Analysis of Kenya study shows simultaneously confronting AIDS, malaria and waterborne illness improves health.

A volunteer in 2008 shows people from the Lurambi District in Western Kenya how to use incecticide-treated bednets to prevent the spread of malaria

The great paradox of global health efforts is that regions of the world most plagued by poverty, poor infrastructure and rampant disease are often the most difficult to support. Now, scientists have demonstrated that confronting several diseases at once can make the most of thinly-stretched donor dollars and national health care budgets, to help to save lives.

A new analysis published this week in the open-access journal PLoS ONE (Feb. 3) focused on a combined public health campaign in Western Province, Kenya led by the Swiss-based company Vestergaard Frandsen, the Kenyan Ministry of Health and the U.S. Centers for Disease Control and Prevention (CDC). The analysis looked at the cost effectiveness of simultaneously confronting the problems of HIV/AIDS, malaria and diarrhea caused by waterborne pathogens.

The researchers used the results of the campaign to build an analysis of the impact such efforts could have if carried out more broadly. The analysis found that for every 1,000 people reached through such campaigns, some $16,015 in health care costs would be avoided and more than 16 lives would be saved. As a result, local populations would gain hundreds of years of healthy life. The cost would be $32 per person, but averted health care costs would be greater, leading to the net savings.

“That’s a very attractive deal,” said James G. Kahn, M.D., M.P.H., a professor of health policy, epidemiology and global health at the University of California, San Francisco, who is the senior author on the PLoS ONE study and led the economic aspect of the research. “This kind of a campaign is an excellent use of global health dollars.”

Health care workers distributed “CarePacks” at 37 locations in Kenya over seven days in 2008. These packs contained insecticide-treated bed nets to reduce the spread of malaria, water filters for preventing diarrheal diseases, and condoms.

Some 47,000 people ultimately received the packs, which also contained educational information as incentive for local residents to participate in a voluntary HIV testing and counseling program.

By combining efforts to reduce the burdens of malaria, diarrhea and HIV/AIDS, the program efficiently stretched the impact of its funds, Kahn said, which is important in areas where per capita health expenditures may amount to little more than a few dollars a year. Combining these public health efforts into one program also saved a great deal of time, he added.

“This program was implemented in seven days, reaching 80 percent of the local population,” Kahn said. “This rapid implementation means more health benefits were quickly achieved.”

Other co-authors of the article, “Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-effectiveness” are N. Muraguri, B. Harris, E. Lugada, T. Clasen, M. Grabowsky, J. Mermin and S. Shariff.

Kahn is based in the UCSF Philip R. Lee Institute for Health Policy Studies, the Department of Epidemiology and Biostatistics, and Global Health Sciences.

In addition to UCSF, authors on this study are affiliated with the Kenyan Ministry of Public Health and Sanitation, CHF International, the London School of Hygiene & Tropical Medicine, the ESP/UN Foundation, and the CDC.

The analysis was funded by the U.S. National Institute on Drug Abuse and by the company Vestergard Frandsen, which managed the campaign and manufactured the water filters and bed nets distributed.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.

By curbing consumption, funding treatment, tens of thousands of lives could be saved.

Kirsten Bibbins-Domingo, UC San Francisco

Every year, Americans drink 13.8 billion gallons of soda, fruit punch, sweet tea, sports drinks, and other sweetened beverages — a mass consumption of sugar that is fueling soaring obesity and diabetes rates in the United States.

Now a group of scientists at the University of California, San Francisco, San Francisco General Hospital and Trauma Center (SFGH) and Columbia University have analyzed the effect of a nationwide tax on these sugary drinks.

They estimate slapping a penny-per-ounce tax on sweetened beverages would prevent nearly 100,000 cases of heart disease, 8,000 strokes, and 26,000 deaths over the next decade.

