Using information on whether consumers read food labels the first time they buy a product, the research finds that people who observe the labels and do not exercise display a slightly greater likelihood of weight loss than those who do exercise but do not pay attention to food labels. By simply adding an exercise routine to their lifestyle regular food label readers can increase their changes of losing weight. Women between the ages of 37-50 years are more likely to read food labels than men, and are therefore more likely to lose weight.”

Previous research has focused on food marketing and behavior but has not followed related weight loss over time in this middle-aged demographic group. The data for this study was taken from a National Longitudinal Survey of Youth compiled from 2002-2006. The survey began in 1979 with over 12,000 male and female participants born in the years 1957-1964.

Over fifty percent of participants reported that they were trying to lose or control weight. Of these participants, almost seventy percent were obese or overweight. Almost fifty percent were actively reading food labels on their first time purchase and slightly more than twenty-five percent were actively participating in vigorous exercise. Overall, older individuals are less likely to lose weight by reading food labels, and general participation in vigorous exercise drops off after age forty-five.

Additionally, the Nutrition Labeling and Education Act (NLEA), enacted in 1994, requires all food manufactures to present essential nutrient and ingredient information on food packages. According to the recently-passed health care reform bill there will be easier access to nutritional information at restaurants, retail food establishments, and vending machines. Combined with these new findings, it is likely that this measure will be useful to those who want to lose weight and read food labels to make well-informed decision regarding their diets in and outside their homes.

Weight loss programs and plans would do well in augmenting their client’s weight loss goals with the recommended use of food labels, in order to maintain a healthy weight. This is particularly important as people enter middle age and are at a risk for heart disease, obesity-related diabetes, cancer and dementia.

Material adapted from Wiley-Blackwell.

Reference
“Use of Food Labels as a Weight Loss Behavior.” Bidisha Mandal. Journal of Consumer Affairs; Published Online: September 8, 2010 (DOI: 10.1111/j.1745-6606.2010.01181.x)

“We tend to think of adolescence as the time when kids become sensitive about their body image, but our findings suggest that the seeds of body dissatisfaction are actually being sown much earlier,” said Timothy D. Nelson, assistant professor of psychology at the University of Nebraska-Lincoln and the study’s lead author. “Criticism of weight, in particular, can contribute to issues that go beyond general problems with self-esteem.”

For the study, Nelson and his colleagues surveyed hundreds of public school students whose average age was 10.8 years. They collected participants’ heights and weights and calculated their Body Mass Index, then examined the relationships between weight-related criticism and children’s perceptions of themselves.

Their results showed that overweight pre-teens who endured weight-based criticism tended to judge their bodies more harshly and were less satisfied with their body sizes than students who weren’t teased about their weight.

The effects of weight-based teasing were significant even when researchers removed the effects of students’ BMI from their analysis in an attempt to separate the relative contributions of physical reality and children’s social interactions to their body perceptions, Nelson said.

Because children who develop such negative views of their bodies are at higher risk for internalizing problems, developing irregular eating behaviors and ongoing victimization, researchers said these results should be a signal for more early identification and intervention efforts at schools.

“In a way, weight-related criticism is one of the last socially acceptable forms of criticism,” Nelson said. “There’s often a sense that overweight people ‘deserve’ it, or that if they are continually prodded about their weight, they’ll do something about it.

“In fact, our research suggests that this kind of criticism tends to increase the victim’s body dissatisfaction, which has been shown to be a factor in poorer outcomes with pediatric weight management programs. It becomes something of a vicious cycle.”

The study notes that children’s views of their bodies are a complex interaction between physical reality and socially influenced perceptions. Peer criticism about weight is an important social factor that could affect how pre-adolescents interpret the physical reality of their bodies, Nelson said.

The findings, Nelson said, should be relevant to understanding the consequences of weight-related criticism and considering interventions with preadolescents who are frequent targets of the taunts.

“While weight-related criticism is identifiable, programs targeting it are limited,” he said. “Early identification of children who are targets of frequent and chronic weight-based criticism may also be important in reducing it and its harmful effects.”

Material adapted from University of Nebraska-Lincoln.

In the early 2000s, low-carbohydrate claims gained huge popularity in response to such books as Dr. Atkin’s New Diet Revolution and The South Beach Diet. In a study published in AC Nielsen Consumer Insights, it was noted that there was a 516% sales increase in low-carbohydrate food products from 2001 to 2005 showing that front of package claims can play a large part in consumer decisions.

Existing research suggests that consumers are less likely to turn to the back of a package to look at the Nutrition Facts panel when there is a claim on the front of the package. In the new study, researchers at the United States Food and Drug Administration, Center for Food Safety and Applied Nutrition sought to determine whether low-carbohydrate claims might lead consumers to perceive products to have benefits that are not necessarily related to being low in carbohydrate. Using an online questionnaire, 4,320 consumer panelists rated products for their perceived healthfulness, helpfulness for weight management, and caloric content based on front-of-package-only conditions (nutrition claims versus no nutrition claims) and availability of Nutrition Facts panels.

This study documents that in the absence of Nutrition Facts panels, “low-carbohydrate claims led to more favorable perceptions about products’ helpfulness for weight management, healthfulness, and caloric content. Because an individual packaged food product’s usefulness for weight management as part of an overall diet, its healthfulness, and total calorie content are not dependent solely on the amount of total carbohydrate it contains, the study demonstrated that consumers could misattribute benefits to products that claim to be low in carbohydrate.”

However, the researchers found that when the Nutrition Facts panels are available “participants’ perceptions became more consistent with the nutrition profile of the products. By showing the claims and the nutrition facts side-by-side, both pieces of information were equally accessible to participants as they answered the study questions. The presence of the nutrition facts, however, allowed participants to use this more diagnostic information to judge the product.”

One limitation mentioned in this study by Dr. Judith Labiner-Wolfe, former consumer science specialist at the United States Food and Drug Administration (now an evaluation specialist at the United States Department of Health and Human Services’ Office on Women’s Health) and colleagues is that “the online venue for viewing the stimuli and answering the study questions may have fewer distractions than situations in which consumers make real product judgments, such as in a busy grocery store. Therefore, this study may overestimate the effect of the Nutrition Facts panel. Findings from this research are consistent with previous experimental studies that found participants misattribute health benefits to products with claims and that nutrition information has an independent effect on perceptions.” The authors’ state, “although exposure to the Nutrition Facts has the potential for mitigating inappropriate benefits attributed to products claiming to be low carbohydrate, previous consumer research suggests that when a food product carries a front-of-package claim, consumers are less likely to turn the package over to look at the Nutrition Facts panel.”

Within the article, the researchers emphasize the important role nutrition educators have in helping consumers better understand the limited meaning of front- of- package claims and to further emphasize the importance of using the Nutrition Facts panel when making food choices.

Material adapted from Elsevier Health Sciences.

Reference
“Effect of Low-carbohydrate Claims on Consumer Perceptions about Food Products’ Healthfulness and Helpfulness for Weight Management” by Judith Labiner-Wolfe, PhD; Chung-Tung Jordan Lin, PhD; and Linda Verrill, PhD. It appears in the Journal of Nutrition Education and Behavior, Volume 42, Issue 5 (September/October 2010) published by Elsevier

Most proposals to solve this problem focus on giving pharmaceutical companies financial incentives to develop new drugs that could replace those that are no longer working. But a new report published today in the September issue of Health Affairs suggests that approach won’t work for long. New drugs will face microbial foes that figure out how to evade treatment, say two medical policy experts.

“This is a war we cannot win unless we adopt a two-pronged strategy: one that would boost the supply of new drugs and at the same time preserve the ones we have left,” says Aaron Kesselheim, M.D., J.D., M.P.H., one of the paper’s co-authors. He conducted the analysis of antibacterial drugs and their impact on public health through a grant from Public Health Law Research (PHLR), a national program of the Robert Wood Johnson Foundation (RWJF).

The current pharmaceutical reimbursement system gives companies an incentive to oversell antibiotics, says Kesselheim, who is also an instructor in medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics at Brigham and Women’s Hospital and Harvard Medical School in Boston. Companies that have spent large sums of money on research and development for a new drug often seek to turn a profit on that product as quickly as possible—before resistance sets in, he says.

But the practice of aggressively marketing antibiotics actually adds to the resistance problem, says co-author Kevin Outterson, J.D., a professor at Boston University Law School. Overselling and overuse create an environment in which microbes are awash in antibiotics, which speeds the process of resistance, he says.

“Right now, pharmaceutical companies are rewarded for actions that conflict with the public health goal of reducing antibiotic resistance,” Outterson says. “That has to stop.”

