Prevention Matters

A study showing that children benefit from laws that regulate locations where smoking is allowed was named the “Best Prevention Idea of the Week,” while a study that found that loose infection practices are contributing to problems with infection control at same-day surgery centers was named the “Worst Prevention Idea of the Week."

BEST

Smoke-Free Laws Benefit Kids, Too

Kids benefit from laws that regulate locations where smoking is allowed, a new study shows.

Smoke-free-air laws have already been shown to reduce exposure to secondhand smoke among adults. Now a study shows that such laws benefit children and adolescents, too, as long as they don't live with a smoker.

Researchers analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and found that youngsters who live in a county with extensive smoke-free-air laws had a 39% lower prevalence of cotinine in their blood. Cotinine, an alkaloid found in tobacco, is a major metabolite of nicotine and a common biomarker of secondhand smoke exposure. It is detectable in blood for a minimum of several days after exposure to tobacco smoke.

WORST

Poor infection control at many surgery centers


A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control. Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients. The findings, appearing in last Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

The Centers for Medicare and Medicaid Services (CMS) has proposed a new measure, which is still preliminary, that would expand coverage for evidence-based tobacco cessation counseling for all Medicare recipients. Current Medicare language limits reimbursement for tobacco cessation counseling to patients who have a tobacco-related disease.

The CMS has set a period of time for Public Comments on the proposed determination, after which they will issue a final decision. This period ends June 27, 2010. Partnership for Prevention urges you to offer your own public comment in support of tobacco cessation counseling for Medicare beneficiaries. It’s easy to do – just click on this link, then click on the orange “Comment” button at the top. Type in the box whatever you see fit to communicate about this matter.

As an example, here’s what I wrote in my message to the CMS this morning:

I am writing to express my strong support for the Centers for Medicare and Medicaid Services proposed decision to extend tobacco cessation counseling to all Medicare beneficiaries. It is Partnership for Prevention's position that this policy will help many tobacco users break free from a deadly behavior, people who otherwise would have been unable to do so. Undoubtedly, many lives will be extended and much money saved if this decision is enacted.

Not only is tobacco cessation counseling a Grade A rated recommendation by the U.S. Preventive Services Task Force, it is also received the highest ranking by Partnership for Prevention's National Commission on Prevention Priorities. In that review, physician tobacco cessation counseling was one of only three clinical preventive services to receive the highest score for cost and prevention effectiveness.

I urge the CMS to move forward with this critical public health measure when the public comment period has concluded. The entire Medicare community deserves to benefit from this service, not only those who have been diagnosed with a tobacco related illness. After all, that's what prevention is all about.

It is important that the CMS hears from constituents who support disease prevention, health promotion, and tobacco cessation. If enacted, this measure represents a lifesaving advance in our capacity to guarantee that all tobacco users have access to evidence-based tobacco cessation counseling. A significant public health benefit will be realized.

David Zauche
Senior Program Officer
Partnership for Prevention

There’s good news in the health reform law for small businesses that pay at least half the cost of their employees’ health insurance. Beginning this year, businesses with fewer than 25 employees and with average wages under $50,000 can claim a tax credit on their income tax return. Small non-profit organizations also qualify. As an example, an employer with 10 or fewer full-time employees and with average annual wages under $25,000 (not including what the owner makes), will receive a 35% tax credit on the amount the business pays for employees’ health insurance in 2010. An online calculator to estimate savings can be found at http://www.smallbusinessmajority.org/.

This tax credit will be available to small businesses until 2014; when the credit is scheduled to increase and be available from state-based insurance exchanges which will be operating by that time.

Having health insurance makes a difference. On average, people without health insurance are less likely to get preventive care such as immunizations or mammograms, more likely to miss work, and to have worse health outcomes when they do get sick than people with insurance.

Susan K. Maloney
Managing Senior Fellow
Partnership for Prevention

The possibility of a preventive breast cancer vaccine becoming available for humans was named the “Best Prevention Idea of the Week,” while twenty percent of college students admitting to driving while drunk was named the “Worst Prevention Idea of the Week."

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Breast Cancer Vaccine Possible, Scientists Say

A study in mice suggests that a preventive breast cancer vaccine might be possible in humans, scientists say.

Women may begin taking part in the next stage of research as soon as next year, they added.

"We believe that this vaccine will someday be used to prevent breast cancer in adult women in the same way that vaccines have prevented many childhood diseases," principal investigator Vincent Tuohy, an immunologist in Cleveland Clinic's Lerner Research Institute, said in a news release. "If it works in humans the way it works in mice, this will be monumental. We could eliminate breast cancer."

WORST

1 in 5 College Students Admitted to Drunk Driving, Study Found


Drinking and driving among college students is still a major public health problem, new research reveals, with one in five admitting to driving while drunk and 40 percent acknowledging they have ridden with a drunk driver.

Equally worrisome, their tendency to drive under the influence soars when they hit the minimum legal drinking age of 21.

The findings were gleaned from a study co-authored by Amelia M. Arria, director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, that followed more than 1,250 first-year college students enrolled at a large mid-Atlantic university.

A recent analysis of surveillance data reported in the May issue of the American Journal of Preventive Medicine found that only about one third of adolescent girls ages 13-17 in a six-state sample have received more than one dose of the HPV vaccine.

Since the vaccine first received FDA approval in 2006, little research has been done to assess its use. For this analysis the researchers used data from the 2008 Behavioral Risk Factor Surveillance System and the 2000 U.S. census on 1,709 girls in Delaware, New York, Oklahoma, Pennsylvania, Texas, and West Virginia. It is not clear from the study findings why these six states were chosen. 70% of the girls in the study were white and 74% were insured.

The study also found that girls in states with higher poverty levels were less likely to be vaccinated, but those in counties with higher poverty levels were more likely to be vaccianted.

"Although seemingly contradictory, this indicates that while girls in poorer states had overall lower odds, girls living in any state experienced higher odds of vaccination if they lived in counties with higher poverty levels," said Sandi L. Pruitt, PhD, and Mario Schootman, PhD, of Washington University in St. Louis. "This may be partially explained by the limited resources of poor states," Pruitt said.

These findings show the need for interventions to increase vaccination among all eligible girls.

Christianne Johnson
Program Manager
Partnership for Prevention

The use of electronic records significantly increasing how fast patients with Chlamydia are treated was named the “Best Prevention Idea of the Week,” while children on Medicaid not receiving all required preventive screening services was named the “Worst Prevention Idea of the Week."

BEST

Chlamydia Treated Sooner When Docs Use E-Records

Switching to electronic medical records can significantly boost how quickly patients with the sexually transmitted disease chlamydia are treated, a new study shows.

Researchers found that an electronic medical record system more than doubled the percentage of patients treated within two weeks of diagnosis. The longer a sexually transmitted infection goes untreated, "the more risk there is of onward transmission and of clinical complications," the authors wrote. "Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods for the good of our patients and the betterment of public health."

WORST

Medicaid Children Are Not Receiving All Required Preventive Screening Services

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.

Partnership for Prevention is proud that the Indiana state Tobacco Prevention and Control agency took the lead to convene a summit of leaders from around the state representing business, insurers, health systems, policymakers and community educators. The summit participants agreed on a goal of reducing the adult prevalence rate to 8 percent by 2015. To make that possible, many strategies were identified to reduce Indiana’s high smoking rate (currently 23%) through increased access and utilization of tobacco cessation services.

The summit lives on in a new media campaign to promote cessation to tobacco users and their employers.

Diane Canova
Vice President, Policy & Programs
Partnership for Prevention