Put down the salt shaker

Sometimes, a small change can make an enormous difference.

When Broome County in upstate New York reduced the sodium content in school lunches by 300 mg a day, the effort cut a ton of salt out of kids' diets in a two-year period. Yep, a ton (or 2,381 pounds of salt, presenter Yvonne Johnston of New York's Binghamton University said during yesterday’s “Sodium in School Meals and the Local Food Environment” session).

Grant money and California’s year-round availability of fresh produce helped lead the sodium-reduction effort at the Los Angeles Unified School District, which serves more than 650,000 meals a day at more than 800 sites. And 80 percent of students qualify for free or reduced-price lunch, said Patricia Cummings of the Los Angeles County Department of Public Health's Division of Chronic Disease and Injury Prevention.

That school district has traditionally been on the forefront of healthy changes and has been working to adopt the Institute of Medicine’s recommendations on school meals. A preliminary evaluation of the sodium reduction piece found levels dropped in half for school breakfasts, from a whopping 1,064 mg in middle and high schools to 502 mg.

What helped? The school district’s food service team and board of education championed the policy and menu change, Cummings said. They also benefited from national momentum, including Centers for Disease Control and Prevention funding (such as a Community Transformation Grant) and Michelle Obama’s Let’s Move! campaign. Something she strongly recommended for others undertaking sodium reduction: taste testing for parents and kids. The school district served more than 30,000 meals as part of its taste testing, which was “really informative in finding out what the students liked and what they didn’t like.”

That’s not to say such change was or will be easy, both Cummings and Johnston said. For one, cost is a problem. Broome County found the popular grilled cheese and tomato soup offering was 53 percent more expensive in its reduced-sodium version.

“We have this challenge of looking at all the nutrients and micro-nutrients essential to health and putting it on a plate with little cents signs and figuring out the cost,” Johnston said. But connecting local growers with schools to improve the supply of local fruits and vegetables is a start.

Los Angeles County, when replacing high-sodium pepperoni pizza with choices like hummus and quinoa, found some kids really miss their pizza. Both school districts are looking for the right recipe for a lower-sodium pizza with whole grain crust. One idea: add garbanzo bean flour to the crust for a fiber and protein boost.

Like many public health movements, though, the effort to improve nutrition in school meals is one that demands all our support.

“This work at the local level is actually starting to create a demand (for lower-sodium foods)," Cummings said. “I think it’s this whole momentum nationwide and at the local level that’s really going to make a difference in lowering sodium.”

— D.C.

And the winner is...

 

APHA honored pubic health's movers and shakers during last night's Public Health Awards Reception and Ceremony. To read more about APHA annual awards, click here.

Above from top to bottom, Beth Roemer (left) presents the Milton and Ruth Roemer Prize for Creative Public Health Work to Gretchen Sampson; APHA Awards Committee Chair Satya Verma (left) presents APHA's Award of Excellence to Jonathan Fielding, who accepted on behalf of Antronette Yancey; and Mariana Clair Arcaya speaks after accepting the Jay S. Drotman Memorial Award. Photos courtesy Jim Ezell/EZ Event Photography

Fracked?

The public health implications of hydraulic fracturing, or fracking, to harness natural gas are still not well understood, as research into the practice “is in its infancy,” said Roxanna Witter of the Colorado School of Public Health.

“This is really a very, very, very new literature,” Witter said yesterday during a session on “Fracking — Public Health Implications of Shale Gas Development.” “This is good for the time limitations of (this) presentation, but not for anything we’re attempting to do in scientific knowledge.”

Presenter Dallas Burtraw, a researcher with Resources for the Future, talked about acknowledging how the use of natural gas can be a good thing, especially considering that a gas-fired power plant would have much lower emissions than a coal-fired plant. But he also acknowledged a lack of any studies examining the long-term health effects of fracking.

He cited many possible benefits of fracking, such as cheaper electricity, cheaper home and commercial heating, and the possibility of reducing oil consumption in transportation. And one of the “big issues on the table,” even in the face of health concerns, is the economic revitalization of some areas, he said.

However, even the U.S. Environmental Protection Agency is noting possible water contamination at fracking sites, such as in Pavillion, Wyo. In fact, the literature review Witter conducted found evidence of water and air contamination linked to fracking.

The National Resources Defense Council is so opposed to fracking, the organization has a “Don’t Get Fracked” page dedicated to helping people learn about the health dangers of fracking and how to stay informed. They put it this way: “Although drilling can create jobs and income, many fear the effects of drilling on their health, land and quality of life. Current laws need to be changed to catch up with the drilling explosion.”

Click here to read more about the public health effects of fracking in The Nation’s Health.

— D.C.

Tuesday's storyboard

Happy Halloween public healthers! Here's your round-up from yesterday's Annual Meeting events brought you by APHA's Storify.

Wednesday's Have You Heard

One life (span) to live: Stick with this year's Annual Meeting theme and check out Wednesday session 5036, "Healthy People 2020 Across the Life Span," which starts at 8:30 a.m. in Marriott Marquis Yerba Buena Ballroom Salon 2.

Bridging the gap: It's a topic that often comes up in this new era of health reform: better integrating public health and health care. Explore the topic with your fellow public healthers on Wednesday at 10:30 a.m. at session 5128, "Public Health and Hospitals: More Than Ever Needed and Under Attack," in Moscone Convention Center South Room 228.

Finding the less fortunate: Join APHA's Caucus on Homelessness for a walking tour of San Francisco homeless service providers from 11 a.m. to 12:45 p.m. Meet at the Moscone Convention Center South main entrance.

Still a global epidemic: The world of HIV prevention will descend on Moscone Convention Center Esplanade Ballroom 300 on Wednesday for session 5187, "International Issues in HIV Prevention," starting at 12:30 p.m. Hear presentations on HIV prevention and treatment efforts in China, Russia and Central Asia.