The analysis in Health Affairs crafts an innovative solution to the problem, one that gives pharmaceutical companies financial incentives to market drugs in a way that would keep resistance rates at low levels.

Specifically, Kesselheim and Outterson suggest that government experts study the rates of resistance and set “effectiveness targets” for newly approved antibiotics. To meet those goals, which the authors say would be based on factors related to the disease targeted by the antibiotic, such as lower resistance rates, drug companies would need to coordinate with physicians and hospitals so that the drugs are prescribed only when clinically indicated. Such action would remove the current incentive to oversell.

Companies that met the predetermined targets (achieved through responsible use of the drugs) would be rewarded. For example, the authors suggest that Medicare could pay a bonus to companies producing drugs that meet their resistance targets. Or policy-makers could grant such companies extended market exclusivity so they could continue to earn revenues—as long as the drug use remained within the target zone.

Such a policy could help slow development of resistance in microbes and ensure new antibiotics have a longer shelf life, a bonus that would help not just individual patients but society as a whole, Kesselheim and Outterson predict.

The authors, and other experts, say that the United States must adopt more comprehensive strategies that give drug companies and others incentives to reduce antibiotic resistance. For example, hospitals should be financially rewarded for adhering to strict infection-control practices, which can reduce the spread of antibiotic-resistant microbes, says Ramanan Laxminarayan, Ph.D., principal investigator for Extending the Cure, an RWJF-funded project on antibiotic resistance.

Material adapted from Burness Communications.

The paper calls access to food “a basic human need and fundamental right,” defining food insecurity as “limited or intermittent access to nutritionally adequate, safe and acceptable foods accessed in socially acceptable ways.”

According to ADA’s position paper, food insecurity is prevalent throughout the country: More than 49 million people living in the United States experienced food insecurity in 2008. In addition, 5.7 percent of all households representing 17.3 million people including 1.1 million children, had “very low food security,” defined by the U.S. Department of Agriculture as “multiple indications of disrupted eating patterns and reduced food intake.”

The paper, published in the September issue of the Journal of the American Dietetic Association, represents ADA’s official stance on food insecurity in the United States:

It is the position of the American Dietetic Association that systematic and sustained action is needed to achieve food and nutrition security for all in the United States. To eliminate food insecurity, interventions are needed, including adequate funding for and increased utilization of food and nutrition assistance programs, inclusion of food and nutrition education in such programs, and innovative programs to promote and support individual and household economic self-sufficiency.

“In children, adolescents and adults, negative nutrition and non-nutrition-related outcomes have been associated with food insecurity including substandard academic achievement, inadequate intake of key nutrients, poor health, chronic disease risk and development, and poor psychological and cognitive functioning,” according to ADA’s position paper.

Households receiving food from emergency food providers such as pantries, kitchens and shelters “appear to be particularly vulnerable to food insecurity,” according to ADA’s position. However, nearly 70 percent of food-insecure households do not use a pantry, “despite knowing of availability of one in their community.”

ADA’s position recommends “adequate funding for and increased use of food and nutrition assistance programs, as well as innovative programs to promote and support economic self-sufficiency….Registered dietitians and dietetic technicians, registered can encourage clients to access existing programs providing food and nutrition assistance, social services and job training as an immediate intervention. RDs and DTRs can also partner with key stakeholders in the community to build local food systems and reduce hunger.”

Material adapted from American Dietetic Association.

“Although quitting smoking is the most important preventive action in reducing lung cancer risk, consuming a mix of different types of fruit and vegetables may also reduce risk, independent of the amount, especially among smokers,” said H. Bas Bueno-de-Mesquita, M.D., M.P.H., Ph.D., senior scientist and project director of cancer epidemiology at The National Institute for Public Health and the Environment, The Netherlands.

Using information from the ongoing, multi-centered European Prospective Investigation into Cancer and Nutrition (EPIC) study, Bueno-de-Mesquita and colleagues evaluated 452,187 participants with complete information, 1,613 of whom were diagnosed with lung cancer.

Information was obtained on 14 commonly eaten fruits and 26 commonly eaten vegetables. The fruits and vegetables evaluated in the EPIC study consisted of a wide variety of fresh, canned, or dried products.

Previous results from the EPIC study showed that the quantity of vegetables and fruits may decrease risk of lung cancer; in particular the risk of one specific type of lung cancer, squamous cell carcinoma, decreased in current smokers.

Regardless of the amount, the researchers on the current study found that risk of lung cancer also decreased when a variety of vegetables were consumed. In addition, the risk of squamous cell carcinoma decreased substantially when a variety of fruits and vegetables were eaten. However, Bueno-de-Mesquita said that they “cannot exclude that these results can still be explained by smoking.”

“Fruits and vegetables contain many different bioactive compounds, and it makes sense to assume that it is important that you not only eat the recommended amounts, but also consume a rich mix of these bioactive compounds by consuming a large variety,” he said.

While previous research has shown the influence of the quantity of fruits and vegetables on cancer development, Stephen Hecht, Ph.D., editorial board member for Cancer Epidemiology, Biomarkers & Prevention, believes this study is one of the first to evaluate diversity of fruit and vegetable consumption, rather than quantity.

“The results are very interesting and demonstrate a protective effect in smokers. There are still over a billion smokers in the world, and many are addicted to nicotine and cannot stop in spite of their best efforts,” added Hecht, who is the Wallin Land Grant Professor of Cancer Prevention at the Masonic Cancer Center, University of Minnesota.

Tobacco smoke contains a complex mixture of cancer causing agents. Therefore, a mixture of protective agents is needed to have any beneficial effect in reducing one’s chance of lung cancer, Hecht said.

“Nevertheless, the public should be made aware and be reminded that the only proven way to reduce your risk for lung cancer is to avoid tobacco in all its forms,” he said.

American Association for Cancer Research.

The Healthy Lifestyle Initiative (HLI) began by partnering MU Extension specialists with community leaders in four Missouri counties. The MU Extension specialists provided assistance in the areas of agriculture, nutrition and physical activity, and business, community, and youth development. Each team recruited a variety of stakeholders, including families, students, agricultural producers and healthcare providers, to develop and implement community plans focused on policy and environmental changes to support healthy lifestyles.

Local elementary schools are using 'grow labs' and 'learning gardens' to help students learn about growing vegetables and experience the taste of fresh vegetables. (Credit: MU Extension)

“The goal of HLI is to turn goals and ideas into action by identifying the resources and expertise already in place within communities,” said Ann Cohen, HLI co-director and associate state nutrition specialist in the MU College of Human Environmental Sciences. “Initiative leaders work alongside community members, bringing together local resources and university expertise to create sustainable change. The models being developed can be replicated by other communities to combat sedentary lifestyles and related diseases, and foster positive changes and lifelong health.”

The four initial counties (Lafayette, Dent, Ralls and Boone), selected in 2008, have seen positive changes. In Lafayette County, schools and local farms are participating in Farm to Cafeteria, a national project that brings locally grown fruit and vegetables into school cafeterias. Chefs with the Bistro Kids program teach creative ways to cook fresh vegetables, and the Kids in the Kitchen curriculum in Ralls County encourages youth to eat healthily by teaching them to prepare simple, healthy foods.

In Lafayette County, Kiersten Firquain, a chef with Bistro Kids, presented a demonstration on creative ways to prepare fresh vegetables and incorporate them into school meals. She also taught knife technique at the Farm to Cafeteria workshop attended by area school food service staff. In 2007, Bistro Kids launched the Farm to School Lunch Program and currently feeds healthy lunches to nearly 1,000 students in Kansas City and St. Louis. (Credit: MU Extension)

Several counties have established farmers markets to increase access to locally grown foods. In Lafayette and Dent, young entrepreneurs received training in commercial gardening through the local farmers market.

“I am a big supporter of buying local and now that our community has weekly farmers markets, I’m able to support local farmers and prepare healthier meals for my family and friends,” said Christy Fuenfhausen, a young professional and resident of Lexington. “The farmers market provides a wonderful opportunity to purchase a wide variety of fresh fruits and vegetables. It has been a huge success already, providing a local networking system, different options for produce, new recipes and local programs.”

Other counties have begun planting community gardens. In Dent and Boone County, schools are utilizing “grow labs” and “learning gardens” to teach kids about science, health and nutrition. Many students are experiencing farm-fresh produce for the first time.

“My fiancé and I have four plots in the community garden,” said Becki Godi, MU Extension associate in Dent County. “It has been a great experience for my stepson to watch the growing process from seed to harvest. We often ride our bikes to the garden to water and collect our veggies. It is very satisfying to grow and eat our own food. It is a great opportunity to introduce people of all ages to the benefits of natural food.”