“You would also prevent 240,000 cases of diabetes per year,” said Kirsten Bibbins-Domingo, M.D., Ph.D., an associate professor of medicine and of epidemiology and biostatistics at UCSF and acting director of the Center for Vulnerable Populations at the UCSF-affiliated SFGH.

In addition to $13 billion per year in direct tax revenue, Bibbins-Domingo and her colleagues estimated that such a tax would save the public $17 billion over the next decade in health care-related expenses due to the decline of obesity-related diseases.

“Our hope is that these types of numbers are useful for policy makers to weigh decisions,” she said.

Read more

Parents, physicians recall different advice on children’s weight management counseling.

Ulfat Shaikh, UC Davis

Parents of overweight children and their pediatricians agree that doctors routinely provide weight-management counseling — but they disagree on just what the doctor actually ordered, a study by researchers at UC Davis has found.

The rigorous study, which involved the use of parent questionnaires, audiotapes of well-child visits during which the weight-management counseling was delivered and examination of electronic health records, found that parents tend to overreport and doctors underreport the counseling delivered on weight, nutrition and physical activity.

The study on the “Accuracy of parental report and electronic health record documentation as measures of diet and physical activity counseling,” is published online today (Jan. 3) in the journal Academic Pediatrics.

“It’s important to find ways to accurately understand what occurs during medical care,” said Ulfat Shaikh, director of Healthcare Quality Integration at the UC Davis Schools of Health and the study’s lead author. “Reviews of medical records and patient surveys are commonly used as proxies for actually being inside an examination room and observing the visit. But before we use these methods to figure out what happens during a patient visit, we first need to make sure that what we measure reflects what actually happened.”

Nearly one-third of the estimated 75 million children in the United States between the ages of 2 and 19 are overweight or obese — 17 percent are obese and 15 percent are overweight. Overweight and obesity are risk factors for the development of multiple health conditions in children and adults, such as diabetes and heart disease.

Modifying children’s food intake and increasing their levels of physical activity are cornerstones of weight management and obesity prevention, and a key source of advice on weight management and weight loss is physician counseling on nutrition and physical activity.

In fact, doctors are required to provide such counseling to address this serious health concern. Counseling for nutrition and physical activity for children and adolescents is a quality measure in the Healthcare Effectiveness Data and Information Set, a widely used set of performance measures in the managed care industry, developed and maintained by the National Committee for Quality Assurance (NCQA). The counseling also is a criterion for “meaningful use” of electronic health records under the American Recovery and Reinvestment Act of 2009.

To assess how frequently physicians provided weight-management counseling, Shaikh and her colleagues at UC Davis enrolled 198 diverse children between 2 and 12 years of age who were seen for well-child visits in the general pediatrics outpatient clinic at UC Davis Children’s Hospital. The children averaged 5½ years of age, roughly divided evenly between boys and girls.

The children’s parents were informed that the study would assess their perspectives about the well-child visit. The 38 treating physicians in the clinic were informed that parent education would be assessed for these patients, but the topics that would be evaluated were not specified.

With parents’ and physicians’ full knowledge, audiotape recorders were placed in the examination rooms in inconspicuous locations. The researchers audiotaped each complete visit for study participants. After the well-child visits a research assistant entered the examination room and provided parents with a questionnaire to complete before they departed the clinic.

The researchers then compared the parental reports of counseling on the questionnaires, the audiotaped records, and what information was included in the electronic health record by the physician after the conclusion of the well-child visit. The study found significant differences between what the parents reported, what was recorded on the audiotapes, and what appeared in the electronic health record.

Parents, in general, tended to remember and report discussing a wide variety of topics with greater frequency than was recorded in the audiotapes, indicating a high level of “false positive” reports.

For example, 90 percent of parents reported receiving counseling on weight management on the questionnaires; the audiotaped assessments indicated that the topics were discussed 87 percent of the time; the medical record documented these discussions at only 39 percent. Parents indicated that their pediatricians discussed consumption of fruits and vegetables 80 percent of the time; the audiotaped assessments recorded these discussions at 77 percent; but the medical record documentation indicated these discussions took place only 44 percent of the time.

