The Obesity Epidemic: State- and District-Level Policies Are Leaving Adolescents Behind

As a nation we are concerned about childhood/adolescent obesity and overweight, yet state and district-level policies regarding physical education, physical activity, and nutrition are significantly lacking, especially at the middle and high school level. Students at the middle and high school level have the highest rates of obesity among all children and adolescents. Judging by these facts, you would think that more state- and district-level policies would be in place to help counter the growing obesity epidemic among this age-group. However, a recent publication by the National Association of State Boards of Education (NASBE) titled “Obesity Prevention for Middle and High Schools: Are We Doing Enough?,” reviewed state-level and district-level policies regarding physical activity and nutrition and found a strong paradox: “while adolescents have the highest rates of obesity, are the least physically active, and consume more junk food and sugary beverages, both state- and district-level policies addressing these issues in the school environment are often more frequent and restrictive at the elementary level. In addition, in many areas, policies are simply not addressing critical components of school nutrition and physical activity at any level.”

The 2008 Physical Activity Guidelines for Americans recommends that children and adolescents obtain at least 30 minutes of the required 60 minutes per day of physical activity at school. Despite this guideline, NASBE’s survey found that only three states required time in minutes outside of physical education, only 20% of states had a required time and/or frequency for physical education at the high school level, and only 34% of states requiring physical education at the middle school level had a time frequency requirement. In addition, no states and only 8% of districts had a high school requirement for a percentage of class time to be spent in moderate-to-vigorous physical activity and only 6% of states and 9% of districts had this requirement at a middle school level. Finally, 82% of states had a high school physical education requirement but 28% of these states had liberal exemption policies.

Regarding nutrition, only three states had policies which aimed at increasing access to fruits and vegetables at the middle and high school level and only three states had a policy restricting food marketing. In addition, only 22% of states required nutrition standards limiting fats, sugar, calories, and/or portion sizes in middle and high schools. 38% of states and 49% of districts had nutrition standard policies in high schools, 46% of states and 51% of districts had these standards in middle schools, and 50% of states had these standards in elementary schools. Finally, only three states and 2% of districts had policies at the middle and high school levels that prohibited all sodas (both regular and diet) and all other sugar-sweetened beverages and 30% of states only prohibited regular sugar-sweetened sodas.

All this data brings up one major question: Why aren’t states and districts pushing for more frequent and stronger policies regarding physical activity and nutrition? After all, we have a growing epidemic on our hands and children and adolescents are at the heart of it. Currently, an estimated 34% of adolescents are overweight or obese and this trend is only increasing. If widespread policies are not adopted soon these overweight children and adolescents will become overweight or obese adults, threatened by preventable chronic diseases since “overweight adolescents have a 70% chance of becoming overweight or obese adults.” While it is true that middle and high schools have many demands including increasing overall student achievement and decreasing drop-out rates, this does not mean that physical activity and nutrition should fall by the wayside. By placing physical activity and nutrition at the bottom of the priority list, schools may in fact be negatively affecting the overall success of their students since “overweight and obese students are more likely to have greater rates of absenteeism and experience more bullying and teasing, which may affect their academic performance and achievement.”

So, are we actually doing enough?

The answer is No. Policies and programs addressing middle and high schools need to be more frequent, more restrictive, and required rather than merely suggested. The promotion of physical activity and nutrition needs to be widespread at all school levels: elementary, middle, and high school. We may gasp at the obesity problem and encourage children and adolescents to exercise and eat healthfully, but if our policies do not match our message then we are failing the students we intend to serve.

Note: All direct quotes come from NASBE’s May 2010 publication, “Obesity Prevention for Middle and High Schools: Are We Doing Enough?” which can be found here.

Kathryn Burggraf
Tobacco Control Intern
Partnership for Prevention

Breastfeeding Boosts Babies’ Immune Systems, Cartoon Characters Selling Unhealthy Foods Named "Best, Worst Prevention Ideas of the Week"

A new study showing that babies who were breast-fed had a lower risk of infections was named the “Best Prevention Idea of the Week,” while children finding foods tastier when their package displays a cartoon was named the “Worst Prevention Idea of the Week."

The “Best/Worst” awards are announced each week in “Prevention Matters,” the blog of Partnership for Prevention. Nominees are submitted by Partnership staff as well as the general public, and are voted on by the staff. Partnership for Prevention is a nonpartisan organization of business, nonprofit and government leaders who are working to make evidence-based disease prevention and health promotion a national priority. More information is available at http://www.prevent.org/.

BEST

Breast Milk Reduces Infections in Babies

Breast-feeding seems to provide an immune system boost to infants, helping to prevent respiratory and gastrointestinal illnesses in babies, according to new research.