“Sustainable transformation is a product of changing policies and environments,” Cohen said. “Making healthy choices isn’t always easy, but having access to fresh foods and safe places for physical activity makes it easier.”

Material adapted from University of Missouri-Columbia.

In “A New Research and Development Policy Framework for the Biomedical Research Enterprise,” the authors lament the erosion of biomedical research funding and call for a strong focused direction moving forward, as presidential leadership has “waxed and waned” in past years.

“Biomedical research is integral to almost every realm of government responsibility – from protecting health and security to promoting economic growth and global competitiveness,” they write.

In the commentary, Federoff and Rubin suggest guidelines for a new funding model that aligns the biomedical research enterprise with national needs — bringing together government, academia and industry to build on strict principles, and that the outcomes of funding be “measurable and address training, scientific consequences, technology creation, and economic benefit.”

The authors support their case for a new framework saying the “The United States’ position as the dominant investor in a range of research and development programs is declining,” and they warn that the US “… could fall behind in the biomedical sciences as international capabilities and markets change and countries make new investment choices.”

“The United States has no national agency or research and development planning mechanism and no separately-identified research and development budget,” say the authors who point out that the today’s biomedical research enterprise is built on “a shifting foundation of policy making, which limits planning and operational effectiveness.” Federoff and Rubin say the current funding system has not evolved to keep pace with science.

An unchanged policy in biomedical research can lead to “further slowing of already unacceptable rates of translatable discoveries into patient treatments and cures; declining economic growth; loss of a critical research workforce and talent diverted from biomedical scientific careers; diminished innovation and technological advances; reduced creation of intellectual property; a weakened higher education system; and new threats to national security,” Federoff and Rubin argue.

“A new funding model is essential to create secure, long-term, sustainable funding based on strategic priorities,” they add. It requires an academic-government-industry-foundation research partnership. This new policy framework “would advance the nation’s health and economic well-being by ensuring that academic health centers can harness the full potential of the biomedical research enterprise to keep the United States healthy and competitive.”

Material adapted from Georgetown University Medical Center.

Researchers often regard these dense clusters of connections to be redundant when it comes to spreading information; networks featuring such clusters are considered less efficient than networks with a greater proportion of long ties. But getting people to change ingrained habits, Centola found, requires the extra reinforcement that comes from those redundancies. In other words, people need to hear a new idea multiple times before making a change.

“For about 35 years, wisdom in the social sciences has been that the more long ties there are in a network, the faster a thing will spread,” says Centola. “It’s startling to see that this is not always the case.” Centola’s paper on the subject, “The Spread of Behavior in an Online Social Network Experiment,” is published in the Sept. 3 issue of the journal Science.

These figures show experimentally manipulated on-line social networks. The first community (left) has a clustered network structure, while the second one is a more 'random' casual contact network. Node colors indicate people who adopted a behavior (blue) and those who did not (white), with lighted links showing the active pathways of communication. The clustered networks spread the behavior to more people than the casual contact networks. Image: Damon Centola

To see what difference the form of a social network makes, Centola ran a series of experiments using an Internet-based health community he developed. The 1,528 people in the study had anonymous online profiles and a series of health interests; they were matched with other participants sharing the same interests — “health buddies,” as Centola calls them in the paper. Participants received e-mail updates notifying them about the activities of their health buddies.

Centola placed participants into one of two distinct kinds of networks — those oriented around long ties, and those featuring larger clusters of people — and ran six separate trials over a period of a few weeks to see which groups were more likely to register for an online health forum website offering ratings of health resources.

Overall, 54 percent of the people in clustered networks registered for the health forum, compared to 38 percent in the networks oriented around longer ties; the rate of adoption in the clustered networks was also four times as fast. Moreover, people were more likely to participate regularly in the health forum if they had more health buddies who registered for it. Only 15 percent of forum participants with one friend in the forum returned to it, but more than 30 percent of subjects with two friends returned to it, and over 40 percent with three friends in the forum made repeat visits.

“Social reinforcement from multiple health buddies made participants much more willing to adopt the behavior,” notes Centola in the paper. Significantly, he writes, this effect on individuals “translates into a system-level phenomenon whereby large-scale diffusion can reach more people, and spread more quickly, in clustered networks than in random networks.”

Centola thinks the existence of this effect has important implications for health officials. A “simple contagion,” in network theory, can spread with a single contact; a “complex contagion” requires multiple exposures for transmission. A disease, Centola suggests, can spread as a simple contagion, but behavior that can prevent the disease — such as going to a clinic for a vaccination — might spread only as a complex contagion, thus needing to be spurred by reinforcement from multiple neighbors in a social network.

“If there is a significant difference between simple and complex contagions, that actually matters for our policy interventions,” says Centola. The public promotion of screenings and other forms of disease prevention might best be aimed at communities and groups that act as closely clustered networks.

Centola thinks there is also further work to be done evaluating the effects of online social networks on behavior. “There is a natural implication in terms of what this means for designing online communities,” says Centola. His new research, building on his current paper, aims to find new designs for online communities, in order to promote good health practices.

Material adapted from MIT.

Reference
“The Spread of Behavior in an Online Social Network Experiment,” by Damon Centola. Science, 03 September, 2010.

The “epidemic” of obesity and diabetes leaves no racial, ethnic, economic or geographic segment of the state unscathed, according to the researchers. Although American Indians, African Americans and Latinos are particularly affected by both obesity and diabetes, these conditions increased among all racial and ethnic groups between 2001 and 2007.

Similarly, while both conditions disproportionately affect the poorest Californians, there were upward trends in prevalence among all income groups during the same time period. California’s youth are also affected: More than a quarter of California adolescents — some 970,000 children — are obese or overweight.

“When so many people of different ages, income and educational levels, and cultural backgrounds are struggling with obesity and diabetes, it suggests that ‘going on a diet’ is not enough,” said research co-author Dr. Allison Diamant, a faculty associate with the center and an associate adjunct professor of general internal medicine and health services research. “We need to take a hard look at the environmental and structural factors that contribute to these conditions.

The study specifically recommends that policymakers and others seek ways to increase access to recreational facilities and parks, as well as promote policies that encourage farmers markets and improve access to food outlets that stock fresh fruits and vegetables and other healthy fare.

The consequences of failure are severe. California is falling far short of the targets for obesity and diabetes set by Healthy People 2010, a national health-promotion and disease-prevention plan. For example, obesity among California adolescents is more than twice as high as the national target of 5.0 percent, while the rate of diabetes among California adults is more than three times the federal goal of 2.5 percent of the population.

“It is a travesty that beer and Flaming Hot Cheetos are more readily available than an apple in low-income communities across the state,” said Dr. Robert K. Ross, president and CEO of The California Endowment, which supported the study. “Local governments must support community efforts to bring in healthy food to these communities and expand opportunities for children and families to engage in physical activity by cleaning up parks and improving community safety.”

In California, the total annual cost of diabetes is estimated to be $24 billion, with $17 billion spent on direct medical care and $7 billion on indirect costs associated with the disease. The cost of obesity to families, employers, the health care industry and the government is equally steep: $21 billion. If obesity and diabetes continue to affect more and more of the population, the associated costs will continue to grow.

Although there are a number of factors associated with diabetes and obesity, ranging from genetics to individual behaviors, the composition and structure of neighborhoods and social environments have been increasingly implicated as impediments to maintaining a healthy lifestyle. Both physical activity and healthy eating are important for preventing and reducing obesity and diabetes.

California has enacted reforms to encourage healthy eating, including requiring chain restaurants to display calorie information and prohibiting the sale of soda and other sweetened beverages on school campuses.

However, the study authors conclude that more needs to be done to promote environments that promote regular exercise and healthy eating.

Other study findings:

Hardest-hit counties
Obesity prevalence was highest in Imperial (39.6 percent), Merced (34.3 percent) and Tulare (31.1 percent) counties, while diabetes prevalence was highest in Tulare (12.1 percent) and Fresno (10.9 percent). Regionally, the San Joaquin Valley had the highest prevalence of both obesity (30.0 percent) and diabetes (9.4 percent). Los Angeles County, due to the size of its population, had by far the most obese residents (1.7 million) and the most residents diagnosed with diabetes (642,000).

Low-income adults at risk
Adults living below the poverty line had a significantly higher prevalence of obesity (27.7 percent) than higher-income adults (19.6 percent). Similarly, diabetes was more prevalent among the poorest adults — those living below 200 percent of the federal poverty level.

Education a factor
The prevalence of obesity was nearly twice as high among adults with no more than an eighth-grade education (30.3 percent) as among those who graduated from college (14.9 percent). Diabetes prevalence was three times as high among adults with no high school education (14.8 percent) as among those who graduated from college (5.1 percent).

