TAG: "Public health"

Smoking’s $18B toll on California


Despite declines in numbers of smokers, related diseases account for 1 in 7 deaths in state.

Read the full report (click image to view)

By Carolyn McMillan, UC Newsroom

Fewer Californians smoke today than 10 years ago, yet smoking continues to take an enormous toll on the state and its residents, triggering $18.1 billion in health care costs and lost productivity from illness and premature death.

In the first comprehensive analysis of the financial and health impacts of tobacco in more than a decade, UC San Francisco researchers found that smoking accounted for 1 in 7 deaths in the state — more than from AIDS, influenza, diabetes, or many other causes.

While the number of smokers in California declined from a decade ago, nearly 4 million people still smoke, including an estimated 146,000 adolescents, the UCSF study found.

Far too many smoking deaths

“We found that while the California tobacco control program has led to reductions in tobacco use in the state over the last decade, smoking is still far too prevalent and results in far too many deaths and high health care costs,” said principal investigator Wendy Max, Ph.D., professor of health economics at the UCSF School of Nursing and director of the UCSF Institute for Health & Aging.

The research was conducted at the institute, with grant funding from the Tobacco-Related Disease Research Program of the University of California’s Office of the President.

The findings offer a snapshot of tobacco use throughout the state drawn from 2009 data, the most recent available when the study began.

UCSF researchers profiled each of the state’s 58 counties with total costs, costs per resident and per smoker, expenditures for each type of health care, smoking prevalence and mortality measures. The same investigators conducted similar statewide studies in 1999 and 1989.

The report found that smoking prevalence was higher in some parts of the state than others, and that males — whether teens or adults — were far more likely to smoke than females.

“This kind of detailed data helps us target our limited smoking cessation resources where they are needed most,” said Dr. Michael Ong, chair of the California Tobacco Education and Research Oversight Committee and a UCLA physician. “We also see clearly from this report that tobacco — despite declines in its prevalence — remains a major threat to public health and a drain on health care resources.”

An extraordinary economic burden

The cost to California, its counties and its residents from smoke-related diseases remains significant. In Los Angeles County, for example, smoking carried a $4.4 billion price tag in 2009 — the highest of any county in the state. That total included $2.3 billion in direct health care costs and $2.1 billion for indirect costs, of which $1.7 billion was due to premature deaths.

“Smoking exacts an extraordinary economic burden on our county,” said Dr. Paul Simon, director of the LA County Public Health’s division of Chronic Disease and Injury Prevention. “The dollar amount is staggering, and it does not take into account the untold emotional costs on family members and friends.”

UC President Janet Napolitano said the study exemplifies the ways in which university research informs the work of public health offices around the state. UC campuses conduct a wide range of research each year aimed at improving the lives of Californians and people around the world — often in partnership with state and federal agencies looking to understand and address important health issues.

“In partnership with the state, we’ve made great strides in educating people about the risks of smoking, but as this important study shows, there is much more to do,” Napolitano said.

As the former Arizona attorney general, Napolitano was heavily involved in implementing the Master Settlement Agreement and represented the nation’s attorneys general on the Board of the Legacy Foundation, the largest national nonprofit public health organization devoted to tobacco control.

Statewide, smoking represented $6.8 billion in lost productivity and about 587,000 years of potential life lost from 34,363 deaths, or 17.1 years per death, the researchers found.

More deaths than AIDS, diabetes or Alzheimer’s

Smoking also was found to be a leading cause of death in 2009. The 34,363 total deaths from smoking were 17 times the number from AIDS; five times the deaths from diabetes, influenza and pneumonia; and three times the number of deaths from Alzheimer’s disease and unintentional injuries.

Cancer was the primary cause of smoking-attributable death, accounting for 13,514 deaths, followed by cardiovascular disease with 10,490 deaths, and respiratory diseases with 10,331. Pediatric disease accounted for 27 deaths, and secondhand smoke exposure was attributed to 794 adult deaths.