Documentation of counseling in medical records is important because it serves as a memory aid to physicians when they talk to families at future visits, said Shaikh, who also is an associate professor of pediatrics. Knowing what lifestyle goals were set during the last visit helps physicians follow-up on these goals and provide support to patients and their families to help them make lifestyle changes and maintain a healthy weight. Detailed documentation in the health record also helps to improve communication between clinicians and patients, thereby improving clinical care.

Documentation in medical records of counseling on weight, nutrition and physical activity also is now used by insurers as a measurement of whether counseling has been provided and is tied to physician payment.

The study suggests that for health-care professionals, electronic health record documentation may significantly underestimate the counseling that patients receive. The study also suggests that what goes into electronic medical records may vary depending upon nuances in electronic health record tools and templates used by physicians.

“Parental report via the use of a questionnaire administered immediately following the patient visit is a more valid method of assessing physician counseling on weight, nutrition and physical activity in pediatric primary care, compared to medical record documentation,” Shaikh said.

Additional study authors include Jasmine Nettiksimmons, Robert Bell, Daniel Tancredi and Patrick Romano, all of UC Davis.

The study was funded by a grant from the UC Davis Center for Healthcare Policy and Research and the Center for Clinical and Translational Research. Shaikh also is supported by a career development award from the Agency for Healthcare Research and Quality.

The UC Davis School of Medicine is among the nation’s leading medical schools, recognized for its research and primary-care programs. The school offers fully accredited master’s degree programs in public health and in informatics, and its combined M.D.-Ph.D. program is training the next generation of physician-scientists to conduct high-impact research and translate discoveries into better clinical care. Along with being a recognized leader in medical research, the school is committed to serving underserved communities and advancing rural health. For more information, visit UC Davis School of Medicine at www.ucdmc.ucdavis.edu/medschool.

Former UCSF medical resident, UC Berkeley alum delivers health policy lecture.

Alfredo Quiñones-Hinojosa, associate professor of neurosurgery and oncology at Johns Hopkins Medical Center, delivers the 10th Annual Rhoda Goldman Lecture in Health Policy at UC Berkeley. Named as one of the 100 most influential Hispanics in 2008, Quiñones-Hinojosa recently wrote his third book, “Becoming Dr. Q: My Journey from Migrant Farm Worker to Brain Surgeon,” published by UC Press. Quiñones-Hinojosa has a bachelor’s degree from UC Berkeley and completed his medical residency at UC San Francisco.

Related links:
UC Press page on the book
UC Press blog post and podcast

Most receive little or no treatment, UCLA report shows.

Nearly 2 million adults in California, about 8 percent of the population, need mental health treatment, but the majority receive no services or inadequate services, despite a state law mandating that health insurance providers include mental health treatment in their coverage options, a new report by the UCLA Center for Health Policy Research shows.

The report, which provides some of the first comprehensive data in recent years on the mental health of California’s adult population, found that one in 12 Californians reported symptoms consistent with serious psychological distress and experienced difficulty functioning at home or at work.

Over half of these adults reported receiving no treatment for their disorders, and about one-quarter received “inadequate” treatment, defined as less than four visits with a health professional over the past 12 months or using prescription drugs to manage mental health needs.

The study draws on data from the 2007 California Health Interview Survey (CHIS), which is conducted by the center.

“There is a huge gap between needing help and getting help,” said David Grant, the study’s lead author and director of CHIS. ”The data also shows large disparities in mental health status and treatment by demographic, economic and social factors. These findings can help direct the state’s limited resources to those in greatest need of help.”

Among the findings:

Insurance
Unsurprisingly, uninsured adults had the highest rate of unmet needs (87 percent), which includes receiving no treatment or receiving less than minimally adequate treatment; 66 percent of these adults received no treatment. By contrast, 77 percent of privately insured and 65 percent of publically insured Californians reported unmet needs. Although poverty and mental health needs are strongly correlated, the lower rate of unmet needs by public program participants suggests that these programs are more likely to effectively offer mental health services than even private insurance policies.