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UCLA Health Policy Brief

Material adapted from University of California – Los Angeles.

The authors used a cohort study of 20,430 people living in Norwich, UK and examined 12 different genetic variants which are known to increase the risk of obesity. The researchers tested how many of these variants each study participants had inherited from either parent. They then assessed the overall genetic susceptibility to obesity by summing the number of variants inherited into a ‘genetic predisposition score’.

Most individuals inherited between 10 and 13 variants, but some had inherited more than 17 variants, while others fewer than 6. In addition the researchers assessed occupational and leisure-time physical activities in each individual by using a validated self-administered questionnaire. The researchers then used modeling techniques to examine whether a higher ‘genetic predisposition score’ was associated with a higher body mass index (BMI)/obesity risk and, most importantly, they also tested whether a physically active lifestyle could attenuate the genetic influence on BMI and obesity risk.

The researchers found that each additional genetic variant in the score was associated with an increase in BMI equivalent to 445g in body weight for a person 1.70 m tall and that the size of this effect was greater in inactive people than in active people. In individuals who had a physically active lifestyle, this increase was only 379 g/variant, or 36% lower than in physically inactive individuals in whom the increase was 592 g/variant. Furthermore, in the total sample each additional obesity-susceptibility variant increased the odds of obesity by 1.1-fold. However, the increased odds per variant for obesity risk were 40% lower in physically active individuals (1.095 odds/variant) compared to physically inactive individuals (1.16 odds/variant).

These findings challenge deterministic views of the genetic predisposition to obesity that are often held by the public, as they suggest that even people at greater genetic risk of obesity can benefit from adopting a healthy lifestyle.

The authors say: “Our findings further emphasize the importance of physical activity in the prevention of obesity.”

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Physical Activity Attenuates the Genetic Predisposition to Obesity in 20,000 Men and Women from EPIC-Norfolk Prospective Population Study.

Material adapted from Public Library of Science.

To the team’s knowledge, it is the first to ask research participants’ opinions about the need for informed consent for sharing their own information. The team explored participants’ preferences while collaborating on the Electronic Medical Records and Genomics (eMERGE) Network. The Network involves volunteers enrolled in the joint Group Health-UW Adult Changes in Thought (ACT) study. ACT is a longitudinal cohort study that tracks aging-related changes in thousands of older Group Health patients over time.

When the team asked Group Health patients who participate in ACT whether their “de-identified” (anonymous) genetic and medical record information could be shared in the database, 86 percent said yes. Then the team surveyed 365 ACT study participants who had agreed to let their genetic information be shared, mostly because of a “desire to help others.” In the survey, 90 percent of participants said they thought it was important to have been asked for this reconsent.

Reconsent means getting additional informed consent from research participants before using their information for a purpose beyond what they agreed to originally. Alternatives to reconsent—including opting out, being notified, or neither individual permission nor notification – were unacceptable to 40 percent, 67 percent, and 70 percent of the surveyed participants, respectively.

“We were surprised that so many people felt it was important for us to ask them, even though they decided to give their consent,” said lead author Evette Ludman, PhD, a senior research associate at Group Health Research Institute. “This indicates that even if most of a study’s participants would agree to data sharing, it’s still crucial to ask them.”

Since 2008, the National Institutes of Health (NIH) has strongly encouraged many studies to submit genetic information to the federal database of Genotypes and Phenotypes (dbGaP). The reason is that genomic research on large numbers of people can yield insights that aren’t possible with smaller numbers.

For new studies that will enroll participants prospectively, informed consent can—and should—address such sharing. But sharing genetic data raises ethical questions for longitudinal cohort studies, including ACT, which started long before dbGaP was established in 2006. Few existing informed consents address data sharing through this new mechanism. Ideally, Dr. Ludman suggested, research grants would include funding and time to pursue reconsent. In this study, it cost around $50 for each participant who was asked.

“Trust is a two-way street, and human research requires lots of trust,” Dr. Ludman said. “People have an understandable feeling of ownership over their bodies and medical records, including their genetic information,” she added. “Researchers show we’re worthy of trust when we ask research participants for permission to use their information in a way that they haven’t already agreed to.”

Recent high-profile legal cases have highlighted the issue of consent and trust in research, including the Havasupai tribe vs. Arizona State University and parents vs. the Texas health department over storing newborn blood samples without parental consent. So too has the bestselling book, The Immortal Life of Henrietta Lacks, about the history surrounding the HeLa cell line, the world’s most widely grown human cells.

Material adapted from Group Health Research Institute.

Three Harvard-affiliated physicians report that out of a list of 326 doctors identified as members of the provider network of CeltiCare, a for-profit insurer contracted by the state of Massachusetts to take over coverage of about 30,000 legal immigrants (and, more recently, low-income citizens), only 217 were non-duplicate adult primary care providers. Of these 217 doctors, 25 percent could not be reached by telephone.

Of those primary care doctors who were reachable by telephone, only 37 percent, or 60 providers, said they were accepting new CeltiCare patients. In those cases, the average wait time for an appointment was 33 days, even though the patient was described as having a chronic illness like diabetes or hypertension.

Moreover, although many of the patients who had been forced into the CeltiCare plan don’t speak English, only 38 of the doctors who were accepting new patients had any form of translation services.

The plan’s failure to provide adequate access to doctors for its members raises grave concerns not only about Massachusetts’ reform, but also about the recently enacted national reform, the researchers say. The national plan closely mirrors Massachusetts’ reform, but relies far more heavily on for-profit insurers.

The report points out that even when patients have insurance, profit-driven plans may discourage them from getting the care they need by “rationing by inconvenience.”

The data appears in a letter titled “Immigrants’ experience with publicly funded private health insurance” in the Aug. 5 print edition of the journal. It was written by two resident physicians at the Harvard-affiliated Cambridge Health Alliance and a Harvard Medical School faculty adviser, and is based on the work of a group of interns, residents and medical students from several Boston-area hospitals and medical schools.

These doctors-in-training carried out the research after they became worried when some of their sickest patients – patients with cancer, diabetes and other severe health problems – were forced from their existing insurance plan into the CeltiCare plan. They then were told that they could no longer be treated at many of their previous health clinics, forcing them to find new doctors.

The researchers identified doctors available to the CeltiCare patients using the plan’s “Find a Provider” website. They called each of the doctors’ offices within a 5-mile radius of their hospital, identifying themselves as relatives of a chronically ill, older adult who needed an appointment soon. If an appointment was offered, the researcher asked about the availability of translators.

“Trying to get an appointment was even more daunting than these numbers suggest,” said Dr. Cassie Frank, a co-author of the article. “Many clinics forced me to call several times to get an appointment. One said they only open up appointments on Monday morning, and that to have a chance of getting any appointment slot I’d have to show up an hour before the clinic opened to be first in line.”

Dr. Malgorzata Dawiskiba, another co-author, said: “The state suddenly shifted thousands of sick patients to a cut-rate plan. But instead of getting a bargain, the patients were left stranded – insured, but unable to find a doctor who could care for them. These were people whom we knew. We and our supervisors had been their doctors, sometimes for many years, and overnight they were told ‘you can’t come here anymore.’”

Dr. Ruth Hertzman-Miller, an instructor at Harvard Medical School and study co-author, commented: “The problems faced by CeltiCare’s patients may soon become much more widespread. Our legislative leaders want to require every insurer in Massachusetts to offer a plan with a restricted list of doctors and a lower price tag. But that kind of restricted coverage may be little more than a worthless piece of paper.”

Material adapted from Physicians for a National Health Program.

Reference
“Immigrants’ experience with publicly funded private health insurance,” Ruth Hertzman-Miller, M.D., M.P.H.; Malgorzata Dawiskiba, M.D.; Cassie Frank, M.D. New England Journal of Medicine, Aug. 5, 2010.

“This observational study is one of the few to examine the perceived emotional benefits of smoking among adolescents,” says lead author Michael Chaiton, a research associate at the Ontario Tobacco Research Unit of the University of Toronto. “Although cigarettes may appear to have self-medicating effects or to improve mood, in the long term we found teens who started to smoke reported higher depressive symptoms.”

As part of the study, some 662 high school teenagers completed up to 20 questionnaires from grades 7 to 11 about their use of cigarettes to affect mood. Secondary schools were selected to provide a mix of French and English participants, urban and rural schools, and schools located in high, moderate and low socioeconomic neighbourhoods.

Participants were divided into three groups: never smokers; smokers who did not use cigarettes to self-medicate, improve mood, or physical state; smokers who used cigarettes to self-medicate. Depressive symptoms were measured using a scale that asked how often participants felt too tired to do things; had trouble going to sleep or staying asleep; felt unhappy, sad, or depressed; felt hopeless about the future; felt nervous or tense; and worried too much about things.

