TAG: "Public health"

Study to examine social adversity, early puberty, risk-taking by teens


Researchers will work with a group of more than 600 youth and their parents in Salinas.

How does social adversity affect the timing of puberty? How do social adversity and early puberty influence risk-taking behavior in teens?

Julianna Deardorff, assistant professor in the UC Berkeley School of Public Health’s Maternal and Child Health program, recently received a $2.5 million grant from the National Institutes of Health to find out.

Deardorff and her team (which will include an M.P.H. student and a postdoctoral fellow) will work with a group of more than 600 youth and their parents in Salinas. The research will include analyzing pubertal hormones, stress hormones and cultural factors that may exacerbate or protect against the negative effects of stressful circumstances.

“My goal has always been to understand how stress gets under the skin and can lead potentially to earlier and faster puberty and to sexual risk-taking behaviors in Latino youth who are growing up in adverse circumstances,” says Deardorff, who will start working with this migrant farming community in April.

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Study: E-cigarettes a gateway to nicotine addiction for U.S. teens


First national analysis strongly associates e-cigarettes with smoking for many adolescents.

Lauren Dutra, UC San Francisco

E-cigarettes, promoted as a way to quit regular cigarettes, may actually be a new route to conventional smoking and nicotine addiction for teenagers, according to a new UC San Francisco study.

In the first analysis of the relationship between e-cigarette use and smoking among adolescents in the United States, UCSF researchers found that adolescents who used the devices were more likely to smoke cigarettes and less likely to quit smoking. The study of nearly 40,000 youth around the country also found that e-cigarette use among middle and high school students doubled between 2011 and 2012, from 3.1 percent to 6.5 percent.

“Despite claims that e-cigarettes are helping people quit smoking, we found that e-cigarettes were associated with more, not less, cigarette smoking among adolescents,” said lead author Lauren Dutra, a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education.

“E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco,” she said.

The study was published online today (March 6) in JAMA Pediatrics.

E-cigarettes are battery-powered devices that look like cigarettes and deliver an aerosol of nicotine and other chemicals. Promoted as safer alternatives to cigarettes and smoking cessation aids, the devices are rapidly gaining popularity among adults and youth in the U.S. and around the world. Unregulated by the U.S. Food and Drug Administration, e-cigarettes have been widely promoted by their manufacturers as a way for people to quit smoking conventional cigarettes. They are sold in flavors such as chocolate and strawberry that are banned in conventional cigarettes because of their appeal to youth.

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Indian company licenses Berkeley Lab invention for arsenic-free water


Technology could help save millions of lives in India and Bangladesh.

When Lawrence Berkeley National Laboratory (Berkeley Lab) scientist Ashok Gadgil set out to solve an insidious public health problem afflicting South Asia, arsenic contamination of groundwater, he knew the hard part would not just be inventing the technology but also ensuring a way to sustain its long-term use on a large scale.

“A lot of technologies to remove arsenic on the community- and household- scale have been donated. But if you go to these villages it’s like a technology graveyard,” said Gadgil, who heads the Lab’s Environmental Energy Technologies Division and is also a professor of civil and environmental engineering at UC Berkeley. “One study found that more than 90 percent failed within six months, and then were abandoned to rust in the field.”

So Gadgil and his lab came up with ECAR, Electrochemical Arsenic Remediation, which binds arsenic using iron dissolved in water. Their innovation was twofold. They created a technology that is exceptionally effective, inexpensive and easy to maintain. And just as importantly, from the start they conceptualized a business model for implementing the technology in a way that creates incentives for its longevity.  Now Indian company Luminous Water Technologies has licensed ECAR and plans to bring it to arsenic-affected villages throughout India and Bangladesh.

“Technology alone is not enough. It has to fit within a sustainable system based on partnerships with local entities,” said Susan Amrose, who has worked on ECAR since 2008 as the lead project scientist in Gadgil’s lab. “Other technologies have failed because there is no system of incentives or money or knowledge to keep them running. The key difference with ECAR is that it was designed to fit within a local system aimed at achieving successful social placement — so a flow of funds pays for ongoing operation, maintenance and social marketing, without turning it into privatized water.”

Arsenic-contaminated groundwater can be found all over the world, including in the United States, but the problem is particularly acute in South Asia, where tens of millions of people in India and Bangladesh get their drinking water from tube wells highly contaminated with arsenic, almost all of it occurring naturally. Arsenic poisoning, or arsenicosis, can cause painful lesions, diabetes, cancer and blood vessel diseases that often lead to gangrene, amputation and premature death.

Amrose has seen the devastation first-hand in her travels to affected villages. “Over time you’ll see people get worse and worse,” she said. “There was one man who in 2009 had lost his right pinkie finger by amputation due to arsenic. In 2011 he lost his right hand, and in 2013 lost his entire arm. Earlier this year he committed suicide. In some areas, you’ll see a lot of people with black spots on their palms, an external sign of arsenicosis. And a lot of things you won’t see. People will be linked with arsenic and ostracized, or young people unable to marry because their family lives in an area that has arsenic.”

