Prevention Matters

Few would argue the importance of increasing funding for community prevention. That’s the reason prevention advocates were so delighted Congress established a Prevention and Public Health Fund to “provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.” The fund makes available $500 million in new spending in FY2010; the fiscal year ending September 30. There is a tough decision ahead to spend a great deal of money in a short period of time.

There are many worthy ideas vying for DHHS Secretary Kathleen Sebelius’ attention. She is the official charged by the new law in allocating the funds “for prevention, wellness and public health activities…”

How should the Secretary make the initial trust fund allocation given that so many deserving programs are asking for a slice from the pie?

In an Op Ed (“The Prevention Dilemma”) written for Kaiser Health News, Partnership for Prevention CEO, Dr. Robert Gould, answers the tough question.

“There will never be enough federal money to address every prevention need. What the secretary needs to decide is whether there is sufficient political courage to concentrate early prevention funding to deliver a knockout blow to the leading cause of premature death in the country? … The criteria for prioritizing this specific funding should be simple: what are the evidence-based programs that are primed and ready to go, that are proven to work, that we know will move us toward a healthier society and that we can be sure will deliver a large, measurable return on investment? By these criteria, the top priority for prevention spending should be tobacco control.”

Gould recommends DHHS focus their resources on three well tested, evidence-based components::

1) Nationwide public education campaign modeled on the highly successful Truth® campaign that dissuades thousands of young people from initiating tobacco use and encourages smoking cessation;

2) Fully funding quit lines that provide direct cessation services and significantly improve quit rates efficiently and effectively, especially among disadvantaged populations served by Medicaid; and

3) Support for existing state and community-based tobacco control programs that reach people where they live, work, play and worship.”

The Partnership leader believes the goal of this potentially historic investment is simple and most important, achievable.. Gould concludes:

“If community-based tobacco control programs could be brought to scale nationally, we have a genuine opportunity to drive smoking rates into single digits. The rapid and enduring payoff, in lives and money saved, is there for the taking. It’s a rare opportunity. I urge Secretary Sebelius to seize it.”

Sounds like good advice. Do you agree?

Ripley Forbes
Director, Government Affairs
Partnership for Prevention

The Environmental and Energy Study Institute, (EESI) held a Congressional briefing on May 24, 2010 that highlighted the important health choice Congress will need to consider as it debates a pending, multiyear reauthorization of Federal transportation spending. The briefing featured a presentation by Jonathan Patz, MD, MPH, professor and director of Global Environmental Health, University of Wisconsin, who spoke of the direct impact on public health that results from climate change; specifically the role that transportation policy plays in healthy/unhealthy air and lifestyles. While its well known that air pollution can cause respiratory diseases such as chronic obstructive pulmonary disease and asthma, Patz told congressional staffers that poorly planned transportation policies have a morbidity and mortality rate significantly higher than the conventional associations with automobile and pedestrian accidents.

In addition to extensive health consequences resulting from air pollution, Patz argued that transportation decisions are significant factors contributing to the nation’s obesity epidemic due to community designs that foster inactivity and chronic disease. Chronic diseases, such as diabetes, obesity, heart disease and cancer, are an inevitable result of a unhealthy lifestyle. Patz noted that nearly half of all car trips are less than two miles long, and a significant number could be reduced through investments and incentives in alternative transportation methods; especially investments such as mass transit, community design and other policies that reduce reliance on private automobiles and increase walking and other forms of physical activity. Whats the bottom line? While organizations like the American Public Health Association have persuasively argued that “climate change is a public health issue” Dr. Patz's presentation included a powerful image (see below) illustrating how simple policies can hinder or enhance a physically active lifestyle.

Dr. Jonathan Patz's complete presentation is available on the Environmental and Energy Study Institute website.

Amy Himmelstein
Policy and Program Intern
Partnership for Prevention

Food companies committing to take 1.5 trillion calories out of their products by 2015 was named the “Best Prevention Idea of the Week,” while teens mistaking smokeless tobacco products for candy 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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Food makers to trim 1.5 trillion calories

Several of the nation's largest food companies say they will take 1.5 trillion calories out of their products by 2015 in an effort to reduce childhood obesity.

The companies made the announcement through the Healthy Weight Commitment Foundation, a coalition of retailers, food and beverage manufacturers and industry trade associations. They pledged to reduce the calories as part of an agreement with a group of nonprofit organizations concerned with childhood obesity, first lady Michelle Obama said last Monday.

