Teens and E-cigarettes

Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration’s Center for Tobacco Products (CTP). Findings from the 2014 National Youth Tobacco Survey show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students.

This is the first time since the survey started collecting data on e-cigarettes in 2011 that current e-cigarette use has surpassed current use of every other tobacco product overall, including conventional cigarettes. E-cigarettes were the most used tobacco product for non-Hispanic whites, Hispanics, and non-Hispanic other race while cigars were the most commonly used product among non-Hispanic blacks.

“We want parents to know that nicotine is dangerous for kids at any age, whether it’s an e-cigarette, hookah, cigarette or cigar,” said CDC Director Tom Frieden, M.D., M.P.H. “Adolescence is a critical time for brain development. Nicotine exposure at a young age may cause lasting harm to brain development, promote addiction, and lead to sustained tobacco use.”

Hookah smoking roughly doubled for middle and high school students, while cigarette use declined among high school students and remained unchanged for middle school students. Among high school students, current hookah use rose from 5.2 percent in 2013 (about 770,000 students) to 9.4 percent in 2014 (about 1.3 million students).

The increases in e-cigarette and hookah use offset declines in use of more traditional products such as cigarettes and cigars. There was no decline in overall tobacco use between 2011 and 2014. Overall rates of any tobacco product use were 24.6 percent for high school students and 7.7 percent for middle school students in 2014.

“In today’s rapidly evolving tobacco marketplace, the surge in youth use of novel products like e-cigarettes forces us to confront the reality that the progress we have made in reducing youth cigarette smoking rates is being threatened,” said Mitch Zeller, J.D., director of FDA’s Center for Tobacco Products. “These staggering increases in such a short time underscore why FDA intends to regulate these additional products to protect public health.”

This report concludes that further reducing youth tobacco use and initiation is achievable through regulation of the manufacturing, distribution, and marketing of tobacco products coupled with proven strategies.  Several states have passed laws establishing a minimum age for purchase of e-cigarettes or extending smoke-free laws to include e-cigarettes, both of which could help further prevent youth use and initiation.

For broadcast-quality video and audio clips featuring FDA’s Center for Tobacco Products Director Mitch Zeller speaking about the findings from the 2014 National Youth Tobacco Survey, visit http://dmr.homefrontdc.com/697/ctp-nyts-findings.

Beyond Lung Cancer---Other Smoking Effects

We are well aware that cigarette smoking has a direct link to lung cancer.  Did you know that the latest Surgeon General's report identified 21 other diseases that have a causal relationship to cigarettes?

The list included 12 types of cancer, 6 categories of cardiovascular disease, diabetes, chronic obstructive pulmonary disease, and some pneumonias.  But a new report put  out by the American Heart Association, the National Cancer Institute and several major medical centers that pooled data on millions of subjects of both sexes and age 55 years and older found other concerns for smokers. In this study,  mortality was followed from 2000 to 2011.

 There were 181,377 deaths overall---19% in smokers and 14% in non smokers. The study reconfirmed the increase morality due to smoking in the conditions listed above.    However, 17% of the smokers with increased mortality helped identify new conditions impacted by smoking:   renal failure, intestinal ischemia, hypertensive heart disease, infections, various respiratory conditions, breast cancer and prostate cancer---conditions not part of the earlier "21". 

While the study provides a more complete lists of conditions increased due to smoking, it also reinforces the fact that the rate of death from almost any cause was two to three time higher in current smokers when compared to non smokers.  While more study is needed to rule our other behaviours and determine how smoking effects treatment, the study demonstrates how important it is to reduce smoking espeically in young people.   Smoking also impacts one's  quality of life and will often cause mortality due to chronic conditions a decade earlier in smokers.  It sure makes sense to put those cigarettes away.