Reading, writing and babies?: Does reading ability predict teen pregnancy risk? Find out at Wednesday session 5194, "Teen Pregnancy: Fostering Health and Prevention," at 12:30 p.m. in Moscone Convention Center South Room 200.

Call to justice: Cap off your 140th APHA Annual Meeting experience with Wednesday's "Closing General Session: Incarceration, Justice and Health," featuring keynote speaker Angela Davis, author, lecturer, researcher and social justice activist. Also, meet APHA's incoming president, Adewale Troutman. Congrats Dr. Troutman! The closing session starts at 2:30 p.m. in Moscone Convention Center West Room 2001/2003/2005.

Taking on tobacco

Earlier today, Stanton Glantz and Sharon Eubanks signed copies of their book, "Bad Acts: The Racketeering Case Against the Tobacco Industry," at Everything APHA at the Public Health Expo. Stop by the Expo tomorrow before it closes at 12:30 p.m. to pick up your copy! And click here to read a Q&A with Eubanks from APHA's Public Health Newswire.

Photo courtesy Jim Ezell/EZ Event Photography

Will there be a doctor in the house?

Public health advocates rightfully cheered the passage of health reform in the form of the Affordable Care Act in 2010. Expanded insurance options and greater eligibility for Medicaid mean that more people will have the safety net of coverage.

But 30 million to 40 million more insured people also means more people making appointments at the doctors' offices, and, at a time when the primary care workforce is already stretched, how will we accommodate all of these new people? And as the U.S. grows more diverse, how will we find culturally and linguistically competent providers?

We'll need to be innovative, said presenters at a Tuesday session on "Who Will Serve Them? Health Workforce Shortages Under Expanded Coverage."

The current system creates too many barriers for those who wish to be health care providers, particularly if those people are licensed in their home countries, said Jose Ramon Fernandez-Pena, founder of the Welcome Back Initiative. The program, which seeks to build a bridge between internationally trained health workers living in the U.S. and the need for a culturally competent workforce, operates centers in California, Massachusetts, Rhode Island, Maryland, Texas, New York and Colorado.

"The lack of minority health professionals compounds the nation's persistent racial and ethnic health disparities," he said during his presentation.

"The Welcome Back Initiative asks 'Who were you, who are you and who do you want to be?' and we try to start rescuing pieces of their professional persona," Fernandez-Pena said.

One of the main problems faced by health professionals seeking to work in the U.S. is a lack of command of English, a problem the initiative addresses with an intensive English-as-a-second-language program aimed at medical professionals.

So far, the initiative has assisted 110 physicians to enter residency training, helped more than 3,400 validate their credentials, 1,900 pass licensing exams and 1,100 obtain licenses in their original professions, he said.

Another avenue for expanding the workforce is expanded use of nurse practitioners and physician assistants, said Catherine Dower, of the University of California–San Francisco's Center for the Health Professions.

In this area, state legislators can be important drivers of change. Studies of the variations among the jobs that nurse practitioners can do in each state showed that no two states are the same. In some, nurse practitioners have full prescribing power, while others require that they work in poorly defined "collaboration" with physicians.

This leads to a lack of clarity about who can do what as well as a lack of communication.

"People don't talk to each other when they don't know what each other can do," she said. "They're not working together in the patients' best interest."

Solutions include expanding the legal scope of practice for nurse practitioners and physician assistants, tapping into underused pools of providers, including military veterans who might have medical field experience, and expanding loan repayment programs, she said.

— C.T.

Transforming the nation one community at a time

Arriving at Huston-Tilloston University to talk to faculty and staff about implementing a tobacco-free policy, Phillip Huang was met by a security guard smoking a cigarette.

Just a few months later, that same guard had quit smoking and was one of the most outspoken supporters of the campus-wide tobacco ban.

The Austin, Texas, school’s comprehensive tobacco-free policy was just one of many heartening success stories shared during today’s session on “Early Lessons Learned from Community Transformation Grants Communities.” APHA is one of three national organizations working to support projects funded by the Centers for Disease Control and Prevention grants, which are aimed at preventing chronic disease by reducing tobacco use, improving healthy eating and physical activity, and widening access to preventive services such as cancer screenings. The grants where created via the Patient Protection and Affordable Care Act.

Huang, medical director of Austin/Travis County Health & Human Services' Disease Prevention and Health Promotion Division, shared the road to putting tobacco-free campus policies in place at two other Austin area schools. The process at the University of Texas, for example, started with a student resolution that asked the school administration to enforce a tobacco-free campus within seven years. 

Then, the Cancer Prevention Research Institute of Texas adopted a policy that anyone receiving their grant funding (including the University of Texas) had to have a tobacco-free policy. Effective April 9, the campus became mostly tobacco-free. Designated smoking areas will be eliminated at the end of February 2013.

“You have to treat these campaigns almost like a political campaign and be ready to be nimble and respond to whatever is happening,” Huang said.

Other examples of the transformation grants in action: In Bernalillo County, N.M., a new database of existing policies on topics like tobacco-free spaces and built environments that supports active living has been set up to help identify where gaps exist. And in Maryland, work already has resulted in tobacco-free policies in apartment buildings, among other successes.

Learn more about what’s working well and the pitfalls to avoid during a Community Transformation Grant networking session today from 6:30–7:30 p.m. in the Mix and Mingle Lounge in Moscone Convention Center South.

There won't be any food at tonight's session, but there will be “a lot of really great conversation because we’re all doing really great work,” said Shawn McIntosh, APHA’s project coordinator for the Community Transformation Grants. “One of the best things we can do is talk to each other about all the wonderful things we are doing so we can learn from each other.”

— D.C.