Smoking down in the U.S.

The proportion of adults in the United States who smoke declined from 20.9 percent in 2005 to 18.1 percent in 2012, according to data from the 2012 National Health Interview Survey.

The smoking rate in 2012 was significantly higher among males (20.5 percent) than females (15.8 percent) and among persons aged 18–24 years (17.3 percent), 25–44 years (21.6 percent), and 45–64 years (19.5 percent) than among those aged 65 years or older (8.9 percent).

The decline in smoking is encouraging and likely reflects the success of tobacco control efforts across the country, according to researchers. For example: the 2009 Family Smoking Prevention and Tobacco Control Act granted the Food and Drug Administration the authority to regulate the manufacture, distribution, and marketing of tobacco products; the 2009 Children’s Health Insurance Program Reauthorization Act raised the federal tax rate for cigarettes from $0.39 to $1.01 per pack; and the 2010 Patient Protection and Affordable Care Act provided expanded coverage for evidence-based smoking-cessation treatments. Also, in 2012 the Center for Disease Control and Prevention (CDC) debuted Tips from Former Smokers (TIPS), the first federally funded, nationwide, paid-media tobacco education campaign in the United States. During the campaign, calls to the quitline portal 1-800-QUIT-NOW increased 132 percent, and the number of unique visitors to a smoking cessation website (www.smokefree.gov) increased 428 percent. An estimated 1.6 million quit attempts were attributable to the campaign.

Additionally, smoking prevalence was:

• highest among adults of multiple races (26.1 percent) and lowest among Asians (10.7 percent);
• highest among persons with a graduate education development certificate (41.9 percent) and lowest among those with a graduate (5.9 percent) or undergraduate (9.1 percent) degree;
• higher among persons living below the poverty level (27.9 percent) than those living at or above this level (17 percent); and
• higher among people living in the South (19.7 percent) and Midwest (20.6 percent) than those in the West (14.2 percent) and Northeast (16.5 percent).

Citation:
1. Agaku IT, King BA, Dube SR. Current Cigarette Smoking Among Adults—United States, 2005–2012. Morbidity and Mortality Weekly Report 2014; 63(02): 29-34. (open access)

Investing in fruits, vegetables can save lives, reduce health care costs

Increasing the consumption of fruits and vegetables could save more than 100,000 lives and $17 billion in health care costs from heart disease each year in the United States, according to a new report by the Union of Concerned Scientists.

The report, The $11 Trillion Dollar Reward, explains that better federal agricultural policies, designed to encourage production of healthy food instead of processed junk foods, will help reap those benefits.

If Americans consumed just one additional serving of fruits or vegetables a day, the nation would save $5 billion in health care expenditures and prevent 30,301 heart disease and stroke deaths annually. And if Americans were to go a step further and eat a full 2.5 cups of vegetables and two cups of fruit daily, as recommended by federal dietary guidelines, it could prevent 127,261 deaths each year and save $17 billion in medical costs. The economic value of the lives saved from cardiovascular diseases is an astounding $11 trillion, according to the report.

The report researchers advocate for cost-effective policies that increase access to and reduce the cost of domestically grown fruits and vegetables for consumers, especially for low-income consumers who are hardest hit by cardiovascular disease and other diet-related illnesses. Low-income neighborhoods–where some 30 million Americans reside–are often far from grocery stores and other sources of fresh produce, hindering access.

Current federal agricultural policies channel taxpayer dollars into subsidies for commodity crops, such as corn and soybeans, which are used as feed for livestock, biofuels and as processed food ingredients. These policies offer few incentives for farmers to grow fruits and vegetables–effectively discouraging production of the very foods federal dietary guidelines recommend.

A three-minute video produced by UCS summarizes how we can achieve an $11 trillion reward through forward-looking agricultural policies.

Citation:
1. O’Hara JK. The $11 Trillion Reward: How Simple Dietary Changes Can Save Lives and Money, and How We Get There. Cambridge, Mass.: Union of Concerned Scientists, 2013.

Three years of tobacco control progress averts smoking-related deaths

Between 2007 and 2010, 41 countries and territories implemented tobacco control policies that will collectively result in 15 million fewer smokers and prevent nearly 7.5 million smoking-related deaths globally by 2050, according to a World Health Organization (WHO) study.

These findings demonstrate the magnitude of the actions already taken by countries and underscore the potential for millions of additional lives to be saved with continued adoption of MPOWER policies. To assist countries with implementing Framework Convention on Tobacco Control (FCTC) obligations, in 2008 the WHO introduced the MPOWER package of evidence-based tobacco control measures. The MPOWER package includes: Monitoring tobacco use and tobacco control policies; Protecting people from the dangers of tobacco smoke; Offering help to quit tobacco; Warning the public about the dangers of tobacco; Enforcing bans on tobacco advertising, promotion and sponsorship; and Raising tobacco taxes. The goal of the MPOWER package is to reduce smoking-attributable deaths, which are projected to rise to 8.3 million annually by 2030.