The direct health care costs of smoking accounted for 54.4 percent of the total $18.1 billion cost of smoking, or $9.8 billion. Lost productivity due to illness comprised 7.9 percent ($1.4 billion), and lost productivity from premature death comprised 37.6 percent ($6.8 billion).

Hospital care of current and former smokers cost $4.3 billion of the $9.8 billion total health care costs of smoking. Ambulatory care services were $2.1 billion; nursing home care, $1.5 billion; prescription drugs, $1.1 billion; and home health care, $794 million.

The report found that the state’s tobacco control efforts have been effective in reducing smoking-attributable deaths, reducing the prevalence of smoking and cutting the real costs of smoking, as compared to a decade ago.

Nonetheless, costs remain high and the wide variation in smoking costs across the counties suggests that many geographic areas would benefit from targeted efforts to reduce smoking.

“County-level estimates of the costs of smoking help to identify geographic disparities in the economic burden of tobacco use. These data are useful for local governments and policy makers to develop more effective tobacco control policies at the local level,” said co-author Hai-Yen Sung, Ph.D., professor of health economics at the UCSF School of Nursing and the UCSF Institute for Health & Aging.

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Arsenic in drinking water linked to 50% drop in breast cancer deaths


‘What we found was astonishing.’

One typically does not hear talk of the health benefits of arsenic, but a new study by researchers from UC Berkeley and the Pontifical Catholic University of Chile has linked arsenic to a 50 percent drop in breast cancer deaths.

The study, published this month in the journal EBioMedicine, presents results of breast cancer mortality data from a region in Chile where residents were inadvertently exposed to high levels of arsenic, a naturally occurring element found in many minerals. Instead of an increase in mortality, as with many other cancer sites, the study found that breast cancer deaths were cut in half during the period that coincided with high arsenic exposure. The effect was more pronounced among women under age 60, with mortality in these women reduced by 70 percent.

“What we found was astonishing,” said study lead author Dr. Allan Smith, UC Berkeley professor of epidemiology and director of the Arsenic Health Effects Research Program. “We’ve been studying the long-term effects of arsenic in this population for many years, focusing on increased disease and mortality attributed to the historical exposure to arsenic in this population.”

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Study: Hospital mergers, acquisitions leading to increased patient costs


Counterintuitive findings published in Journal of the American Medical Association.

The trend of hospitals consolidating medical groups and physician practices in an effort to improve the coordination of patient care is backfiring and increasing the cost of patient care, according to a new study led by a UC Berkeley health policy expert.

The counterintuitive findings, published today (Oct. 21) in the Journal of the American Medical Association, come as a growing number of local hospitals and large, multi-hospital systems in this country are acquiring physician groups and medical practices.

“This consolidation is meant to better coordinate care and to have a stronger bargaining position with insurance plans,” said study lead author James Robinson, professor and head of health policy and management at UC Berkeley’s School of Public Health. “The movement also aligns with the goals of the Affordable Care Act, since physicians and hospitals working together in ‘accountable care organizations’ can provide care better than the traditional fee-for-service and solo practice models. The intent of consolidation is to reduce costs and improve quality, but the problem with all this is that hospitals are very expensive and complex organizations, and they are not known for their efficiency and low prices.”

Robinson teamed up with study co-author Kelly Miller, program analyst at Integrated Healthcare Association, a nonprofit organization that promotes health care quality improvement, accountability and affordability in California.

The researchers analyzed four years of data, from 2009 to 2012, on 158 major medical groups and 4.5 million patients in California. Groups were put into three categories: owned by physicians, owned by a local hospital or hospital system, or owned by a large hospital system that spans multiple geographic markets in the state.

The measure of costs included physician visits, inpatient hospital admissions, outpatient surgery and diagnostic procedures, drugs, and all other forms of medical care except for mental health services. (The researchers did not have data on mental health services since they are paid for separately.)