One of the aims of Gadgil’s lab is to reduce the time lag between invention and commercialization from 18 years, the current norm, to 10 years. “We’re actually quite on target with ECAR,” Amrose said.

They started work on the concept in 2005. They’re now preparing a 10,000 liter-per-day trial over 15 months. “As we get to larger-scale field trials we’re intent on conducting them with our field partners,” Amrose said. “By working on a common goal, we get to effectively transfer the technology know-how, while they guide us towards what needs to be done to effectively scale up.”

Luminous Water Technologies was founded by an Indian serial entrepreneur, Rakesh Malhotra, with the aim of providing clean drinking water and commercializing new technologies in the drinking water market. Luminous’ current focus is on reverse osmosis systems, and they were looking to diversify in other water technologies when they identified ECAR for licensing.

“Arsenic poisoning is an endemic problem in India and Bangladesh and is seen as a silent killer,” said Luminous Managing Director RS Rajan. “It is Dr. Gadgil’s conviction and perseverance which has been a key motivating factor in Luminous opting for this technology. Luminous Water, with its reach across India and longstanding business record, will work towards commercializing this technology along with Berkeley Lab and create a sustainable module to provide solutions to impacted communities.”

ECAR works by using electricity to quickly dissolve iron in water. This forms a type of rust that readily binds to arsenic; the rust can then be separated from the water through filtration or settling. For the remaining waste Gadgil’s lab is now working on partnerships with cement and concrete companies to do research on embedding the sludge in concrete.

“We find in early tests that it’s very well stabilized, and the arsenic is not getting back into the environment,” Amrose said. “We expect and hope this form of sludge management will be viable and pass environmental approvals for market scale-up. Until then Luminous will dispose of the waste according to prevailing pollution control guidelines.”

ECAR is envisaged to operate as a village-owned micro utility in the villages where it is installed. Luminous would operate and maintain the utility and sell the water, with concurrent support for social marketing and education.

Last year ECAR was awarded a UC Proof of Concept Program Commercialization Gap Grant to see if it could be used to remediate arsenic-contaminated groundwater in California. Rural communities in California are often too poor to afford commonly available arsenic remediation techniques, and most techniques are only cost effective on larger scales, such as the city water supply system. As a result, many California residents drink water with dangerous levels of arsenic every day. The burden falls disproportionately on minorities and residents of lower socioeconomic status, particularly migrant farming communities and Native American communities.

ECAR has yet to be proven in California groundwater, which is known to contain a different composition of interfering ions from that in South Asia. This grant funds a proof-of-concept demonstration of ECAR in California to reduce entry risk for potential licensees.

The ECAR effort was initiated at Berkeley Lab with internal seed funds (from Laboratory Directed Research and Development funding) in 2005. It is being further developed in part with funding from the Development Impact Lab at UC Berkeley. ECAR technology is available for licensing in the United States. For more on Gadgil’s arsenic removal research visit arsenic.lbl.gov.

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Acetaminophen use during pregnancy linked to ADHD in children


UCLA study raises concerns about use of acetaminophen during pregnancy.

Beate Ritz, UCLA

Acetaminophen, found in over-the-counter products such as Excedrin and Tylenol, provides many people with relief from headaches and sore muscles. When used appropriately, it is considered mostly harmless. Over recent decades, the drug, which has been marketed since the 1950s, has become the medication most commonly used by pregnant women for fevers and pain.

Now, a long-term study by UCLA, in collaboration with the University of Aarhus in Denmark, has raised concerns about the use of acetaminophen during pregnancy.

In a report in the current online edition of JAMA Pediatrics, researchers from the UCLA Fielding School of Public Health show that taking acetaminophen during pregnancy is associated with a higher risk in children of attention-deficit/hyperactivity disorder and hyperkinetic disorder. The data raises the question of whether the drug should be considered safe for use by pregnant women.

ADHD, one of the most common neurobehavioral disorders worldwide, is characterized by inattention, hyperactivity, increased impulsivity, and motivational and emotional dysregulation. Hyperkinetic disorder is a particularly severe form of ADHD.

“The causes of ADHD and hyperkinetic disorder are not well understood, but both environmental and genetic factors clearly contribute,” said Dr. Beate Ritz, professor and chair of the department of epidemiology at the Fielding School and one of the senior authors of the paper. “We know there has been a rapid increase in childhood neurodevelopmental disorders, including ADHD, over the past decades, and it’s likely that the rise is not solely attributable to better diagnoses or parental awareness. It’s likely there are environmental components as well.”

“That gave us the motivation to search for environmental causes that are avoidable,” said the University of Aarhus’ Dr. Jørn Olsen, another senior author and former chair of the UCLA Fielding School’s epidemiology department. “Part of the neuropathology may already be present at birth, making exposures during pregnancy and/or infancy of particular interest. Because acetaminophen is the most commonly used medication for pain and fever during pregnancy, it was something we thought we should look at.”

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Using formula in hospitals deters breastfeeding


Mothers who planned to breastfeed did so far less when their babies received formula.

