Anti-Smoking Legislation—Benefits beyond lowering your dry-cleaning bills!

Yuck! You just got home from meeting up with friends at a neighborhood bar, and your hair, your coat—everything—smells like cigarette smoke! And you’re not even a smoker!

While anti-smoking legislation may be the norm in some areas (for example, Massachusetts has banned smoking inside bars, restaurants, and other workplaces since 2004), many states and cities still allow smoking in public places (such as, yes, that neighborhood bar). Because there is no federal standard, states are free to enact their own laws—which means that regulations vary state to state and even city to city. Overall, only 28 states have fully banned smoking in enclosed public places (and even these have exceptions). That leaves a lot of areas where you may still be subject to second-hand smoke!

Luckily for you, a recent study may provide law-makers with more reason to put anti-smoking legislation in place.

Researchers at the University of California, San Francisco, recently published an analysis of 43 different studies assessing the health impacts of anti-smoking legislation. Researchers categorized legislation by comprehensiveness, leading to three categories: 1) ban in workplaces only, 2) ban in workplaces and restaurants, 3) ban in workplaces, restaurants, and bars. They then looked at various cardiovascular diseases (like heart attack, chest pain), strokes, and breathing-related problems (such as asthma and lung infections). They then compared hospital admissions for each disease before and after the legislation was put in place.

Overall, the researchers showed that the most comprehensive laws were associated with a significant reduction in the number of hospital admissions for almost all of the diseases studied. For these types of laws, the researchers found a 15% reduction in hospital admissions for heart attacks. Some of the studies in this analysis also showed substantial reductions in healthcare costs after legislation was put in place.

So, what does this mean for you? And your dry-cleaning bills, as you try to get rid of that cigarette-smoke smell?

Well, although this particular study cannot make any claims regarding the effect of anti-smoking legislation on individual health, it may help to push law-makers at state and local levels to enact anti-smoking legislation based on the fact that these laws do appear to reduce hospital admissions and healthcare costs.

You can help by supporting anti-smoking legislation in your own area, patronizing bars and restaurants that have smoking bans, or even suggesting a ban on indoors smoking at your workplace, if one doesn't exist already.

It’s also a good idea to reduce your exposure to second-hand smoke in general: according to the Surgeon General, “there is no safe level” of tobacco smoke. Even second-hand smoke is a carcinogen, and can increase your risk of heart disease.  

So, next time, suggest meeting at that bar that doesn’t allow smoking. Your heart and lungs—and your clothes—will thank you!

Tan, Crystal E. and Stanton A. Glantz. "Association Between Smoke-Free Legislation and Hospitalizations for Cardiac, Cerebrovascular, and Respiratory Diseases : A Meta-Analysis." Circulation. 2012;126:2177-2183.

Rachel M. Burke is a PhD student at Emory University. She enjoys running, cooking, and crossword puzzles, and hates the smell of cigarette smoke in her hair. 

Dr. Dog, keeping your kids fit and healthy!

                A few years ago I adopted a sweet little dog named Sasha, an adorably cute and playful rascal.  She’s a Jack Russell terrier, a type of dog well known for being energetic and active, so I’ve tried to match Sasha’s enthusiasm by taking her for regular runs.  Sasha’s become the best personal fitness trainer I could ever ask for!

Sasha, slightly wet and muddy but still cute as ever!

                It turns out I’m not alone.  A study in the American Journal of Public Health revealed that kids in families with dogs tended to get more daily exercise.  That’s one great way to get Junior off the couch and playing outside!

Tell me more about this study!

                Kids from 78 schools across England were asked if their families had dogs, and were fitted with special hip bands that tracked their physical activity for a week.  Kids with dogs got more light exercise (like walking) and vigorous exercise (like running) compared to kids without dogs.

                Did this mean that getting dogs helped kids exercise more, or simply that families that were already fit tended to get dogs?  According to study author Dr. Christopher Owen (from the University of London), “Studies in adults before and after dog ownership suggest that dog owners become more active”.  In other words, people get more exercise right after getting a dog (like Sasha and me!).

                One concern that Dr. Owen noted is that families of black or Asian race were less likely to own a dog than white families.  There may be cultural differences that serve as a barrier to dog ownership; we need to do a better job of communicating the benefits of dogs to everyone!

