TAG: "Public health"

New movement focuses on paradox of cigarette sales in pharmacies

UCSF scientists, major pharmacy launch national move to halt tobacco sales in drugstores.

Steven Schroeder, UC San Francisco

Pharmacies, focused on the health and well-being of their customers, have long been saddled with a paradox: they sell cigarettes and other tobacco products, even though tobacco use is the nation’s leading cause of preventable death.

If retailers, particularly pharmacies, were to discontinue selling cigarettes, fewer smokers and fewer deaths by smoking would occur, according to a new opinion article co-written by a UC San Francisco scientist. That’s also the premise behind a new decision by CVS Caremark, the nation’s largest pharmacy health care company, to end cigarette and tobacco sales in its stores this year.

In a Viewpoint article published online today (Feb. 5) in JAMA, the Journal of the American Medical Association, the authors say that selling tobacco products is “clearly antithetical” to the role of pharmacies, especially as pharmacies expand their role as an integral part of the nation’s health care system.

The JAMA Viewpoint is written by Troyen A. Brennan, M.D., M.P.H., executive vice president and chief medical officer of CVS Caremark; and Steven A. Schroeder, M.D., a UCSF professor and director of the Smoking Cessation Leadership Center.

Casting a harsh light on tobacco sales in drugstores, the authors say that selling tobacco products contradicts a commitment to health care.

The goal of the authors: eliminate tobacco sales in America’s drugstores.

“Nowhere else in health care are tobacco products available in the same setting where diseases are being diagnosed and treated,” they write.

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Tighter economic regulation needed to reverse obesity epidemic

Study suggests government action to control food industries can help prevent obesity.

Roberto De Vogli, UC Davis

Roberto De Vogli, UC Davis

Governments could slow — and even reverse — the growing epidemic of obesity by taking measures to counter fast food consumption, according to a study published today (Feb. 2) in the Bulletin of the World Health Organization.

Led by Roberto De Vogli of UC Davis, the study showed that fast food purchases were independent predictors of increases in the average body mass index (BMI) in the U.S. and 24 other wealthy nations from 1999 to 2008. Nations with stronger government regulations — such as producer protection, price controls, and stronger intervention on competition and taxes — experienced slower increases in fast food purchases and average BMIs.

De Vogli’s research is the first to look at the effects of deregulation in the economy, including the agricultural and food sectors, and the resulting increase in fast food transactions and BMIs over time. It suggests that if governments take action to control food industries, they can help prevent overweight and obesity and its serious health consequences, including cardiovascular disease, diabetes, stroke and diet-related cancers.

“Unless governments take steps to regulate their economies, the ‘invisible hand of the market’ will continue to promote obesity worldwide with disastrous consequences for future public health and economic productivity,” said De Vogli, associate professor in the UC Davis Department of Public Health Sciences.

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Students learn by doing good

Global children’s oral health, nutrition program helps stem tooth decay around the world.

Global Children's Oral Health and Nutrition ProgramEvery year since 2010, Dr. Karen Sokal-Gutierrez, Dr. Susan Ivey and a group of students have taken toothbrushes, toothpaste, and a big pink and white model of teeth to Latin America and, since 2011, Asia. There, they teach communities about nutrition and oral health. The Global Children’s Oral Health and Nutrition Program was created to stem the epidemic rise in tooth decay in developing countries around the world. Sokal-Gutierrez is an associate clinical professor and Ivey an associate adjunct professor in the UC Berkeley School of Public Health. Both teach in the UC Berkeley-UC San Francisco Joint Medical Program.

The program began in El Salvador in 2003, where Sokal-Gutierrez noticed a trend in tooth decay of children up to 6 years old. Since then, the program has expanded to Nepal, India, Vietnam, Ecuador and Peru. Sokal-Gutierrez and Ivey estimate that the program has served about 10,000 children and their parents since its inception. But the Children’s Oral Health and Nutrition Program has also made another big impact, this time on the UC Berkeley campus: bringing transformative experiences to students launching their careers in public health, medicine and dentistry.

“How can we do our best to improve the health of children, and how can we do our best to mentor the students and give them this good hands-on opportunity?” asks Sokal-Gutierrez. “I’m always trying to pay attention to both of those things.”