But successes are uneven, UCLA study finds.

A new study released today (Nov. 9) offers hope that California may finally be getting a handle on its 30-year battle with childhood obesity, but it also showcases a patchwork of progress that leaves the majority of the state’s counties still registering increases in obesity rates among school-age children.

According to the study, “A Patchwork of Progress: Changes in Overweight and Obesity Among California 5th, 7th and 9th Graders, 2005-2010,” prepared by the UCLA Center for Health Policy Research and the California Center for Public Health Advocacy (CCPHA), the percentage of overweight and obese children in the state dropped 1.1 percent from 2005 to 2010. However, 38 percent of children are still affected — a rate nearly three times higher than it was 30 years ago, when the obesity epidemic began.

Even more concerning, according to the lead author of the study, UCLA’s Susan Babey, Ph.D., is that improvements are not being seen statewide.

“Children’s health is still at risk in a significant number of counties,” Babey said. “We found that 31 of California’s 58 counties experienced an increase in childhood overweight over the five-year period from 2005 to 2010. We hope this county-by-county analysis will help community leaders pinpoint and take action in counties in the greatest danger.”

The highest rates in the state were found in Imperial (46.9 percent), Colusa (45.7 percent), Del Norte (45.2 percent) and Monterey (44.6 percent) counties. Two of those counties, Del Norte and Colusa, also had the dubious distinction of having the highest increases over the last five years (16.2 percent and 13.3 percent, respectively).

Marin County, with 24.9 percent of children overweight or obese, had the lowest level in the state. However, the Marin County rate, historically the lowest in the state, has grown 5.5 percent since 2005.

The study describes both the health and economic repercussions of elevated obesity rates. According to the study, children who are overweight or obese often grow up to be obese adults with increased risk for chronic diseases like diabetes, cardiovascular disease, strokes and some cancers. What’s more, the study says, California spends more public and private money on the health consequences of obesity than any other state — more than $21 billion annually.

In 2004, California began implementing a series of state laws banning sugary drinks and junk food from public school campuses. That, along with other local and statewide policies addressing the availability, marketing and promotion of unhealthy foods and an increased emphasis on healthier food and expanding opportunities for physical activity, may be contributing to the statewide improvements revealed in this study.

“California led the nation in establishing many of the most innovative programs and policies that are improving our children’s chances for a healthier life,” said the CCPHA’s Harold Goldstein, Dr.P.H. “Increased awareness and a growing array of school and community policies and programs are beginning to have an impact. But in light of the huge number of counties where childhood obesity rates continue to climb, our efforts must continue and even expand, especially in those areas where we now know children are most at risk.”

Data for the study was drawn from the California Physical Fitness Test (Fitnessgram), which is administered annually to all California public school students in grades five, seven and nine. Measured height and weight data from the test were used to calculate body mass index (BMI), and BMI was used to determine rates of overweight and obesity, based on the 2000 Centers for Disease Control and Prevention sex-specific BMI-for-age growth charts.

Read the study on websites of the CCPHA or the UCLA Center for Health Policy Research.

“The radial method is a better approach.”

The cath lab team at UC San Francisco Heart and Vascular Center monitor the progress of Dan Gulley’s heart catheterization procedure.

Dan Gulley waits patiently in a hospital bed at UC San Francisco Medical Center at the Parnassus campus early Friday morning. He is here for a heart procedure to take care of a 90 percentage blockage in one of his coronary arteries.

The retired, 75-year-old former FBI employee is not worried, though. His doctor will perform a lower-risk cardiac procedure that goes through the radial artery in his arm, an uncommon practice in this country. More than 95 percent of heart catheterizations in the U.S. are performed through the femoral artery in the patient’s leg. Only one to five percent are performed through the radial artery.