Also, one more birthday party to celebrate!

Why is exercise for kids important?

                 Children becoming overweight or obese (extremely overweight) is an increasing problem in America and many other countries in the world.  Overweight kids are much more likely to develop serious health problems as they grow up, including diabetes, heart disease, and even some cancers.  More than one-third of all children in America are overweight or obese!

                The problem has become so dire that our First Lady, Michelle Obama, has made addressing childhood obesity her #1 priority.  Michelle started a program called “Let’s Move” which focuses on figuring out ways to get children to exercise and lose those extra pounds. Michelle works hard on exercising with her own daughters (Malia and Sasha, just like my little pooch!).  Shortly after the Obamas moved to Washington DC, they got a fun-loving puppy named Bo.  In an interview with Bark magazine, Michelle said that “Through Let’s Move! we encourage families to find creative ways to stay active… since Bo is an energetic dog, I know that when the girls take him out for his nightly walk they also run around and play outside with him.”

Bo hanging with his family

So what should I do?

                Simple – if you have kids that need to be pried away from the TV, get a dog!  In addition to the health benefits of additional exercise, it’s a great way to teach kids about responsibility, and they’ll surely be glad about getting a new best bud.  Now getting a dog isn’t for everyone, but some of the common concerns about dog ownership can be addressed by getting the right type of dog.  Have family members that are allergic to dog fur?  There are many dog breeds that don’t cause allergic reactions, such as poodles or schnauzers.  Worried that your apartment is too cramped for a dog?  Some dog breeds like pugs or bulldogs do just fine in smaller spaces.

                So head on down to your local animal shelter, and don’t forget to thank Fido for making exercise fun again!

Joe Abrams is a PhD student at Emory University and researcher at the Centers for Disease Control and Prevention.  Sasha Abrams is a world-class speed demon, squirrel chaser, and cutie pie.

Where the Wild Things Are: Unknown and Invisible Killers

You are quite the busy bee! You are overwhelmed by the paperwork piling up on your desk, your children’s obligations at school and the many meetings today you are preparing for. As your mind cycles through its to-do list, your body is coming into contact with millions of infectious organisms that threaten to derail your productivity at any moment. Fortunately, your immune system has seen them before and can fight (most) of them off.

Despite the impressive repertoire of immune defenses that we have, there are many other microorganisms that are lurking in the wild which our immune systems would be completely unable to recognize. Approximately 75% of all infectious diseases that affect humans originate in animals, and transmission of diseases between animals and humans is facilitated by close contact and disruption of natural habitats. Our genetic similarity to certain animals, such as chimpanzees, bonobos and gorillas, lends an ideal mixing bowl that can enable easy spread of diseases from one species to another. 

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One study, published in the Journal of Virology by a large team of  scientists from around the world, sought to compare adenovirus strains from wild non-human primates to those isolated in captive primates at zoos and primate facilities. It also sought to clarify whether strains were being passed to and from humans and non-human primates. For healthy individuals, adenovirus itself is typically not very dangerous, causing some annoying but non-life threatening symptoms such as fever, coughing, sore throat and eye and ear infections. It can also cause some yucky gastrointestinal issues. But for those whose immune systems are weakened (say, through HIV infection), adenovirus infection can be fatal.

All adenoviruses specifically infect only closely-related species. 30 different adenoviruses were detected in primate facilities and zoos across North America, and most were found to be very similar to human viruses. In and of itself, the presence of these viruses in these facilities provides a viable scenario in which disease transmission can occur between species. Most of what we know about viruses that affect non-human primates comes from captive animals, but little is known about the strains that are circulating in wild populations.

In this study, one chimpanzee strain was 99.2% identical to a human strain that causes conjunctivitis and upper respiratory symptoms, and another was 99.8% identical to a human strain that causes gastrointestinal issues. The study also reported a recent respiratory illness of a scientist who was infected with an unknown adenovirus while investigating a fatal outbreak of pneumonia and hepatitis in Titi monkeys at a primate research center in California. He wound up being infected with a simian virus, which up to that point, had never been detected in human populations. This all indicates likely transmission between non-human primates and humans and recent divergence of human and simian strains.