In the decade since it began, nearly 200 volunteers have participated in the program. Most are UC Berkeley undergraduates who plan to pursue careers in public health, medicine, and dentistry. They also include graduate students and professionals from the fields of medicine, dentistry and public health. Additionally, Sokal-Gutierrez and Ivey often seek out students whose families emigrated from countries where this program might be needed. It offers a chance for students to connect abstract concepts to real-world scenarios, take on positions of leadership, and be mentors in medicine and public health.

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Grant will fund research in use of wireless technologies to manage health

Sensors to remotely monitor TB treatment.

Sara Browne, UC San Diego

Sara Browne, UC San Diego

The Alliance Healthcare Foundation has awarded the University of California, San Diego School of Medicine a $1 million Innovation Initiative (i2) Grant to support the work of Dr. Sara Browne, associate professor in the School of Medicine’s Division of Infectious Diseases. The grant is funding groundbreaking research in the use of wireless technologies in the management of personal and public health.

Browne is collaborating with colleagues at UC San Diego’s Anti-Viral Research Center, using technology developed by Proteus Digital Health, which has developed a system to track how and when individuals take medications. The system utilizes an ingestible and wearable sensor platform.

The ingestible sensor records time of medication ingestion and transmits the data to the wearable sensor in the form of a patch worn on the patient’s torso. The patch also collects activity and rest patterns and sends the information to a secure mobile application.

“The power of such a technology for physicians is that it reveals regular information on patients’ medication taking behavior and daily health patterns, enabling them to make better informed treatment decisions and to provide tailored support to their patients,” said Browne.

Browne and colleagues are using this technology to remotely monitor TB treatment, comparing it to directly observed therapy (DOT), where a health care worker personally witnesses the ingestion of medication by the patient. While DOT is the current gold standard for TB treatment monitoring, it is very time- and resource-intensive, making it unattainable for many developing countries, as well as too expensive for many domestic TB programs. Poor adherence to medication for TB is a major problem, one that exacerbates infection rates and boosts drug resistance.

“Wireless technologies have the potential to positively impact public health in San Diego and Imperial counties,” said Browne. “This technology can ultimately impact TB treatment globally, providing new methods of TB therapy monitoring and support to many more patients. This would mean better treatment completion rates, less drug resistance and, consequently, fewer cases of TB.”

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Testosterone therapy linked to heart attacks in men under 65

Study also confirms twofold increase in heart attack risk in men over 65 who use the therapy.

You may have seen one of the many advertisements geared toward men asking if they suffer from “low T” — low testosterone levels that, according to the ads, can result in lost sex drive, diminished energy and moodiness. The answer, they suggest, may be as simple as applying testosterone through a gel or patch.

So successful has the marketing for this testosterone therapy been that, according to Drugs.com, an independent medicine website, sales of the testosterone gel Androgel in 2013 exceeded sales of Viagra.

Now, a new joint study by UCLA, the National Institutes of Health and Consolidated Research Inc., has shown there is a twofold increase in the risk of a heart attack shortly after beginning testosterone therapy among men under 65 who have a history of heart disease. Further, the study confirmed earlier studies that found a twofold increase in heart attack risk shortly after treatment began in men older than 65.

The study, the largest to date examining heart disease in men using testosterone supplements, appears in today’s (Jan. 29) online edition of the journal PLOS ONE.

The research was prompted by three small, earlier studies that raised concerns about possible adverse cardiovascular outcomes associated with testosterone therapy. These included a randomized clinical trialofmen older than 65, which was reported in the New England Journal of Medicine and was stopped in 2010 due to a variety of cardiovascular events.

“We decided to investigate cardiovascular risks of this therapy in a large health care database since these previous studies were modest in size and only focused on men 65 and older,” said the study’s senior author, Sander Greenland, a professor of epidemiology at the UCLA Fielding School of Public Health and a professor of statistics in the UCLA College of Letters and Science. “Our study allowed us to examine cardiovascular risk in men under the age of 65 and to replicate the findings in men over 65.”

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Exposures to some phthalates fall after federal ban

UCSF study finds widespread exposure to these endocrine disrupters.

Ami Zota, UC San Francisco

Ami Zota

Americans are being exposed to significantly lower levels of some phthalates that were banned from children’s articles in 2008, but exposures to other forms of these chemicals are rising steeply, according to a study led by researchers at UC San Francisco.