The largest number of smoking-related deaths was averted as a result of increased cigarette taxes (3.5 million), smoke-free air laws (2.5 million), health warnings (700,000), cessation treatments (380,000), and bans on tobacco marketing (306,000).

“It is imperative that the public health community continue to advocate for MPOWER policies of the highest level,” the study concluded.

Citation:
1. Levy DT, Ellis JA, Mays D, Huang A-T. Smoking-related deaths averted due to three years of policy progress. Bulletin of the World Health Organization 2013; 91:509-518. (open access)

Physical activity recommendations for children

Physical activity recommendations in early childhood should be a focus of future cardiovascular disease prevention efforts, according to a study of 3,000 children age 2-9 years from eight European countries.

The age and sex of the children are important factors in determining the right physical activity requirements. Boys age six years or younger need at least 60 minutes of moderate-to-vigorous physical activity per day, whereas boys age 6-9 years need at least 80 minutes. Girls in either age group need approximately 15 minutes less. Recommendations should also include 20 minutes of vigorous physical activity per day in all children.

Clinicians should avoid using generalized physical activity guidelines and evaluate children at risk of cardiovascular disease on a case-by-case basis, the researchers said.

Citation:
1. Jiménez-Pavón D, Konstabel K, Bergman P, et al. Physical activity and clustered cardiovascular disease risk factors in young children: a cross-sectional study (the IDEFICS study). BMC Medicine 2013; 11: 172. (open access)
2. McMurray RG. Insights into physical activity and cardiovascular disease risk in young children: IDEFICS study. BMC Medicine 2013; 11: 173. (open access)

Positive impact of mass media campaign on bed net use in Cameroon

A mass media health education intervention in support of investments in malaria control commodities such as insecticide-treated mosquito bed nets can result in significant, large-scale positive health changes, according to a study conducted in Cameroon.

The study found that Cameroonians with at least one bed net in their household were more likely to use the bed nets after being exposed to the “KO Palu” (Knock Out Malaria) national campaign. Approximately 298,000 adults and more than 221,000 of their children under age five slept under a bed net because of the knowledge, motivation, and/or timely reminder provided by KO Palu NightWatch activities.

The health communication program cost less than $0.16 per adult reached, and less than $1.62 per additional person protected by a net.

According to the World Health Organization’s World Malaria Report 2011, every one of Cameroon’s 19.6 million citizens is at risk of malaria, with 71 percent of them living in high transmission areas. More than 1.8 million suspected cases of malaria were recorded countrywide in 2010, along with over 4,500 recorded malaria-attributed deaths. Malaria was estimated to be responsible for 19 percent of under-five child deaths in 2008, more than any other single cause.

Citation:
1. Bowen HL. Impact of a mass media campaign on bed net use in Cameroon. Malaria Journal 2013; 12: 36. (open access)

mHealth in the developing world: Is it effective?

The use of mobile communication technology has been shown to improve access to health services and medical information, but two systematic reviews published in PLoS Medicine indicate a lack of evidence that mHealth is an effective solution to health challenges in the developing world.

The majority of studies on mHealth effectiveness are conducted in industrialized countries and may not apply to low- and middle-income countries. According to the systematic reviews, three out of 75 trials that aimed to assess whether mobile technology interventions could improve health behavior or disease management were from developing countries.

Previous studies in sub-Saharan Africa have found mobile phone text messaging to improve adherence to HIV treatment, while others have shown their failure to do so. The new reviews found that for disease management, the only two mHealth applications with sufficient evidence of benefit are ones related to adherence to antiretroviral therapy and smoking cessation.

The reviews call for additional rigorous mHealth tests in low- and middle-income settings.

Citations:
1. Free C, Phillips G, Galli L, et al. The Effectiveness of Mobile-Health Technology-Based Health Behaviour Change or Disease Management Interventions for Health Care Consumers: A Systematic Review. PLoS Medicine 2013; 10(1): e1001362. (open access)
2. Free C, Phillips G, Watson L, et al. The Effectiveness of Mobile-Health Technologies to Improve Health Care Service Delivery Processes: A Systematic Review and Meta-Analysis. PLoS Medicine 2013; 10(1): e1001363. (open access)
3. Tatalovic M. “Evidence lacking on mHealth effectiveness in poor countries.” SciDevNet: 15 Jan 2013.

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Slowdown in fight against malaria

An effective concerted effort to strengthen malaria control globally in the last decade has had the greatest impact in countries with high malaria transmission. Close to 60 percent of the 1.1 million lives saved during this period were in the 10 highest burden countries. However, the expansion of funding for malaria prevention and control has leveled off in recent years, and progress in the delivery of some life-saving commodities has slowed. These developments are signs of a slowdown that could threaten to reverse the recent gains in the fight against one of the world’s leading infectious diseases, according to the World Malaria Report 2012.