This study also illustrates the potential for viruses of all families to spread between species. So what should we, as a population, do? Certainly, we cannot avoid animals altogether. And we love taking our children to the zoo. I must highlight that the risk of disease transmission from that cute chimpanzee or marmoset to your little one is very low and no cause for alarm; however, we do need to be aware of the diseases that could be unleashed if we continue to disrupt these animals’ natural habitats. This adds another dimension to the conservation movement- the immediate human benefit.

Dr. William Karesh, Executive Vice President for Health and Policy at EcoHealth Alliance, noted that “it’s one world, and we only have one health and our lives are inextricably linked to the health of the environment.” Living in an environmentally sustainable manner and informing others of the human toll of habitat disruption can prevent new diseases from springing up in humans.

  

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Laura Zambrano, MPH is a Ph.D. student in Environmental Health Sciences at the Emory University Rollins School of Public Health. She is particularly interested in studying the impact of how human activities impact the environment, and how environmental change can facilitate disease transmission between animals and humans. That said, she enjoys playing with puppies, watching squirrels and cuddling with kittens... and still thinks monkeys are pretty darn cute.

Wevers, D, S. Metzger, F. Babweteera, M. Bieberbach, C. Boesch, K. Cameron, E. Couacy-Hymann, M. Cranfield, M. Gray, L. Harris, J. Head, K. Jeffrey, S. Knauf, F. Lankester, S. Leendertz, E. Lonsdorf, L. Mugisha, A. Nitsche, P. Reed, M. Robbins, D. Travis, Z Zommers, F. Leendertz & B. Ehlers. 2011. Novel adenoviruses in wild primates: A high level of genetic diversity and evidence of zoonotic transmission. J Virology 85(20): 10774-10784

HIV risk may depend on syringe design

Do you happen to inject drugs? Or care about those who do? If so, there is some good news for you. Certain syringes, those with the low dead space, may help prevent HIV infection, says recent  article by Dr. William Zule and colleagues. 

What is dead space and why it matters? The point is that after the plunger is fully squeezed, a tiny amount of fluid still remains in the syringe in the space behind the needle (or dead space, see the picture).

Source: Eurasian Harm Reduction Network

In some syringes, usually the ones with detachable needles, this dead space is larger (they are called high dead space syringes). Some others, like a 1-ml insulin-type syringe with a non-detachable needle, have much smaller dead space. According to the article, the smaller the dead space, the less fluid stays there after the injection. If injection involves drawing blood from the vein, some of it stays there too. And if the person who injected with that syringe had HIV, some of the viruses may also be in that blood. So the larger the dead space, the more viruses remain in the syringe and can be passed to someone else using that syringe.  

This is how Dr. Zule and the team figured it out. First they tested both types of  syringes in the lab by simulating the process of injecting drugs and counting how much blood and HIV viruses remain in the syringe. It turned out that the number of HIV viruses in the low dead space syringes after injection is about one thousand times lower  than in the high dead space ones, meaning there are one thousand times less chances for the virus to get into the body. 

Then the scientists ran a special program in the computer to see what would happen if 95% of people who inject drugs in an area would switch to the low dead space syringes. The computer said that in this case the HIV epidemic will not happen or, if HIV is already there, the epidemis will eventually fade away, even if syringe sharing continues.  To confirm the results they looked at HIV levels in 67 cities around the world and found  that in places where low dead space syringes are more popular HIV level as a rule is lower as compared to the areas where high dead space ones are mostly used.

Thus chances are high that using the low dead space syringes would help prevent or curb down HIV epidemic among people who inject drugs. Some more research is still needed to be 100% sure, but that will take time and money while people will continue getting infected. So  Dr. Zule points out that we need not to wait and should start promoting these low dead space syringes right now. As another expert, James Bridge from the Global Fund to Fight AIDS, TB and Malaria wrote: “if we could reduce HIV transmission simply by providing one kind of syringe over another, then this is something that must be rolled out as soon as possible”.