Percutaneous Coronary Intervention (PCI) performed radially is not only a lower-risk alternative, it is also lower-cost, since some patients can go home the same day. On average, the cost for UCSF patients who had a radial approach PCI were 28.5 percent lower than those who had a PCI using a femoral approach. Typically, PCI’s performed through the patient’s femoral artery require patients to stay overnight for observations, which requires more medical resources.

“It’s pretty amazing if you think about it, compared to the old way where they had to do the procedure by cracking open a chest,” Gulley said. “So this is the same result but much easier.”

UCSF leads the Bay Area in radial catheterization innovation. In 2006, only 2 percent of cardiac catheterizations were performed though the radial artery. Last year, it was more than 30 percent; this year it will be well over the 50 percent mark. UCSF is actively involved in studying new methods to improve radial artery catheterizations, hoping that more cardiologists nationwide will adopt the radial artery approach.

“In the beginning I was using equipment made for the leg so I went out and bought all the proper guide catheters designed for the arm and I worked my way through,” said Andrew Boyle, M.B.B.S., Ph.D., an interventional cardiologist with the UCSF Heart and Vascular Center. “We use smaller catheters now and technological advancements have allowed us to increase the size of the artery by 24 percent. All these incremental steps have made radial much more doable.”

Cardiac catheterization started as a surgical procedure in the 1930s that required a “cut down” method — called the Sones approach — in which surgeons removed soft tissues in the patient’s arm until they saw the brachial artery, which was punctured by a catheter. Surgeons then sutured the artery, and stitched the arm back together.

In 1953, Swedish radiologist Ivar Seldinger developed a percutaneous approach, in which access to the artery is performed through a needle puncture instead of cutting into the flesh to expose the artery. Since the leg’s femoral artery is large and easily accessible, the percutaneous approach quickly became the standard for more than 30 years.

Radial catheterization signals the latest milestone in treatment of coronary artery disease. It has been adopted as the overwhelming standard in places like Norway, Japan and Canada, with implementation rate as high as 90 percent. However, some countries like Australia and the U.S. are slower to adopt, with saturation as low as 4.2 percent, according to the Cardiovascular Roundtable Research and Analysis.

“The radial method is a better approach,” said Boyle. “It has less bleeding, less damage to the artery you’re going in, less requirement for blood transfusions, and less requirement for surgery to repair the damage to the artery.”

Patients who underwent radial interventions had a significantly lower rate of major vascular complications and mortality — about two-thirds less — compared to those receiving cardiac catheterization through the femoral artery, according to the Cardiovascular Roundtable Research and Analysis. Locally, Boyle has had only two complications out of more than a thousand radial procedures performed.

Read more

UC Davis study shows that fast-food dining is most popular for those with middle incomes, not those with lowest incomes.

J. Paul Leigh, UC Davis

>>Read release in Spanish

A new national study of eating out and income shows that fast-food dining becomes more common as earnings increase from low to middle incomes, weakening the popular notion that fast-food should be blamed for higher rates of obesity among the poor.

“There is a correlation between obesity and lower income, but it cannot be solely attributed to restaurant choice,” said J. Paul Leigh, professor of public health sciences at UC Davis and senior author of the study, which is published online in Population Health Management. “Fast-food dining is most popular among the middle class, who are less likely to be obese.”

In conducting the study, Leigh and co-author DaeHwan Kim, specialists in health economics, used data from the 1994 to 1996 Continuing Survey of Food Intakes by Individuals and the accompanying Diet and Health Knowledge Survey. The nationally representative sample of nearly 5,000 people in the U.S. included data about food consumption patterns, including restaurant visits, over two nonconsecutive days, which was compared with demographic variables such as household income, race, gender, age and education.

They found that eating at full-service restaurants, which involve a range of food choices and sit-down service, followed an expected pattern: as income rose, visits increased. In contrast, eating at fast-food restaurants, characterized by minimal table service and food preparation time, followed a different pattern. Fast-food restaurant visits rose along with annual household income up to $60,000. As income increased beyond that level, fast-food visits decreased.

