Governor Asked to Sign Lead Bill

There is a guest essay in today’s Democrat & Chronicle by Peter Carpino (United Way or Greater Rochester) and Brian Hetherington (Empire Justice Center) that calls upon Gov. Paterson to sign into law legislation that would, among other things, provide tax credits for homeowners for lead abatement.

Gov. Paterson: Sign lead bill; save kids from brain damage

Peter C. Carpino and Bryan Hetherington

Gov. David Paterson deserves much credit for responding quickly and forcefully to the financial crisis. However, there are other critical issues that he must address using that same firm leadership.

In the next few days, Paterson must decide whether to sign into law the Childhood Lead Poisoning Primary Prevention and Safe Housing Act of 2008. The act would identify the top 30 high-risk areas in the state, require prevention plans for those communities, increase the amount of information available to the public and offer tax credits for homeowners for lead hazard reduction.

It has taken years to get this legislation passed in both houses. The research is clear that signing the bill would mean many more New York children would succeed in school and many fewer would end up in jail. Costs for health care, criminal justice and special education would decrease an estimated $25 million a year, and tax revenues would rise.

Minority Reporter Dedicates Issue to Health

Last month, the Minority Reporter, a weekly publication that serves the African American population in Rochester, came out with an issue that was dedicated to health care.  It highlights some of the health challenges facing the city’s residents (particularly the disparities in many health indicators) and profiles some of the programs that are addressing these issues.  You can see a PDF of the issue here.

LA Restricts Fast Food Restaurants

The government response to the obesity crisis has taken many forms over the last several years, including banning trans-fats, removing soda and candy from schools, and requiring calories to be posted on menus.  However, last month Los Angeles took perhaps the most aggressive step by banning the construction of fast food restaurants in some of the city’s poorest neighborhoods.   Public control over the built environment in the name of health has many advocates, including Tulane University’s Tom Farley who visited the Medical Center to discuss this very topic, which he has termed “healthscaping,” last year.  The restriction, which is coupled with incentives for new grocery stores and (healthier) restaurants to move into the neighborhoods, has ignited a debate over the line between public health and personal choice.

You can read a NY Times story about the debate over the ban here.

In the News: Cancer Rates and Education and Obesity and Diabetes

Two new studies of interest out today.  The first links cancer rates and socioeconomic status, particularly education.  Researchers associate the drop in cancer rates among well educated (people with at least 16 years of education) to better prevention/screening and declines in smoking.  You can read a Reuters story on the study here.

The childhood obestiy epidemic could have a lasting legacy of a growing number of adults with diabetes.   You can read a HealthDay story on the Michigan study here.

Health Disparities in Rochester: What Needs to be Done

In a follow-up to the previous post (Report Details Disparities in Care), Nancy Bennett, M.D. and Wade Norwood have written a piece that appeared in today’s Democrat & Chronicle. Bennett is director of the URMC Center for Community Health and Norwood is director of Community Engagement for the Finger Lakes Health Systems Agency.

The piece (which appears below) addresses the underlying factors behind disparities in our community, the progress that has been made, and the challenges that remain.

Spread good health to all corners of Rochester

Dr. Nancy Bennett and Wade Norwood

In the World Health Organization’s comparison of the health of nations, the United States ranks 24th, below most industrialized nations. However, the United States spends more per capita, and our expenditures are rising faster than those in any other country. While the reasons for this paradox are many, one critical factor is the persistence of health disparities based on race, ethnicity and socioeconomic status.

To improve our country’s health, we must improve the health of our most vulnerable populations. While we all are cared for by the same health systems, white suburban populations enjoy relatively good health, but poor urban and rural populations do not.

One example of these horrible inequalities was reported this month by the Dartmouth Atlas Project: African Americans are more likely to suffer leg amputations than white people.

The reasons for such differences are complex.

• African Americans have higher rates of obesity and smoking, putting them at greater risk for diabetes and peripheral vascular disease, heightening the risk of amputation.
• African Americans are likely to have poorer access to primary and specialty care, which might improve the management of chronic disease, thus preventing complications.
• African Americans often have poorer access to advanced surgical alternatives to amputation.

Although these differences may be related to the adequacy of insurance, studies have shown that differences remain even when coverage is equal. We need to understand, through public health and health services research, the complexities of this pathway so that we can eliminate inequalities.