“Smokers who used cigarettes as mood enhancers had higher risks of elevated depressive symptoms than teens who had never smoked,” says coauthor Jennifer O’Loughlin, a professor at the University of Montreal Department of Social and Preventive Medicine and scientist at the of the University of Montreal Hospital Research Centre. “Our study found that adolescent smokers who reported emotional benefits from smoking are at higher risk of developing depressive symptoms.”

The association between depression and smoking exists principally among teens that use cigarettes to feel better. “It’s important to emphasize that depressive symptom scores were higher among teenagers who reported emotional benefits from smoking after they began to smoke,” says Dr. Chaiton.

Material adapted from University of Montreal.

Reference
Michael Chaiton, Joanna Cohen, Jennifer O’Loughlin, Juergen Rehm, Use of cigarettes to improve affect and depressive symptoms in a longitudinal study of adolescents, Addictive Behaviors, In Press, Corrected Proof, Available online 23 July 2010, ISSN 0306-4603, DOI: 10.1016/j.addbeh.2010.07.002.

The researchers also found that smaller, rural, and public hospitals fell further behind their larger, private, and urban counterparts in adopting EHRs, further widening the gap between the two groups in receiving the benefits of health information technology.

The study appears August 26, 2010, in an advance online edition of Health Affairs.

“Getting hospitals to start using EHRs is critical,” said lead author Ashish Jha, associate professor of Health Policy and Management. “Paper-based medical records lead to hundreds of thousands of errors each year in American hospitals and probably contribute to the deaths of tens of thousands of Americans. This is not acceptable. There is overwhelming evidence that EHRs can help, yet the expense and the disruption that implementing these systems can cause has forced many hospitals to move slowly.”

The researchers drew from a survey by the American Hospital Association, which asked 4,493 acute-care non-federal hospitals about their health information technology efforts as of March 1, 2009; 3,101 (69%) responded. A representative from each hospital reported on the presence or absence of 32 clinical functions of an EHR and how widely they had been implemented throughout the hospital. Responses were statistically adjusted to balance for hospitals that did not respond.

They found that hospitals’ adoption of basic or comprehensive EHR systems increased by 3.2% between 2008 and 2009. Based on the measures examined by the authors, only approximately 2% of U.S. hospitals described EHRs that would allow them to meet the criteria in the American Recovery and Reinvestment Act for “meaningful use,” which doctors and hospitals must meet by 2012 in order to receive financial incentives through Medicare and Medicaid reimbursements. These meaningful use guidelines include 14 core functions, such as prescribing electronically and keeping an active medication list for patients.

Given the state of the economy at the time the survey was conducted, Jha is not surprised that adoption rates for EHR systems, which can cost tens of millions of dollars to purchase and implement, remain low. He notes that the government’s financial incentives may go primarily to larger, academic hospitals, further widening an already large digital divide.

“The problem is that the bonuses that hospitals get for meeting meaningful use are front-loaded, meaning hospitals have to implement and use EHRs by 2012 in order to get the bulk of the incentives,” Jha said. “This is an aggressive timeline, and many hospitals may not make it. If they miss out, it may be years before many of these hospitals will be able to afford to purchase and install their own EHR systems.”

Material adapted from Harvard School of Public Health.

As it has done before, CMS is proposing to disproportionately cut reimbursement for mental health and other cost-effective services, by as much as 5% overall for psychologists, to offset the ever-increasing cost of equipment, technology and overhead in the system.

Because of the complex calculations behind Medicare reimbursement rates and the insular nature of the agency, we are pursuing a remedy to address these new cuts through both traditional means and a comprehensive strategy integrating regulatory and legislative advocacy.

Since our primary opportunity to influence the rule is through the regulatory rulemaking process, APA first submitted a comment letter objecting to the cuts and arguing that psychologists should not be penalized for providing cost-effective services with minimal overhead. A copy of the letter is available here.

Second, taking advantage of the Practice Organization’s lobbying presence and relationships on the Hill, we reached out to key allies and persuaded Representatives Lois Capps (D-CA), Paul Tonko (D-NY), and Tammy Baldwin (D-WI) to circulate a Dear Colleague letter and weigh in directly with CMS. Citizen psychologists worked quickly to signal grassroots support and were able to ensure that the letter sent a strong message with an impressive bipartisan list of 22 signers. The Representatives have pressed Administrator Donald Berwick, M.D. to prevent an access crisis in Medicare mental health services by taking into consideration the disproportionate impact on mental health and more fairly apportioning the burden. The letter is available here.

We are hopeful that CMS will reconsider the revision before the rule is finalized in November. However, if CMS refuses to recognize the disproportionate impact on mental health, we will not give up the fight. We will need your help and that of our allies to persuade Congress to step in.

Thanks for your ongoing support. While we face significant challenges in our efforts to ensure fair reimbursement for psychological services, we will continue to work together in a deliberate manner combining direct lobbying, grassroots mobilization and political giving to increase the prospects for the best possible result for psychologists and the patients you serve. We will keep you posted.

Background:
CMS recently published its proposed rule on the 2011 Medicare fee schedule. In addition to reflecting an expected cut to all services as a result of the Sustainable Growth Rate (SGR) formula and changes to the Physician Quality Reporting Initiative (PQRI) payments, the rule would significantly negatively impact psychological and other mental health services due to revisions to the medical economic index (MEI).

Specifically, CMS is proposing to “rebase” the MEI by linking it to data from the 2006 physician practice survey and “revise” it by making changes to nine expense categories such as medical equipment, chemicals, materials and supplies. The changes would result in an increase in practice expense values. However, because the agency is required to remain budget neutral in its rulemaking, CMS would impose a 4% across the board reduction to the work component for all services. CMS would not change the work values assigned to each code but instead lower the payment by reducing the conversion factor that the work value is multiplied by. The net result is that work-intensive specialties would see a decrease, while practice expense-intensive specialties would see an increase.

Psychologists and social workers would experience the deepest projected average cut of 5% because mental health services are most heavily weighted toward work values. Psychiatrists, emergency medicine doctors and anesthesiologists would each face a 3% cut. Radiation therapy centers (+8%), portable x-ray suppliers (+6%) and diagnostic testing facilities (+6%) would see the greatest increases because of their reliance on costly technology and overhead. In addition, psychology and social work are already scheduled to receive an additional 2% cut due to the second year implementation of 2009 practice expense adjustments, through which practice expense was also increased at the expense of mental health and other work-intensive specialties.

CMS has repeatedly made changes to Medicare formulas that have significantly devalued and reduced reimbursement for the time and expertise of health care professionals. It is simply wrong for CMS to continually cut reimbursement for cost-effective services to boost payment for expensive equipment and overhead that are driving the inflation of health care costs. Patients and providers cannot afford for the federal government to fail to address this recurring problem. CMS must recognize the disproportionate impact of such changes in its rulemaking. If CMS refuses to do so, Congress must step in and require it.

Jeff Cook, J.D.
Director of Field & State Operations
American Psychological Association Practice Organization
750 First Street, NE Washington, DC 20002
(202) 336-5875 (Office)
(202) 336-5797 (Fax)
jco…@apa.org (click to verify and reveal email)

Republished with permission: APAPO

Psychology professor and Beckman Institute director Art Kramer, doctoral student Michelle Voss and their colleagues found that a year of moderate walking improved the connectivity of specific brain networks in older adults. (Credit: L. Brian Stauffer, UI News Bureau.)

Rather than focusing on specific brain structures, the study looked at activity in brain regions that function together as networks.

“Almost nothing in the brain gets done by one area – it’s more of a circuit,” said University of Illinois psychology professor and Beckman Institute Director Art Kramer, who led the study with kinesiology and community health professor Edward McAuley and doctoral student Michelle Voss. “These networks can become more or less connected. In general, as we get older, they become less connected, so we were interested in the effects of fitness on connectivity of brain networks that show the most dysfunction with age.”

Neuroscientists have identified several distinct brain circuits. Perhaps the most intriguing is the default mode network (DMN), which dominates brain activity when a person is least engaged with the outside world – either passively observing something or simply daydreaming.

Previous studies found that a loss of coordination in the DMN is a common symptom of aging and in extreme cases can be a marker of disease, Voss said.

Moderate walking three times per week for a year increased brain connectivity and brain function in older adults, the researchers found. (Credit: Photo by Elise McAuley for the Exercise Psychology Laboratory at the University of Illinois.)

In a healthy young brain, activity in the DMN quickly diminishes when a person engages in an activity that requires focus on the external environment. Older people, people with Alzheimer’s disease and those who are schizophrenic have more difficulty “down-regulating” the DMN so that other brain networks can come to the fore, Kramer said.