Leigh noted that the fast-food industry attracts the middle class by locating restaurants right off freeways in middle-income areas and by offering products that appeal to a large proportion of Americans.

“Low prices, convenience and free toys target the middle class — especially budget-conscious, hurried parents — very well,” said Leigh.

Additional correlations revealed in the study included:

• Men were more likely than women to go to both fast-food and full-service restaurants.
• People with more education were more likely to go to full-service restaurants.
• People who worked more hours were more likely to go to both fast-food and full-service restaurants.
• Smokers were more likely to go to fast-food rather than full-service restaurants.

The study was limited by the fact that the data came from the mid-1990s, the most recent information available on this subject. Although incomes have changed considerably since then, Leigh believes that the eating-out patterns found in this study would still hold if more up-to-date data were available.

“It has traditionally been difficult to define patterns of restaurant consumption for Americans according to their incomes,” said Leigh. “By using a very large, nationally representative database that includes detailed information on income, we have solved that puzzle.”

Based on his findings, Leigh, who is affiliated with the UC Davis Center for Healthcare Policy and Research, suggests that policymakers and researchers look beyond restaurant type for reasons for and solutions to the obesity epidemic. He will study the effects of food pricing on food choices.

“Pricing is critical to low-income families, and over the past 30 years the costs of less healthy options have dropped compared to healthier fare,” said Leigh. “One potential way to encourage healthier eating could be to charge taxes that increase based on the number of calories in food. Proceeds from the taxes could then be used to subsidize and reduce the costs of healthy foods.”

Co-author DaeHwan Kim, who earned his doctorate in economics at UC Davis, is currently with the Korea Insurance Research Institutes in Seoul.

Kim and Leigh’s study — “Are Meals at Full-Service and Fast-Food Restaurants ‘Normal’ or ‘Inferior’?” — will be published in the December print issue of the journal. A copy can be requested by emailing kruehle@liebertpub.com.

The research was funded in part by the National Institute of Occupational Safety and Health.

About the UC Davis Center for Healthcare Policy and Research:
The Center for Healthcare Policy Research conducts research on health-care access, delivery, costs, outcomes and policy to improve the practice of medicine, especially primary care. Established as an interdisciplinary unit, the center includes more than 80 health-care researchers who represent disciplines ranging from business management and epidemiology to psychiatry and pediatrics. For more information, visit the center’s website.

Nearly 1M California children at risk of secondhand smoke exposure.

CORRECTION:  [Nov. 2, 2011]

A sample size miscalculation in the original version of this publication resulted in errors to the estimated number of children affected by secondhand smoke, although the percentages, interpretation and findings remain correct. The errors were related to pooling three cycles of CHIS data. The UCLA Center for Health Policy Research regrets the error.  A corrected version of the policy brief is attached, as well as an updated version of the original press release.  Specifically, the following numbers were revised: The total estimated number of children annually affected by secondhand smoke was revised from 2.5 million to 966,000. The total number of children estimated to be exposed to secondhand smoke in their homes each year was revised from 561,000 to 224,000. The total number of children estimated to live in homes where there is an adult or teen smoker in the household, but smoking is never allowed in the home, was revised from 1.9 million to 742,000. Race/ethnicity breakdowns changed from 180,616 to 60,800 for white children; 168,285 to 70,400 for Latino children; 121,126 to 41,200 for African-American children; and, 49,016 to 21,300 for Asian children. The correct estimated number of children in the Los Angeles region is 1.7 million and not 4.5 million. All other numbers and percentages in the study remain correct. Please contact the center’s Communications Department for further information: (310) 794-0930.

Despite having the second-lowest smoking rate in the nation, California is still home to nearly 1 million children under the age of 12 who are exposed to secondhand smoke, according to a new policy brief from the UCLA Center for Health Policy Research.

