Online-only: Public health extras: News roundup on smoking, prostate cancer, lead and more

Smoking cessation treatments save money, lives

A recent report from the American Lung Association found that helping smokers quit not only saves lives but is also good for the U.S. economy.

Released in mid-September, the report, “Smoking Cessation: The Economic Benefits,” includes a nationwide cost-benefit analysis comparing the costs to society of smoking with the economic benefits of states providing cessation coverage.

The report “spells out in dollars and cents the great potential economic benefits to states of helping smokers quit,” said Charles D. Connor, president and CEO of the American Lung Association.

For example, if states were to invest in comprehensive smoking cessation programs, each of those states, on average, would receive a 26 percent return on that investment. Simply stated, every dollar spent on helping smokers quit would bring states, on average, a return of $1.26. And some states would see higher returns on their investments than other states. States with higher than average returns include Louisiana, at $1.47, and Massachusetts, which would receive $1.43 for every dollar spent on smoking cessation. At $1.94, the District of Columbia, which was also included in the report, would receive the highest return on its investment.

Overall, the report found smoking results in yearly costs of more than $301 billion to the U.S. economy — including workplace productivity losses of $67.5 billion, costs of premature deaths at $117 billion and direct medical expenditures of $116 billion. Smoking is the leading preventable cause of illness and death in the United States, and surveys have shown 70 percent of smokers want to quit.

The full report, which includes state-specific data, is available at www.lungusa.org/cessationbenefits.

Childhood lead exposure may delay puberty

Exposure to lead in childhood has been linked to delayed puberty in girls, according to a recent National Institutes of Health study.

Researchers analyzed data on blood drawn from 700 girls ages 6–11 and found those with elevated levels of lead — at or above five micrograms of lead per deciliter of blood — were 75 percent less likely than girls with low lead levels to have key adolescent hormones at levels that are associated with beginning puberty. In girls with elevated levels of both lead and cadmium, the pattern was even more pronounced.

The study’s authors said that lead, either alone or in concert with cadmium, might suppress the ovary’s production of hormones that prepare a young girl’s body to ovulate, or release an egg, for the first time.

“Our findings suggest childhood exposure to lead has worrisome effects as children age and reach adolescence,” said lead study author Audra L. Gollenberg, PhD, a fellow at the National Institute of Child Health and Human Development. “These issues are of concern in some parts of the United States as well as in countries where children are exposed to leaded gasoline, paint or industrial pollutants.”

The study also suggested delayed puberty associated with lead was more prevalent in girls with iron deficiency, and Gollenberg said health providers may “wish to pay particular attention to the importance of screening for iron deficiency among girls at high risk for exposure to lead.”

The study was published in the September issue of Environmental Health Perspectives, online at http://ehp03.niehs.nih.gov.

Most gay teens harassed at school

Nearly nine out of 10 lesbian, gay, bisexual or transgender students experienced harassment at school in the past year, and nearly two-thirds felt unsafe because of their sexual orientation, according to a recent survey.

Released in September by the Gay, Lesbian and Straight Education Network, the 2009 survey of more than 7,200 middle and high school students also found nearly a third of lesbian, gay, bisexual or transgender students skipped at least one day of school in the previous month because of safety concerns. An analysis of the National School Climate Survey data showed a decrease in students hearing homophobic remarks but a relatively constant level of gay students’ experiences with more severe forms of bullying and harassment.

“It could not be clearer that there is an urgent need for action to create safe and affirming schools for LGBT students,” said Eliza Byard, executive director of the Gay, Lesbian and Straight Education Network. “As our nation seems to finally be taking bullying more seriously, it is crucial that LGBT students are no longer left out of efforts to address this public health crisis.”

The 2009 National School Climate Survey is available at www.glsen.org.

CDC issues health worker advisory on fingerstick devices

Out of increasing concern about the risks of transmitting hepatitis B virus and other bloodborne pathogens to people undergoing fingerstick procedures for blood sampling, federal health officials have issued an advisory against reusing fingerstick devices.

Released in August by the Centers for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases, the clinical reminder said “fingerstick devices should never be used for more than one person.” The devices are used to prick the skin and obtain drops of blood for testing and can be designed for single use or for reuse on a single person. The reminder cites reports of hepatitis B infection outbreaks linked to diabetes care, which often uses the small hand-held devices.

The Clinician Outreach and Communication Activity Clinical Reminder from the Division of Healthcare Quality Promotion is available at http://www.bt.cdc.gov/coca/reminders/2010/2010aug26.asp.

