R U ready?

Technology’s role in public health is not a new development, but with each passing year, public health professionals are finding new ways to embrace technology and use it to their advantage, according to speakers at a Monday session on the use of social media and mobile apps to disseminate information about emergencies.

And the Centers for Disease Control and Prevention is at the forefront of these efforts, as highlighted by the agency’s work preparing for and responding to Superstorm Sandy in 2012.

Sandy was the No. 2 most talked-about topic on Facebook in 2012, 1.1 million people mentioned the word “hurricane” within a 21-hour period of the storm’s landfall, and at the height of posting, 10 storm-related pictures were posted to Instagram every second, said Jay Dempsey, a health communications specialist who presented at the session.

The bad news is that social media can also be a key way of sharing misinformation — a point driven home by the fact that a Photoshopped image of a storm looming over New York has become one of the most popular images associated with Sandy, although it is completely fictional, Dempsey said.

CDC prepares for emergency events by combing its websites and preparing materials that can quickly be tweeted out to followers before, during and after a storm or other emergency event. The agency has a plan in effect that includes phases of information – everything from how to prepare for an event such as a storm to how to respond even weeks later.

For instance, in the aftermath of Sandy, @CDC_DrPortier, the Twitter handle of then-director of CDC’s National Center for Environmental Health, linked to a CDC Web page that provides information on cleaning up mold. In the weeks after that storm, the site clocked 14,000 hits, whereas it had only about 700 in the weeks before the Tweet.

“Retweets are key,” Dempsey said, explaining how the message could spread far beyond Portier’s followers when others repeated it. “Retweets really amplified the messaging. We would post and then it would be shared on other channels and would ripple throughout state and local and individuals.”

There’s little doubt about the importance of social media, but other presenters noted that it can be difficult to spread the word to those who need it most during or after an emergency. If phone lines, cell towers and electricity are out, those most in need of response messages might be those least likely to receive them, said Rahul Gupta, of West Virginia’s Kanawha-Charleston Health Department.

To address the problem, the county developed KCHD Ready, a free app available to smartphone users that lives on the phone’s memory card rather than online. That way, if cell towers are down, people can still access information about disaster preparedness as well as maps detailing how to evacuate from the area, whom to contact in the event of an emergency and links to other important information.

— C.T.

Public health and the power of law

Public health workers would be more likely to respond in emergencies if the law guaranteed they would receive personal protective equipment and recovery services, according to preliminary data presented today at an Annual Meeting session on law and the public health workforce.

For instance, more than 75 percent of public health workers said they would be more willing to respond to incidents of anthrax or bioterrorism, a dirty bomb or pandemic flu if they knew they’d have the proper equipment. For a weather-related event specifically, 83 percent said they would be more willing to respond if equipment was guaranteed.

Rutkow

Researchers questioned 1,100 urban and rural public health workers in Florida, Minnesota and Missouri. They examined public health workers’ willingness to respond to disasters if state laws guaranteed them things like family priority access to health care for any condition related to the emergency as well as individual access to mental health services during and after the response.

But what are the implications to policy and practice, asked presenter Lainie Rutkow, a public health lawyer at Johns Hopkins Bloomberg School of Public Health. Is it ethical to give certain people priority access to health care? Would guaranteeing personal protective equipment be an unfunded mandate?

“And for something like provision of mental health services during an actual disaster response, how would something like that be operationalized?” Rutkow asked.

Mark Pertschuk, director of Grassroots Change in Oakland, Calif., also examined how law affects public health locally. He noted that grassroots movement building is much more effective than the use of “pre-emption,” which can get in the way of strong local efforts. Pre-emption is when state laws supersede local ordinances that communities have already enacted.

Pertschuk

For example, Pertschuk took session attendees through the history of legal requirements for fire sprinklers in homes. While an effective sprinkler head was patented in 1874, the safety tool is still mostly used in commercial buildings.

However, 85 percent of all fire deaths occur in one- to two-family homes. In 2010, there were 3,120 fire deaths (excluding fire fighters) and 17,720 injuries, according to Pertschuk.

“While the numbers of those who are impacted directly by this are smaller than, for example, alcohol-related problems or tobacco, the nature of these deaths and injuries resulting from fires are often very expensive and very horrific,” he said. 

As of 2011, there were 368 local ordinances requiring fire sprinkler system installation in all new residential buildings, while only two states have statewide requirements. The numbers show the power of grassroots movements, Pertschuk said, and represent a diversity of political leanings.

“These are not blue states or red states,” he said.

As a result of the movement for better fire safety, California and Maryland passed statewide codes. But it was not until 31 communities in Maryland and 146 in California had passed local ordinances.

“That illustrates the innovative power of local public health policy advocacy,” Pertschuk said.

— M.P.

Photos by Melanie Padgett Powers

Smile!

APHA is all smiles! From top to bottom, attendees smile for the camera at the APHA Membership booth at the Public Health Expo; attendees enjoy the LGBT Caucus of Public Health Professionals Networking Social Hour; lucky expo visitors get a seat in massage chairs; and this meeting attendee even smiles as she's getting her flu shot at the Walgreens expo booth.

All photos by Michele Late, courtesy The Nation's Health

Which nutrition labels are most helpful to shoppers?

Grocery shopping for nutritious food can be overwhelming for even the most educated consumer, as illustrated by preliminary studies presented today at APHA’s 141st Annual Meeting and Exposition.

While there is no standardization of front-of-package nutrition labeling, the Institute of Medicine has proposed a graded star rating system. The food industry, however, is already using Facts Up Front, which displays nutritional information on the front of packaging.

Researchers examined consumer reaction to five different labeling systems to determine which helped them accurately identify healthier products, accurately compare nutrients among products, and ultimately purchase a healthier product.