Junk Journalism and the Scientific Method

In the last few weeks, we saw the Rolling Stone retract a highly read article about an alleged gang rape at the U of Virginia that raised a lot of questions about the ethics of journalism.  In short, many of the accusations posed by the reporter were not backed up by facts and in the end cast a dark cloud over the university and the fraternities that were involved.  Theconversation.com, an online news source written by academics and scholars, posted an article by Ivan Oransky, an associate professor at New York University, and Adam Marcus, that asks whether or not journalism should use the scientific method with its rigourous investigation, questioning of evidence, testing and revised hypotheses as a good model for self-correction.   This article also takes a look at the scientific method itself and whether or not it, too, has some shortcomings and is vulnerable to human biases.   

If you are a fan of truth in reporting and rigor in science, you will find this article thoughtful.   Unlike a Rolling Stone:  is science really better than journalism at self-correction? 

Equal Pay Day: Women Earnings Still Down!

Equal Pay Day is finally here! Equal Pay Day (April 14, 2015)  is the symbolic day when women's earnings catch up to men's earnings for the previous year.  The most recent data shows that on average for every dollar paid to a man, a woman receives 78 cents.  That is one penny more than the statistic women have been stuck at for the past decade and this gap is of course even wider for women of color!

So what can you do to ensure equal pay for women?  You can start by asking your local member of congress to support an important piece of legislation, the Paycheck Fairness Act.  This act would update the Equal Pay Act of 1963 by closing loopholes that prevent the original legislation from fully addressing the gender pay gap.  Contact your state representatives and urge them to support the Paycheck Fairness Act because women deserve better!   

Seeking young women to share breast cancer stories

While rare, breast cancer does affect women under the age of 45. In young women, the disease is more often hereditary than it is in older women. Young women, however, may not realize they are at risk for this disease. The Centers for Disease Control and Prevention’s (CDC) new Bring Your Brave campaign will feature young women telling their personal stories about how their lives have been affected by breast cancer. The goals of the campaign are to motivate young women to learn about the disease and its prevention, learn their family history of cancer, and engage in conversations with their health care provider.

CDC is looking for stories from women ages 18-44 who:

  • Found a lump or abnormal change in their breast that turned out not to be breast cancer.
  • Have a mother, sister or first counsil who had breast cancer before age 50 and is BRCA+
  • Have a family history of breast and/or ovarian cancer
  • Have undergone genetic counseling/testing and fit one of the following:  have had breast cancer and a BRCA mutation, have a family history of breast/ovarian cancer nad BRCA mutation, are of Ashkenazi Jewish heritage with a personal/family history of breast cancer and BRCA mutation.

CDC is also looking for stories from women of any age who have been diagnosed with breast cancer before age 50, have a BRCA mutation, AND have a daughter age 18 through 40. Both women must be willing to share their story about hereditary cancer, learning about family history, and having a BRCA mutation.

To be considered for this project women must:

Not smoke or use illegal drugs.
Have completed their cancer treatment (if applicable) at
least one year ago.
If you are interested in participating or know of someone who might be, please contact CDC for more information by May 15th.

Web www.cdc.gov/BringYourBrave/casting
Email BYBRecrutiment@cdc.gov
Phone (202) 729-4099

Teen pregnancy down but LARC use is too low

Teen childbearing can carry health, economic, and social costs for mothers and their children. Teen births in the US have declined, but still more than 273,000 infants were born to teens ages 15 to 19 in 2013. The good news is that more teens are waiting to have sex, and for sexually active teens, nearly 90% used birth control the last time they had sex. However, teens most often use condoms and birth control pills, which are less effective at preventing pregnancy when not used consistently and correctly.

Intrauterine devices (IUDs) and implants, known as Long-Acting Reversible Contraception (LARC), are the most effective types of birth control for teens. LARC is safe to use, does not require taking a pill each day or doing something each time before having sex, and can prevent pregnancy for 3 to 10 years, depending on the method. Less than 1% of LARC users would become pregnant during the first year of use.

Few teens (ages 15 to 19) on birth control use the most effective types.