Babies who were breast-fed exclusively for 4 months, and then partially until they were 6 months old, had a reduced risk of respiratory and gastrointestinal infections compared to babies who had never been breast-fed, the Dutch team found. "Exclusive breast-feeding reduces respiratory and gastrointestinal infections in infancy," said the study's senior author, Dr. Henriette Moll, a professor of pediatrics at Erasmus Medical Center's Sophia's Children's Hospital in Rotterdam.

WORST

Cartoon Characters Sell Kids on Unhealthy Foods

Popular cartoon characters are influencing the taste preferences of very young children, and not in a positive way, a new study suggests. Researchers found that the branding of American food product packaging with characters such as Dora the Explorer drives preschoolers to choose higher-calorie, less healthful foods over more nutritious options.

"The bottom line is that when kids are presented with a choice of graham crackers, fruit snacks or carrots, and the only difference is that one package has a licensed character on it, they actually think that the food with the character tastes better," said study author Christina Roberto, a doctoral student working at the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Conn.

The findings, reported online June 21 in Pediatrics, reflect on the food preferences of 4- to 6-year-old boys and girls who found foods tastier when the packaging bore the likenesses of beloved TV and movie characters.

New Regulations Go Into Effect: The One Year Anniversary of the Tobacco Control Act

A year ago today, June 22, 2009, President Obama signed the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act), which places the regulation of tobacco products under the authority of the Food and Drug Administration (FDA).

Under the provisions of this Act, the FDA established the Center for Tobacco Products whose main goals include preventing the initiation of tobacco use among America’s children and adolescents; aiding adults with tobacco cessation; supplying the public with necessary information on the ingredients of tobacco products and the potential harms of using tobacco products; and using the regulation of tobacco products to protect the public from the health burden of tobacco, which is currently the leading cause of preventable disease in the United States.

So what happens today, June 22, 2010?

Today, new restrictions on tobacco product sales and marketing go into effect. These include the banning of descriptors such as “light,” “mild,” and “low” in cigarette and smokeless tobacco labeling and advertisements; larger and more graphic warning labels on smokeless tobacco products and advertisements; and the implementation of the 1996 Rule on Youth Access and Marketing. This rule aims to prevent the use of tobacco related products among America’s youth through regulations that prohibit the sale of cigarettes and smokeless tobacco to minors under federal law; ban tobacco related sponsorships of athletic, social, and other cultural events; and prohibit the sale of cigarette packages with less than twenty cigarettes.

And what should we look for in the future?

In the future the FDA is looking to develop tobacco product standards, regulate the introduction of new tobacco products, and place larger and more graphic warning labels on cigarette packaging and advertisements. Until then, the FDA urges states and localities to continue implementing tobacco taxes, smoke-free laws, funding for tobacco prevention and cessation, and coverage for smoking cessation services – all of which have proven to be effective in controlling the use of tobacco.

As Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation explains, “Tobacco use is a contributing factor to dozens of diseases and conditions that impact American and accounts for $96 billion each year in health care costs. This groundbreaking legislation is a big investment in prevention that will help all Americans lead healthier lives.”

Read more about the Tobacco Control Act’s One Year Anniversary by clicking here.

Kathryn Burggraf
Tobacco Control Intern
Partnership for Prevention

Healthy Diet Helps to Decrease Colorectal Cancer Risk, Slight Increase in Tobacco Sales to Minors Named "Best, Worst Prevention Ideas of the Week"

A new study showing that eating a diet filled with fruits, vegetables, and low-fat dairy foods is associated with a reduced risk of colorectal cancer was named the “Best Prevention Idea of the Week,” while the recent Synar report revealing the national weighted average rate of tobacco sales to minors increased, from 9.9 percent in FFY 2008, to 10.9 percent in FFY 2009 was named the “Worst Prevention Idea of the Week."

BEST

Healthy Diet May Cut Colorectal Cancer Risk

Eating a diet rich in fruits and vegetables, low-fat dairy foods, and fish may reduce your risk of colorectal cancer, according to a new study. Although previous studies have produced conflicting findings about the effectiveness of such a diet, the new research found a benefit.


''We found that eating a largely plant-based diet with higher intakes of fruits, vegetables, whole grains, nuts, seeds, vegetable oils, and low-fat dairy in women and fish in men was associated with a reduced risk of colorectal cancer," says Paige Miller, PhD, a researcher at Pennsylvania State University.

Eating in this healthful way reduced the risk of colon cancer by 65% in women and by 62% in men, she says. ''Why fish was a part of the protective dietary pattern only in men and low-fat diary only in women is not known at this time," Miller tells WebMD.