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One out of Three Teens Mistook Smokeless Tobacco Products for Candy


According to a survey administered by the Virginia Foundation for Healthy Youth, one out of three teenagers younger than 18 mistakenly identified a new type of smokeless tobacco product as candy or gum. The survey of about 1,400 Virginia residents, including 728 younger than 18, asked them to identify package images for several types of new, smokeless tobacco products, as well as package images of mints and gums. About 39 percent of the respondents younger than 18 identified Camel Orbs, an oral tobacco product that dissolves in the mouth and delivers nicotine to the user, as mints or gum. Of the teenagers younger than 18 surveyed who do not currently use tobacco, 27 percent said they would try Camel Orbs based on packaging alone.

Why do people fighting against schizophrenia die so much earlier than the population at large? The answer may surprise you. And it’s related to tobacco cessation.

In a study published this month in the journal Addiction, researchers have determined that treatment for smoking dependence is as effective among people with severe mental illnesses as it is for the general population. Historically, the problem has been that many in the medical community have opted not to treat tobacco addiction in this population for fear of worsening their patients’ mental health. However, this study concluded that offering such treatments does not appear to cause deterioration in mental health. It also found that pharmaceutical and behavioral treatments doubled the probability of quitting among these patients, whose smoking rates are two to three times higher than average.

Professor Simon Gilbody from the University of York & Hull York Medical School, who co-authored the review, commented that “schizophrenia is a devastating condition which causes people to die 25 years earlier than the rest of the population. This is a huge health inequality, and it is largely due to smoking-related illness rather than schizophrenia itself.”

Dr Lindsay Banham, who led the review, added “what this review suggests is that quit-smoking treatments like nicotine replacement therapy may work just as well for people with disorders like schizophrenia. Smoking by those with severe mental illness has largely been ignored and people with schizophrenia are not consistently offered treatment or services. We found evidence that smoking cessation treatments are effective and safe. We hope our research leads to better services for this neglected population.”

David A. Zauche
Senior Program Officer
Partnership for Prevention

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

The EPSDT program provides “a comprehensive and preventive child health program for children under the age of 21. Every State Medicaid program must offer the EPSDT benefit…In 2007, 31.5 million children were eligible for EPSDT…Services provided under the EPSDT benefit are intended to screen, diagnose, and treat children eligible for EPSDT services at early, regular intervals to avoid or minimize childhood illness. The EPSDT services cover four health-related areas: medical, vision, hearing, and dental. This study focused on medical, vision, and hearing screenings. Only medical screenings have components specifically required by the statute. Complete medical screenings under the EPSDT benefit must include the following five age-appropriate components: a comprehensive health and developmental history, a comprehensive unclothed physical examination, appropriate immunizations according to age and health history, appropriate laboratory tests, and health education.

States selected for the review included Arkansas, Florida, Idaho, Illinois, Missouri, North Carolina, Texas, Vermont and West Virginia.

The IG found that two primary factors contributed to children not receiving required screenings.

First, children did not receive the correct number of each type of screening. Second, when children received medical screenings, the screenings were often incomplete. These two factors taken together indicate that very few children received the correct number of complete screenings required by law.

Seventy-six percent of children, or 2.7 million children, in the States selected for the review did not receive all of the required number of medical, vision, and hearing screenings. Forty-one percent of children did not receive any required medical screenings. In addition, more than half of children did not receive any required vision or hearing screenings.

Fifty-five percent of children in the nine States received a medical screening during the study period. Of these children, 59 percent lacked at least one component of a complete medical screening. The component that children were missing most often was appropriate laboratory tests.

Officials from all nine selected States identified strategies to improve participation in the EPSDT and the completeness of medical screenings. The disconnection between States’ efforts to improve the EPSDT program and the low number of children receiving required screenings is difficult to account for, but it indicates that additional efforts are required.

Based on these findings, the IG recommended that CMS: (1) require States to report vision and hearing screenings, (2) collaborate with States and providers to develop effective strategies to encourage beneficiary participation in EPSDT screenings, (3) collaborate with States and providers to develop education and incentives for providers to encourage complete medical screenings, and (4) identify and disseminate promising State practices for increasing children’s participation in EPSDT screenings and providers’ delivery of complete medical screenings.

New requirements under Health Reform will require expanded coverage of clinical prevention services under Medicare and new individual and group private plans. To realize the benefits of these services it is essential the Administration require that new coverage be accompanied by effective strategies and resources to encourage participation.

