California’s health care costs, cigarette sales drop dramatically over 20 years.

The California Department of Public Health ran this billboard ad, titled "Chemo," in 1999 as part of its statewide tobacco control program.

Over a span of nearly 20 years, California’s tobacco control program cost $2.4 billion and reduced health care costs by $134 billion, according to a new study by UC San Francisco.

Additionally, the study — covering the beginning of the program in 1989 to 2008 — found that the state program helped lead to some 6.8 billion fewer packs of cigarettes being sold that would have been worth $28.5 billion in sales to cigarette companies.

The study grew out of a special policy initiative by the Tobacco-Related Disease Research Program (TRDRP) at the UC Office of the President. Responding to the needs of the California’s tobacco control community, TRDRP in 2008 convened a statewide board that identified a chief priority: Conduct research to show that the California’s Tobacco Control Program was not only saving lives, but also saving the state money.

James Lightwood, UC San Francisco

The UCSF study was designed to calculate the fiscal impact of California’s large public health program on smoking prevalence and cigarette consumption. The new research shows that tobacco control funding is directly tied to reductions in both the prevalence of smoking and cigarette consumption per smoker — and generates significant savings in overall health care expenditures.

“These health care cost savings began to appear almost immediately after the program started and have grown over time, reaching more than $25 billion a year in 2008,” said first author James Lightwood, a UCSF associate professor of clinical pharmacy.

The study was published today (Feb. 13) in the journal PLOS ONE.

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Calls for new measures to enable world’s children to thrive, not merely survive.

A new report launched today by the UCLA World Policy Analysis Center presents never-before-available comparative data on nearly every country in the world, revealing how millions of children across the globe face conditions that limit their opportunities to thrive and reach their full potential. Dr. Jody Heymann, dean of the UCLA Jonathan and Karin Fielding School of Public Health, co-authored the study.

“Changing Children’s Chances” provides a thorough analysis of the laws and public policies of 191 countries covering the areas of poverty, discrimination, education, health, child labor, child marriage and parental care.

Governments in both developed and developing countries are not taking widely agreed-upon steps in critical areas known to make a difference to children’s opportunities, said Heymann.

This new research, she says, aims to focus global attention on these issues to ensure that existing policies governing child welfare are fully implemented and that new measures are introduced that will enable children’s full and healthy development.

The report includes unique full-color world maps and tables offering insights into global policies on a range of topics, including how long girls are protected from marrying, compared with boys; which countries charge tuition fees for secondary education; which countries guarantee paid leave for new mothers and fathers; and which offer inclusive education to children with disabilities.

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UCSF study looks at impact of salty foods on heart attack and stroke rates over 10 years.

Pam Coxson, UC San Francisco

Hundreds of thousands of lives could be saved over 10 years if Americans reduced their sodium consumption to the levels recommended in federal guidelines, according to a new study by researchers at UC San Francisco, Harvard Medical School and Simon Fraser University in Canada.

Described this week in the journal Hypertension, the study emerged from a workshop convened last year by the U.S. Centers for Disease Control and Prevention (CDC), which sought to quantify the health benefits of population-wide sodium reduction.

The CDC brought together groups of scientists from the three universities, who each used completely different computer models to estimate how lowering sodium would save lives – largely by reducing the number of heart attacks and strokes. All three models found consistent, substantial benefits of reducing U.S. sodium consumption from the current level of intake to a level close to the upper limit of the federal guideline of 2,300 mg/day in the following ways:

• Immediately reducing sodium intake to the current upper limit of the guidelines would save 500,000 to 850,000 lives over the next 10 years.
• Gradually reducing sodium intake through processed or restaurant-prepared foods by 4 percent per year over 10 years would still yield substantial health benefits, saving 280,000 to 500,000 lives over a decade.

“No matter how we look at it, the story is the same – there will be huge benefits in reducing sodium,” said Pam Coxson, Ph.D., a UCSF mathematician and the lead author on the paper who performed one of the three analyses. Coxson is based at the UCSF Center for Vulnerable Populations, located at the San Francisco General Hospital and Trauma Center (SFGH).

The overall average sodium consumption in the United States has been estimated at 3,500 mg/day, well above the upper limit of 2,300 mg recommended by federal agencies and the Institute of Medicine. The average American male consumes even more – about twice as much sodium as recommended.

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UCLA research results not encouraging.

Past studies have suggested a relationship between neighborhood characteristics and obesity, as well as a connection between obesity and advertisements on television and in magazines.