WORST

Reverse in Trend – Tobacco Sales to Minors No Longer Declining

Although illegal sales of tobacco have decreased over the past 13 years, 2009 sees the first slight upward tick in sales to minors. The Substance Abuse and Mental Health Services Administration recently announced that all the states and the District of Columbia have continued to meet their goals of curtailing sales of tobacco to underage youth (those under 18). However, in federal fiscal year 2009, for the first time ever, the data show a slight increase in the average national rate of tobacco sales to underage youth of about one percent. States goals, set under the Synar Amendment program – a federal and state partnership, are aimed at ending illegal tobacco sales to minors. The increase in the rate may be due to States reducing the number of enforcement inspections they conduct in the face of State budget cuts.

Kids Benefitting from Smoke-Free Laws, Serious Problems with Infection Control at Surgical Sites Named Best/Worst Prevention Ideas of the Week

A study showing that children benefit from laws that regulate locations where smoking is allowed was named the “Best Prevention Idea of the Week,” while a study that found that loose infection practices are contributing to problems with infection control at same-day surgery centers was named the “Worst Prevention Idea of the Week."

BEST

Smoke-Free Laws Benefit Kids, Too

Kids benefit from laws that regulate locations where smoking is allowed, a new study shows.

Smoke-free-air laws have already been shown to reduce exposure to secondhand smoke among adults. Now a study shows that such laws benefit children and adolescents, too, as long as they don't live with a smoker.

Researchers analyzed data from the 1999-2006 National Health and Nutrition Examination Survey and found that youngsters who live in a county with extensive smoke-free-air laws had a 39% lower prevalence of cotinine in their blood. Cotinine, an alkaloid found in tobacco, is a major metabolite of nicotine and a common biomarker of secondhand smoke exposure. It is detectable in blood for a minimum of several days after exposure to tobacco smoke.

WORST

Poor infection control at many surgery centers

A new federal study finds many same-day surgery centers — where patients get such things as foot operations and pain injections — have serious problems with infection control. Failure to wash hands, wear gloves and clean blood glucose meters were among the reported breaches. Clinics reused devices meant for one person or dipped into single-dose medicine vials for multiple patients. The findings, appearing in last Wednesday's Journal of the American Medical Association, suggest lax infection practices may pervade the nation's more than 5,000 outpatient centers, experts said.

Public Comments Urged on Centers for Medicare and Medicaid Services’ Proposed Tobacco Cessation Measure

The Centers for Medicare and Medicaid Services (CMS) has proposed a new measure, which is still preliminary, that would expand coverage for evidence-based tobacco cessation counseling for all Medicare recipients. Current Medicare language limits reimbursement for tobacco cessation counseling to patients who have a tobacco-related disease.

The CMS has set a period of time for Public Comments on the proposed determination, after which they will issue a final decision. This period ends June 27, 2010. Partnership for Prevention urges you to offer your own public comment in support of tobacco cessation counseling for Medicare beneficiaries. It’s easy to do – just click on this link, then click on the orange “Comment” button at the top. Type in the box whatever you see fit to communicate about this matter.

As an example, here’s what I wrote in my message to the CMS this morning:

I am writing to express my strong support for the Centers for Medicare and Medicaid Services proposed decision to extend tobacco cessation counseling to all Medicare beneficiaries. It is Partnership for Prevention's position that this policy will help many tobacco users break free from a deadly behavior, people who otherwise would have been unable to do so. Undoubtedly, many lives will be extended and much money saved if this decision is enacted.

Not only is tobacco cessation counseling a Grade A rated recommendation by the U.S. Preventive Services Task Force, it is also received the highest ranking by Partnership for Prevention's National Commission on Prevention Priorities. In that review, physician tobacco cessation counseling was one of only three clinical preventive services to receive the highest score for cost and prevention effectiveness.

I urge the CMS to move forward with this critical public health measure when the public comment period has concluded. The entire Medicare community deserves to benefit from this service, not only those who have been diagnosed with a tobacco related illness. After all, that's what prevention is all about.

It is important that the CMS hears from constituents who support disease prevention, health promotion, and tobacco cessation. If enacted, this measure represents a lifesaving advance in our capacity to guarantee that all tobacco users have access to evidence-based tobacco cessation counseling. A significant public health benefit will be realized.

David Zauche
Senior Program Officer
Partnership for Prevention

Big tax benefits for small businesses

There’s good news in the health reform law for small businesses that pay at least half the cost of their employees’ health insurance. Beginning this year, businesses with fewer than 25 employees and with average wages under $50,000 can claim a tax credit on their income tax return. Small non-profit organizations also qualify. As an example, an employer with 10 or fewer full-time employees and with average annual wages under $25,000 (not including what the owner makes), will receive a 35% tax credit on the amount the business pays for employees’ health insurance in 2010. An online calculator to estimate savings can be found at http://www.smallbusinessmajority.org/.

This tax credit will be available to small businesses until 2014; when the credit is scheduled to increase and be available from state-based insurance exchanges which will be operating by that time.