Caroline Chantry, UC Davis

When mothers feed their newborns formula in the hospital, they are less likely to fully breastfeed their babies in the second month of life and more likely to quit breastfeeding early, even if they had hoped to breastfeed longer, UC Davis researchers have found.

“We are a step closer to showing that giving formula in the hospital can cause problems by reducing how much women breastfeed later,” says Caroline Chantry, lead author and professor of clinical pediatrics at UC Davis Medical Center. “Despite being highly motivated to breastfeed their babies, in-hospital formula use limits this important practice. Given the benefits of breastfeeding for both mother and baby, this is a public health issue.”

“In-Hospital Formula Use Shortens Breastfeeding Duration” was published online in The Journal of Pediatrics today (Feb. 14). The study only included women who intended to exclusively breastfeed their babies for at least a week, meaning they did not plan to use formula in the hospital.

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Study connects smoke-free laws, dentists’ advice to quit


Smoke-free laws can help influence behavior and attitudes.

Cigarette buttsSmoke-free laws may help encourage dentists to recommend that their patients kick the smoking habit, according to new research co-authored by UC Merced professsor Mariaelena Gonzalez.

The paper, published in the American Journal of Public Health, suggests the societal change manifested by smoke-free laws can contribute to an atmosphere in which dentists pay more attention to patients’ smoking habits.

“Smoke-free laws can have strong effects – and not just on stopping individual-level behavior,” said Gonzalez, whose research focuses on tobacco control. “These laws can influence other behavior and attitudes, as our study shows with dentists. They can have a huge effect on people’s preferences, such as a preference for clean indoor air. Even smokers like clean indoor air.”

Gonzalez co-authored the study “Association of Strong Smoke-Free Laws with Dentists’ Advice to Quit Smoking, 2006-2007,” with Stanton A. Glantz, a professor of medicine at UC San Francisco, and Ashley Sanders-Jackson, a postdoctoral fellow at Stanford University. All three have been associated with the UCSF-based Center for Tobacco Control Research and Education, where Glantz is the director.

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In denial: Some who smoke say they’re not ‘smokers’


Why some “non-identifying smokers” face risks while denying the behavior.

While smoking among California adults has dramatically declined in recent decades, researchers at the UC San Diego School of Medicine report there is a surprisingly large number of people who say they use cigarettes, but don’t consider themselves to be “smokers.”

Writing in the Feb. 5 online issue of Tobacco Control, 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, and colleagues estimate that in 2011 almost 396,000 Californians (12.3 percent of the state’s population of smokers) smoked on a measurable basis, but rejected the characterization of “smoker.”

Almost 22 percent of these smokers consumed tobacco on a daily basis.

Al-Delaimy said the phenomenon has both individual and social ramifications. For individuals, the behavior puts them at many of the same health risks as identified smokers. “There is no safe level of smoking,” he said.

More broadly, non-identification of “non-identifying smokers” or NIS may be negatively impacting efforts to reduce tobacco consumption by overlooking a significant segment of the affected population, the researchers said. This is especially true at the clinical setting where physicians might ask patients if they smoke and patient fail to identify themselves as smokers.

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Home makeovers for health


UCLA public health experts part of effort to help at-risk families in East L.A.

During a home visit, registered dietitian Brenda Robles talks to a study participant about healthy food choices. Promotora Rosalba Cain (middle) is part of the study team.

Home is where more than just the heart is — it’s where the risk of obesity-related conditions such as diabetes and heart disease lurks.

It’s where countless people spend hours sitting on the sofa watching television instead of being physically active. And it’s where they will reach for conveniently packaged processed foods rather than spend the time and energy preparing a healthier meal from scratch.

To help residents change their home environment and reduce these risks, a group of public health experts from the Fielding School of Public Health led by professor William McCarthy, in partnership with researchers at USC and leaders from the East Los Angeles community, has devised a hands-on strategy that goes far beyond merely sitting down with residents to advise them about their diet and the benefits of physical activity.

With the cooperation of residents, they are going into the homes of at-risk families in East Los Angeles to work together to transform their living environment. Call it a home makeover for health.

For the population of East Los Angeles, which is overwhelmingly Mexican American, the risk of obesity-related conditions such as diabetes and heart disease is markedly higher than for most other populations. So community health workers and a registered dietitian with the Cardiovascular Disease Risk Reduction Study are working one-on-one with families to change the “choice architecture” of their homes.

With the permission of residents, they will move the healthiest foods to the front of the family’s refrigerator and pantry. They will confine the television to parts of the home where it’s less likely to be used during meal times. And they will strategically place athletic shoes and exercise equipment so that they are accessible and in plain sight — and thus never out of mind.

It’s an approach that takes its cue from the field of behavioral economics, which says that people’s moment-to-moment choices are heavily influenced by what’s immediately in front of them.

“Our goal is to create a home and neighborhood environment where the healthier option becomes the easy choice, and the less healthy option becomes the more difficult choice,” McCarthy explained.

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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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