Now, new research from UCLA has identified a possible link between outdoor food ads and a tendency to pack on pounds. The findings, researchers say, are not encouraging.

In a study published online in the peer-reviewed journal BMC Public Health, Dr. Lenard Lesser and his colleagues suggest that the more outdoor advertisements promoting fast food and soft drinks there are in a given census tract, the higher the likelihood that the area’s residents are overweight.

“Obesity is a significant health problem, so we need to know the factors that contribute to the overeating of processed food,” said Lesser, who conducted the research while a Robert Wood Johnson Foundation Clinical Scholar at the UCLA Department of Family Medicine and UCLA’s Fielding School of Public Health.

“Previous research has found that fast food ads are more prevalent in low-income, minority areas, and laboratory studies have shown that marketing gets people to eat more,” said Lesser, now a research physician at the Palo Alto Medical Foundation Research Institute in California. “This is one of the first studies to suggest an association between outdoor advertising and obesity.”

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Later detection poses greater health risks.

One out of every four people living with HIV/AIDS is 50 or older, yet these older individuals are far more likely to be diagnosed when they are already in the later stages of infection. Such late diagnoses put their health, and the health of others, at greater risk than would have been the case with earlier detection.

According to the Centers for Disease Control and Prevention, 43 percent of HIV-positive people between the ages of 50 and 55, and 51 percent of those 65 or older, develop full-blown AIDS within a year of their diagnosis, and these older adults account for 35 percent of all AIDS-related deaths. And since many of them are not aware that they have HIV, they could be unknowingly infecting others.

Various psychological barriers may be keeping this older at-risk population from getting tested. Among them are a general mistrust of the government — for example, the belief that the government is run by a few big interests looking out for themselves — and AIDS-related conspiracy theories, including, for example, the belief that the virus is man-made and was created to kill certain groups of people.

Now, a team of UCLA-led researchers has demonstrated that government mistrust and conspiracy fears are deeply ingrained in this vulnerable group and that these concerns often — but in one surprising twist, not always — deter these individuals from getting tested for HIV. The findings are published today (Jan. 29) in the peer-reviewed journal The Gerontologist.

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Leading gun-policy experts offer recommendations.

Garen Wintemute, UC Davis

Research by Garen Wintemute, director of the Violence Prevention Research Program and professor of emergency medicine at UC Davis, forms the basis for several recommendations put forward earlier this month at the summit on Reducing Gun Violence in America, an event organized by the Johns Hopkins University’s Bloomberg School of Public Health that brought together 20 of the world’s leading gun-policy experts representing the fields of law, medicine, public health, advocacy and public safety to summarize relevant research and its implications for policymakers and concerned citizens.

Wintemute presented the results of his leading-edge studies at the summit and consulted on the group’s collective recommendations to inform the policy debate and help lawmakers and opinion leaders reduce gun violence in the U.S. His presentations on “Broadening denial criteria for the purchase and possession of firearms” and “Comprehensive background checks for firearm sales: Evidence from guns shows” are featured in the book “Reducing Gun Violence in America: Informing Policy with Evidence and Analysis.”

Published by Johns Hopkins University Press, the book includes summit presentations by legal scholars who weighed in on the constitutionality of recommended policies and other researchers who provided new data on public support for a wide array of policies designed to reduce gun violence.

“Research clearly shows that it is possible to change policies to reduce gun violence without violating constitutional rights,” Wintemute said. “We know a violent criminal history increases the risk for future firearm violence and crime and that denying gun purchases to this high-risk population is both feasible and effective. Yet few states have policies expanding denial criteria to include persons convicted of any violent misdemeanor crimes, such as assault and battery and brandishing a firearm.

“We also know that alcohol abuse is a major risk factor for firearm-related violence of all types, yet there are no policies in place that deny individuals with a history of abuse from purchasing or possessing a firearm.The recommendations from the summit address these and other shortcomings in federal policy, including the need forcomprehensive background checks for all firearms sales, especially private-party sales, a leading source of guns among those who are prohibited from owning them legally.”

Wintemute’s investigations have produced a uniquely rich and informative body of research on firearms violence that directly improves the health and safety of Americans and that has positioned California as a national leader in efforts to break the cycle of gun violence.

Wintemute’s studies have shown that In California, where policies denying firearm purchases to persons convicted of all violent misdemeanors have existed since 1999, criminal convictions account for 80 to 90 percent of denials, and convictions for violent crimes account for 40 to 55 percent of denials. His work has found that alcohol abuse is a risk factor for crime, and that the prevalence of excessive drinking is increased among firearm owners along with other behaviors that increase the risk for violence. And his landmark work on private-party gun sales has demonstrated the need for comprehensive background checks for all gun sales nationwide.

