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Global Health, Infectious Disease, Public Health, Research, Stanford News

Using video surveillance to gain insights into hand washing behavior

Using video surveillance to gain insights into hand washing behavior

13715-handwashing_newsSimply washing your hands can reduce the reduce respiratory illnesses, such as colds, in the general public by 21 percent, cut the number of people who get sick with diarrhea by 31 percent and lower diarrheal illness in people with weakened immune systems by 58 percent, according to data from the Centers for Disease Control and Prevention.

Despite these compelling facts, and many years of global awareness campaigns, hand-cleaning rates remain far below full compliance — particularly in low-income, developing world settings. But using video surveillance to observe hygiene practices can offers insights that may help improve design, monitoring and evaluation of hand-washing campaigns, according to a new Stanford study.

For the study, researchers installed video cameras at the washing stations outside latrines of four public schools in the Kibera slum of Nairobi, Kenya. Teachers were informed in advance and parents and administrators granted their permission for the experiment. Their findings were highlighted in a Stanford News article published yesterday:

  • Both video observation and in-person observation demonstrated longer hand cleaning times for hand washing with soap as compared to rubbing with sanitizer.
  • Students at schools equipped with soap and water, instead of sanitizer, were 1.3 times more likely to wash their hands during simultaneous video surveillance and in-person observation when compared with periods of in-person observation alone.
  • Overall, when students were alone at a hand-cleaning station, hand cleaning rates averaged 48 percent, compared to 71 percent when at least one other student was present.

Based on their findings, study authors recommended the following approaches for boosting hand washing:

  • Placement of hand cleaning materials in public locations
  • Scheduling specific times for bathroom breaks between classes
  • Designating specific students to be hand hygiene “champions”
  • Formation of student clubs to demonstrate and promote hand hygiene to classmates

Previously: Examining the effectiveness of hand sanitizers, Survey outlines barriers to handwashing in schools, Examining hand hygiene in the emergency department, Good advice from Washyourhandsington and Hey, health workers: Washing your hands is good for your patients
Photo by Amy Pickering

Addiction, Health Disparities, In the News, Public Health

Menthol cigarettes: How they’re being used by and marketed towards African Americans

Menthol pic - smallHere’s a scary statistic, included in a recently published Newsweek article: “Each year, smoking-related illnesses kill more black Americans than AIDS, car crashes, murders and drug and alcohol abuse combined, according to the Centers for Disease Control and Prevention (CDC).” And then there’s this: “More than four in five black smokers choose menthol cigarettes, a far higher proportion than for other groups… By mitigating the harshness of cigarettes and numbing the throat, menthol makes smoking more palatable, easier to start – and harder to quit.”

The article discusses advocates’ call for a ban on menthol cigarettes (all other flavored cigarettes were banned in 2009) before going on to describe the history of African Americans and menthol-cigarette use, and tobacco companies’ aggressive marketing tactics. (“The tobacco industry… positioned itself as an ally of the very community it was seducing,” writes Abigail Jones.) It also quotes Stanford’s Robert Jackler, MD, founder of Stanford Research into the Impact of Tobacco Advertising, who expresses his concerns with ads that appear in a prominent African-American publication:

…[Jackler] has analyzed Ebony magazines since the 1940s and discovered it ran 59 cigarette ads in 1990, 10 in 2011 and 19 last year.

Ebony published 21 articles about breast cancer and 11 about prostate cancer between 1999 and 2013 but did not publish a single full-length story on lung cancer in that 15-year period. “Tobacco advertising is a huge revenue stream,” says Jackler. “Ebony professes itself to be the so-called ‘heart and soul and voice of the African-American community,’ and it completely neglects smoking.”

Previously: E-Cigarettes: The explosion of vaping is about to be regulated, What’s being done about the way tobacco companies market and manufacture products, Menthol “sweetens the poison,” attracts more young smokers, Menthol cigarette marketing aimed at young African Americans and NPR’s Picture Show highlights Stanford collection of cigarette ads
Photo by Classic Film

Public Health, Videos

Exploring popular health myths and how they influence health-care decisions

Exploring popular health myths and how they influence health-care decisions

This week on the TEDMED Great Challenges series, guests discussed popular health myths, ways these myths spread. and how doctors and patients can better evaluate medical information. In the video above, Rusty Hoffman, MD, chief of interventional radiology at Stanford, addresses a variety of topics, including misconceptions related to heart disease and uncertainty around new mammogram guidelines, and discusses building trust between doctors and patients to dispel myths using evidence-based medicine.

