Idea #294 for December 9th, 2009: A Missed Opportunity or States Cutting Anti-Smoking Program Funding

I’ve written before about the embarrassingly low percentage of tobacco settlement funds that states have actually used for tobacco prevention programs, as they were intended to be used. Now there’s news that the percentage has been cut back even smaller by many states. Faced with budget crises, states have cut tobacco prevention funding by 15% in the last year, with New York leading the way with a more than 30% decrease in spending for the programs.

Overall, states are projected to spend about half a billion dollars on anti-tobacco programs in 2010. That represents only 2.3% of the $25 billion in tobacco tax and settlement funds they pull in. To put that in perspective, the tobacco industries will spend twenty times that amount in the coming year on marketing their products. While it’s not expected that states spend 100% — or even 50% — of the tobacco revenue on smoking prevention programs, they have to do a lot better than 2%. It’s even more important now that smoking rates have leveled off after years of decline.

Read more about this issue here.

Idea #273 for November 18th, 2009: Progress Report or Rethinking Hospital Report Cards

Evaluating hospitals with report cards has been seen as a way to prod under-performing facilities into making improvements. However, the conventional thinking on this subject may be incorrect, says new research from Canada. The study looked specifically at heart patients in Ontario, and found that quality of treatment did not improve after the report cards were released.

It should be pointed out that this study is not all-encompassing by any means: a few dozen hospitals in one Canadian province were evaluated only on treatment for heart patients. That said, it does indicate a certain trend that we should be aware of. If hospital report cards in this country are as ineffective at improving care as they seem to be in Ontario, then we should rethink their value going forward. Still, report cards can be an important tool for the public when they weigh which hospitals to go to, even if they have limited value in terms of improving care. For that reason, the report cards should continue to serve a meaningful role in healthcare, even if they cannot convince hospitals to improve.

Read more about this research here.

Idea #271 for November 16th, 2009: Who’s Really In Charge? or Adverse Event Legislation That Doesn’t Work

In 2002, Connecticut enacted “adverse event” legislation requiring hospitals to report to their health department when adverse events were harming their patients. The impetus for that law was a report from the Institute of Medicine that claimed nearly 100,000 patients in the US were dying yearly due to human error in hospitals. However, that Connecticut law has not proven effective at all, as most adverse events are not reported publicly today.

The breakdown in the process started in 2004 when the law was changed (following complaints from hospitals and their lobbyists). Those changes included limiting the scope of adverse events that needed to be reported as well as keeping reports secret unless an investigation was necessary. Since then, public access to the reports has fallen by 90%. This mess has become an example of how not to make adverse event legislation. The original intent of the law was more openness in the face of staggering numbers of adverse events caused by human error. The current state of the law is anything but open. Other states that are considering adopting similar legislation should look to Connecticut to see how not to do it. The influence of lobbying groups and hospitals has taken the teeth out of the law entirely.

Read more about this in the Hartford Courant.

Idea #270 for November 15th, 2009: Pick Up The Phone or The Best Way To Conduct Telephone Counseling For Smoking Cessation

Telephone counseling can be a helpful tool in combating smoking. However, the way in which the calls are carried out is a vital factor in their success. New research shows that counseling that requires the smoker to take the initiative and place the telephone call is not as effective as pro-active counseling that involves counselors calling patients on a set schedule.

The new study involved about 1,000 smokers who were either mailed smoking cessation materials, or who were given the opportunity to initiate phone counseling calls. The schedule of the calls were up to the smokers to determine. After a year, there was no significant difference in smoking abstinence rates between the two groups, indicating that this type of counseling is no more effective than mailing out anti-smoking documents. Past research, though, has demonstrated the effectiveness of pro-active phone counseling that follows a set schedule and is initiated by the counselor.

All this is important because every state now has smoking cessation phone lines. While many do follow the pro-active model, there is no standard and methods vary widely. This study suggests that those that do not employ pro-active techniques are likely wasting time and money. Another problem is that only 1% of smokers actually use the lines. More publicity of these phone lines is needed, as well as consistent methodology that greatly improves patients’ chances of quitting.

Read more about this study here.

Idea #260 for November 5th, 2009: More Than Meets The Eye or Avoiding Cancer Cases By Targeting Obesity

When we think of the consequences obesity has on our nation’s health, we often link it to heart disease and other cardiovascular problems. The public sometimes overlooks the other problems that obesity leads to, including cancer. Researchers suggest that more than 100,000 cases of cancer each year are caused by obesity.

Certain cancers seem to be more closely tied to obesity than others. For instance, about half of all endometrial cancers are believed to be caused by obesity. For esophageal cancer cases, about 35% are obesity-related. More than a quarter of Americans are obese, so we definitely have room for improvement. Bringing those numbers down could mean avoiding tens-of-thousands of additional cases of cancer each year. It’s imperative that we fight the root causes of our obesity epidemic to prevent the myriad health problems that stem from it.

Read more about this research here.

Idea #198 for September 4th, 2009: Viruses on the iPhone or An App to Track Infectious Disease

Want to know about swine flu in your region? There’s an app for that, thanks to researchers at MIT and Children’s Hospital in Boston. Their application for the iPhone shows outbreaks of diseases in your area, and is called “Outbreaks Near Me.” It builds on information from HealthMap, which in turn gleans its data from Google searches, news items, blogs, and other media. In the Outbreaks Near Me app, users can see a map view of their location with pinpoints showing recent infectious disease cases in their area. They can also search for more information by disease or location.

