Thursday, April 30, 2009

Dirty mouth? You could be breathing dirty air...

An article today mentions that 186.1 million people live in communities with dangerously high levels of air pollution. That's greater than 50% of the US population, so odds are, it's probably you.

Cleanest city overall? Fargo, ND -- the only city to pass in all three categories: ozone pollution, year round particle pollution and short-term particle pollution. But who lives in Fargo anyway?

Dirtiest city? Los Angeles! It has held it's number one spot for the past 10 years. Gross.

Other dirty cities for ozone: Bakersfield, Calif.; Visalia-Porterville, Calif.; Pittsburgh-New Castle, Pa.; and Fresno-Madera, Calif.

Air pollution can have serious affects -- one study showed that live expectancy increased in 51 cities by 5 months (!!) between 1980-2000 due to air pollition reductions.

The article suggests aiding the cause by using less electricity, drive less, avoid burning wood or trash and push for clean-up of old diesel bus fleets in their communities. You can also plant some trees and increase the green space around your home.

Check out the State of the Air at: American Lung Association

FYI - Fulton County, GA get's a big ole F. Not surprising given the traffic in Atlanta but still disappointing.

WHO General-Director increases influenza pandemic alert to Phase 5

So what does that mean exactly? The phases are mapped out by the World Health Organization and sketch out the face of a possible influenza pandemic. Currently, we're still at pandemic-alert.

Interpandemic period

Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low.

Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease.
Pandemic alert period

Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact.

Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

Pandemic period

Phase 6: Pandemic: increased and sustained transmission in general population.
Notes: The distinction between phases 1 and 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and other scientific parameters.

If you have a lot of time on your hands, or are interested -- check out the WHO global Influenza preparedness plan here. It might be interesting to see how well the US and the world as a whole is following the plans set prior to the reality of an actual pandemic. There are so many different variables that could never be accounted for when a group of people are writing a plan. And as we all know -- rarely do things happen according to a plan. Unfortunately when this whole pandemic is over, the US and the world's actions will be scrutinized and judged. It's important to keep in mind that the folks at the ground level are working as hard as ever to keep the public safe.

Wednesday, April 29, 2009

Yet again... more swine flu news

Here are a bunch of articles about swine flu. Most of these aren't news news - nothing hot-off-the-presses. Just some background stuff and some interesting links to take a look at.

Swine flu - a primer. From

What is an epidemic? From

Just to underscore what swine flu is about - it's not a foodborne disease. You won't get it from eating pork. Not eating pork won't prevent you from getting it. (Says me, but also say the pork farmers in the U.S. as well.)

So as this outbreak has hit, we have several holes in our political leadership. The secretary of Health and Human Services has just been confirmed (Kathleen Sebelius) but the posts of CDC director and Surgeon General are still open. This article provides insight on this.

Some commentary from a New York Times blog.

And last but NOT least, how to prevent contracting swine flu? WASH YOUR HANDS. This fact sheet (with pictures, just in case you need help) is going up on my office bathroom mirror in a few minutes. For good hygiene and also for swine flu. Come on, people, wash your hands after you use the bathroom!

Links for the week

The Kaiser Family Foundation reports results from a survey that show Americans find the HIV epidemic less urgent, even after the latest incidence estimate showed that more people than previously thought are contracting the virus each year. Interesting results - one would think public pressure to do something about the HIV epidemic would be even higher, but it's not.

Generally, public health is important! If you're reading this, the concept is nothing new - I'm preaching to the proverbial choir. This article brings home the point once again. Epidemiology and surveillance, clean water, disease treatment and prevention, food safety, and more. The author, Valerie Bassett, puts this very eloquently: "Who needs public health? We all do. Every resident of the Commonwealth - whether aware of it or not - relies on a strong, functioning public health system - a system that is greatly endangered. Without public health, there is no way for the Commonwealth to succeed in education, economic growth, environmental innovation, or civic engagement."

Take a look at this article about doctor shortages. While not directly public health, it certainly has an impact on public health.

In case you haven't heard, red meat isn't good for you.

See my next post for updates on swine flu!