Using data from several cycles of the California Health Interview Survey, the study’s authors estimate that 224,000 children are directly exposed to secondhand smoke in the home. Another 742,000 are at risk because they live in a home where another family member is a smoker, even though smoking may not be allowed in the home itself.

Secondhand smoke exposes children to a greater risk of developing asthma, respiratory infections and countless other ailments. Research shows that children raised by smokers have a greater risk of becoming smokers themselves.

“The next frontier in the campaign against smoking is to reduce smoking at home,” said Sue Holtby, the study’s lead author and a senior researcher at the Public Health Institute, which works with the UCLA Center for Health Policy Research in conducting the California Health Interview Survey. “California’s fight against tobacco has been a major public health success story, but we still need to spread awareness and ensure that every family knows the dire consequences of addiction.”

Among the findings:

• African-American children three times more likely to live with smokers
  Nearly 12.6 percent of African-American children live in homes where smoking is permitted, three times the rate of any other racial or ethnic group. Both African-American (13.4 percent) and white children (12.2 percent) are significantly more likely than other groups to have an adult or teen smoker in their household.
• Income level and smoking
  Children living in households at or above 300 percent of the federal poverty level (FPL) are far less likely to be exposed to secondhand smoke than children from lower-income levels.
• Rural children at greater risk than urban
  Approximately 19.4 percent of households in California’s Northern/Sierra region and 14.6 percent of those in the San Joaquin Valley region have someone in the home who smokes. Comparatively, only 9.5 percent of households on the Central Coast contain a smoker. The Central Coast also has the lowest rate of households that permit smoking in the home. In contrast, close to 5 percent of homes in the San Joaquin Valley and Northern/Sierra regions permit smoking indoors.
• Los Angeles paradox
  Although Los Angeles doesn’t have the highest percentage of smoking households (10.8 percent) it has a surprisingly high percentage (4.1 percent) of households with children where smoking in the home is allowed, relative to other regions.

The authors noted that the data can help identify communities that may benefit from targeted messages concerning the adverse health effects of secondhand smoke. In particular, media campaigns aimed at African-American families, as well as families in the Los Angeles area, may effectively communicate the potential risks that secondhand smoke poses to the health of young children, the researchers said.

Service providers and case workers also have an opportunity to deliver smoking-prevention messages to low-income families eligible for a variety of state and federal assistance programs, such as Medi-Cal and the WIC (Women, Infants and Children) program. Since Medi-Cal and WIC providers usually screen patients and clients for smoking status, they are ideally positioned to identify those who are most at risk and to point parents toward information about smoking-cessation programs in their areas, the authors said.

The study was funded with a grant from First 5 California.

Read the policy brief: “Children’s Exposure to Secondhand Smoke: Nearly One Million Affected in California.”

First 5 California is dedicated to educating parents and caregivers about the important role they play in their children’s first years. First 5 California’s services and support are designed to ensure that more children are born healthy and reach their full potential.

The California Health Interview Survey (CHIS) is the nation’s largest state health survey and one of the largest health surveys in the United States.

The UCLA Center for Health Policy Research is one of the nation’s leading health policy research centers and the premier source of health-related information on Californians.

Garen Corbett to lead UC-administered California Health Benefits Review Program.

Garen Corbett

Garen Corbett has been named director of the California Health Benefits Review Program, a University of California-administered program whose faculty and staff analysts provide independent analysis to the state Legislature.

Corbett’s appointment is effective Nov. 1. He has been CHBRP’s interim director since August and joined the program as principal analyst in early 2010, bringing with him more than 13 years of policy and health care business experience. Previously, he was deputy director of The Health Industry Forum at Brandeis University, which worked on reimbursement and health technology issues with policymakers and business executives.

“Garen will provide accomplished leadership as CHBRP faces the challenges of a changing policy environment generated by health reform,” said Dr. John Stobo, UC senior vice president for health sciences and services, in announcing the appointment.