After controlling for such factors as the mix of severely ill patients and geographic differences in cost, the researchers found that per patient expenditures were 19.8 percent higher for physician groups in multi-hospital systems compared with physician-owned organizations. Groups owned by local hospitals were better, but per patient costs still ran 10.3 percent higher compared with physician-owned groups.

Why would consolidation lead to increased costs? It could be that once a medical group has been acquired, physicians in those groups are expected to admit their patients to the high-priced hospital, Robinson said.

“Hospital-owned medical groups usually are expected to conduct ambulatory surgery and diagnostic procedures in the outpatient departments of their parent hospital, but hospital outpatient departments are much more costly and charge much higher prices than freestanding, non-hospital ambulatory centers,” he said.

Robinson said that public policy should not encourage mergers and acquisitions as a means of promoting collaboration. Instead, he said, policymakers should consider supporting the use of bundled payments for hospitals and physicians to improve coordination of care.

“Hospitals are an essential part of the health care system, but they should not be the center of the delivery system,” said Robinson. “Rather, physician-led organizations based in ambulatory and community settings are likely to be more efficient and provide cheaper care.”

The study authors noted that their findings are limited to California, and that further studies should be done using data from other states.

“Nevertheless, these findings are important since California is the nation’s leader in terms of having physicians participate in large medical groups that already perform the functions ascribed to ‘accountable care organizations’ by the Obama administration,” said Robinson.

The Robert Wood Johnson Foundation provided support for this research.

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UC Davis names chair of public health sciences


Distinguished cancer prevention researcher Brad Pollock to lead department.

Brad Pollock

Brad Pollock, a leading researcher on the incidence and control of childhood and adolescent cancer, has become chair of the Department of Public Health Sciences at the UC Davis School of Medicine.

Pollock directs a team of 35 investigators who conduct population-based studies aimed at preventing disease and shaping health policy. Department faculty members have advanced knowledge of cancer, autism, reproductive health and agricultural exposures, and they are among the nation’s leaders in the fields of epidemiology, biostatistics, and environmental and occupational health sciences. Together, they have received nearly $100 million in research funding from the National Institutes of Health, state of California and foundations.

The department also offers a master’s degree program in public health and leads graduate groups in epidemiology and biostatistics.

Pollock came to UC Davis from the University of Texas Health Science Center at San Antonio, where he was the founding chair of the Department of Epidemiology and Biostatistics in the School of Medicine. He is the principal investigator of a $19 million National Cancer Institute grant to engage community physicians in expanding participation in cancer clinical trials as well as research on cancer control and cancer care delivery. The grant includes a focus on underserved populations, including Latinos, adolescents and young adults. He also co-chairs the Clinical Trials Task Force for the Patient-Centered Outcomes Research Institute’s PCORnet national network, and he previously chaired the Biostatistics, Epidemiology, Research Design Key Function Committee of the national Clinical Translational Science Award Program.

While his research focuses on pediatric oncology, Pollock also has extensive experience in multi-institutional studies on adult cancer, HIV, diabetes and obesity. He is known for combining medical informatics with clinical, translational and transdisciplinary approaches in addressing health issues.

“Dr. Pollock’s accomplishments align perfectly with our team’s mission of having a meaningful impact on health and quality of life,” said Julie Freischlag, vice chancellor for Human Health Sciences and dean of the School of Medicine at UC Davis. “His success at linking multiple research methodologies with population science will guide the department to new levels of achievement as a comprehensive program with international influence.”

Pollock earned his bachelor’s degree from UC Irvine and his master’s and doctorate degrees from UCLA’s School of Public Health.

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Drinking sugared soda associated with cell aging


UCSF scientists find shorter telomeres in immune cells of soda drinkers.

Elissa Epel, UC San Frnacisco

Sugar-sweetened soda consumption might promote disease independently from its role in obesity, according to UC San Francisco researchers who found in a new study that drinking sugary drinks was associated with cell aging.

