April 2007 AJPH Highlights: In Service

Newswise — The articles below will be published online February 28, 2007, at 4 p.m. (EST) by the American Journal of Public Health under "First Look" at http://www.ajph.org/first_look.shtml, and will appear in the April 2007 print issue of the Journal. "First Look" articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org. To stay up to date on the latest in public health research, sign up for new Journal content e-mail alerts at http://www.ajph.org/subscriptions/etoc.shtml?ck=nck.

(1) CHILDREN GAIN WEIGHT FASTER DURING SUMMER VACATIONEven though many schools fall short when it comes to offering daily physical education and balanced meals, children are more likely to pack on pounds during summer break than during the school year.

A study based on twice-yearly body mass index (BMI) measurements from 5,380 children in 310 schools found that BMI gains were faster and more variable during summer vacation than during the kindergarten and first grade school years. In addition, the difference between school and summer gain rates was highest among three subgroups at high risk for obesity: black children, Hispanic children and children who were already overweight at the beginning of kindergarten.

"Do schools contribute to childhood obesity? They may, to some degree, but it appears that other factors are more to blame," the study's authors said. They suggested that school-based interventions aimed at helping kids learn healthy habits should "target children's behavior not only during school hours, but also, and most importantly, after the bell rings." [From: "Changes in Children's Body Mass Index During the School Year and During Summer Vacation" ]

(2) SOCIAL CHANGE COULD TRUMP MEDICAL ADVANCES IN SAVING LIVES Although medical advances prevented nearly 175,000 deaths in 1996-2000, correcting the conditions that account for disparities in education could have saved eight times as many lives.

A study using vital statistics data from 1996-2002 estimated the maximum number of averted deaths attributable to medical advances and the number of deaths that would have been averted if adults with lesser education had experienced the mortality rates of college-educated adults. The result: medical advances prevented approximately 175,000 deaths, whereas giving all adults the death rate of those with a college education would have saved 1.4 million lives.

Higher death rates among people with lower education levels are linked to complex factors including lower incomes, inferior access to health care and unhealthy environments. Social change could surpass medical breakthroughs in saving lives because social conditions hold great influence over health status.

"On the basis of how many lives can be saved, our data suggest that efforts to correct the social conditions causing education-associated excess mortality should be proportionately greater than society's investment in medical advances. Today's leaders embrace opposite priorities, however," the study's authors said. "Indeed, budget pressures from escalating health care costs and medical research have led the government to reduce support for social services, including education, thereby choking off an upstream strategy that could reduce the demand for health care." [From: "Giving Everyone the Health of the Educated: An Examination of Whether Social Change Would Save More Lives Than Medical Advances" ] (3) NEIGHBORHOOD HAS IMPACT ON BLACK WOMEN'S RISK FOR HYPERTENSIONLiving in a poor neighborhood increases a black woman's risk for hypertension even if she has a relatively high income or education level and exercises regularly.

Researchers used data collected in the Black Women's Health Study, a prospective follow-up study of 59,000 black women ages 21-69 at entry in 1995. Median housing value from U.S. Census Bureau data was used as a measure of neighborhood socioeconomic status. Cases of hypertension were identified through mailed questionnaires, and the accuracy of self-report was found to be very high.

The study found that median housing value is inversely associated with hypertension in black women but is independent of their individual risk factors such as weight and physical inactivity. "Lowering hypertension risk in black women will require a greater understanding of the underlying social inequalities that adversely affect health and of the mechanisms and pathways that are amenable to intervention," the study's authors said. [From: "Relation Between Neighborhood Median Housing Value and Hypertension Risk Among Black Women in the United States" ]

(4) STATES CAN SUCCEED IN INSURING KIDSIn the absence of federal and state reform offering universal health care coverage, local coalitions can make a big difference for children without health insurance.

A study of 28 California counties or regions with Healthy Kids coalitions found that the efforts have linked 85,000 kids with health insurance coverage. Coalition leaders attributed their success to having a diverse group of stakeholders, strong leadership and generous local and statewide contributors. Because such coalitions face obstacles in surviving the long haul, most are "cautiously looking toward statewide legislative solutions," the study's authors wrote.

In the meantime, local coalitions may become the gold standard as other states struggle with declines in employer-based coverage and increasing immigration and poverty rates. [From: "Children's Health Initiatives in California: The Experiences of Local Coalitions Pursuing of Universal Coverage for Children." ]

(5) WARNINGS OF INCREASED SUICIDE RISK DIDN'T DAMPEN ANTIDEPRESSANT PRESCRIPTIONS"Black box" warnings on labels of certain antidepressants about possible increased suicide risk had no effect on the amounts of the medications prescribed in North America.

A study based on a time-series analysis of new antidepressant prescriptions in Ontario, Canada from April 1998-March 2005 found that a series of warnings about increased suicide risk linked to the medication had little effect on prescribing trends. Researchers examined monthly prescription rates for patients younger than 20, ages 21-64 and 66 and older. They found that the United Kingdom Committee on Safety of Medicines advisory against prescribing the drug paroxetine to patients younger than 20 resulted in significant and persistent reductions in prescriptions for younger patients but not for the other two age groups. A series of advisories, including two published warnings from the U.S. Food and Drug Administration, about increased suicide risk associated with antidepressants did not change prescription rates.

The study's authors said, "After the UK warning, physicians may have prescribed an alternate antidepressant in patients who otherwise might have received paroxetine. Conversely, more general warnings about multiple antidepressants may have left physicians with no acceptable therapeutic options, causing them to disregard the warning." [From: "The Effect of Antidepressant Warnings on Prescribing Trends in Ontario, Canada" ]

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