Previously: European experts debunk six myths about flu shot, Four common myths about U.S. health care, Exploring popular sleep myths and MythBusters looks at pain myths with Stanford doctor on April 28

Health and Fitness, In the News, Obesity, Public Health

In Boston, doctor’s orders may include discounted bike-share memberships

Some Boston docs are delivering a dose of preventive care the old-fashioned way. Encouraging physical exercise under the city’s new “Prescribe-a-Bike” program, physicians at Boston Medical Center can refer low-income patients to a $5 bike-share membership, complete with helmet.

Common Health reports:

“Obesity is a significant and growing health concern for our city, particularly among low-income Boston residents,” BMC President and CEO Kate Walsh said in a statement. “Regular exercise is key to combating this trend, and Prescribe-a-Bike is one important way our caregivers can help patients get the exercise they need to be healthy.”

Previously: A bike helmet that doubles as a stress-o-meter and Modest increases in bike ridership could yield major economic, health benefits

Addiction, Public Health, Research

What the experience of Swedish snuff can teach us about e-cigarettes

snusA new study in JAMA Internal Medicine suggests that e-cigarettes don’t help tobacco smokers quit.  This study will no doubt attract enormous attention because it relates to the hottest debate in tobacco control: Whether e-cigarettes are a boon or bane to public health. E-cigarette proponents see them as a way for cigarette smokers to transition to a less damaging way of consuming tobacco; opponents worry that e-cigarettes will entice non-smokers into using a product that will ultimately be a gateway to cigarette smoking. Until more definitive data are gathered on e-cigarettes, participants in this debate would do well to examine the experience of Swedish snuff (also known as “snus”).

Snus is a smokeless tobacco that is mainly used in Scandinavia. Its use is damaging to health, but because it is not smoked and contains a low level of cancer-causing nitrosamines, the damage to users and those around them from snus is less than that of tobacco cigarettes. The fundamental question at play in the current e-cigarette debate was also raised regarding snus: Would it be a net harm or a net benefit to public health?

A study of 15,000 Swedish males examined snus use and smoking among a younger (age 16-44) and older (age 45-84) cohort. About 18 percent of tobacco smokers had previously been snus users. This gateway effect from snus to cigarettes was more common for older than younger individuals.  However, in both cohorts, the reverse pattern was far more common, leading to an overall drop in tobacco smoking. Among the younger cohort, snus accounted for six smoking quitters for each smoking starter.  In the older cohort, the benefit was less: About two smoking quitters per starter. Given the size of these effects and the prevalence of snus use, it is entirely credible to argue that snus has contributed to the declining lung cancer rate in the Swedish population.

The Swedish results would seem to make a conclusive case for the public health benefits of snus. However, a subsequent study of 1151 Finnish men had starkly different results. Only 22 participants in the study had replaced tobacco smoking with snus use. The norm in this population was to use snus to supplement rather than replace cigarette smoking, tending to increase the physical dependence of tobacco users. Although not able to draw a definitive conclusion, the authors noted that “it is likely that snus use complicates the attempts to quit smoking”.

The science on snus is thus unsatisfying for those desiring a simple answer regarding the public health value of putatively less harmful forms of tobacco. In one context, snus was enormously beneficial. In another, it appears to have made things worse. The effect of snus also varied across historical time periods as younger and older people used it in distinct ways.

The experience of e-cigarettes may very well follow the same pattern – or perhaps it is better said – the same lack of a pattern. An empirically grounded, universally valid judgment on the impact of e-cigarettes may be difficult to attain. Whether they are a net positive or negative for public health will depend on the context in which they are used, the degree to which different generations adopt them, and the regulations society sets regarding them.

Addiction expert Keith Humphreys, PhD, is a professor of psychiatry and behavioral sciences at Stanford and a career research scientist at the Palo Alto VA. He recently completed a one-year stint as a senior advisor in the Office of National Drug Control Policy in Washington. He can be followed on Twitter at @KeithNHumphreys.

Previously: E-Cigarettes: The explosion of vaping is about to be regulated
Photo by Ole C Eid

Addiction, FDA, Health Policy, Podcasts, Public Health

E-Cigarettes: The explosion of vaping is about to be regulated

E-Cigarettes: The explosion of vaping is about to be regulated

E-cigarettes are about to get zapped. To date, across the globe, they’ve been largely unregulated – and their growth since they first came on the scene in 2007 has been exponential. Now, in the first big regulatory action that is sure to spur similar responses across the pond, the European Parliament approved rules last week to ban e-cigarette advertising in the 28 EU member nations beginning in mid-2016.  The strong action also requires the products to carry graphic health warnings, be childproof and contain no more than 20 milligrams of nicotine per milliliter. It’s expected that the U.S. Food and Drug Administration will soon follow suit and the days of great independence for e-cigarettes will come to a crashing halt. A few U.S. cities, Los Angeles most recently, have banned e-cigarettes in public spaces.

e-cigUntil recently, I was completely ignorant about the whole phenomenon of e-cigarettes. What is the delivery system? Where are they manufactured? Are they a safe alternative to smoking? And how are they being marketed and to whom? Well here’s an eye opener: According to the Centers for Disease Control and Prevention, e-cigarette usage more than doubled among middle and high school students users from 2011 to 2012. Altogether, nearly 1.8 million middle and high school students nationwide use e-cigarettes.