Phthalates, which are used to soften plastic, can be found in nail polish, fragrances, plastics and building materials, as well as the food supply. An accumulating body of scientific evidence suggests they can disrupt the endocrine system, which secretes hormones, and may have serious long-term health consequences.

Phthalate exposures to adult men have been linked to DNA damage in sperm and lower sperm quality, while exposures to pregnant women have been linked to alterations in the genital development of their male children, as well as cognitive and behavioral problems in boys and girls.

The paper, published in Environmental Health Perspectives, is the first to examine how phthalate exposures have changed over time in a large, representative sample of the U.S. population. It delineates trends in a decade’s worth of data — from 2001 to 2010 — in exposure to eight phthalates among 11,000 people who took part in the National Health and Nutrition Examination Survey conducted by the U.S. Centers for Disease Control and Prevention.

“We were excited to see that exposure to some of the phthalates that are of public health concern actually went down,” said Ami Zota, Sc.D., M.S., an assistant professor of environmental and occupational health at the George Washington University School of Public Health and Health Services, who did the research when she was a postdoctoral fellow at UCSF’s Program on Reproductive Health and the Environment. “Unfortunately, our data also suggest that these are being replaced by other phthalates with potential adverse health effects.”

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How information consumption impacts health behaviors

Misconceptions can have serious implications on a person’s overall health.

Susana Ramirez, UC Merced

Susana Ramirez, UC Merced

From sunrise to sunset, people consume all kinds of information from television, online and from other sources.

UC Merced public health professor A. Susana Ramirez wants to know how that influences people’s health decisions and behaviors. Quite often, misconceptions about leading a healthy life can have serious implications on a person’s overall health.

For example, one paper she led shows that people who got health information from the media made healthier choices, including exercising more and eating more fruits and vegetables. There may be several explanations for this finding, including that people who sought information resolved to be healthier, or that information seeking reinforced an existing commitment to engage in healthy behaviors.

Before coming to UC Merced in 2013, Ramirez was a postdoctoral research fellow at the National Cancer Institute, which is based in Bethesda, Md. She earned a master’s in public health from Harvard University and a Ph.D. in communications from the University of Pennsylvania.

Ramirez, who is particularly interested in Latino health, plans to partner with San Joaquin Valley communities in her research, as well as using the findings to improve residents’ health.

“The San Joaquin Valley has a diverse Latino population, in terms of generation and language,” she said. “There’s a compelling case and need for the kind of research I’m doing.”

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Total smoking ban works best

UC San Diego researchers say with no place to puff, smokers more likely to cut back or quit.

Wael Al-Delaimy, UC San Diego

Wael Al-Delaimy, UC San Diego

Completely banning tobacco use inside the home – or more broadly in the whole city – measurably boosts the odds of smokers either cutting back or quitting entirely, report UC San Diego School of Medicine researchers in the current online issue of Preventive Medicine.

“When there’s a total smoking ban in the home, we found that smokers are more likely to reduce tobacco consumption and attempt to quit than when they’re allowed to smoke in some parts of the house,” said Wael K. Al-Delaimy, M.D., Ph.D., professor and chief of the Division of Global Health in the UC San Diego Department of Family and Preventive Medicine.

“The same held true when smokers report a total smoking ban in their city or town. Having both home and city bans on smoking appears to be even more effective.”

Al-Delaimy said the findings underscore the public health importance of smoking bans inside and outside the home as a way to change smoking behaviors and reduce tobacco consumption at individual and societal levels.

“California was the first state in the world to ban smoking in public places in 1994 and we are still finding the positive impact of that ban by changing the social norm and having more homes and cities banning smoking,” he said.

“These results provide quantitative evidence that smoking bans that are mainly for the protection of non-smokers from risks of secondhand smoke actually encourage quitting behaviors among smokers in California. They highlight the potential value of increasing city-level smoking bans and creating a win-win outcome.”

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UCLA helping change the way a community eats, one store at a time

Euclid Market is latest store to be transformed.

Transformation of Euclid Market's exterior

Transformation of Euclid Market's exterior

Big chain grocery stores, farmers markets and other sources of healthy foods are usually in short supply in low-income communities. Public health experts refer to these areas as “food swamps” for their lack of available nutritious foods.