However, there are some issues with the low dead space syringes. First of all, some people who inject drugs do not want to use these syringes - one of the reasons is that the needle cannot be replaced. This requires improvements in the syringe design (some manufacturers are already working on this). Another problem is that buying and distributing these syringes will cost money that is not available in many cases. Finally, using these syringes does not guarantee complete safety if syringe sharing happens.

Regardless of these unresolved issues, action by people like you is still important. You can pass the word about these syringes around. If you inject drugs and cannot stop, try to use the low dead space syringes. If there is a clean syringe distribution program in your area, ask them if they have those syringes; or, if you manage such a program, add the low dead space syringes into your product assortment. You may also contact your local health board, legislature or a Congress representative about supporting low dead space syringe promotion.

Umed Ibragimov is a public health PhD student at Emory University. He is a native of Tajikistan, a small Central Asian country lying on one of the major Afghan heroin trafficking route. Umed’s research interests include drugs and sex.

William A. Zule, Harry E. Cross, John Stover, Carel Pretorius, Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries, International Journal of Drug Policy, Available online 9 August 2012, ISSN 0955-3959, 10.1016/j.drugpo.2012.07.002.

 

Bounce Out of Yo-Yo Dieting…

With the holidays coming up, many people will be both gaining weight and starting the time honored New Year’s tradition of trying to lose it. Most New Year’s resolutions to lose weight end up in failure. While most people can lose weight, most people can’t maintain that weight loss for any appreciable amount of time.

A new study from the Journal of Consulting and Clinical Psychology suggests a new way to approach a weight loss effort. Rather than trying to lose weight right away, half of the 267 overweight or obese women were randomized to a program teaching them various skills to help maintain their current weight for 8 weeks. After the 8 weeks were over, the women embarked on proven weight loss strategies such as increased physical activity and food journaling for another 20 weeks. The control group had the opposite order of their training. They first participated in 20 weeks of weight loss counseling, and then 8 weeks of weight maintenance training.

At the end of the 28-week programs, both groups of women lost on average 17 pounds. A year and no outside help later, the control group had regained on average 7 pounds while the pre-weight loss skill group had regained only 3 pounds. The lead author commented, “Losing a significant amount of weight requires a lot of focused attention to what you’re doing, and most people can’t keep up that intensity over the long term. For weight maintenance, we wanted something that would make the day-to-day experience positive while not requiring overwhelming amounts of effort.”

For this year’s New Year’s resolution, you might want to start in November, spending two months or so practicing small weight maintenance skills such as finding low-fat or low-calorie foods that can substitute for high-fat/high-calorie foods without making you feel deprived, occasionally eating and savoring small amounts of your favorite sinful foods, weighing yourself daily to see how your body weight naturally fluctuates, identifying a 5 pound range that encompasses normal fluctuations in body weight and activity, being more careful with your diet and exercise before you knowingly have a break such as a vacation coming up, or eating a little more if your weight is at the low end of your 5 pound range of normal. So before you head home for Thanksgiving turkey, practice eating healthy with some salads or veggies!

Krista Whalen is a PhD Student at Emory University Department of Epidemiology, who does research in nutrition and chronic disease. She also is a great lover of the zombie genre, and feels preparing for the zombie apocalypse is a great reason to get into better shape. 

Michaela Kiernan, Susan D. Brown, Danielle E. Schoffman, Katherine Lee, Abby C. King, C. Barr Taylor, Nina C. Schleicher, Michael G. Perri. Promoting Healthy Weight With “Stability Skills First”: A Randomized Trial..Journal of Consulting and Clinical Psychology, 2012;

Image: http://www.choosemyplate.gov/

Can We Stop Diabetes?

A

 lot of people in India are already affected by the condition diabetes. Many studies have shown that Indians are particularly prone to develop diabetes and its complications. Experts have warned that about 9% of our population will soon be affected by this condition. For a country with over a billion population, this forms a huge number. Isn't it important for us to look for solutions?  

A study by Ramachandran and others in India have shown some promising answers. The study tried to understand the benefit of different interventions in preventing diabetes. It was conducted among people aged between 35 to 55 years who have not become diabetic, but shown a relatively high level of sugar in their blood, a condition known as pre-diabetic stage. Among the 531 people who were included in the study by dividing them into four groups, the first group was given medicines to lower their blood glucose levels and the second group was helped though regular classes and counselling to change their lifestyles including adherence to a better healthy diet and consistent moderate daily physical activities. The third group of people received both medicine and help for lifestyle modification. The fourth group was not any intervention.