A recent study by Kramer, Voss and their colleagues found that older adults who are more fit tend to have better connectivity in specific regions of the DMN than their sedentary peers. Those with more connectivity in the DMN also tend to be better at planning, prioritizing, strategizing and multi-tasking.

The new study used functional magnetic resonance imaging (fMRI) to determine whether aerobic activity increased connectivity in the DMN or other brain networks. The researchers measured participants’ brain connectivity and performance on cognitive tasks at the beginning of the study, at six months and after a year of either walking or toning and stretching.

At the end of the year, DMN connectivity was significantly improved in the brains of the older walkers, but not in the stretching and toning group, the researchers report.

The walkers also had increased connectivity in parts of another brain circuit (the fronto-executive network, which aids in the performance of complex tasks) and they did significantly better on cognitive tests than their toning and stretching peers.

Previous studies have found that aerobic exercise can enhance the function of specific brain structures, Kramer said. This study shows that even moderate aerobic exercise also improves the coordination of important brain networks.

“The higher the connectivity, the better the performance on some of these cognitive tasks, especially the ones we call executive control tasks – things like planning, scheduling, dealing with ambiguity, working memory and multitasking,” Kramer said. These are the very skills that tend to decline with aging, he said.

Material adapted from University of Illinois at Urbana-Champaign.

Results will be published in the November 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Although alcohol misuse is linked to many medical conditions, considerable epidemiological evidence indicates that moderate alcohol use is related to reduced total mortality,” explained Charles J. Holahan, a professor in the department of psychology at The University of Texas at Austin and corresponding author for the study. “We expected that a substantial part of the health benefits associated with moderating drinking were due to confounding factors associated with alcohol abstention. For example, abstainers may include former problem drinkers with health problems and individuals who are atypical in terms of sociodemographic and social-behavioral factors that may increase health risk.”

“None of the studies that have examined the association of drinking and mortality and cardiovascular disease have been experimental studies in which a group of people was randomly chosen to drink a particular amount of alcohol or to not drink alcohol,” observed Alison A. Moore, professor of medicine and psychiatry in the David Geffen School of Medicine at the University of California, Los Angeles. “All have been observational studies, meaning those in which persons who consume varying amounts of alcohol are compared with those who don’t. Because conditions in these observational studies are not controlled and the characteristics of persons who choose to drink varying amounts of alcohol or not differ quite a bit, it is impossible to prove that alcohol consumption causes reduced risks for coronary heart disease, diabetes or mortality.”

For this study, using data gathered from a larger study of late-life patterns of drinking and related problems, researchers followed 1,824 older adults (1,142 men, 682 women) between the ages of 55 and 65 years of age – who were former or current drinkers – for 20 years. The information collected included: daily alcohol consumption, sociodemographic factors, former problem-drinking status, health factors, and social behavioral factors. Death was confirmed primarily by a death certificate.

“Controlling only for age and gender, mortality was highest among abstainers and heavy drinkers and lowest in moderate drinkers,” said Holahan. “Controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 49 percent and 42 percent, respectively, compared to moderate drinkers.”

“In other words, the association of moderate drinking and reduced mortality among older adults is reduced but still present when taking into consideration factors that affect both alcohol consumption and mortality,” said Moore. “For example, socioeconomic status has been a consistent factor in the link between alcohol consumption and mortality. That is, those with higher income and/or education are less likely to be abstainers and to die.”

Thus, the health benefits of moderate drinking is complicated because a number of underlying health risks are correlated with later life abstention, Holahan noted.

“Our findings demonstrate that abstainers were significantly more likely to have had prior drinking problems, to be obese, and to smoke cigarettes than moderate drinkers and scored significantly higher than moderate drinkers on health problems, depressive symptoms, and avoidance coping,” he said. “In addition, abstainers were significantly lower than moderate drinkers on socioeconomic status, physical activity, number of close friends, and quality of friend support and significantly less likely to be married than moderate drinkers. Moreover, all of these factors that were associated with abstention significantly predicted mortality.”

Both Holahan and Moore reiterated that any health benefits are linked to moderation. “Older persons drinking alcohol should remember that consuming more than two drinks a day exceeds recommended alcohol consumption guidelines in the U.S. and is associated with increased falls, a higher risk of alcohol use problems, and potential adverse interactions with medications,” said Holahan. “Moreover, nondrinkers should not start drinking to try to enhance their health, and individuals who are or plan to become pregnant, or have alcohol problems or medical conditions that could be worsened by alcohol should not drink.”

Material adapted from Alcoholism: Clinical & Experimental Research.

The same research study found, however, that children who eat both the breakfast and lunch sponsored by the federal government are less heavy than children who do not participate in either, and than children who eat only the lunch, says economist Daniel L. Millimet at Southern Methodist University in Dallas.

Millimet authored the study with economists Rusty Tchernis, Georgia State University, and Muna S. Hussain, Kuwait University. For a link to the journal article and to more information see http://tinyurl.com/2874wqn.

“The fact that federally funded school lunches contribute to the childhood obesity epidemic is disconcerting, although not altogether surprising,” said Millimet, whose research expertise is the economics of children, specifically topics related to schooling and health.

The new study was published in the Summer issue of The Journal of Human Resources. It is titled “School Nutrition Programs and the Incidence of Childhood Obesity.”

The U.S. Department of Agriculture oversees the federal lunch and breakfast programs. Through USDA the federal government reimburses schools for a portion of school lunch costs and also donates surplus agricultural food items. While USDA does require that the meals meet certain nutritional standards, schools choose the specific foods.

A la carte items outside the guidelines Schools also can serve individual food items a la carte, which fall outside the scope of the federal guidelines and allow students to choose additional foods.

For their study, the researchers analyzed data on more than 13,500 elementary school students. Students were interviewed in kindergarten, first and third grades, and then again in later grades. “First, it is very difficult to plan healthy but inviting school lunches at a low price,” Millimet said. “Second, given the tight budgets faced by many school districts, funding from the sales of a la carte lunch items receives high priority. That said, it’s comforting to know that the U.S. Department of Agriculture, which oversees the federal school nutrition programs, takes the issue very seriously. The USDA sponsors not only my research, but that of others as well, to investigate the issues and possible solutions.”

The USDA is partnering with First Lady Michelle Obama to fight what experts say is a childhood obesity epidemic among America’s school children. The First Lady on May 18 released the results and recommendations of The White House Task Force on Childhood Obesity report, which said that more than 30 percent of American children ages 2 to 19 are overweight or obese. The report recommends serving healthier foods in schools.

Lunches may not be in compliance
Judging from the results of the study, Millimet said, the food being served in school lunches may not maintain a healthy weight in children. The food in school breakfasts appears to be healthier, however.

“Technically what is going on is that the federal government establishes nutrition guidelines for lunches and breakfasts if schools wish to receive federal funding,” Millimet said. “But there’s evidence that school lunches are less in compliance with these guidelines than breakfasts. The other possible issue is that these days schools try to make money from a la carte items at lunch. And it’s possible that even if the school lunch is healthy, kids buying lunch are more likely to tack on extra items that are not healthy.”

Nutritionists strongly advocate eating breakfast for a healthy lifestyle, Millimet said, noting that — up to a point — any breakfast is better than no breakfast.

The National Student Lunch Program supplies meals to about 30 million children in 100,000 public and nonprofit private schools, according to the USDA.

The School Breakfast Program gives cash assistance to more than 80,000 schools for about 10 million children.

Obesity among students takes jump
The study cites data from the National Health and Nutrition Examination Survey taken between 1971 and 1974 and again from 2003 to 2004 that found the prevalence of overweight preschool children ages 2-5 jumped from 5 percent to 13.9 percent. Among school-aged children, it jumped from 4 percent to 18.8 percent for children 6-11; and 6.1 percent to 17.4 percent for those 12-19.

Material adapted from Southern Methodist University.

Following on a statewide estimate published earlier this year, the new analysis finds that the number of Californians without health insurance grew in all counties and that 37 counties – from Imperial to Kern to Shasta – had uninsured rates above the statewide average of 24.3%.

Rates increased on average by 5 percentage points from 2007 data.  (2007 county level data can be found in the Center’s omnibus report on health insurance: “The State of Health Insurance in California“ - page 34, exhibit 17).

Loss of health insurance was concentrated in counties in Southern California (Imperial, Riverside and San Bernardino), the San Joaquin Valley (all counties) and the Northern/Sierra areas (every county but Sutter and Humbolt), all of which had 2009 uninsured rates that were above the statewide average of 24 percent.