  • Less than 5% of teens on birth control use LARC.
  • Most teens use birth control pills and condoms, methods which are less effective at preventing pregnancy when not used properly.
  • There are several barriers for teens who might consider LARC:
    • Many teens know very little about LARC.
    • Some teens mistakenly think they cannot use LARC because of their age.
  • Clinics also report barriers:
    • High upfront costs for supplies.
    • Providers may lack awareness about the safety and effectiveness of LARC for teens.
    • Providers may lack training on insertion and removal.

Providers can take steps to increase awareness and availability of LARC.

  • Title X is a federal grant program supporting confidential family planning and related preventive services with priority for low-income clients and teens.*
    • Title X-funded centers have used the latest clinical guidelines on LARC, trained providers on LARC insertion and removal, and secured low- or no-cost options for birth control.
    • Teen use of LARC has increased from less than 1% in 2005 to 7% in 2013.
  • Other state and local programs have made similar efforts.
    • More teens and young women chose LARC, resulting in fewer unplanned pregnancies.

Source:  CDC.

Making Sex Matter in all Research

As we learn more about sex differences, it is  easy to understand why both men and women need to be included in clinical research.  But why does the sex of a cell used in basic research matter?    Cell lines and primary cells are often used by basic scientists in proof-of-concept experiments and when trying to figure out how biological mechanisms work.  These early findings help provide valuable clues for developing new drugs, treatments and diagnostic models that eventually can be applied to humans. 

Recently, researchers in Korea have reported that the sex of cell lines and stem cells (the start of the science pipeline)  is often ignored.  Furthermore, most scientific journals still do not require authors to include the sex of the cells used in an experiment. 

A similar problem exists when using animals like mice and rats---though that is starting to change due to outcries from advocates of sex inclusion in ALL research.

Many researchers use commercially available cells so this problem is not just one for the scientific community to solve.   It also behooves commercial enterprises to help change the paradigm of "sexless" experimentation by clearly defining (and providing) the sex of their biological products. This would help researchers to evaluate sex as a variable and ensure the sex distribution of cells is more balanced.  These changes will help advance science that is more accurate and unbiased.

In the end, to truly advance sex based research, we must ensure that changes are made in partnership with all members of the scientific pipeline:  the cell and animal suppliers, the bench scientist, the clinical scientist, the Institutional Review Boards who approve human study designs, the funding agencies, and the Journals who publish scientific outcomes.

With the new focus on "precision medicine", advocates must continue to make sure that sex differences are part of the equation.

Source:  AJP-Cell Physiolo.doi:10.1152/ajpcell.00369.2014


Safe Sex and Elderly

National STD Awareness Month is not just a reminder for young folks.   Older adults, including senior citizens,  need to pay attention to the messages.  According to the CDC, between 2007 and 2011, chlamydia cases among Americans 65 and older increased 31% and for syphilis 52%.  These percentages are similar to those in the 20- to 24- age group. 

According to the National Survey of Sexual Health and Behavior, among people over 60, more than half the men and 40% of women are sexually active.   Even though pregnancy risk is unlikely in this population, this age group could still harbor and pass on an untreated STD.  Many seniors also grew up before the "safe sex" messaging about condoms took hold and thus their use is lower.

There are several reasons why older adults may be more susceptible or in danger from STDs than younger adults:

  • Lack of regular screening for STDs
  • Menopausal changes in women can lead to less lubrication and thinning of tissues making them more susceptible to infections
  • Less condom use
  • Reduction in immune response in older people.

Social factors that are driving the increase of sexual activity in older adults, and increased exposure to STDs,  include longer healthier lives, new medications like Viagra, and the rise in active retirement living communities where socialization is encouraged.    

Women's Health 1985-2015 Webinar

This year marks the 30th anniversary of the landmark 1985 U.S. Department of Health and Human Services (HHS) Report of the Public Health Service Task Force on Women’s Health Issues. A deliberate focus on women’s health, which continues today, has led to substantial advances in the field. This webinar features federal government leaders in women’s health discussing both achievements from the past and challenges for the future. The presenters will describe progress in women’s reproductive health, understanding of sex differences in medicine, and the inclusion of women in clinical research. The ultimate goal is a nation where women can prevent morbidity and mortality from disease and where quality care and health equity are a reality for all women.

