.

Other issues with the study include adherence to the therapy and disproportionate number of females in the study. Interestingly, the study showed no statistically significant difference between the aspirin and control groups for bleeding. Recently, aspirin use for primary prevention has been questioned due to a potential increased risk for gastrointestinal and intracranial bleeding; this study shows that bleeding events were similar between aspirin and non-aspirin users.

Ultimately, this study shows that ABI or the ABI threshold measurement used (0.95) is not enough to predict higher risk of heart attack and stroke on a population level. Future studies with more participants, improved compliance rates, a more equitable distribution of males and females, and a lower level of ABI for study inclusion are necessary to shed more light on this issue. An editorial, also published in JAMA, further explains the potential limitations of the study. Although at first glance this article appears to be another critique on aspirin for primary prevention-as many media outlets suggested- the current American Heart Association and United States Preventive Services Task Force guidelines for aspirin use to prevent first heart attacks and strokes should still be followed. And, as they recommend, those considering aspirin should talk to their health care provider to determine if aspirin is right for them.

Posted by:
Rebecca Doigan
Program Associate, Partnership for Prevention

In a wide-ranging interview (“Michelle Obama: No longer a 'caricature”) published today in Politico, the First Lady “addressed a doctors’ report that the president is still smoking, saying he has found it difficult to quit amid the rigors of the presidency.”

“What the president struggles with is what every smoker struggles with, it’s a difficult habit to break. It’s understandable that he struggles with it. Do I want him to stop completely? Absolutely. And I will push him to do so, but it’s a process,” Michelle Obama said.

“I’ve never been a smoker so I can’t relate, but people who’ve smoked say like anything, you have dips and valleys, and to try to quit smoking in one of the most stressful times of the nation’s history is sort of like, you know, OK, he’s going to struggle a little bit. This may be the year he’ll struggle,” she said.

We know that quitting smoking is tough work. It takes persistence. That is why Partnership for Prevention and its ACTTION initiative are working to assure that health reform continues to include coverage and access to comprehensive smoking cessation services. But, no less important to successfully quitting, is having the kind of supportive family and workplace environment that is available to the President. I’m not worried about the President. With Michele in his corner he’ll get there.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

An important article in Preventive Medicine underscores the important role that urban design can play in promoting healthy communities. The research comes from an Atlanta project and will be a featured presentation at the 18th Annual Congress of the New Urbanism to be held in Atlanta May 19-22 in partnership with the Centers for Disease Control and Prevention.

The theme of this year’s conference is appropriately enough “New Urbanism: Rx for Healthy Places.”

Those of us in the prevention community need to pay more attention to this “New Urbanism.” Their work is very much at the cutting edge of new, community-based initiatives that can help us achieve success in reducing the incidence of chronic disease.

Want to learn more? There is an engaging 3 minute You Tube video introduction to “New Urbanism” called “Built to Last.” The video explains how this innovative approach to community design helps people replace dependency on driving with the freedom to connect with their community on foot, bicycle, or public transit. And there’s more. The correct approach to community design can help reverse the harmful effects of urban sprawl on the environment AND effect, in a good way, our personal and community health. New Urbanism seems like a strong investment in our future.

“When it comes to saving the planet what we build is the greatest threat … or the greatest hope.”

Posted by:
Ripley Forbes
Director, Government Affiars, Partnership for Prevention

The test to cut down on unnecessary use of antibiotics was named the “Best Prevention Idea of the Week,” while cities shortening yellow lights to nab drivers with a ticket was named “Worst Prevention Idea of the Week.”

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

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Simple Test Could Cut Excessive Antibiotic Use

German researchers found that testing for a marker of bacterial infection known as procalcitonin (PCT) helped identify patients whose respiratory tract infections would respond to antibiotics, and stopped others being offered unnecessary drugs. Respiratory infections are very common and doctors are taught to prescribe antibiotics on the basis of features like sputum or fever, which suggest there may be bacterial infection. But this judgment is not always easy, the researchers said, and lab tests can help sort bacterial from viral infections. Excessive prescribing of antibiotics adds to healthcare costs and to the worldwide problem of multi-drug resistant bacteria, or "superbugs," like MRSA.

WORST

Cities Shortening Yellow Traffic Lights for Deadly Profit

Some cities have been shortening yellow lights to nab drivers with a ticket. But studies show that they're raking in the bucks at the expense of public safety. "With all of the stories we hear on a daily basis, there is little doubt that the desire for ticket revenue trumps safety concerns," Gary Biller, executive director of the National Motorists Association told AlterNet. "A quick current example is California's governor Arnold Schwarzenegger, who a few weeks ago proposed state budget including a proposal to add speed sensors to 500 existing red-light cameras. The reason? Safety wasn't mentioned, but an expected additional annual revenue of $338 million was."

At the recent health summit in Washington, President Obama repeatedly emphasized his commitment to pass meaningful health reform. Despite strong opposition from Republicans in Congress, President Obama is showing the mettle he demonstrated throughout the 2008 campaign. He isn’t giving up and he won’t back down. His commitment to insurance reform and extending high quality health coverage, including access to vital clinical preventive services to millions of uninsured Americans shows courage and character.