One such area is in the Boyle Heights neighborhood of East Los Angeles, where fast food reigns and meals are frequently purchased at corner markets. These small stores tend to be rundown, uninviting and focused on selling the bane of healthy eating — junk food.

At noon on Saturday, Dec. 14, the UCLA–USC Center for Population Health and Health Disparities (CPHHD) and the UCLA Fielding School of Public Health will join with local community members in Boyle Heights to celebrate the grand reopening of the neighborhood’s Euclid Market, which has been transformed into the opposite of what most corner markets are.

Instead of drab, there is fresh paint. Instead of the prominent placement of junk food and beer, the front of the store now highlights healthy foods like fresh fruits and vegetables, bottled water and nutritious snacks.

The Euclid Market is the third store in the East Los Angeles–Boyle Heights area to undergo a CPHHD-supported transformation. The first opened in November 2011, the second in February 2012.

The latest conversion, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health and led by the UCLA Fielding School of Public Health, is part of a collaborative strategy with community members to change eating habits and reduce disease risk among the area’s dominant Latino population, which is plagued by high rates of obesity-related chronic diseases. Obesity stands as one of the nation’s most significant public health problems.

“Both of the existing transformed stores in the East L.A. area are reporting increased profits and greater foot traffic, so that’s good news for the small business owner,” said Alex Ortega, the director of the CPHHD and a professor of public health at the Fielding School.

“But it’s even better news for the people in those areas because having access to nutritious food that’s convenient to buy will help folks change their bad eating habits,” he added. “The goal, of course, is to see improvements in the overall health of our underserved communities.”

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U.S. ranks low in efficiency of health care spending

UCLA, McGill study also shows women fare worse than men in most countries.

Stethoscope on mapA new study by researchers at the UCLA Fielding School of Public Health and McGill University in Montreal reveals that the United States health care system ranks 22nd out of 27 high-income nations when analyzed for its efficiency of turning dollars spent into extending lives.

The study, which appears online today (Dec. 12) in the “First Look” section of the American Journal of Public Health, illuminates stark differences in countries’ efficiency of spending on health care, and the U.S.’s inferior ranking reflects a high price paid and a low return on investment.

For example, every additional hundred dollars spent on health care by the United States translated into a gain of less than half a month of life expectancy. In Germany, every additional hundred dollars spent translated into more than four months of increased life expectancy.

The researchers also discovered significant gender disparities within countries.

“Out of the 27 high-income nations we studied, the United States ranks 25th when it comes to reducing women’s deaths,” said Dr. Jody Heymann, senior author of the study and dean of the UCLA Fielding School of Public Health. “The country’s efficiency of investments in reducing men’s deaths is only slightly better, ranking 18th.”

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UC goes tobacco free starting January 2014

Sales, ads and use of cigarettes will go away throughout the UC system.

Ashtray full of cigarette butts (iStock photo)

All UC campuses will be tobacco-free in 2014 (iStock photo)

By Katherine Tam

University of California campuses across the state will be tobacco free come the New Year, demonstrating UC’s commitment to provide a healthy environment for faculty, staff, students and visitors.

A leader in strong health care practices, UC already bans smoking at its five medical centers. The new tobacco-free policy that begins in January 2014 goes a step further by extending the ban to all campuses and anywhere on campus, including residence halls and parking lots, and also by prohibiting the sale and advertising of tobacco products.

UCLA, UC San Diego and UCSF implemented the new policy earlier this year, with positive results.

“Tobacco use and secondhand smoke continue to be the leading causes of preventable death in the country,” said Cheryl Lloyd, interim director of Risk Services at UC’s Office of the President, which is leading the effort. “We can do our part to help change that by providing a smoke-free environment on our campuses so our employees, students and visitors aren’t exposed to something that damages their health.”

UC’s new tobacco-free policy bans a wide range of products, including cigarettes, chewing tobacco and electronic cigarettes.

Enforcement will rely primarily on educating smokers about the dangers of lighting up and other types of tobacco use, and promoting campus resources to help them quit.