E Ripley Forbes
Director, Government Affairs
Partnership for Prevention

On May 20th, Partnership for Prevention’s work on the National Chlamydia Coalition (NCC) was showcased as part of the Center for Disease Control and Prevention’s (CDC) monthly Public Health Grand Rounds series. The session, entitled "Chlamydia Prevention: Challenges and Strategies for Reducing Disease Burden," featured presentations from active NCC members Dr. Gail Bolan, State STD Director for California and Dr. Gale Burstein, a pediatrician representing the Society of Adolescent Health and Medicine. Dr. Burstein’s presentation highlighted two of the NCC’s publications and outlined our activities aimed to increase chlamydia screening. The CDC’s Dr. Raul Romaguera’s presentation listed the NCC as one of four key partners working with the CDC to reduce chlamydia rates.

Alana Ward
Program Associate
Partnership for Prevention

A policy statement released by the Committee on Substance Abuse for the American Academy of Pediatrics recommends that doctors screen all of their young patients, beginning in middle school, about their use of alcohol.

"A remarkable amount of brain development is still occurring for young people through their 20s," said report lead author Patricia Kokotailo of the University of Wisconsin School of Medicine and Public Health. "This policy statement provides better evidence about how alcohol affects the brains of young people and why it is important to screen children."

The revised policy states that "pediatricians should be knowledgeable about substance abuse to be able to recognize risk factors for alcohol and other substance abuse among youth, screen for use, provide appropriate brief interventions, and refer to treatment."

Committee chair Janet Williams of the University of Texas Health Science Center at San Antonio said that most doctors don't routinely ask about youth alcohol use, and need to know how to provide prevention guidance and where to refer young drinkers to treatment.

Christianne Johnson
Program Manager
Partnership for Prevention

According to British researchers, patients who are over-prescribed antibiotics may develop drug resistance that lasts up to a year. This makes them and the rest of the population more susceptible to problems if more serious treatment is needed.

The researchers analyzed 24 previous studies of antibiotic resistance and found that the more antibiotics prescribed for coughs, flu-like illnesses and urine infections, the more resistant to the antibiotics the bacteria become.

"The effect is greatest in the month immediately after treatment, but may last for up to a year, and this residual effect may be a driver for high levels of resistance in the community," said Alastair Hay, a consultant senior lecturer in primary health care at Bristol University, who led the research.

Experts say the over-prescription of antibiotics is a “vicious cycle” and the only way to turn it around is to prescribe the drugs only when it is absolutely necessary in the first place.

Chantal Morel and Elias Mossialos, specialists in economics and health policy from the London School of Economics, believe financial incentives should be used to encourage drug companies to invest in research to find, test and develop new antibiotics and that there is “a public health as well as economic justification for intervention.”

Brandi Robinson
Tobacco Control Program Associate
Partnership for Prevention

The positive impact improved treatment and more effective preventive measures are having on the death rate from coronary heart disease was named the “Best Prevention Idea of the Week,” while prescription labels inaccurately translated into Spanish 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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Prevention Gets Credit for Fewer Heart Deaths

Improved treatment, coupled with more effective preventive measures, may be having a positive impact on the death rate from coronary heart disease. Death rate data from the United States and Canada both indicate a drop in cardiovascular deaths. According to the American Heart Association, the annual death rate from coronary heart disease from 1996 to 2006 declined 36.4 percent and the actual death rate dropped 21.9 percent.

In Canada, according to a study in the May 12 issue of the Journal of the American Medical Association, the death rate from coronary heart disease in the province of Ontario fell by 35 percent from 1994 to 2005.

"The overall good news is that coronary heart mortality continued to go down despite people growing older," said study author Dr. Harindra C. Wijeysundera, a cardiologist at the Sunnybrook Health Sciences Centre Schulich Heart Centre in Toronto.

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Translated prescriptions often wrong


Pharmacies that print prescription labels translated into Spanish often issue inaccurate or confusing instructions that could be potentially hazardous to a patient's health, according to a report in the May issue of Pediatrics journal. Researchers looked at 76 medicine labels generated by 13 different computer programs that many pharmacies use to make translations and found an overall error rate of 50 percent.

"It's not surprising, and it's something I experience in practice every day," said Dr. Alejandro Clavier, who works at Esperanza Health Center in Chicago's Little Village neighborhood on the Southwest Side.