Then, what happened to them?

After three years of follow-up of all the four groups, the researchers calculated the number of people who moved from a pre-diabetic stage to diabetic condition. The maximum benefit of the interventions was shown by the group which received regular help for their lifestyle modification. Compared to the group which did not receive any intervention, the group which modified their lifestyles had shown 28.5% less chance of developing diabetes. Even the group which had received both medicines and guidance for lifestyle modification had slightly lesser benefit than the group which only modified lifestyles

Though the benefit of lifestyle modification in preventing diabetes has already been established in several populations across the world, this study has confirmed the beneficial effect in the Indian population.  Interestingly, the study also showed that even though there was no overall weight reduction in the group that was helped to change lifestyles, the intervention benefited in terms of reducing their potential to develop diabetes in the future.

What does this study implicate?

The increasing prevalence of diabetes in our population is explained at least partly by the changing lifestyle in recent years in relation to diet and physical activity. These life-style choices are fueled by the development model that we pursue. It is important that we reverse these trends to the extent possible to stop diabetes from crippling more and more people. The core of such a change should be at two levels. The first and foremost is a change at the level of individuals, families and communities who are to embrace healthier choices.  Equally important is the creation of a facilitative environment that helps individuals, families and communities to choose healthier lifestyle choices in relation to diet and physical activities. This requires a stronger political commitment to regulate unhealthy foods and invest in policies and programs that promote healthier habits.

It is always better to turn off the faucet than mopping up the floor when the sink overflows!  

Reference

Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V; Indian Diabetes Prevention Programme (IDPP). The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia. 2006 Feb;49(2):289-97. PMID: 16391903.

Can’t quit smoking? Cutting back may be an option.

The negative health effects of smoking are clear and well established. As a result, smokers have been encouraged to completely quit smoking in order to reduce the risk of health problems. However, despite repeated attempts, most smokers find quitting to be extremely difficult. Without help, less than 1 in 20 smokers can quit; even with outside help, less than 1 in 4 smokers are successful at quitting.

Despite these rather gloomy statistics, the potential benefit of simply reducing the amount of smoking (as opposed to quitting) has not received much attention from the scientific community. However, a recent study changes this. A team of researchers from the School of Public Health at Tel Aviv University followed individuals over a 40 year time period. Smoking habits were recorded for the first two years of the study. The study found that, although quitting resulted in the greatest benefit to survival, reducing smoking was also beneficial. Individuals who reduced their smoking within the first two years lived longer than those who did not change smoking habits. Survival of individuals who quit smoking was even greater than those who reduced smoking habits.

While previous research has focused primarily on the benefits of quitting smoking, this study is among the first to show a health benefit from a reduction in smoking. Jennifer Taussig, MPH, of Emory University notes that “These findings should provide encouragement for smokers who haven’t been able to quit. For these individuals, reducing the number of cigarettes smoked per day may have a positive effect on long-term health.”

If quitting doesn’t seem to be an option, current smokers should consider how to reduce their overall intake of cigarettes. Physicians should use the results of this study to encourage patients to reduce their overall smoking, especially those patients who feel frustrated by not being able to quit.

In addition to smoking cessation programs, this study shows that smoking reduction programs may have the potential to improve health and may be a stepping stone towards quitting. For the larger healthcare system, smoking reduction programs should be designed, researched and implemented, possibly in conjunction with existing cessation programs.

While this is a single study, the results provide evidence that any reduction in smoking may improve health. Although quitting is the best option, for those who currently smoke, these new findings provide a second option to improve health throughout a lifetime.

Adam Vaughan, MPH, MS is a PhD student in epidemiology at Emory University’s Rollins School of Public Health.

Reference: Gerber, Y. et al. Smoking Reduction at Midlife and Lifetime Mortality Risk in Men: A Prospective Cohort Study. American Journal of Epidemiology. 2012;175(10):1006–1012

Photo credit: http://www.fda.gov/forconsumers/consumerupdates/ucm198176.htm