Report Details Racial Disparities in Care

The Dartmouth Atlas Project has released a report titled Disparities in Health and Health Care Among Medicare Beneficiaries.  While disparities in care are generally associated with race and socioeconomic factors, the Dartmouth report reveals that geography also plays an important role.  The report examines geographic disparities in the rates of leg amputations (a complication of diabetes), screening for breast cancer and diabetes, the prevalence of primary care physicians, and ambulatory care vs. hospitalization rates. You can read a NY Times article on the report here.

The Robert Wood Johnson Foundation used the data in the report as a platform to announce $300 million in new grants to fight health disparities.

The Democrat and Chronicle reports on the Rochester numbers in the report (full article after the jump) and notes that that while progress has been made in areas such as immunizations and mammograms, disparities in diabetes care remain.  According to the most recent Monroe County Adult Health Survey, 20 percent of African Americans in the county have diabetes – more than twice the number of whites and Latinos.

CDC Survey Details Teen Behavior

The Centers for Disease Control and Prevention has released its 2007 Youth Risk Behavior Survey. The news is decidedly mixed. The number of teens smoking, drinking, and having sex is down, but risky behavior (drug and alcohol use and attempted suicides) remains high among Hispanics. This is of particular concern as Hispanics are one of the fastest growing populations.

The survey also shows that efforts to convince teens to delay or practice safe sex appear to be faltering. After several years of declines, the sexual behavior rates have leveled off and there is evidence that rates of teen sex may be going up while condom use may be on the decline.

You can find the CDC report and additional data here. You can read articles about the study in USA Today here, the Washington Post here, Reuters here, and the Associated Press here.

The Hazards of Pharmaceuticals in the Home and the Environment

Several stories have recently appeared in the news about the effects of pharmaceuticals in the water supply. The reported negative impacts include hormone disruption in fish, raising questions about potential impacts on human health. There are concerns about the effects of long term human consumption of these and other chemicals. Household pharmaceuticals can get into the water supply because conventional waste and drinking water treatment does not effectively eliminate most of the pharmaceutical compounds such as endocrine disruptor compounds found in oral contraceptives. Some of these chemicals enter the wastewater system when they are excreted by people who take these drugs. In other cases, chemicals may get into the wastewater when people flush old or unwanted medicine down the toilet. Flushing has been recommended in the past as a way to safely dispose of pharmaceuticals. However, because treated wastewater is released into surface water bodies, chemicals remaining in the effluent may affect wildlife or if the water eventually enters drinking water systems, humans may be affected. Below are two recent examples of how EHSC researchers and community outreach agencies are focusing on studying and eliminating pharmaceuticals in our environment.

It is important to safely dispose of unwanted pharmaceuticals to avoid accidental poisonings by children or others. Flushing them down the toilet is no longer a recommended method of disposal. People are discouraged from simply throwing unwanted medicines in the trash since children might pull them out of the trash, or once in a landfill, these chemicals may eventually seep out in drainage water. The only guidance issued to date by a federal agency regarding the disposal of medications (by consumers and other end users) is the guidance issued in February of 2007 by the White House Office of National Drug Center Policy. However several states and localities have developed their own approaches to this issue. In Washington State, a coalition of local and state governments, and non-profit organizations, developed a pilot program in which pharmacies took back unwanted medicine, (www.medicinereturn.com). Legislation that would have implemented this program on a statewide basis was introduced in 2007 but has not been passed. The New York State Legislature is also considering a bill (A. 840) that would regulate the collection and disposal of both prescription and over-the-counter drugs by manufacturers of such drugs. Until such a program is instituted, community collection days may be the safest option (See ‘What Can I Do?’).