Massachusetts is poised to become the first state in the nation to force retailers to prominently display graphic warnings about the perils of smoking right where cigarettes are sold - at tobacco sales racks and next to cash registers. Images of ominously darkened lungs, damaged brains, and diseased teeth could start appearing before the end of the year in more than 9,000 convenience stores, pharmacies, and gas stations, if a proposal by the state Department of Public Health is approved as expected. Other posters would direct smokers to where they can get help to stamp out their habit.

''If somebody is trying to quit smoking and they go back to the store and they're tempted - oh, just one pack - we hope this will help them make a different choice,'' said Lois Keithly, director of the Massachusetts Tobacco Cessation and Prevention Program.

New York City implemented a similar campaign in December, where Anne Pearson serves as an attorney with the city's Bureau of Tobacco Control. ''There's a large body of evidence showing these graphic images are very effective,'' Pearson said. ''They can communicate information in a way that text just can't, and they can also communicate a message to people regardless of their level of literacy and regardless of the language they speak.''

The campaign is being underwritten by $316,000 in federal stimulus money from the Centers for Disease Control and Prevention, which will allow the state to provide the materials to retailers without charge.

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

According to a survey administered by the Virginia Foundation for Healthy Youth, one out of three teenagers younger than 18 mistakenly identified a new type of smokeless tobacco product as candy or gum. The survey of about 1,400 Virginia residents, including 728 younger than 18, asked them to identify package images for several types of new, smokeless tobacco products, as well as package images of mints and gums. About 39 percent of the respondents younger than 18 identified Camel Orbs, an oral tobacco product that dissolves in the month and delivers nicotine to the user, as mints or gum. Of the teenagers younger than 18 surveyed who do not currently use tobacco, 27 percent said they would try Camel Orbs based on packaging alone.

Another product identified in the survey was Stonewall, a type of smokeless, pellet tobacco sold by Star Scientific Inc. About 35 percent of the survey respondents 18 or younger perceived Stonewall to be candy, mints or gum. Twenty-three percent said they would try Stonewall because of the packaging.

The survey results suggest that packaging of the products alone may appeal to youth, said Danny Saggese, director of marketing for the Virginia Foundation for Healthy Youth."It poses a significant risk to youth and raises the possibility of them not only using these products, but using them in places where smoking is now prohibited, and potentially becoming nicotine addicts," he said.

In March 2010, the U.S. Food and Drug Administration issued a rule restricting access and marketing of cigarettes and smokeless tobacco products to youth. The rule becomes effective June 22, 2010 and will require smokeless tobacco products to have warning labels that cover one-third of the front and back of the packages. However, many tobacco prevention groups and government officials believe the FDA should ban smokeless tobacco products altogether. In an April 18th New York Times interview, U.S. Senator Jeff Merkley of Oregon called the products “tobacco candy,” noting that “everything about them is designed for kids.”

Brandi Robinson
Program Associate
Partnership for Prevention

U.S. Department of Health and Human Services Secretary Kathleen Sebelius has named preventing and reducing tobacco use as a strategic initiative for HHS. Sebelius noted that it will require “comprehensive, sustained, and accountable tobacco control efforts based on evidence-based interventions” to lower the current smoking rate of twenty percent in the U.S.

Initial actions identified to increase efforts to prevent and reduce tobacco use include:

• Strengthening the implementation of evidence-based tobacco control interventions and policies in States and communities;
• Changing social norms around tobacco use;
• Accelerating research to expand the science base and monitor progress; and
• Leveraging HHS systems and resources to create a society free of tobacco-related disease and death.

Increasing efforts in the area of tobacco control is a big step in the right direction to ensure that Americans live healthier lives.

Brandi Robinson
Program Associate
Partnership for Prevention

The use of bar-code verification technology to decrease medication errors in hospitals was named the “Best Prevention Idea of the Week,” while misleading tobacco ads aimed at South Asian women 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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Bar-Code Technology Reduces Medication Errors in Hospitals

Use of bar-code verification technology can substantially decrease both transcription errors and medication administration errors in hospitals, according to research published in the May 6 issue of the New England Journal of Medicine. "Taken together, our findings show that the bar-code eMAR technology improves medication safety by reducing administration and transcription errors, providing support for the inclusion of this technology as a 2013 criterion for achieving meaningful use under the American Recovery and Reinvestment Act. Given challenges in implementing this technology, however, further research should focus on identifying factors that will lead to its optimal implementation," the authors write.