“Such changes won’t end firearm violence, but they will reduce it, and that is a goal worth fighting for,” he said.

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Wellness Letter: Chronic arsenic exposure from rice, other foods poses long-term health risks.

Arsenic, a naturally occurring element and industrial byproduct, poses a significant health risk to millions of people worldwide when it leaches into drinking water. It’s highly poisonous at high doses, but chronic exposure to lower levels increases the risk of bladder, lung and skin cancer, as well as infertility and possibly diabetes, heart disease and other conditions.

Though this is often thought of as a major problem only in developing countries, such as Bangladesh, the U.S. has arsenic problems of its own. In fact, it’s estimated that over two million Americans drink water from private wells that have high arsenic concentrations. This past year, arsenic made headlines on several occasions for its presence in rice and other foods, too.

Against the grain

In September, Consumer Reports released results of its analysis of 223 rice samples, which included white and brown, organic and conventionally grown, domestic and imported, and brand-name and store-brand rices. It also tested rice-based products, such as rice cereals, beverages, pasta, flour, and crackers. Virtually all were found to contain both inorganic arsenic (a known human carcinogen) and organic arsenic (considered less harmful but still of concern) — many at “worrisome levels.” In this context, the term “organic” refers to the element’s chemistry, not whether the food was grown organically.

There were wide variations in the findings — after all, there are many different kinds of rice grown all over the world and under different conditions. But some trends emerged: White rice from Arkansas, Louisiana, Missouri and Texas (where most U.S. rice comes from) had more total and inorganic arsenic than rice grown elsewhere (including California, India and Thailand). And within the same brands, brown rice had more arsenic than white rice (some arsenic is removed when the grain’s outer layer is stripped during processing to make white rice). Preliminary results from an FDA analysis of 200 rice products, also released in September, were consistent with those of Consumer Reports; results from about a thousand more samples are due out shortly.

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UCLA study shows links to more immediate health problems than previously thought.

Neal Halfon, UCLA

While a great deal of research on childhood obesity has spotlighted the long-term health problems that emerge in adulthood, a new UCLA study focuses on the condition’s immediate consequences and shows that obese youngsters are at far greater risk than had been supposed.

Compared to kids who are not overweight, obese children are at nearly twice the risk of having three or more reported medical, mental or developmental conditions, the UCLA researchers found. Overweight children had a 1.3 times higher risk.

“This study paints a comprehensive picture of childhood obesity, and we were surprised to see just how many conditions were associated with childhood obesity,” said lead author Dr. Neal Halfon, a professor of pediatrics, public health and public policy at UCLA, where he directs the Center for Healthier Children, Families and Communities. “The findings should serve as a wake-up call to physicians, parents and teachers, who should be better informed of the risk for other health conditions associated with childhood obesity so that they can target interventions that can result in better health outcomes.”

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New research condemning fructose consumption no surprise to UCSF’s Robert Lustig.

Robert Lustig, UC San Francisco

Fructose, a sugar much maligned in recent years, recently took another hit when a preliminary study by Yale University found that it might stimulate appetite more than other sugar types. The results came as no surprise to Robert Lustig, M.D., a pediatric endocrinologist at the UC San Francisco Benioff Children’s Hospital who’s made headlines for years with his public health crusade against excess sugar consumption.

In the Jan. 2 study published in the Journal of the American Medical Association (JAMA), researchers used magnetic resonance imaging (MRI) techniques to demonstrate that ingested fructose affects blood flow differently than glucose in the brainregions associated with feeding behavior, including the hippocampus and the striatum. The Yale researchers concluded that fructose consumption might be more likely to stimulate rather than curb appetite, similar to what was found in earlier animal research.

In fact, on average, the 20 normal-weight, young adults who participated in the study reported that hunger was sated by glucose, but not by fructose, although the study does not demonstrate that fructose causes obesity.

At UCSF, where many researchers and physicians are trying to understand obesity and its causes, Lustig stands out for his concern over the physiological effects of sugar consumption. He’s also a strong advocate of policy changes that would lessen what he believes are sugar’s contribution to the obesity epidemic in the United States.

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Reproductive specialist Jeanne Conry acknowledged as environmental health champion.