Swine flu video from 1976

Monday, April 27, 2009

Swine flu

The swine flu outbreak is here and it's real. See my last post for more information, but here are a couple good places to visit:

Obviously any news site would be good -, New York Times, whatever you news source of choice is. And of course CDC is always a good standby for all public health related news. is the place to start.

This New York Times article has a good "Understanding Swine Flu" graphic that is interesting and helpful. Click here to go to the graphic.

This map shows where the outbreaks are, it's a good visual way to picture the spread of the outbreak.

It is important to note that the U.S. declaring a public health emergency does not mean that all hell should break loose. It just frees up resources, allows antivirals to be positioned in case they're needed, etc. The precautions you should take are to wash your hands with warm, soapy water and stay away from being in close contact with those who are sick. That's just general common sense!

Friday, April 24, 2009

Swine Flu News

Keep up with Swine Flu news here as news updates will be posted here.

For those who haven't heard: Read U.S. swine flu linked to Mexico outbreak

A couple more links

This senior in high school won an award for an epidemiology paper she wrote. Great job, Marilyn! Go epidemiology! Now go to college, get your MPH in epi, and work to improve capacity at the state level!

French kissing can give you infectious diseases. Apparently (duh) saliva transmits some infectious diseases. Is it worth the risk? That's not for me to say...

Counterintuitive: This article reports on a study that says the addition of healthy menu choices can lead to unhealthier decisions. Huh? Apparently when a side salad was an option, consumers were more likely to choose french fries. Why would that be? Maybe I shouldn't comment since I love french fries, but it doesn't seem to make sense to me.

Colon cancer prevention: According to this article, colon cancer prevention in Utah is about to get a big boost. Generally chronic disease and cancer are getting a lot of attention these days, as Obama has highlighted it. Rightly so - both are huge public health issues, and it's about time they get addressed as a national priority!

Thursday, April 23, 2009

Pesiticides and Parkinson's Disease

Chronic Neurologic Diseases get spotlighted every once in a while in society's current events. We have Michael J Fox who has found new life since his diagnosis of Parkinson's Disease, a debilitating disorder of the central nervous system. We also have Jack Bauer in Fox's 24 who has contracted Creutzfeldt–Jakob disease from the Starkwood bio-weapon. It's a shame that these diseases only become real when someone we know or someone we see on TV is affected.

Research and policy implementation, sometimes unfortunately, must follow the general public's fears and desires, and overcome the industrial forces that are against exposure of the truth (pun intended). A recent article has been a long time coming: Pesticides linked to Parkinson's The connection between pesticides and Parkinson's was suspected long ago but epidemiologic research today gives facts and figures that strengthen this association to warrant lawful regulation of potentially harmful chemicals such as Maneb or Paraquat: Link.

Q: How much longer will it take for action to be taken?
A: Is smoking actually bad for your health?

Links for the week

Story of the week: Possible swine flu outbreak. Read more about swine flu here. Be assured that we'll post more if we get more news about this!

"Ill from food? Investigations vary by state" - New York Times article about how varied states are in their foodborne illness surveillance and the importance of epidemiology in foodborne illness outbreaks. Go epi!

HHS updates guidelines for health information security

Go public health! An article about what it is that one local public health department does.

Public health goes 21st century. This article briefly touches on public health's use of social networking sites to affect the spread of STDs. This link to CDC's social media page has all sorts of ways that CDC uses blogs, email, Twitter, and other modern communication tools.

Mandatory bicycle helmet laws

Commentary on bicycle helmet blog post:
So this is a public health blog. So naturally we're going to be in favor of measures that improve the public's health. Take laws that mandate children and/or adults wearing bicycle helmets. It seems pretty intuitive, right? Wear helmet = less impact if you fall = fewer traumatic brain injuries = improved health population-wide. All for the low cost of a simple bike helmet. This man's blog post doesn't agree. Take a look.

This fact sheet from the National Highway Traffic Safety Administration shows facts to the contrary; bike helmets reduce head injuries and bike helmet laws increase bike helmet use. This CDC MMWR article recommends bike helmet use. Here are some statistics and a summary of state laws from the Bicycle Helmet Safety Institute.

Now, I know that these statistics by themselves aren't a cohesive argument for mandating helmet use, but why the heck not? We mandate seatbelt use, we mandate lots of things that improve your health every day. You don't wake up in the morning without public health touching your life. Why not save especially a child's life by mandating that he or she wear a bicycle helmet while joyfully riding through the neighborhood?

Breastfeeding keeps moms healthy

To all of the new moms who debate whether to breastfeed or not, a recent study was published saying that breastfeeding had a protective effect on the mothers with a reduced risk in diabetes, high blood pressure and for developing cardiovascular disease during menopause. How can the act of breastfeeding have so many long term benefits?

Breastfeeding is known to have many positive side effects for the mother -- burning off tons of extra calories (dropping that baby weight), causing uterine contractions to reshape the uterus back to its normal size and reducing the risk of type-2 diabetes, osteoporosis and breast cancer. While the docs don't know how it works physiologically, the results are easier to study than the mechanism itself. One hypothesis is that the horomone oxytocin is produced during breastfeeding and causes the blood vessels to be more flexible and more resistant to plaque build-up. Our bodies do amazing things all on their own. Breastfeeding is completely natural and women's bodies are built to produce, nourish and recover. It's not surprising that the female body has built in recovery-horomones to fix itself to create more babies!

So, if you're a new mom or a future mom, think through all of the choices and consider not only the health benefits for yourself but all of the immunological and caloric benefits for your new baby. has a lot of information for you to consider
Breastfeeding associated with increased intelligence

Source: NY Times Article, April 19, 2009

Tuesday, April 21, 2009

Can foreclosures cause public health problems?

What a cool article!
The gist of it: foreclosures = abandoned homes = neglected swimming pools = standing water = mosquitoes = increased incidence of West Nile Virus. What a connection to make.

Other possible public health problems that might result from foreclosures:
- Environmental toxin exposures as homes sit and are neglected.
- Mental health concerns stemming from homeowner stress. (A fact sheet about mental health & public health, another fact sheet, and an article.)
- Injuries from neighborhood kids playing around the foreclosed house.

Any other ideas?

Monday, April 20, 2009

Suicide prevention

Given the recent House episode about suicide, I thought it fitting to do a quick post about suicide and suicide prevention, as mental health as a public health issue is quickly gaining notice in the field. The House episode directed viewers to a mental health organization. The episode sparked a LOT of conversation in person and on blogs, for example this one. Or Google "house suicide episode" or some such phrase and you'll get over 3 million results!

Suicide is a serious matter. There are people and organizations out there. All I ask is that you reach out to 1 person. Know that whoever you are, whatever your situation is, there will always be 1 person who cares about you. It may not "all be ok" - no one can guarantee that. But please reach out, there will be a better day. 1-800-273-TALK

A couple links:

Friday, April 17, 2009

Links for the day

Here are some articles you might be interested in:

State, local changes seen as key to U.S. food safety - This is based on a report released today regarding food safety. So true! The system needs to be integrated, and hopefully the various proposals out there to reform the food safety system will be implemented to help strengthen the system.

This article by Paula Crossfield at the Huffington Post critiques an article in the NY Times recently that warns consumers about the dangers of trichinosis in free-range pork. There were a few problems with the analysis, which Paula smartly points out.

A policy cocktail for fighting HIV - Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at NIH, discusses three "bold new" policy moves to combat HIV in the U.S. First is PrEP, pre-exposure prophylaxis, would provide antiretrovirals to those at high risk of infection. Second is "universally available, voluntary, annual testing for HIV infection" followed by immediate treatment of those found HIV-positive. The third policy addresses the long-term treatment of HIV-positive people. (Frankly, the third policy isn't spelled out very succinctly.)

New York considers making HIV testing routine - This is a pretty controversial idea to make HIV testing routine during physician visits, but studies have found that asking patients to opt into testing is a barrier. So there are pros and cons to this approach. We'll see where the NY legislature takes this.

Access to outpatient mental health services - Primary care physicians are finding difficulty getting mental health services for their patients. This study in Health Affairs (great journal) says that it is up to twice as difficult to get mental health services than other medical services.

Thursday, April 16, 2009

Wednesday, April 15, 2009

Health surveillance & the internet

This article discusses detecting disease outbreaks through the internet. Wow.. whoever thought! Shoe leather epidemiology goes high tech. There are several sites that do this already, and they are growing in popularity and are quite intriguing. (Click here. Or here.) But it does indeed seem to hold up, at least to some extent - tracking disease through internet searches does seem to correlate with disease trends. The article uses a Canadian listeriosis outbreak as an example and has a nifty graph.
Screen shot of Google Flu (the Georgia trends, of course!)

Don't forget the sunscreen...or data to prove your point

Commentary on: South Dakota sun lovers smarter than most By Jon Walker,, April 14, 2009

This article actually details how South Dakota residents are really bad at wearing sunscreen. Considering that many S. Dakota residents work outside (i.e. farming, ranching, etc) the risk for skin cancer is quite high. The article's title implies that South Dakotans are actually good at protecting themselves with sunscreen, "...sun lovers smarter than most," but the author never provides data of sunscreen usage in other states for a true I did!

The American Cancer Society has some really great information on this from 2008 (source). Here are states that have counts below South Dakota:

State -- New cases of melanoma (skin cancer)
South Dakota -- 160
Wyoming -- 120
North Dakota -- 110
Alabama -- 80
Dist. of Columbia -- 50

Now, the numbers above are frequencies (just counts) and they can also be misleading unless you compare the rates of new cases. Rates are more representative of the situation since it takes into account population size. Rates are important to understand what's going on.

So, I took into account each state's population and calculated the rates of new cases below:

State -- Rates of new cases of melanoma (count/total pop) x 100
South Dakota --0.21%
Wyoming -- 0.02%
North Dakota --0.02%
Alabama -- 0.002%
Dist. of Columbia --0.01%

Now -- looking at these rates, we have a completely different picture than we did with just the count data. According to the rates, South Dakota is the WORST at preventing new rates of skin cancer. This is discordant with what the article proclaims.

Bottom line:
  • South Dakota needs to be better at applying sunscreen as a state.
  • Be careful of data without denominators and
  • Beware of misleading titles (like the one in this article).
  • Always look for data to support the author's claims.
  • Finally-- do a quick google images search of 'skin cancer' or 'melanoma' and you will see just how ugly it really is. Eghh. Apply sunscreen liberally!

If you want to know the skin cancer rates in your state or do your own fact checking, check out the American Cancer Society's 2008 data:

This is Public Health Video

Check out this organization:
They emphasize that public health is EVERYWHERE - and it's true! They also give information about public health careers, schools of public health, and more. Very catchy marketing!

Tuesday, April 14, 2009

American Indians need the Voice of Epi

Commentary on:

Treatment with Respect to Tradition

By DIANE COCHRAN, Billings Gazette, April 12, 2009

Epidemiology may not be able to determine definitive answers for an individual’s health, but it can certainly give a voice to people’s health. Statistics speak loudly. Unfortunately, they are thrown around so often that people have become calloused to numbers. They tell you silly statistics to combat your hard earned statistics, “90% of statistics are false.” When read in context, it usually only requires an ounce of common sense to decipher bogus figures from well-planned studies.

“People from native cultures live an average of 2.4 fewer years than do Americans of all other races. Their disease rates, especially for diabetes, are significantly higher, as is their infant mortality rate.”

I don’t doubt it. I’m surprised it’s not even more than that. Does that include the skyrocketing number of teenage suicides? I heard diabetes is endemic with American Indians. Are there trends in different tribes? What is being done to bridge this gap? Ask questions.

“American Indians are much more likely to die from diabetes, accidents, homicide, suicide, and alcoholism than are other Americans, partly because they are half as likely as people in other populations to received needed medical care.”

Oh look, the next paragraph addresses a number of my questions and confirms a few hypotheses that I raised. In fact, I have even more questions now. The power of epidemiology rests solely on the shoulders of the DATA – the quality, the robustness, the timeliness. How are programs to be evaluated? What are the most important outcomes of our health system? It usually doesn’t take high-level complicated multivariate analyses to realize that some of the most dire circumstances have been in front of our faces the entire time.