The study revealed that telomeres — the protective units of DNA that cap the ends of chromosomes in cells — were shorter in the white blood cells of survey participants who reported drinking more soda. The findings were reported online today (Oct. 16) in the American Journal of Public Health.

The length of telomeres within white blood cells — where it can most easily be measured — has previously been associated with human lifespan. Short telomeres also have been associated with the development of chronic diseases of aging, including heart disease, diabetes, and some types of cancer.

“Regular consumption of sugar-sweetened sodas might influence disease development, not only by straining the body’s metabolic control of sugars, but also through accelerated cellular aging of tissues,” said Elissa Epel, Ph.D., professor of psychiatry at UCSF and senior author of the study.

“This is the first demonstration that soda is associated with telomere shortness,” Epel said. “This finding held regardless of age, race, income and education level. Telomere shortening starts long before disease onset.  Further, although we only studied adults here, it is possible that soda consumption is associated with telomere shortening in children, as well.”

The authors cautioned that they only compared telomere length and sugar-sweetened soda consumption for each participant at a single time point, and that an association does not demonstrate causation. Epel is co-leading a new study in which participants will be tracked for weeks in real time to look for effects of sugar-sweetened soda consumption on aspects of cellular aging. Telomere shortening has previously been associated with oxidative damage to tissue, to inflammation, and to insulin resistance.

Based on the way telomere length shortens on average with chronological age, the UCSF researchers calculated that daily consumption of a 20-ounce soda was associated with 4.6 years of additional biological aging. This effect on telomere length is comparable to the effect of smoking, or to the effect of regular exercise in the opposite, anti-aging direction, according to UCSF postdoctoral fellow Cindy Leung, Sc.D., from the UCSF Center for Health and Community and the lead author of the newly published study.

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Sesame Street helps teach physicians a lesson


Incarceration plays major role in health disparities in U.S., says UC Riverside professor.

UC Riverside’s Scott Allen (left) is seen here with Sesame Street’s Alex, a blue-haired, green-nosed Muppet who has a father in jail, and Brown University’s Josiah Rich (right). (Photo courtesy of Pam Hacker, Sesame Street)

More than two million people are incarcerated in the United States, the highest incarceration rate in the world. So perhaps it comes as no surprise that last year the popular children’s television series Sesame Street introduced a character that has an incarcerated father.

With incarceration having found a home even on Sesame Street, public health practitioners, policymakers and health care providers ought to pay closer attention to incarceration’s impact on health inequality in the country, argue a team of two physicians and a medical researcher in an article published today (Oct. 6) in Annals of Internal Medicine.

Scott A. Allen, M.D., a professor of medicine in the School of Medicine at the University of California, Riverside, and his colleagues report that while many people need to be in prison for the safety of society, a majority are incarcerated due to behaviors linked to treatable diseases such as mental illness and addiction.

“In such cases, incarceration will improve neither the imprisoned person nor the social problem without medical intervention,” Allen writes, along with co-authors Dora M. Dumont, Ph.D., M.P.H., at the Rhode Island Department of Health and Josiah D. Rich, M.D., M.P.H., at Brown University.

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Shining a light on a secret shame: suicide


UCLA professor Mark Kaplan says raising awareness about suicide is a key to preventing it.

Mark Kaplan, UCLA

When people think of public health, they do not often think of suicidology — the study of the causes and prevention of suicide. Historically, public health has been either associated with Hollywood-style images of government workers investigating disease outbreaks or mistakenly equated to local health departments responsible for restaurant inspections and bureaucracy.

But more recently, the ever-changing public health field now faces a growing list of problems, including, chronic diseases such as cancer, heart disease and diabetes. Mark Kaplan, professor of social welfare at the UCLA Luskin School of Public Affairs, is working to ensure that suicide, the 10th-leading cause of death in the United States, is on this list.