But the issue of smoking is one where we value quitters. According to press reports President Obama’s recent physical revealed that he continues to struggle to quit smoking. Most smokers have trouble quitting tobacco so the President’s situation is not unusual. It is ironic that the President who has done so much to protect children from tobacco, and through health reform, increase the availability of tobacco cessation therapies, would struggle to win his personal cessation campaign. But Obama is human and difficulty quitting tobacco is an all too common experience among the millions of smokers who try to quit each year.

Writing in the March 1st Christian Science Monitor, Ron Scherer notes that “anti-smoking advocates view the president’s cigarette struggles not so much as a setback, but rather as an opportunity to try to get more Americans to quit. And they place more importance on his desire to snuff out his tobacco usage than on his success in those efforts.”

Now that’s something we should all be able to agree with. That the President has struggled to quit smoking underscores why it is so important that insurance plans, employers, friends and family members do all they can to support and encourage smokers seeking to quit what is all too often a lifelong and life threatening addiction.

A CBS TV News Healthwatch segment (“Up in Smoke”) added important commentary from medical correspondent and physician Jennifer Ashton. Dr. Ashton cautioned that most former smokers find success only after trying to quit multiple times. She urged that smokers take advantage of available treatments including counseling, OTC nicotine replacement products and prescription medications. Ashton said the decision to quit smoking is really “a life or death issue and the single most important thing you can do for your health.”

Good advice for the public…and for our President.

Posted by:
Ripley Forbes
Director, Government Affairs, Partnership for Prevention

According to a new study based on a survey of 1,552 parents, one in four U.S. parents believes some vaccines cause autism in healthy children. However, extensive medical research has found no connection between the two. The unfounded fear stems from a flawed 1998 study published in The Lancet that was recently retracted after a council that regulates Britain's doctors ruled the study's author acted dishonestly and unethically. This new study is based on a University of Michigan survey of parents that took place a year ago—before The Lancet study retraction.

There is some good news, though. Many of the parents surveyed that worried about vaccine risks still think their children should be vaccinated.

"Nine out of 10 parents believe that vaccination is a good way to prevent diseases for their children," said lead author Dr. Gary Freed of the University of Michigan. "Luckily their concerns don't outweigh their decision to get vaccines so their children can be protected from life-threatening illnesses."

For more information on additional findings of the study, you can view the Pediatrics article for free here.

Posted by:
Christianne Johnson, Program Manager, Partnership for Prevention

Writer Sarah Wildman suggests that one asset President Obama has yet to use in getting health reform over the goal line would be to enlist help from the First Lady. In an engaging piece of “what if” writing, Wildman argues that Mrs. Obama’s enormous popularity gives her a potentially powerful platform to show Americans that health reform is an “apolitical” problem that affects us all.

Wildman is disappointed that the Mrs. Obama stayed in the family garden focusing her time on the important but “safe” First Lady-like issue of childhood obesity.

“At a moment when an entire year's worth of bickering over health care reform has unraveled into a partisan wrestling match, and the very word "reform" has nearly ceased to be meaningful, tackling obesity is cheerfully unobjectionable. Laudable even. But it's not the most important thing on the agenda right now… As a concept it vaguely brushes up against the health care reform debate but without, in reality, getting anywhere close.”

Wildman argues that the First Lady should use her popularity “to get America to understand how very nonpartisan health care reform might be? … The First Lady could have gathered together a task force comprised of a clutch of women -- moms, mostly -- and presented their stories, simply and without fanfare, to highlight how un-family friendly our current insurance policies are. How anti-woman. How anti-mother."

She might have brought in, say, a widow who lost health insurance after her husband died, therefore leaving the family uninsured. Women, she would have pointed out, are more likely to be on their husband's insurance than vice versa, leaving them vulnerable in the event of divorce, or death, or job loss. She might have invited a young, entrepreneurial would-be mother who desperately sought health insurance to cover a potential future pregnancy, but discovered there was no way to sufficiently cover maternity on the individual insurance market. She might have shown America a mother who owns her own business and discovered, happily, she was pregnant and that, unhappily, she could not find health insurance to cover the prenatal care, labor, and delivery.”

Wildman writes that the First Lady could have told the country that “On the individual market, pregnancy … is a pre-existing condition. Most insurance companies will not allow a woman to purchase insurance once she is already with child. Worrisome, the First Lady would have said, because this woman now has to decide between caring for her fetus and going into debt. Maternity benefits, she would have explained to the cameras, are never a guarantee.”

At the moment health reform appears stuck between a partisan divide. Although many of us are rightfully focused on the important nuances of prevention coverage and policy, the larger context of health reform – coverage, fairness, quality -- is fundamental to our national character. The First Lady can do much to remind us of this even as we are called to become more physically active and less attracted to junk food.

As we enter the final quarter of play lets remember that health reform is a team sport and no one should be left on the bench.

Posted by:
Ripley Forbes
Director, Government Affairs
Partnership for Prevention