EPA Administrator Lisa Jackson and Southwest Regional Administrator Jared Blumenfeld with Jeanne Conry, UC Davis (center)

Jeanne Conry, associate clinical professor in the Department of Obstetrics and Gynecology and an alumna of the UC Davis School of Medicine, was honored by U.S. Environmental Protection Agency (EPA) Administrator Lisa Jackson as an environmental health champion for her national leadership to advance understanding of the risk to reproductive health of exposures to environmental toxins.

Conry was presented with the 2012 Children’s Environmental Health Champion Award for the Pacific Southwest Region during a ceremony in San Francisco. She was lauded for her extensive efforts to promote better health for babies and women by preventing harmful chemical exposures during pregnancy. She was further acknowledged with a lecture before medical students and health professionals at UC San Francisco on “Reproductive Health and the Environment: Well Women Care and Preconception Health on the National Agenda.” Administrator Jackson and Southwest Regional Administrator Jared Blumenfeld also delivered remarks.

“I am deeply honored to accept this award from the Environmental Protection Agency,” Conry said. “It has become clear that environmental exposures have the potential to seriously impact the health of women and the health of future generations. As physicians, we are in a unique role, advising our patients, sharing information with colleagues and advocating for changes that ultimately improve the quality of care.”

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Audio “interview” preferred to face-to-face interview.

Pamina Gorbach, UCLA

With nearly 23 million people across the African continent living with HIV/AIDS, public health experts across the globe are working feverishly to stem the epidemic. Among them is UCLA’s Pamina M. Gorbach, a behavioral epidemiologist whose research recently took her to Malawi, where 10 percent of the population lives with HIV/AIDS, the leading cause of death in that country.

As part of a study of the effectiveness of new HIV-prevention medications, called microbicides, Gorbach, a professor in the Department of Epidemiology at the UCLA Fielding School of Public Health as well as the Division of Infectious Diseases at the David Geffen School of Medicine, explored the use of a new high-tech approach to interviewing the study’s 585 women research subjects. The study, which was reported in the journal AIDS and Behavior, used Audio Computer-Assisted Self-Interviewing (ACASI), a technology developed by epidemiologists in the U.S. Population Council, which conducts biomedical, social science and public health research, to obtain information on sensitive subjects like sexual behavior and drug use.

Gorbach and her research team found that the women in the Malawi study reported that they preferred to do an audio “interview” with a handheld ACASI device compared to a face-to-face interview. Particularly significant to researchers, the participants were likely to give more honest and accurate responses in a computer-assisted interview than when asked the same questions face-to-face by a human interviewer.

Perhaps these results aren’t so surprising, given such deeply personal interview questions as “In the past three months, how many sex partners have you had?,” “Have you had anal sex?” and “The last time you had vaginal sex, did you use study gel [the experimental microbicide] or a condom?” While questions like these must be asked to enable a better understanding of HIV/AIDS transmission and prevention, Gorbach said that “sensitive or “socially undesirable” sexual behaviors are known to be underreported, while socially desirable behaviors such as adherence to taking medication or using condoms tend to be overreported. The ACASI interviews in Malawi, conversely, produced higher reports of sexual behaviors and lower reports of adherence — results that, Gorbach noted, “support the assumption that [computer-assisted interviews] can improve the accuracy of the data.”

Enhancing the user-friendliness of this approach, the audio devices were programmed to ask the interview questions in the local Chichewa language — one of 21 languages and dialects in which the software can be programmed. The devices also incorporated images to improve comprehension for women with low literacy levels.

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Risk higher for women and younger workers, UC Davis study finds.

J. Paul Leigh, UC Davis

Workers earning the lowest wages have a higher risk of hypertension than workers with the highest wages, according to new research from UC Davis.

The correlation between wages and hypertension was especially strong among women and persons between the ages of 25 to 44.

“We were surprised that low wages were such a strong risk factor for two populations not typically associated with hypertension, which is more often linked with being older and male,” said J. Paul Leigh, senior author of the study and professor of public health sciences at UC Davis. “Our outcome shows that women and younger employees working at the lowest pay scales should be screened regularly for hypertension as well.”

The study, published in the December issue of the European Journal of Public Health, is believed to be the first to isolate the role of wages in hypertension, which occurs when the force of circulating blood against artery walls is too high. According to the Centers for Disease Control and Prevention, hypertension affects approximately 1 in 3 adults in the U.S. and costs more than $90 billion each year in health care services, medications and missed work days. It also is a major contributor to heart disease and stroke, both of which are leading causes of death and disability.

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