The number of long-lasting insecticidal neets delivered to endemic countries in sub-Saharan Africa dropped from a peak of 145 million in 2010 to an estimated 66 million in 2012. The expansion of indoor residual spraying programs also leveled off, with coverage levels in the World Health Organization (WHO) African Region staying at 11 percent of the population at risk (77 million people) between 2010-2011.

The malaria burden is concentrated in 14 endemic countries, which account for an estimated 80 percent of malaria deaths. The Democratic Republic of the Congo and Nigeria are the most affected countries in sub-Saharan Africa, while India is the most affected country in South-East Asia.

The report indicates that international funding for malaria appears to have reached a plateau well below the level required to reach the health-related Millennium Development Goals and other internationally-agreed global malaria targets.

While the plateauing of funding is affecting the scale-up of some interventions, the report documents a major increase in the sales of rapid diagnostics tests, from 88 million in 2010 to 155 million in 2011, as well as a substantial improvement in the quality of tests over recent years. Deliveries to countries of artemisinin-based combination therapies (ACTs), the treatment recommended by the WHO for the treatment of falciparum malaria, also increased substantially, from 181 million in 2010 to 278 million in 2011, largely as a result of increased sales of subsidized ACTs in the private sector.

The report summarizes information received from 99 countries with on-going transmission and other sources, and updates the analyses presented in the 2011 report. Malaria is an entirely preventable and treatable vector-borne disease. In 2010, an estimated 219 million cases occurred globally, while the disease killed about 660,000 people, mostly children under age five years.

Citation:
1. World Health Organization. World Malaria Report 2012. Geneva, Switzerland: WHO, 2012.

Motivating HIV testing among MSM using internet and mobile phones

Men who have sex with men (MSM) have the highest HIV prevalence in Peru, yet they are underserved by traditional preventive programs. In Peru, the Internet and mobile phones have emerged as an effective and convenient tool to reach this population. A study published in PLoS ONE identifies five key themes that should be considered when designing an effective campaign to motivate HIV testing.

1. Overcome fear of getting tested for HIV. Previous studies identify “fear of the consequences of a positive test result” as the main barrier for not getting tested among MSM. Since the 1980s, HIV testing campaigns in Peru have focused on fear, stigmatizing the disease and causing people to avoid getting tested out of fear of being positive. Future campaigns need to counteract this by providing motivational messages that transmit calmness and explain that HIV is now a chronic and treatable disease.
2. Increase risk perception. MSM with high-risk practices often do not perceive themselves at risk. A brief explanation on the modes of transmission along with messages that can prompt participants to remember common risk situations they may have experienced would be useful to better understand the risks.
3. Explain logistics. A successful campaign should include the marketing of the personnel, the place, information about the process, including the test itself, and the price of testing. The personnel include the professionals who will perform the HIV test and who will provide the results. The place includes the physical location where the test will be conducted, the operating hours, general attractiveness, comfort and accessibility. The price refers not only to monetary cost but also intangible costs such as embarrassment and psychological strain.
4. Avoid stigmatizing and stereotyping content. Avoid language that implies gay men are promiscuous or more likely to have HIV. Use neutral characters (not stereotyped caricatures of gay men), as well as neutral language (absence of gay-related jargon) because either they were considered stigmatizing for gay-identified MSM, or because they will not feel identified within the heterosexually-identified MSM.
5. Use appropriate layout and language. Study participants recommended that all text based information, when possible, should always be presented with images. Language should be simple and colloquial but not vulgar. The Layout should avoid the use of red, dark or gloomy colors. When possible, use humor because it makes information easier to understand and to remember.

These results serve as the basis to design an effective campaign to motivate HIV testing among gay and non-gay identified MSM in Lima, Peru, the study concludes.

Citation:
1. Blas MM, Menacho LA, Alva IE, et al. Motivating Men Who Have Sex with Men to Get Tested for HIV through the Internet and Mobile Phones: A Qualitative Study. PLoS ONE 2013; 8(1): e54012. (open access)

Plain cigarette packs may reduce smoking appeal

Plain packaging and removal of descriptors on cigarette packs may reduce the appeal of smoking for teens and young adults, and consequently reduce the likelihood of smoking, according to a study of young women aged 16-26 years in Brazil.

Study participants were asked to rate three types of cigarette packages (standard branded, plain packaging, and plain packaging with no descriptors, e.g., flavors). Branded cigarette packs were rated as significantly more appealing, better tasting and smoother than plain packs and were associated with greater style and sophistication.

Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes.

Citation:
1. White CM, Hammond D, Thrasher JF, Fong GT. The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study. BMC Public Health 2012; 12: 737. (open access)