In an online survey, approximately 1,000 participants were shown various food labels and asked to buy items. Two systems performed better than the others: the NuVal Nutritional Scoring System, which rates food from 1–100 based on nutrients, and a multiple traffic light labeling system, with green being healthier than yellow, which is healthier than red.

The NuVal system, which was developed by an independent panel of nutrition and medical experts, shows the information on shelf price tags and is currently being used at participating supermarket chains.

“I think the big message from this is the Institute of Medicine symbol didn’t really shine in any of these outcomes,” said session presenter Christina Roberto, a Robert Wood Johnson Foundation Health and Society Scholar at the Harvard School of Public Health.

In fact, the IoM star rating system seemed to confuse consumers — people saw a star and thought a product was healthy when it wasn’t.

Presenter Dan Graham, a psychology professor at Colorado State University, also found that certain labeling techniques fare better than others. Graham is using eye-tracking cameras to show which areas of packaging people look at.

Preliminary data of 153 parents showed they viewed nutrition labels, which are now on the backs and sides of packages, 279 times, compared with viewing front-of-package labeling 1,442 times. Further analysis showed that people weren’t just accidentally glancing at the labels either.

“It does seem to be an intentional effort to look at [front-of-package labeling], but there appears to be little understanding of how to use them effectively,” Graham said. “A key piece of whatever system is adopted [needs to include] more education of how to use these products and what they mean.”

— M.P.

A little birdie told me so: Tweet of the day

Well, this is definitely a new one for APHA.

Today's tweet of the day (and a big Congratulations!) goes to @derrhea, who wrote: He proposed at #APHA13 :-) I said Yes!

How about an APHA wedding, too? I hear New Orleans is nice in November :)

U.S. health lags behind peer nations

Steven Woolf said he usually tells his audience to take an anti-depressant before he discusses the report he presented Monday morning at APHA’s 141st Annual Meeting and Exposition.

That’s because there’s very little good news in his report comparing health in the U.S. to 16 peer nations.

We have the second highest mortality from noncommunicable diseases.

We’re fourth highest in death from communicable diseases.

And men in the U.S. have the lowest life expectancy at birth than men in 16 other countries. Women don’t do much better: they’re 16th out of 17.

Is there any good news? A smidge. The U.S. is good at keeping older people alive.

“For every five year age group from birth to age 75, the U.S. ranking for life expectancy is either at the bottom or near the bottom,” Woolf told a standing-room-only crowd at the morning session. “Older age groups appear to [fare better].”

Those figures show that the shorter U.S. life expectancy cannot be tied to diseases of middle age or infant mortality, Woolf said.

“We’re seeing a pervasive problem across all age groups,” he told attendees.

The Institute of Medicine report Woolf was presenting, “U.S. Health in International Perspective: Shorter Lives, Poorer Health,” compared health in the U.S. with 16 peer countries — generally democracies with large economies and high incomes.

One of the findings is that the situation appears to be getting worse, not better.

In 1980, for example, life expectancy for U.S. women was about average — in the middle of the peer group. But since then, U.S. women have joined men at the bottom of the heap.

On specific measures, the U.S. is not gaining ground as fast as other countries. For example, from 1995 to 2009, mortality from transportation accidents fell about 40 percent in the 17 countries studied, Woolf said. But it fell just 11 percent in the U.S.

Reasons for the unhealthiness of Americans are myriad, but according to the report, they include lack of access to preventable care, higher rates of drug abuse, consumption of more calories per person and higher rates of poverty.

Despite all of these problems, Woolf reported that Americans’ perception of their own health is actually a high point of the study.

“Americans are much more likely to rate their health as excellent than people in other countries,” he said.

To download a copy of the IoM report, click here.

—C.T.

The alternative approach

Some APHA Annual Meeting sessions take a more interactive approach to sharing best practices, such as this Monday morning session of roundtable discussions on complementary, alternative and integrative health practices.

Above from top to bottom: HIV researcher Michelle Teti, with the University of Missouri, discusses how to use the concept of “photovoice” — taking photos to express yourself and share ideas — to improve the quality of life among people living with HIV.

Wendy Thompson, of Andrews University in Berrien Springs, Mich., on the left, and Sister Rose Carmel Scalone, with LaSalle University in Philadelphia, participate in one of the session’s roundtables.

And Kathleen Miller, with the Benson-Henry Institute for Mind Body Science at Massachusetts General Hospital, on the left, said she was fascinated by her discussion with Marlene Wilken, with Creighton University, about using American Indian talking circles for diabetes self-management.

— M.P.

Photos by Melanie Padgett Powers

More tube time equals less sleep

Kids who watch more television get less sleep, and kids with televisions in their bedrooms sleep even less, according to a study presented today at APHA’s 141st Annual Meeting and Exposition.

The study looked at 1,864 participants at age 6 months and every year from ages 1 to 7. Mothers reported the child’s average TV watching and sleep duration.

The study concluded that for each additional hour of television watching, children got seven minutes less sleep per day. Even that small amount of decreased sleep could be detrimental, according to presenter Elizabeth Cespedes of Harvard’s School of Public Health.

“Modest decreases in sleep due to TV [watching] or bedroom TV could lead to sleep deficits,” which can have major impacts, she said.

The study’s authors found that television viewing creeps up in duration over time, as does the presence of televisions in children’s bedrooms, which rose from 17 percent at age 4 to 23 percent at age 7. Racial and ethnic minority children were more likely than white children to have televisions in their bedrooms.

The difference in sleep effects of having televisions in the bedroom was clearest when white children were compared to racial and ethnic minority children, researchers found. Minority children with televisions in their bedrooms were estimated to get a full half hour less sleep than white children without televisions in their bedrooms.

— C.T.