Aside from viewing data, users can submit their own data — even photos — to the team responsible for the application. The hope is that with enough participation, the app can become a powerful surveillance tool in the fight against infection diseases. Considering the popularity of iPhones, it makes sense to employ them for public health uses. It wouldn’t hurt if they expanded this app to phones on Android too. It’s useful for tracking a number of infectious diseases, but its real test may come in the next few months when H1N1 is expected to spread rapidly in the US.

Read more about this app from this Reuters story.

Idea #157 for July 25th, 2009: The Needle Debate or Federal Funding For Needle Exchange Programs

On the face of it, using federal money to buy new needles for drug addicts doesn’t seem like a wise move, especially amid the current budget crunch. But consider these facts: a quarter of HIV infections in this country are a result of drug use, an NIH study in 1997 found that needle exchange programs reduced HIV infection by 30% and risky behavior in general by 80%, and the exchange programs do not result in an increase in drug use. Funding needle exchange programs not only makes sense, it’s sound public health policy. For the last 20 years, though, there’s been a ban on federal funding of such programs — but that may soon change.

On Friday, the House passed a bill that would lift the federal ban on needle exchange funding. It also contains the reasonable provision that needles not be given out within 1,000 feet of schools, parks, day care centers, or other places where children might congregate. Providing clean needles to drug users not only affects the rate of HIV transmission, but also allows social workers an opportunity to steer potential HIV victims to healthcare facilities and programs. In that respect, needle exchange programs provide a valuable service to bring HIV positive individuals into treatment. Our minds may tell us that providing needles to drug addicts is a silly idea, but facts and science tell us another story.

Read more about the legislation here and here.

Idea #119 for June 17th, 2009: From the Comfort of Home or LA County’s STD Test Kits

Los Angeles County has seen a rise in the number of chlamydia cases in the last decade, and now make up three-quarters of the county’s STD cases. In fact, the CDC ranked LA County first among counties nationwide in cases of chlamydia. Sixty-three percent of the county’s cases occur in women between 15-24. With this in mind, LA County Public Health has developed and implemented a free chlamydia home test kit for young women.

From the Public Health Department’s website women can order the test kit, learn the results, and receive referral and treatment information. The test itself entails using a swab, sealing it in a provided container, and mailing it back to the lab. A week later, patients can get the results over the phone or online. The site also provides a map of nearby clinics for those who test positive.

This program has the potential to reach young people who may otherwise be reluctant to visit clinics for STD testing. Allowing patients to administer the test from their own home will certainly reduce costs associated with providers and facilities. Clearly, catching and treating chlamydia and other STDs before they spread is vital to public health efforts, and this program could be a great help. It will be fascinating to see if LA County’s high STD rates are reduced as a result, and if it turns out be more cost-effective than traditional office visits.

See the county’s website for this program here, and read about the program in the news here and here.

Idea #110 for June 8th, 2009: Erasing the Stigma or Encouraging More People to Get Tested for HIV

In medicine, stigmas can have deadly results. Take for example HIV: fears about the perceptions of being HIV positive has caused some people to avoid getting tested for the disease. The CDC estimates that 20% of people with HIV are unaware of their condition because they have not been tested.

Early testing leads to early treatment, and in the case of HIV patients, that means better long-term prognoses. Now, a community in North Carolina is trying to fight the stigma with a advertising campaign. The campaign will feature television commercials and print media that will convey the message that HIV positive individuals are deserving of the same respect and human rights as any other members of society.

Additionally, the group will attempt to gather 5,000 signatures from community members as a way of showing AIDS patients that they have the community’s support. It will be interesting to see if the rates of HIV testing go up after the campaign launches. If so, there is a case to be made for this to be replicated in other communities where stigmas hinder testing rates.

In the news, see these two local news stories.

Idea #74 for May 3rd, 2009: Communicating With Teens The Only Way They Know How or Texting Sex Ed

It’s encouraging when public health organizations embrace a popular technology that can enable them to reach out to more people. With texting fast becoming the main form of communication among teens, some health organizations are latching onto the technology to better serve that demographic.

An article in the New York Times highlights a program in North Carolina in which public health workers answer kids’ questions about sex, via text messaging. The program is called the Birds and Bees Text Line and is part of the Adolescent Pregnancy Prevention Campaign of North Carolina. Paid for mostly by the state and the CDC, the Birds and Bees Text Line allows teens to anonymously text their questions to public health workers, who then reply within 24 hours. Questions deal with issues like STDs, safe sex, pregnancy, and anything else on the minds of teens. Health workers follow guidelines when crafting the answers, such as not advocating abortion, not dispensing medical advice, and referring the texters to clinics when appropriate.

In North Carolina, whose teenage pregnancy rate is among the highest in the nation, it’s vital to reach teens in ways that traditional sex education is not. Submitting queries via text allows kids to be discreet and ask questions that they might be embarrassed to ask face-to-face. This system should not totally supplant traditional sex ed in the classroom, but it’s a nice complement to existing educational tools. If it proves successful in North Carolina, other states should fund similar programs.