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Tobacco firms take aim at Bangladeshi, Asian women

Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths. Advertisements telling smokers they are smarter, more energetic and better lovers than their non-smoking counterparts are a familiar sight across Bangladesh — something unimaginable in most other countries. The promotion is being linked to an alarming rise in tobacco use in the impoverished South Asian country, particularly among women and the young — a trend repeated across many developing countries, anti-tobacco groups say.

An analysis of a large number of medical records of people born in Finland indicates a link between psychiatric illness and prenatal exposure to tobacco smoke. Mikael Ekblad, a doctoral student at Turku University in Finland, reported these findings at the meeting of the Pediatric Academic Societies. Children born to mothers who smoked while pregnant had a 44% increased risk of psychiatric drug use later in life, presumably because of psychiatric disorders.

It has long been known that maternal smoking can affect the placenta, often leading to low birth weight or prematurity, and some previous studies had demonstrated the link between mental illness and tobacco smoke in the womb.

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

InSPOT, a website to help people who are infected with STDs inform their sex partners about testing and treatment options using playful, serious, and humorous e-cards that link to free and low-cost testing services, is now available throughout the U.S.

The service was first launched by ISIS in 2004 in response to a significant rise in syphilis in San Francisco and continues to be "an innovative way to empower people who are diagnosed with a STD take charge of their own sex lives". The site currently has about 15,000 users annually in 13 states and 11 cities, and with this national expansion, ISIS projects that users will jump to nearly 150,000 in 40 states and 25 cities by 2013.  


Partner notification plays a significant role in reducing STD rates by finding and treating people who have had contact with an infected person before they can pass the disease onto others. InSPOT provides a clever, easy, inexpensive way for people to notify their partners, especially if they are uncomfortable having a face-to-face or phone conversation about this often embarrassing topic, or if they don't know their partner very well. 


Christianne Johnson
Program Manager
Partnership for Prevention

The World Health Organization’s World No Tobacco Day 2010 will be celebrated on May 31. This year’s health theme is “Gender and Tobacco”, with an emphasis on marketing to women. Though women comprise only 20% of the world’s one billion smokers, the rise in prevalence, especially among girls, is alarming.

The new WHO report, Women and Health, cites the fact that the tobacco industry has ramped up its marketing efforts to women in countries worldwide.

Details about the event and the 2010 focus on women can be found on the WHO website.

On World No Tobacco Day 2010, and throughout the following year, WHO will encourage governments to pay particular attention to protecting women from the tobacco companies' attempts to lure them into lifetimes of nicotine dependence. By responding to WHO's call, governments can reduce the toll of fatal and crippling heart attacks, strokes, cancers and respiratory diseases that have become increasingly prevalent among women. Tobacco use could kill one billion people during this century. Recognizing the importance of reducing tobacco use among women, and acting upon that recognition, would save many lives.

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

On April 28th Partnership's Garry Lindsay was interviewed by Sarah Kessler for her Inc. magazine article “How to Start a Wellness Program.”  Kessler's article includes several links for free resources from Partnership for Prevention and other sources that can be used by small to mid-sized employers to plan and implement worksite health promotion programs.

The five minute flexi-scope colon cancer test that could reduce the number of deaths from the disease by about 40 percent was named the “Best Prevention Idea of the Week,” while a report showing that six in 10 Americans live in areas with unclean air 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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Colon cancer test could save thousands in Britain

A five-minute colon cancer test could reduce the number of deaths from the disease by about 40 percent, a new study says. British researchers followed more than 170,000 people for about 11 years. Of those, more than 40,000 had a "flexi-scope" test, an exam that removes polyps, small growths that could become cancerous. Researchers compared those results to more than 113,000 people who were not screened. They found the flexi-scope test reduced peoples' chances of getting colon cancer by one third. It also cut their chances of dying by 43 percent. Researchers said the test needed to be done just once in a person's lifetime.

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Report: Most Americans still live in unclean air


Six in 10 Americans - about 175 million people - are living in places where air pollution often reaches dangerous levels, despite progress in reducing particle pollution, the American Lung Association said in a report released last Wednesday. The Los Angeles area had the nation's worst ozone pollution.

The report examined fine particulate matter over 24-hour periods and as a year-round average. Bakersfield, Calif., had the worst short-term particle pollution, and the Phoenix-Mesa-Scottsdale area of Arizona had the worst year-round particle pollution.

The U.S. cities with the cleanest air were Fargo, N.D., Wahpeton, N.D., and Lincoln, Neb.