Robert Jackler, MD, chair of otolaryngology at Stanford Medicine, has long studied the effects of tobacco advertising, marketing, and promotion through his center, SRITA (Stanford Research Into the Impact of Tobacco Advertising). After years of detailing how tobacco use became ubiquitous in the U.S. he’s now tracking the marketing of e-cigarettes, and what he’s found probably won’t surprise you. The same sales techniques that brought about the explosive growth of tobacco use are being deployed again to make e-cigarettes look sexy, cool and defiant.

While there are claims by the e-cigarette industry that e-cigarettes are important tools to help people kick the tobacco habit, there’s little evidence to date to back up that claim. And Jackler isn’t completely sold on the notion that e-cigarettes will bring about a great cessation of tobacco smoking; he sees them more as a continuity product. He told me:

What the industry would like to see you do is when you go to a place that you can’t smoke, that you pick up your e‑cigarette and you vape, and you get your nicotine dose in the airport when waiting, or when you’re in your workplace, or when you’re even in school, and that way, when you leave school or the workplace, you go back to the combustible tobacco products.

Sorry if I’m a bit cynical, but as an ex-smoker I find it hard to believe that Big Tobacco – which is increasingly getting into the e-cigarette business – doesn’t also see vaping as a way to continue to keep smokers smoking. Bubble gum flavors and packaging designed to resemble lipstick containers! Who’s really being targeted here?

After my 1:2:1 podcast (above) with Jackler, I’m convinced we’ve been down this road before and it wasn’t pretty health-wise. More than 16 million Americans suffer from a disease caused by smoking. Listen to the podcast and you be the  judge about the true intentions of those promoting e-cigarettes.

Previously: Stanford chair of otolaryngology discusses federal court’s ruling on graphic cigarette labelsWhat’s being done about the way tobacco companies market and manufacture products and Image of the Week: Vintage Christmas cigarette advertisement
Photo by lindsay-fox

Health and Fitness, Public Health, Research, Sports

Lingering effects of injuries sideline many former college athletes later in life

Lingering effects of injuries sideline many former college athletes later in life

basketball playerWhile playing sports in college, it wasn’t uncommon to see medical trainers tape up teammates’ bruised ribs or administer cortisone shots so that athletes wouldn’t have to sit out a game. I always felt fortunate that I suffered only a series of sprained ankles, but concern for my health grew after reading about new research showing that many college athletes are inactive later in late due to the long-term consequences of past injuries.

The study, which appears in the American Journal of Sports Medicine, examined more than 230 men and women who were former Division I athletes and 225 who didn’t play high-level sports in college. Individuals ranged from 40-65 years old. As reported in a recent Health Day story, the Indiana University researchers’ findings showed:

Former Division I athletes were more than twice as likely to have physical problems that limited their daily activities and exercise. Sixty-seven percent of these former athletes said they had suffered a major injury and 50 percent said they had chronic injuries during college, compared with 28 percent and 26 percent, respectively, among non-athletes.

The study also found that 70 percent of athletes said they had practiced or played with an injury, compared with 33 percent of non-athletes. Forty percent of athletes were diagnosed with osteoarthritis after college, compared with 24 percent of non-athletes.

Previous joint injuries may increase the risk of developing osteoarthritis, the study authors said.

The former college athletes also had higher levels of depression, fatigue and poor sleep than non-athletes, according to the study, which was published recently in the American Journal of Sports Medicine.

Previously: Is repetitive heading in soccer a health hazard?, Study shows men, rather than women, may be more prone to ACL injuries and Researchers call for improvements to health screenings for female college athletes
Photo by K.M. Klemencic

In the News, Public Health, Research, Stanford News

When caffeine dependence affects quality of life

When caffeine dependence affects quality of life

coffee3Caffeine use disorder: It’s a thing. Maybe you follow your nose to a $5 cup of artisan coffee or perform a morning home-brew ritual and drink in moderation. Even if your fix comes from a six-pack of Nescafé 3in1, your habit wouldn’t necessarily be considered a medical issue. An article in today’s San Francisco Chronicle discusses what constitutes caffeine use disorder, its estimated rate of occurrence, and the comparatively small amount of research that’s been published on it compared with data on the potential health benefits and risks of the drug.