It is only when you have the numbers that you can begin to advocate for marginalized societies who can’t speak up for themselves. It is only when you have the numbers that you can say, ‘We shouldn’t be sleeping at night because the disparities are so great.’ It is only when you have the numbers that you can say, high mortality rate is the symptom – the real disease is unemployment. And from there, you’re not using antibiotics or surgery to rescue one, but you’re using policy and grassroot programs to prevent entire groups of people from jumping into the proverbial river.

Minnesota as food safety first responders - always!

Commentary on:

“When food illnesses reported, Minnesota team gets the call”

By Julie Schmit and Elizabeth Weise, USA Today, March 6, 2009

The last few years has brought several foodborne disease outbreaks of national importance. In the summer of 2008, there was a salmonella outbreak involving hot peppers. In winter of 2009, a salmonella outbreak involving peanuts. Why are we hearing about so many outbreaks? One answer is that they are being detected more and more thanks to more sophisticated testing. But how are they detected?

Minnesota is a leader in foodborne illness outbreak investigation. Minnesota is one of ten states that receive extra funds to track foodborne diseases. These extra funds help the Minnesota department of health detect and respond to outbreaks at a faster pace.

What does foodborne illness outbreak response entail? First, complaints come into the local or state health department. In most cases, there must be at least two complaints to merit an investigation into the food product. When someone gets sick and goes to the doctor, a stool sample is collected which is sent to the public health lab for testing. If the sample is positive for salmonella or E. coli, “state investigators go to work.” The next phase is interviewing patients to find common foods eaten. The answers to these interviews are pieced together to find the source of the outbreak. In Minnesota, “Team Diarrhea,” a group of grad students, conducts the interviews.

This process seems straightforward enough.. so why the delays? Many health departments are underfunded or understaffed for foodborne illness investigation, and therefore they may have to prioritize between a foodborne illness outbreak and a whooping cough outbreak. Cited in this article, Tim Jones, epidemiologist in Tennessee, notes that “food safety is about the same everywhere” but the capacity to detect and respond to outbreaks is what differs.

The bottom line is that less money and less staff equals less investigation of complaints, less testing of samples, less inspection of sites, and decreased ability to respond to outbreaks, much less prevent them.

Epi studies.. what do they mean?!

Commentary on:

“Get smart about science: Conflicting studies about health risks and benefits can drive you crazy. Here’s how to sort through the science”

By Trine Tsoudero, Chicago Tribune, February 16, 2009

The news abounds with stories such as “drinking coffee causes cancer”, “drinking coffee prevents cavities”, and even drinking coffee does not cause cancer or prevent cavities. What?! How can you sift through all of this? More importantly, why do the media report this stuff with such frequency and confidence?

This article brings to light an important fact about these epidemiologic studies: “sometimes findings that sound spectacular may be completely useless to you – though important to other scientists working on the bigger picture.” In other words, epidemiologic studies such as studying the link between drinking wine and heart disease are important to the larger body of science on the issue, but each individual study does not bring definitive answers.

One study this article examines involves investigating coffee drinkers versus non-coffee drinkers and their development of oral, pharyngeal, or esophageal cancers. Although coffee drinkers developed these cancers half as often as non-coffee drinkers, this finding delivers only the relative risk. Looking at the bigger picture, only a few people developed cancer out of this study, so drinking coffee may cut your risk from small to very small.

Second, researchers don’t always take into account other risk factors that may contribute to the finding. Coffee drinkers may have some other characteristic that decreases their risk. Perhaps coffee drinkers are those who can afford to buy coffee at a retail establishment and are therefore higher income level. Or perhaps non-coffee drinkers are more likely to sleep more and be more sedentary.

The bottom line is: realize that epidemiologic studies that you see reported frequently in the media are more likely to be contributing to larger unresolved questions in the scientific world than determining definitive answers for your health. Do more research before diving into that giant full-fat cappuccino every day.