While the causes of suicide are complex, during his 20-plus years studying it, Kaplan has become a leading suicidologist working to understand the range of determinants that lead to suicide.

At the heart of Kaplan’s study is one motivating factor: “to do work that can save lives.” In many of his conversations, Kaplan mentions two statistics that tumble off his tongue with the speed and familiarity of someone who has spent years laboring under them. Nearly, 40,000 people die by suicide every year in the United States and more than half of all suicides involve firearms.

“In general, we underappreciate the impact that suicide has on our country and even globally,” Kaplan said. “Not only is the victim of concern, but scores of others are affected, such as family members. A colleague of mine at my former university took her life at the peak of her career and left behind a very young child. We have all been touched by suicide.”

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Making maps to predict malaria


UCSF, Google Earth Engine fighting infectious disease with cloud computing.

A sample risk map of malaria in Swaziland during the transmission season using data from 2011-13.

UC San Francisco (UCSF) is working to create an online platform that health workers around the world can use to predict where malaria is likely to be transmitted using data on Google Earth Engine.

The goal is to enable resource poor countries to wage more targeted and effective campaigns against the mosquito-borne disease, which kills 600,000 people a year, most of them children.

Faced with a multitude of public health needs, countries often make the mistake of cutting their malaria efforts just when they are close to eliminating the disease, said Hugh Sturrock, Ph.D., M.Sc., an assistant professor of epidemiology and biostatistics and a researcher in the Global Health Group, which is a part of UCSF’s Global Health Sciences.

“This can have disastrous consequences, since malaria can quickly rebound, putting years of expensive control efforts to waste,” he said. “But with these maps, health workers will know exactly where to target their scarce resources. That way, they can keep fighting the disease until it’s eliminated within their borders.”

Google Earth Engine brings together the world’s satellite imagery — trillions of scientific measurements dating back almost 40 years — and makes it available online with tools for scientists, independent researchers and nations to mine this massive warehouse of data to detect changes, map trends and quantify differences on the Earth’s surface.

With the malaria prediction platform, local health workers will be able to upload their own data on where and when malaria cases have been occurring and combine it with real-time satellite data on weather and other environmental conditions within Earth Engine to pinpoint where new cases are most likely to occur. That way, they can spray insecticide, distribute bed nets or give antimalarial drugs just to the people who still need them, instead of blanketing the entire country.

By looking at the relationship between disease occurrence and factors such as rainfall, vegetation and the presence of water in the environment, the maps will also help health workers and scientists study what drives malaria transmission. Google Earth Outreach, which helps nonprofits use Google’s mapping technology, is giving UCSF $100,000 to develop the new platform.

The new tool will be piloted in Swaziland, a country in southern Africa that has limited malaria to a few small pockets across the country through the malaria elimination program it launched in 2008 with help from the Global Health Group. Plans are to make the tool available to health workers in other countries working with the Global Health Group’s Malaria Elimination Initiative. The tool could also be adapted to predict other infectious diseases.

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Taking preventive health care into community spaces


Bringing health care to non-traditional locations increases use of preventive services.

Janet Frank, UCLA

A church. A city park. An office. These are not the typical settings for a medical checkup. But a new nationwide study by the UCLA Center for Health Policy Research shows that providing health services in unorthodox settings helps underserved adults get preventive care.

With support from the Centers for Disease Control and Prevention, the study’s authors reviewed 142 outreach programs nationwide and identified 20 that successfully used non-traditional settings, such as churches and parks, to promote or deliver preventive services (such as bone density and cancer screenings) to older underserved populations.

“The research shows that health providers might need to think outside the box on how and where to deliver health services,” said Janet Frank, lead author of the study and an adjunct associate professor at the UCLA Fielding School of Public Health. “The programs that fared the best did not wait for patients to come to them — they went to where the patients were.”

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Breastfeeding may delay onset of puberty in girls


Girls with early-onset puberty at risk for multitude of health challenges.