The losses were due to sharp increases in local unemployment and corresponding drops in both household income and job-based coverage, the report’s authors said.

The authors also noted that major elements of the national health care reform legislation aimed at helping middle- and lower-income families will not go into effect until 2014. Included among these provisions are federal subsidies for purchasing health insurance through a state-based health insurance exchange and a federally funded expansion of Medi-Cal.

“Health care reform is several years away, but families are dealing with health problems right now,” said Shana Alex Lavarreda, lead researcher on the fact sheet. “Every effort should be made to help families in need even sooner than 2014.”

The county estimates were based on a simulation model that predicted changes in county-level uninsurance using data from the 2007 California Health Interview Survey adjusted with 2009 county unemployment rates, and taking into account simultaneous decreases in household income. The model also included county-level increases in public health insurance from 2007 to 2009, based on administrative data from Medi-Cal and Healthy Families enrollment counts.

Development of the fact sheet was supported by the California Endowment and the California Wellness Foundation.

View the fact sheet: California’s Uninsured by County

Material adapted from University of California – Los Angeles.

How healthy a baby is at birth can set the stage for later life outcomes such as IQ, education, and adult health, according to Strully. Babies born to poor mothers frequently weigh less at birth than those born to middle class and wealthier mothers. Lower-birth-weight babies, particularly those under 5.5 pounds, are at higher risk of dying in the first year of life. They are less likely to excel academically and obtain high school degrees. As adults, they earn less than adults who as babies were larger at birth and are at risk of reproducing the cycle of inequality over generations.

In the study, titled “Effects of Prenatal Poverty on Infant Health: State Earned Income Tax Credits and Birth Weight,” the researchers tested whether access to state anti-poverty programs diminished the occurrence of low-birth-weight, at-risk babies. In particular, the authors used the recently expanded, state-based Earned Income Tax Credits (EITC) programs to determine whether improved income in single mothers suggested improved prenatal health, higher birth weights, and reduced maternal smoking. The EITC, the tax credit programs that supplement the incomes of low-wage workers, comprise the largest anti-poverty plans in the United States, and in many states have supplanted traditional welfare programs.

The study’s authors found evidence that participation in state EITC is directly linked to higher birth weights, including reducing chances that a mother smoked during pregnancy.

“The EITC reduces poverty for millions of families each year. But, we know very little about how it is affects families and children beyond income,” said Strully. “Our study offers encouraging evidence that, by relieving poverty with this tax program, we are helping women have healthier babies.”

Because the EITC is targeted at low-wage workers and significantly impacts the employment of single mothers, the authors limited their primary samples to unmarried mothers with a high school degree or less. To test the effects of state EITC on earnings and employment, the study obtained data from the 1980 through 2002 U.S. Natality Detail File, a statistical record of nearly every birth in the United States. Information in the Natality File is collected directly from birth certificates, ensuring that birth weights, recorded by medical professionals rather than recalled by survey respondents, are accurate. Further data, including income and household information, were collected from the 1980 through 2002 March demographic supplements to the Current Population Surveys (CPS). The annual data, collected by the U.S. Census Bureau, are based on a rotating national probability sample of 58,000 households. To qualify for EITC, a person must have some earnings but have an adjusted gross income below a threshold that varies by year and by family size.

Strully cautions that not all anti-poverty policies or programs such as EITC produce health improvements among babies born to high-risk mothers. In addition, the study suggests that mothers age 19 to 35 who live in states with active EITCs benefit more from the tax breaks and incentives than younger women or mothers over 35.

Material adapted from American Sociological Association.

Together, these documents indicate that although considerable progress has been made in rebuilding the local economy and infrastructure, there is still an alarming level of psychological distress and housing instability. Investigators believe that housing and community instability and the uncertainty of recovery undermine family resilience and the emotional health of children. These factors characterize what researchers are calling a failed recovery for the Gulf region’s most vulnerable population: economically disadvantaged children whose families remain displaced.

The CHF report, “Legacy of Katrina: The Impact of a Flawed Recovery on Vulnerable Children of the Gulf Coast,” expands upon on a study by NCDP researchers, who have followed a cohort of more than 1,000 families affected by Katrina and the ensuing disruption. According to the Gulf Coast Child & Family Health Study, funded by the Children’s Health Fund and published in the current issue of American Medical Association’s Journal of Disaster Management and Public Health Preparedness, the widespread mental health problems still experience by Gulf Coast children serve as a barometer for the failed recovery of their families and their communities.

Over one-third of the children in displaced families have been clinically diagnosed with at least one mental health problem since Katrina – with behavioral and conduct disorders the most common of these problems. Yet fewer than 50% of parents seeking needed mental health counseling for their children were able to access professional services. Furthermore, nearly half of the households in the study were still living in unstable conditions and, five years later, 60% of respondents still report their situation as being unstable or worse than it was before Katrina.

“This study points to a major crisis facing the children of the post-Katrina Gulf Region,” says Irwin Redlener, M.D., director of the National Center for Disaster Preparedness at Columbia’s Mailman School of Public Health and president of the Children’s Health Fund. “From the perspective of the Gulf’s most vulnerable children and families, the recovery from Katrina and the flooding of New Orleans has been a dismal failure.”

“Previous studies have demonstrated a significant increase in the prevalence of anxiety, depression, and posttraumatic stress disorder following Hurricane Katrina, as well as a rise in violence and suicide,” said Italo Subbarao D.O., MBA, deputy editor of AMA’s Disaster Medicine and Public Health Preparedness journal. “This study adds further credence to widely accepted views that adults and children affected by catastrophic emergencies can experience up to a 40 percent increased in mental and behavioral illness.”

According to David M. Abramson, Ph.D., MPH, director of research at the NCDP and senior author of the study which looked at the roles of parents and communities in children’s recovery, “Children are completely dependent upon others in their lives to provide the security and stability that will help them recover. This suggests that the many support systems in children’s lives – their parents, their communities, and their schools – are not yet functioning properly. The slow recovery of children’s mental health in Gulf Coast populations is a bellwether indicator of how well the region is recovering.”

Additional key findings:

• Even as long as four and a half years after the event, about 45% of parents report that their children are experiencing emotional or psychological problems that they hadn’t experienced prior to Katrina.
• Children post-Katrina are 4.5 times more likely to have serious emotional disturbance than pre-Katrina. For the purposes of this study, such disturbances were defined as emotional issues, hyperactivity, conduct, and problems relating to peers.
• Nearly half of people who had been displaced for over a year by Katrina are still living in unstable conditions.

The study findings are supported by clinical data from the Children’s Health Fund, which provides mobile clinics that travel to underserved areas in the Gulf Coast to provide care for families and children. In the period of June 2009 through June 2010, despite improvement in housing conditions in Louisiana, psychiatric, developmental or learning-related disorders in children were diagnosed as frequently as respiratory illness. And in New Orleans alone, approximately 30,000 school children were not able to return to public school. However, data also shows that children who were relocated sooner did better in school than students with longer periods of displacement and those who were enrolled in higher performing schools did the best, thus highlighting the importance of social systems in a child’s post-disaster recovery.

Both the study and the clinical reports from the Children’s Health Fund’s Gulf Coast pediatric programs paint a clear picture of how insufficient government response and recovery efforts continue to take a toll on children’s welfare, especially those who are the most underserved. Dr.Redlener, a pediatrician and professor at Columbia University’s Mailman School of Public Health, outlined a number of implications for policymakers and others: “Affected families need urgent assistance to return to a state of ‘normalcy’ characterized by safe communities and stable housing. Nearly two out of three children affected by Katrina continue to experience serious mental and behavioral problems or the stress of unstable housing or both, with children living in poverty over two times as susceptible to serious emotional disorders. We believe that this represents at least 20,000 children affected by Katrina – and perhaps considerably more. Immediate action needs to be taken to increase mental health services in the region.”

Dr. Redlener continues, “And it’s not just clinical services that are needed by these marginalized families. Every effort must be made to rapidly bring back a ‘state of normalcy’, that is, stable safe housing for every family in communities with appropriate access to essential services and economic stability.”

The Gulf Coast Child & Family Health Study has collected mental health data in the Gulf Coast since January 2006 and covers a random sample of 1,079 households in Louisiana and Mississippi, including 427 children. Face-to-face interviews were conducted by trained interviewers, and the key outcome variable was Serious Emotional Disturbance, based upon the Strengths and Difficulties Questionnaire (SDQ), a widely validated diagnostic screener. The data were collected in four waves over the course of four years with the majority of data for this analysis drawn from the fourth round of data, collected through March 2010.

Material adapted from Columbia University’s Mailman School of Public Health.