To learn more:  Progress in Women’s Health: 1985 - 2015

April 7th,  2015 |  1:00 - 2:00 p.m. ET | Register Now

April is STD Awareness Month.


Know the facts! GYT: Get Yourself Tested

False assumptions about sexually transmitted diseases (STDs)—how they're spread, treated, and prevented—are everywhere and it can be especially hard for people to get the facts. Here are five you need to know:

  • You can't tell someone has an STD just by looking at them.
  • STD tests aren't always a part of a regular doctor visit.
  • Almost all STDs that can be spread via unprotected vaginal sex can also be spread through unprotected oral and anal sex.
  • Using a condom can take a lot of the worry out of sex, since it can prevent unintended pregnancy and protect you from STDs.
  • STD testing is a basic part of staying healthy.

Because half of the estimated 20 million STDs that occur in the United States each year are among young people, STD Awareness Month 2015 is focused on this population. This month-long observance provides an opportunity to clear up misperceptions about STD prevention and testing, and confront the unique challenges that young people face when it comes to preventing these infections.

To learn more:  Visit HERE.

Smoking Mom may affect Daughter's Reproductive Health

Daughters of mothers who smoked during pregnancy enter puberty at a younger age.  As a result, these offspring start their periods earlier---a risk factor for uterine, endometrials and breast cancers later in life.  Study researchers from Australia say that maternal smoking could create health problems in daughters even before they are born.

Health risks children often have when a mother smokes during pregancy include low birth rate, asthma, type 2 diabetes and obesity.   This new study suggests that there are many more possible adverse effects that are just beginning to be  discovered and may evolve over a lifetime in the exposed fetus.  According to study author, Alison Behie, there are several factors that influence when a girl has her first period:  puberty age of mother, body weight of the girl at ages 8-9, and based on this study, mother's smoking habit.

This study only followed girls till ages 12-13 and the next study will look at girls 14-15 years.  This data will need to be teased out for confounding factors and other influences but it does suggest that mothers who smoke while pregnant may want to consider stopping the habit-at least while pregnant.



Dietary Calcium should be First Choice



Clinical guidelines related to calcium are being revisited.   For decades, calcium supplements have been recommended to prevent bone fractures, especially as we age.  However,  new safety concerns about this practice, especially on heart health have grown.   We know that excess calcium increases the risk of kidney stones.   Does too much calcium affect other organs like the heart as well?   On going research is trending toward this possibility.

The best current evidence supports a recommendation to get your calcium from dietary sources rather than supplements.   The problem?   Most western diets (including the U.S.) traditionally have not achieved the recommended goals of calcium and its companion, Vitamin D which helps absorb calcium.   However, this blogger has searched for the best sources of dietary calcium and believe it is surprisingly doable.  Many of these foods (listed below)  were not particularly popular a decade or so ago but if you consider the new "foodie" diet that is catching on among today's younger population, they are definitely on the increase.

Good sources of calcium:

  • Dairy products (milk, cheese, yogurt---especially low fat options)
  • Vegetables (broccoli, cabbage, spinach, greens of all kinds, okra, bok choy)
  • Beans (tofu, white beans, hummus, soy beans)
  • Fish (sardines/salmon canned with bones, tuna, perch, trout)
  • Fortified orange juice and cereal
  • Nuts (almonds, brazil nuts, sunflower seeds, tahini)
  • Dried fruit (figs, apricots).

 Calcium supplements have not been proven to be alarming, but doubts exist and if you can reach your vitamin goal via diet, it is certainly a good habit to develop.

Dad's Depression can affect Toddler


A father’s depression during the first years of parenting – as well as a mother’s – can put their toddler at risk of developing troubling behaviors such as hitting, lying, anxiety and sadness during a critical time of development, according to a new Northwestern Medicine study.