Having health insurance makes a difference. On average, people without health insurance are less likely to get preventive care such as immunizations or mammograms, more likely to miss work, and to have worse health outcomes when they do get sick than people with insurance.

Susan K. Maloney
Managing Senior Fellow
Partnership for Prevention

Possible Breast Cancer Vaccine, College Students Driving While Drunk Named Best/Worst Prevention Ideas of the Week

The possibility of a preventive breast cancer vaccine becoming available for humans was named the “Best Prevention Idea of the Week,” while twenty percent of college students admitting to driving while drunk was named the “Worst Prevention Idea of the Week."

BEST

Breast Cancer Vaccine Possible, Scientists Say

A study in mice suggests that a preventive breast cancer vaccine might be possible in humans, scientists say.

Women may begin taking part in the next stage of research as soon as next year, they added.

"We believe that this vaccine will someday be used to prevent breast cancer in adult women in the same way that vaccines have prevented many childhood diseases," principal investigator Vincent Tuohy, an immunologist in Cleveland Clinic's Lerner Research Institute, said in a news release. "If it works in humans the way it works in mice, this will be monumental. We could eliminate breast cancer."

WORST

1 in 5 College Students Admitted to Drunk Driving, Study Found

Drinking and driving among college students is still a major public health problem, new research reveals, with one in five admitting to driving while drunk and 40 percent acknowledging they have ridden with a drunk driver.

Equally worrisome, their tendency to drive under the influence soars when they hit the minimum legal drinking age of 21.

The findings were gleaned from a study co-authored by Amelia M. Arria, director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health, that followed more than 1,250 first-year college students enrolled at a large mid-Atlantic university.

Use of HPV Vaccine Still Limited

A recent analysis of surveillance data reported in the May issue of the American Journal of Preventive Medicine found that only about one third of adolescent girls ages 13-17 in a six-state sample have received more than one dose of the HPV vaccine.

Since the vaccine first received FDA approval in 2006, little research has been done to assess its use. For this analysis the researchers used data from the 2008 Behavioral Risk Factor Surveillance System and the 2000 U.S. census on 1,709 girls in Delaware, New York, Oklahoma, Pennsylvania, Texas, and West Virginia. It is not clear from the study findings why these six states were chosen. 70% of the girls in the study were white and 74% were insured.

The study also found that girls in states with higher poverty levels were less likely to be vaccinated, but those in counties with higher poverty levels were more likely to be vaccianted.

"Although seemingly contradictory, this indicates that while girls in poorer states had overall lower odds, girls living in any state experienced higher odds of vaccination if they lived in counties with higher poverty levels," said Sandi L. Pruitt, PhD, and Mario Schootman, PhD, of Washington University in St. Louis. "This may be partially explained by the limited resources of poor states," Pruitt said.

These findings show the need for interventions to increase vaccination among all eligible girls.

Christianne Johnson
Program Manager
Partnership for Prevention

Quicker Chlamydia Treatment, Medicaid Children Not Benefiting from Preventive Screening Services Named Best/Worst Prevention Ideas of the Week

The use of electronic records significantly increasing how fast patients with Chlamydia are treated was named the “Best Prevention Idea of the Week,” while children on Medicaid not receiving all required preventive screening services was named the “Worst Prevention Idea of the Week."

BEST

Chlamydia Treated Sooner When Docs Use E-Records

Switching to electronic medical records can significantly boost how quickly patients with the sexually transmitted disease chlamydia are treated, a new study shows.

Researchers found that an electronic medical record system more than doubled the percentage of patients treated within two weeks of diagnosis. The longer a sexually transmitted infection goes untreated, "the more risk there is of onward transmission and of clinical complications," the authors wrote. "Appropriate use of technology greatly improves our ability to treat patients rapidly, and we should strive to use all available methods for the good of our patients and the betterment of public health."

WORST

Medicaid Children Are Not Receiving All Required Preventive Screening Services

The Department of Health and Human Services’ Office of Inspector General (IG) has just released a new report (OEI-05-08-00520) concluding that “Most children in nine selected States are not fully benefiting from Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) comprehensive screening services.”

For anyone concerned about the importance of expanding coverage for clinical preventive services under health reform, this report is a reminder that coverage alone isn’t enough to assure access.

Indiana Charges Ahead on Cessation

Partnership for Prevention is proud that the Indiana state Tobacco Prevention and Control agency took the lead to convene a summit of leaders from around the state representing business, insurers, health systems, policymakers and community educators. The summit participants agreed on a goal of reducing the adult prevalence rate to 8 percent by 2015. To make that possible, many strategies were identified to reduce Indiana’s high smoking rate (currently 23%) through increased access and utilization of tobacco cessation services.

The summit lives on in a new media campaign to promote cessation to tobacco users and their employers.

Diane Canova
Vice President, Policy & Programs
Partnership for Prevention