• In March 2008, 3rd year Toxicology graduate student Fanny Casado presented a talk called “Endocrine Disruptors with estrogenic activity: Promises and Challenges.” The presentation discussed the current widespread use of estrogen-based hormonal therapies that has opened opportunities to do epidemiological studies of the risks and benefits. Endocrine disruptor compounds (EDCs) are defined as chemicals, such as those found in oral contraceptives, that can alter the physiology of endocrine or hormone systems in wild-life and humans. When these chemicals were first introduced, disruptive effects were not fully appreciated. Several different lines of research have elucidated some of the mechanisms of action of these compounds, specifically the ones with estrogenic activity, giving rise to guidelines and restrictions on their use. Despite numerous investigations using in vivo models that provide information about exposure, the relationship between human diseases of the endocrine system and exposure to environmental EDCs is poorly understood.
• Action for a Better Community (ABC), an EHSC Community Advisory Board member, teamed up with the Ruth A. Lawrence Poison Control Center, the City of Rochester, Monroe County Department of Environmental Services, and the Center for Environmental Information to take part in the Environmental Protection Agency’s Great Lakes Earth Day Challenge on April 19th. This event provided opportunities for people to safely dispose of unwanted medicines as well as electronic waste. Over 55,000 doses of unwanted medicine were collected from 66 people at this event. On June 7th, there will be a free Unwanted Pharmaceuticals Collection from 8:00am-1:00pm at the City of Rochester Water Bureau, 10 Felix Street. For more information about this collection, contact Ted Murray at ABC, 325-5116.

Hookah bars: Not a safe alternative for cigarettes

Recently, a “hookah bar” has opened for business in Rochester, NY. Such establishments have been opening up in communities across the US in recent years. Tobacco control experts around the country have been reporting that young people in particular are attracted to such places that offer flavored tobacco, and the ability to use tobacco indoors – even in areas that have “clean indoor air” laws. To get around the laws, they do not serve alcohol or food so they can’t be labeled as a restaurant or a bar. Also, it is consistently reported that the attraction to hookahs is that they are “less harmful” than cigarettes, or not harmful at all because hookahs use unprocessed tobacco.

Tobacco control experts should heighten their efforts to get the word out about the dangers of hookah use however. Consider the following facts.

Recent reports from the World Health Organization (WHO) cast doubt on those claims, saying they hookah is not a harmless alternative to cigarettes. According to WHO, preliminary research reveals some serious misconceptions about the dangers of hookah smoking. Hookah smokers “may inhale as much smoke during one session as a cigarette smoker would inhale consuming 100 or more cigarettes.”

The WHO reports that hookah smoke still “contains high levels of toxic compounds, including carbon monoxide, heavy metals and cancer-causing chemicals.” And users still get nicotine, which causes addiction.

There is also the health risk from the by-products from the combustion of a charcoal pellet used to keep the smoking mixture burning in hookahs.

Users are at higher risk for contracting oral herpes and other communicable diseases. The evidence-base for this statement is new and hopefully growing, but consider this anecdotal report: After attending a Hookah bar in March, 2008 in Fort Collins, CO, several students developed mouth herpes, according to a local Infection Control Physician at Colorado State University’s Hartshorn Health Services.

One hour of smoking a hookah exposes users to 100 to 200 times the volume of smoke of a single cigarette, according to a report on BacchusNetwork.org. The smoke also has arsenic, lead, nickel, and 36 times the tar of a single cigarette and 15 times the CO.

Finally, the marketing of flavored tobacco like “wild berry” has been used by the tobacco industry before to lure non-smokers, especially young people, to begin a life-long addiction to their products. Hookah Bars around the country offer such flavored choices.

Tobacco control experts should plan for effective dissemination of the dangers of hookah use.

Anyone thinking about quitting any type of tobacco product can call the New York State Smoker’s Quitline for information and support at 1-866-NY-QUITS (1-866-697-8487), and visit the Smokers’ Quitsite at http://www.nysmokefree.com. Physician offices can ask the Quitline about how they can get free CME training to help their nicotine-dependent patients (or visit http://cvhpinstitute.org/tcc/.)

Scott McIntosh, PhD

The Dangers of Plastics and the Benefit of Exercise

The Washington Post reports that the federal the NIH appears to have reversed course and is preparing to waded into the debate over the potential health dangers of bisphenol A, or BPA, the ubiquitous chemical found in plastics. A draft report by the National Toxicology Program acknowledges that that chemical, which has been in plastic production for the past 60 years and is found in countless products, may cause cancer and other serious disorders. You can see a draft of the report here.

UPDATE: The New York Times is reporting that the Canadian government is about to declare BPA “toxic.”

USAToday has a story today on the importance of exercise on reducing belly fat. People who exercised for 60 minutes a day, 5 days a week, saw a 10% reduction in their midsection.