Faculty and staff who want to quit smoking can access many resources through any UC-sponsored 2014 medical plan. All the 2014 plans will offer prescription nicotine replacement therapies, such as nicotine inhalers and sprays, at no cost when prescribed by a doctor. Over-the-counter nicotine replacement therapies, such as nicotine patches and gum, when prescribed by a doctor, will be available at the generic copay price for those enrolled in UC Care, Health Net Blue and Gold, and Western Health Advantage. Kaiser members have no copay. Under Core and the Blue Shield Health Savings Plan, these will be subject to the deductible and co-insurance.

UCLA was the first UC academic campus to go tobacco free, kicking off the new policy on Earth Day, April 22. Banners and signs declaring UCLA tobacco free pepper the campus. Wallet-size informational cards are given to smokers to remind them of the policy and available resources to help them quit.

Because the medical center sits inside the academic campus boundaries, UCLA sees a large number of new visitors every day – a challenge when it comes to keeping people educated about the new policy.

Nevertheless, Michael Ong, co-chair of UCLA’s Tobacco-Free Task Force, said there’s been a noticeable decline in smoking around campus, and a survey of cigarette butts collected in hot-spot areas indicates that people are following the new policy. The Institute of the Environment and Sustainability, which conducted biweekly counts before and after the policy was implemented, found that the number of butts in hot-spot areas dropped from an average of 600 to 160.

While smoking has declined, Ong said that reaching 100 percent compliance with the new policy will take time. Tobacco users may struggle with stopping tobacco use on campus or quitting smoking due to nicotine’s addictive qualities. Ong said the task force is working on reinforcing for these continuing users how to comply with the new policy and resources that can help with cessation.

“Nicotine addiction makes quitting smoking very difficult,” said Linda Sarna, chair of UCLA’s task force and a professor of nursing who has studied nurses’ involvement in helping people quit. “There are still lots of misconceptions about quitting by going ‘cold turkey.’”

Studies find low success rates for those who try to quit smoking without support or the medications that relieve withdrawal symptoms, she said. Only three to five out of 100 people will still be smoke-free a year after going cold turkey, studies show, and it often takes five to six attempts before people are able to fully quit.

The campus has partnered with Los Angeles County Department of Public Health to offer a free two-week supply of nicotine patches to faculty, staff and students who want to quit. This is in addition to the resources available through UC-sponsored medical plans.

More than 1,100 other colleges and universities across the country have banned smoking on their campuses, including in residence halls.

More information
Read about UC’s Smoke and Tobacco Free Policy, including facts and frequently asked questions.

For those who want help quitting, resources include:

Katherine Tam is a communications coordinator in Internal Communications at UC’s Office of the President.

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Aging Baby Boomers, higher health care costs to impact long-term care

UC Berkeley study finds that costs could nearly double over next decade.

William Dow, UC Berkeley

William Dow, UC Berkeley

UC Berkeley School of Public Health researchers state in a new study that an unprecedented increase in seniors over the next decade could nearly double Medi-Cal long-term care costs, from $6.6 billion to $12.4 billion annually by 2023.

“This long-anticipated increase in seniors will impact Medi-Cal long-term care costs,” said lead researcher William Dow, professor of health economics and head of the School’s Health Policy and Management division, which released the socioeconomic analysis. “The huge baby boomer generation is now retiring. Over the next 10 years, California will experience a 44 percent increase in seniors, jumping from 4.8 million today to 6.9 million by 2023.”

An 88 percent increase in public expenditures for institutional long-term care is projected over the next decade. Since nearly 90 percent of long-term care is provided by family and friends, the growing demands not only impact state coffers, but family caregivers as well. Family caregivers, the study says, report higher levels of mental and physical health problems and are generally uncompensated for their services. For their employers, the demands of caregiving also hurt productivity and increase absenteeism.

“The burdens on family caregivers are enormous,” explained Brenda Bufford, chief of the state of California’s Partnership for Long-Term Care, which funded the study. “This research highlights those challenges, which are especially pressing when you realize that 70 percent of seniors will need long-term care.”

The study concluded that Californians should strongly consider planning ahead to ensure they live their later years with quality and dignity. At some point, they may require in-home or nursing home assistance with basic, daily functions that are often taken for granted. Without proper planning, paying for long-term care can be a devastating financial burden.

California Partnership for Long-Term Care is a consumer education program of the California Department of Health Care Services. Californians can log onto the Partnership for Long-Term Care website, which offers a free planning tools and access to long-term care insurance policies.

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