Smoking in public housing poses serious health risks

Health and medical professionals are pushing for a ban on cigarette smoking in public housing to protect children from harmful tobacco smoke exposure.

“Research shows that those living in multiple-unit housing are being exposed to toxins from tobacco smoke,” said Jonathan Winickoff, MD, MPH, lead author of an article on the topic published in the June 17 New England Journal of Medicine. “Even if you are not a smoker and don’t smoke inside of your own apartment, if you have a neighbor who is smoking inside of his, the entire building is contaminated.”

More than 7 million people live in public housing in the United States, according to the article, and four of every 10 units are occupied by families with children. The article gives guidance on policy options for public housing authorities and the U.S. Department of Housing and Urban Development to protect all residents from tobacco smoke exposure and clarifies that there are no legal barriers to banning smoking in public housing. In July 2009, HUD issued a memorandum strongly urging local housing authorities to implement no-smoking policies in some or all of their units.

Prostate cancer screening reduces deaths by almost half

While the benefits of routine cancer screening have come under recent debate, a study published online June 30 in the Lancet Oncology found prostate cancer mortality was reduced almost by half in men screened using the prostate-specific antigen, or PSA, test.

The study, which is ongoing, assigned men ages 50–65 to either a screening or control group, with about 10,000 men in each group. Men found to have an elevated PSA were offered additional tests such as a digital rectal exam and prostate biopsies.

Over the study’s 14 years of follow-up, prostate cancer was diagnosed in about 1,140 men in the screening group and about 720 in the control group. Prostate cancers detected in the men in the screening group were more likely to be early-stage cancers.

“The risk of over-diagnosis is less than previously reported, but still 12 men need to be diagnosed to save one life,” the study’s authors wrote.

Consistent rules better for mental health of students with same-sex attractions

Students with feelings of same-sex attraction report better mental health at schools with a clear and consistent set of rules and expectations, according to a study (http://ajph.aphapublications.org/cgi/content/full/100/9/1696) published in the September issue of APHA’s American Journal of Public Health.

Using data collected in 2008 from more than 500 Dutch students ages 12 to 15, researchers found that adolescents with same-sex attraction and who attended schools that scored low for consistency and clarity of rules reported significantly more mental problems than peers with no same-sex attraction. Researchers did not find such a difference in schools with consistent and clear rules and expectations, such as students clearly understanding the consequences of breaking a rule.

The study authors noted that while similar research has focused on policies specifically designed with sexual minority youth in mind, their findings suggest that an “environment in which diversity is respected more generally and in which rules are clear and fairly applied will benefit adolescents with as well as without same-sex attractions.”

“Our findings strongly suggest that, as indicated by others, it is of crucial importance to explore how structural factors contribute to health disparities in relation to sexual orientation or how such factors might mitigate these disparities,” researchers wrote.

Drug-resistant E. coli strain causing serious illness

A new, drug-resistant strain of E. coli is causing serious illness, according to a study in the Aug. 1 issue of Clinical Infectious Diseases.

Researchers found the new strain — ST131 — was a major cause of serious antimicrobial resistant E. coli infections in the United States in 2007. The strain has been reported in multiple countries and across the United States. Researchers analyzed drug-resistant E. coli isolates and identified 54 that account for almost 70 percent of E. coli isolates showing resistance to the antibiotics fluoroquinolone or extended-spectrum cephalosporin.

“If we could discover the sources of the strain, the transmission pathways that allow it to spread so effectively and the factors that have led to its rapid emergence, we could find ways to intervene and possibly slow or halt this strain’s emergence,” said study author James Johnson, MD, of the Veterans Affairs Medical Center in Minneapolis. “If this strain gains one additional resistance gene, it will become almost untreatable and will be a true superbug, which is a very concerning scenario.”

The study’s findings mark a shift from the past, when highly virulent E. coli strains have typically been treatable with antibiotics. Highly resistant strains usually have been fairly weak in terms of their ability to cause disease. The study’s authors urged more study into the new strain’s transmission pathways.

Health sociology papers sought by journal

Research in the Sociology of Health Care, a journal published by Emerald Press, is seeking papers for its upcoming annual volume.

Volume 29 of the journal will focus on themes that include patients as partners in care, factors that impact access to care — such as racial and ethnic, social, demographic and structural sources — and the changing role of health providers. The volume will contain 10–14 papers, generally about 20–40 pages in length.

Completed manuscripts or detailed outlines for review are due by Feb. 1, 2011. For information, e-mail jennie.kronenfeld{at}asu.edu.

— Donya Currie and Kim Krisberg contributed to this report