Julianna Deardorff, UC Berkeley

In a recent study, maternal and child health researchers at the UC Berkeley School of Public Health looked into the idea that breast feeding may serve as a protective mechanism to delay onset of puberty in girls. They found that, in some cohorts, girls who were predominantly breastfed (as opposed to predominantly formula fed) showed later onset of breast development.

Girls with early-onset puberty are at risk for a multitude of health challenges, including greater risks of obesity, hypertension and some cancers. Early maturation is also associated with lower self-esteem, higher rates of depression and norm-breaking behaviors, and lower academic achievement.

“These findings are unique in suggesting that exclusive breastfeeding may delay onset of girls’ pubertal timing,” says Julianna Deardorff, assistant professor of maternal and child health and co-author of the study. “Given the limited number of modifiable factors influencing puberty, this is a promising area of research for intervention.”

The study was led by Aarti Kale, M.P.H. ’11, who analyzed data from a population of 1,237 girls recruited across three geographic locations — New York City, Cincinnati and the San Francisco Bay Area. Breast feeding practices were assessed using self-administered questionnaires with the primary caregiver. The girls were seen on an annual basis to assess breast and pubic hair development. In addition to breastfeeding correlating with pubertal onset, duration of breastfeeding was also directly associated with age at onset of breast development. However, a stratified analysis showed the association only in the Cincinnati cohort.

“The results varied across the sites, suggesting that unique characteristics of these cohorts and their environments modify effects,” says Deardorff. “Further research into the contexts within which breastfeeding and girls’ development occur would potentially illuminate sources of variability.”

The study was published in the Journal of Maternal and Child Health.

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Water conservation strategy should consider health, cost, community concerns


UCLA study says careful planning needed to avoid unintended harm.

In April, California Gov. Jerry Brown issued an executive order asking residents to reduce their water consumption by 20 percent. That hasn’t happened. Since then, the state’s dry conditions have worsened, with more than 80 percent of California now in an extreme drought according to the National Weather Service.

As a result, officials are getting tough on water wasters: The State Water Resources Control Board recently adopted regulations giving local agencies the authority to fine those who waste water up to $500 a day.

But efforts to hit Brown’s target might have unintended, and potentially harmful, consequences for the health of Californians and their communities.

Now a health impact assessment, or HIA, issued by the UCLA Fielding School of Public Health’s Center for Health Advancement provides short- and long-term recommendations for urban water conservation that save water while also protecting and promoting public health. The report was funded by the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts.

“Sharply increasing the cost of water use for the consumer could impact poorer households,” said Brian Cole, an adjunct assistant professor of environmental sciences at the Fielding School and lead author of the report. “Access to valuable urban park and green space, for example, which already tends to be in short supply in poorer communities, could be lost if cities stop watering public spaces. This is exactly what happened during a recent drought in Australia when delays and insufficient water conservation left some cities no choice but to let their parks turn brown.”

In addition, generating more energy to pump and treat water could increase emissions, which would adversely affect air quality; in some areas, urban heat islands could be worsened if vegetation isn’t sufficiently watered.

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Study finds health claims misleading for sports, energy drinks


‘Health halo’ around popular drinks obscures risks to children.

A new report by UC Berkeley researchers questions the health claims of popular energy, sports, tea and fruit drinks on the market.

In a report released today (Aug. 6), the authors evaluated 21 popular drinks with health claims — from immune boosters to energy enhancers — on their labels and in their marketing materials.

“We often see labels on energy and sports drinks that tout health benefits, but the sugar levels in these products rival that of sodas,” said lead author Patricia Crawford, director of the Atkins Center for Weight and Health and UC Berkeley adjunct professor of nutritional sciences and toxicology. “They are essentially sodas without the carbonation, but they give the misleading impression that they are healthy.”

The report, “Looking Beyond the Marketing Claims of New Beverages,” was commissioned by the California Center for Public Health Advocacy. Click here to access the full report, fact sheets and press release.

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