This is one of the first studies to show that the impact of a father’s depression from postpartum to toddlerhood is the same as a mother’s. Previous studies have focused mostly on mothers with postpartum depression and found that their symptoms may impact their children’s behavior during early, formative years.

“Fathers' emotions affect their children,” said Sheehan Fisher, lead author of the study. “New fathers should be screened and treated for postpartum depression, just as we do for mothers.”

Sheehan is an instructor in psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and a psychologist at Northwestern Memorial Hospital. He conducted this study while he was a researcher at the University of Iowa.

The study was published online in the journal Couple and Family Psychology: Research and Practice.

Read more.... By Erin Spain, Northwestern News Center

Shellfish vs. Fin fish


It is generally accepted that it is a good idea to include fish, such as salmon and flounder, that are high in omega-3, in one's diet.   But what about shellfish (lobster, crab, mussels, clams, calamari, oysters, scallops etc)?   While they contain less omega-3 than fin fish, shellfish are a good source of protein (especially octopus), and if you avoid breading and frying, are low in calories.  

Other benefits of specific shellfish:   Oysters are an excellent source of zinc, clams have iron and Vitamin B-12, and crustaceans are a good source of choline, a nutritient that may be good for memory and muscle control.

But, there are some negatives that shellfish lovers need to consider.   Shrimp are high in cholesterol and if you are a 'cholesterol responder' (the cholesterol you eat overly impacts blood cholesterol) you might want to limit your shrimp intake.  While we know that large fin fish like sword fish contain mercury, shellfish more readily absorb toxins often associates with the "red tide".   Red tide is a bloom of plankton, especially dinoflagellates, that causes an usually reddish discoloration of coastal ocean waters. Certain dinoflagellates produce toxins that contaminate shellfish, making them unsafe to eat, and can kill fish. If you eat shellfish from waters with high concentrations of red tide present, you may risk a case of shellfish poisoning.  Symptoms could range from numbness, tingling, headache, dizziness, amenesia, etc.  depending on the specific type of toxin ingested.   Coastal towns often monitor the presence of red tide and post warnings when the levels are too high for swimming or eating local shellfish and fin fish.   This type of tide is more prevalent in warmer, more shallow waters than in cold, deep ocean areas. 

Allergies are another concern more prevalent in shellfish.  Some people are only allergic to one type of shellfish (crustacean vs. molluscan) or even just one specific shellfish.  My mother could not eat oysters and I cannot eat lobster but we both could eat other  seafood.  Go figure!

Overall, seafood is a good source of many nutrients and a good alternative to more fatty red meats. 


France may ban super skinny models, how about the U.S?

This month, the French government is considering a bill that would ban the use of ultra skinny models with a body mass index (BMI) below 18 on the runway or in photo shoots.  Modeling agencies and fashion houses who do not comply could be fined up to $79,000 and may have to serve jail time.   Italy, Spain and Italy already have similar laws in place.

As of today, this blogger could not find any similar legislation or regulations in the United States.   The Council of Fashion Designers in America has formed a "health initiative" to address this growing concern but it focuses on health education and awareness and does not have any real regulatory power.  In fact, the organization states that this in not a policy initiative and does not recommend that the industry require any medical exam to assess the health status of its models.    The fact that 10 out of 100 young women are diagnosed with an eating disorder does not seem to bear any weight on their decision. 

Why should we care what the fashion industry does?   According to the National Association of Anorexia Nervosa and Associated Eating Disorders:

  • The body type portrayed in advertising as the ideal is possessed naturally by only 5% of American females.
  • 47% of girls in 5th-12th grade reported wanting to lose weight because of magazine pictures.
  • 69% of girls in 5th-12th grade reported that magazine pictures influenced their idea of a perfect body shape.
  • 42% of 1st-3rd grade girls want to be thinner 
  • 81% of 10 year olds are afraid of being fat

As young people follow the trends for fashion and glamour on social media 24/7, isn't it time we step to the plate?