Co-author Dr. James Erskine, a psychologist at St. George’s, says the study shows that many smokers attempting to give up – as well as people trying to quit other vices – may be thwarted by the very technique they use to stop.

Erskine said: “These findings have obvious implications for individuals seeking to give up certain behaviors, for example, smoking, overeating, drinking, sex and other excessive behaviors.

“If trying to avoid thoughts of something in an attempt to give it up actually unwittingly triggers a subsequent increase, it’s a poor method of achieving self control. This work may stop people using quitting techniques that are ultimately harmful.”

Erskine and his team set out to test whether smokers experienced behavioral rebound – the phenomenon where trying not to think about something leads to an increase in the behavior. Their previous research into eating behavior and thought suppression showed that people trying not to think about chocolate subsequently ate much more than people who were deliberately thinking about it. However, previous studies only examined behavioral rebound over a period of five minutes, rather than days and weeks.

Eighty-five smokers, who smoked at least ten cigarettes a day, took part in the latest study. They were split into three groups and asked to monitor their cigarette intake over three weeks. All three groups were asked to behave as usual in the first and third weeks. But in the second week one group of 30 people was told to suppress their thoughts of smoking, and one group of 29 people was told to actively express thoughts about smoking. A control group of 26 was told not to change anything.

The first week’s results showed that each group smoked a different average number of cigarettes, so the researchers applied a formula to the following weeks’ results to ensure they were comparing like for like.

The results showed that neither the expression group nor the control group differed significantly in the number of cigarettes smoked from week to week. However, in the second week the suppression group smoked, on average, nearly five less cigarettes each than the expression group and almost four less than the control group. And in the third week – when they stopped suppressing their thoughts – the suppression group smoked nearly three more than the expression group and the control group. From the raw results, the suppression group’s increase from week two to three was six cigarettes per person, roughly three more each than smoked in the first week.

Erskine said: “This shows a clear behavioral rebound. The fact that the suppression group smoked less in the second week shows that this method may be effective in reducing unwanted behavior in the short term. But this actually isn’t helpful, as smokers might then think that thought suppression is a useful strategy in quitting smoking.”

“In this case, we asked the suppression group to stop suppressing in week three, but the rebound effect should be the same whether it is deliberate, or whether other real life factors cause someone to stop suppressing thoughts of smoking. In real life, it can be hard to continue suppressing your thoughts.”

“Although the differences in the number of cigarettes smoked from week to week may seem small, we know that habitual smokers are remarkably consistent in how many they smoke. So, even a small difference can be considered significant.”

“Knowing what techniques not to use should lead to better understanding of what methods of quitting do work.”

Material adapted from Association for Psychological Science.

Alcohol-related motor vehicle accidents claim 17,000 American lives each year – the equivalent of one death every 30 minutes. An increase of blood alcohol concentration (BAC) of 0.02 percent doubles the relative risk of a motor vehicle crash among 16- to 20-year old males, and that risk increases to nearly 52 times when the BAC is between 0.08 percent and 0.10 percent, the legal limits in many states.

Until now, there has been little research to provide a better understanding of the extent to which perception of drunkenness and cognitive abilities are impacted on both the rising and declining limbs of the BAC curve. In this study, Snyder and his colleagues developed a test that could look at rising and declining levels of BAC and study its impacts on functions that would be required for driving. Through a placebo-controlled controlled study of a group of college students, the researchers were able to compare the subjective feelings of drunkenness and their ability to navigate a hidden maze learning task as their BAC both rose and fell over an 8-hour period.

Snyder, who is also professor of neurology at The Warren Alpert Medical School of Brown University, says, “While our study supports past research, the real new piece of information that we have from this study is that unlike basic functions that are commonly studied in alcohol research such as motor speed and information processing speed, executive functions don’t recover as quickly.” Snyder continues, “The subjective feeling that you are drunk does recover more quickly. This explains why so many individuals feel subjectively that they are able to get into a car and be able to drive and feel safe. But that subjective impression does not mesh with the actual recovery in terms of higher order executive functions.”

In this study, individuals were asked to consume alcoholic drinks over an 8-hour period to bring their BAC up to 0.10 percent and then to return to a normal BAC. Throughout the ascending and descending limbs of the BAC curve they were asked to perform a hidden maze learning test on a touch-screen computer. Under normal conditions without alcohol, healthy young individuals normally would make very few mistakes in the maze – the mistakes are indicative of a failure to follow simple rules that they are taught. The researchers noted that these errors increased dramatically with rising BAC levels, and their level of propensity to break the simple rules of the test did not decline as rapidly as the subjective feeling of drunkenness.

Snyder says, “It’s important to know that most healthy normal young adults show one or none of these “rule break” errors at all. As people become increasingly drunk, we see a very dramatic increase in these errors on the test, and the recovery of the underlying cognitive impairments that lead to these errors is slower, and more closely tied to the actual blood alcohol concentration, than the more rapid reduction in participants’ subjective feeling of drunkenness.” This type of cognitive functioning is important for driving skills and making judgments in terms of traveling through intersections or changing lanes when driving.

Snyder and the researchers conclude that because the subjective feeling of recovery is more rapid than the actual recovery, this constitutes a partial explanation for why many people drive drunk, and the concept can be used in the context of education and prevention strategies. Snyder concludes, “Allowing individuals to see that their subjective reports of the intensity of intoxication do not correlate with their observed cognitive performance might underscore the real risk with respect to the decision to drive when alcohol impaired. The bottom line is that subjective perception of intoxication is a poor indicator of sobriety and the ability to operate a motor vehicle.”

The study is published in the August 2010 issue of Experimental and Clinical Psychopharmacology, a publication by the American Psychological Association.

Material adapted from Lifespan.

Dr. Shapira showed in her study that a diet rich in antioxidants and omega-3 fatty acids, like the diet eaten in Mediterranean regions where melanoma rates are extremely low, can help protect us from skin cancer.

The sun’s rays damage both the skin and the immune system by penetrating the skin and causing photo-oxidation, she explains, affecting both the cells themselves and the body’s ability to repair any damage. Her prescription is to “go Greek” with foods such as olive oil, fish, yogurt, and colorful fruits and vegetables to fight the oxidizing effect of the sun, as well as regular applications of sunscreen and appropriate body coverings such as hats, beach coverups, and other sportswear.

Drinking to your health
Previous research demonstrated that the sun’s UV rays damage the skin by exciting its molecules and causing them to become oxidized, says Dr. Shapira. “My theory was that if you prepared the body with sufficient and relevant antioxidants, damage could be reduced.”

For a study at the Baltic Sea, Dr. Shapira and Prof. Bodo Kuklinski of Rostock University organized two groups. One group was provided a drink high in antioxidants, while the other enjoyed beverages such as sodas. Those who hydrated with the antioxidant-rich drink had fifty percent fewer oxidation products (i.e., MDA) in their blood at the end of the two-week period, which included five to six hours of exposure to the sun daily. Further studies proved that these antioxidants, especially carotenoids ― fruit and vegetable pigments like red from tomatoes and watermelons and orange from carrots and pumpkins that accumulate in the skin where they serve as a first line of protection ― had delayed the phenomenon of skin erythema, which indicates the initiation of tissue and DNA damage that can lead to skin cancer.

This information is invaluable, especially in light of climate change, notes Dr. Shapira. As temperature and humidity get stronger, which aggravates the damaging effect of solar UV rays, it is increasingly difficult for sunscreen alone to protect effectively. So while covering up, slathering on the sunscreen, and avoiding the sun during peak hours are still important to prevent a burn, consider dietary changes too, to promote skin health.

Go fish with a glass of red … and other colors
It might be tempting to load up on dietary supplements instead of changing the diet, but according to Dr. Shapira, supplements are simply not as effective. Foods provide nutrient “synergy,” she says. “In foods, many vitamins and various antioxidants and bioactive ingredients work to support one another and the body’s natural protective mechanisms. Synergies between the nutrients in your food, which make a significant contribution to health, may contrast with the relative isolation of a vitamin supplement.”

The research is getting attention: for the first time, the Israeli Cancer Association has included the nutritional information as part of their “Smart in the Sun” advisories.

It is not necessary to move to Greece, Israel, or Turkey to get the benefit of the diet. Most of the appropriate foods are stocked in American grocery stores. Olive oil, fresh fish, fruits and vegetables, red wine in moderation, whole grains, beans and lots of water should be at the top of the shopping list, Dr. Shapira advises.

And there are some foods to avoid, she points out. Go light on red meat, processed foods, and alcohol (red wine is preferable), and be wary of foods that contain the photosensitizing compound psoralen, such as parsley, celery, dill, cilantro and figs.

Material adapted from American Friends of Tel Aviv University.