Established in 2002, CHBRP provides the state Legislature with independent analysis of the medical, financial and public health impacts of bills that mandate or repeal health insurance benefits, ranging from services to help smokers quit to health care reform. A small analytic staff in the UC Office of the President works with a task force of faculty from several UC campuses, Loma Linda University, Stanford University and the University of Southern California as well as actuarial consultants to complete each analysis during a 60-day period. The state funds CHBRP through a yearly assessment on health plans and insurers in California.

“CHBRP is a great example of UC faculty coming together to help inform policy,” Corbett said. “We’re a trusted source for unbiased analysis. Bringing academic-level rigor to the policymaking process is a real asset for California. We hear that from stakeholders on all sides of the political spectrum.”

Corbett, who succeeds Susan Philip, has a master’s degree in public affairs from the University of Massachusetts and a bachelor’s degree in sociology and American studies with honors from Brandeis University.

Related links:
CHBRP website
2010 CHBRP feature story

Preventive services recommended include screening for gestational diabetes, HIV and domestic violence.

Claire Brindis, UC San Francisco

Health policy experts at the University of California, San Francisco, helped shape a historic blueprint to improve women’s health care. Claire Brindis, director of UCSF’s Institute for Health Policy Studies, says they submitted eight preventive services for women that health plans should cover with no co-payment required. These recommendations, which include annual preventive care visits, screening for gestational diabetes, HIV and domestic violence, were accepted by the U.S. Health and Human Services secretary in a report from the Institute of Medicine.

Read more and listen

Ethical responsibilities to disclose results even when they won’t lead to a product.

Michael Rogawski, UC Davis

Drug companies sponsoring human trials of possible new medications have ethical responsibilities to study participants and to science to disclose the results of their clinical research — even when product development is no longer being pursued, says a commentary co-authored by a leading UC Davis drug researcher published online today (Sept. 28) in Science Translational Medicine.

In the commentary, titled “Disclosure of Clinical Trial Results When Product Development is Abandoned,” Michael Rogawski, chair of the Department of Neurology in the UC Davis School of Medicine, says that far too little attention has been given to the failure to reveal study results for drugs or medical devices for which development has been terminated.

Rogawski, an international authority on the development of drugs for epilepsy, says companies most commonly stop development of an investigational drug when clinical trials fail to show evidence of efficacy or if unacceptable adverse events occur. However, in some cases development is terminated because regulatory agencies require additional studies and the company sponsoring the trial is unwilling to comply. Companies may also terminate a program because of a lack of resources or because of a “reevaluation of the market opportunity.”

Many sponsors do publish the results of their clinical trials even when there are no plans to market the product being tested, but there is no legal requirement that they do so. With little incentive to devote resources to an abandoned project, publishing often goes by the wayside. In this situation “scientific information on the efficacy — or lack of efficacy — and safety — or lack of safety — of the investigational agents is not available to the research community, and the opportunity to learn from unsuccessful clinical trials is eliminated,” Rogawski says.

For example, Rogawski says that it is assumed that the mouse models used to identify new drugs to treat epilepsy have high predictive value, because every marketed antiepileptic drug has demonstrated activity in the screening models. But “this assumption could be erroneous, because we do not know if there are drugs that were effective in the models but did not exhibit efficacy or had unacceptable side effects in clinical trials and were therefore terminated by their sponsors.”

Similar concerns have been identified in psychiatric drug research, leading to the conclusion that “translational medicine cannot approach its full potential if negative drug developments are unpublished.”

Commentary co-author Howard J. Federoff, a neuroscientist and dean of the School of Medicine of Georgetown University in Washington, D.C., said disclosing negative results from drug and device trials benefits everyone.

“Disclosing negative results from drug and device clinical trials benefits the entire scientific spectrum,” Federoff says. “Such reporting would lead to greater patient safety, improve treatment research strategies, and allow a more efficient use of limited resources. The HHS has within its power the authority to require such reporting and doing so would positively impact health outcomes.”

Read more