Among the common side effects associated with caffeine misuse – not necessarily caffeine use disorder – are headaches. Erin Allday writes:

“We’re not talking about cancer here. It’s a quality-of-life issue,” said [Robert Cowan, MD,] director of the Stanford Headache Program.

When he sees patients with chronic headaches, one of the first questions he asks is how much caffeine they consume. The caffeine doesn’t necessarily cause the headaches, but the withdrawal can, and even going a few hours without a cup of coffee can cause some people intense pain.

The piece notes some warning signs that caffeine use could be approaching addiction:

“There are people who have chronic reflux, stomach acid pain, bleeding, hemorrhoids – all because of coffee. They’re suffering a lot,” said Keith Humphreys, [PhD,] a Stanford addiction expert. “But they try and they fail to stop.”

Those people may be addicted to caffeine, he said. But he’s loath to apply that label to most people who regularly use caffeine, even those who are physically dependent on it. For something to be considered an addiction, it needs to truly disruptive – causing problems in personal relationships, for example, or interfering with the ability to work.

Previously: Director of Stanford Headache Clinic answers your questions on migraines and headache disordersAsk Stanford Med: Answers to your questions about heart health and cardiovascular research and For new moms, coffee scores a point: Caffeine doesn’t seem to interfere with baby’s sleep in study
Photo by ibeeckmans

Public Health, Research

Study shows no difference in allergy prevalence across different regions of the United States

Study shows no difference in allergy prevalence across different regions of the United States

sneezing_030414Contrary to the many lists declaring the top worst cities for allergy suffers, new research shows the prevalence of allergies is the same regardless of where you live, with the exception of allergies among children 5 years old and younger.

In the study, researchers analyzed blood serum data compiled from roughly 10,000 adults and children in the National Health and Nutrition Examination Survey (NHANES) 2005-2006. Their findings constitute the largest and most comprehensive nationwide study to examine allergy prevalence from early childhood to old age.

Results showed that only children ages 1-5 from the southern United States displayed a higher prevalence of allergies than their peers living in other regions. Paivi Salo, PhD, lead author and an epidemiologist National Institute of Environmental Health Sciences, explained in a release, “The higher allergy prevalence among the youngest children in southern states seemed to be attributable to dust mites and cockroaches… As children get older, both indoor and outdoor allergies become more common, and the difference in the overall prevalence of allergies fades away.”

Other interesting findings from the study include:

The study found that in the 6 years and older group, males, non-Hispanic blacks, and those who avoided pets had an increased chance of having allergen-specific IgE antibodies, the common hallmark of allergies.

Socioeconomic status (SES) did not predict allergies, but people in higher SES groups were more commonly allergic to dogs and cats, whereas those in lower SES groups were more commonly allergic to shrimp and cockroaches.

By generating a more complete picture of U.S. allergen sensitivity, the team uncovered regional differences in the prevalence of specific types of allergies. Sensitization to indoor allergens was more prevalent in the South, while sensitivity to outdoor allergens was more common in the West. Food allergies among those 6 years and older were also highest in the South.

Previously: Researchers find mechanism for destruction of key allergy-inducing complexes, Helping kids cope with allergies and Gesundheit! Spring allergy season is underway
Photo by Allan Foster

Public Health, Research, Science Policy, Videos

Federal investments in research and higher education key to U.S. maintaining innovation edge

Federal investments in research and higher education key to U.S. maintaining innovation edge

Government investment in research and higher education have made the United States a global innovation leader and have led to the creation of the Internet, global positioning systems, magnetic resonance imaging, touch-screen technology, and life-saving vaccines (among other things). But some worry that recent cuts and stagnating funding pose a serious risk to America’s ability to maintain its innovation edge at a time when other nations are rapidly increasing their research investments.

In preparation for the release of President Obama’s fiscal year 2015 budget proposal and the start of the appropriations season on Capitol Hill, a group of 14 business, higher education and scientific organizations have produced a video explaining the direct link between basic research, economic growth, improved medical treatments, and national security. Take a moment to watch it and learn more about how renewed investments in research would significantly benefit the country.

Previously: Future of medical research is at risk, says Stanford medical school dean, The economic benefits of publicly funded medical research, Report: NIH investments created $68 billion in economic activity last year, Academic medical centers bring billions to the economy and New initiatives show how federal stimulus dollars advance scientific and medical research

Stanford Medicine Resources: