As school winds down and camps and sports prepare for the summer season, a new study funded by the Robert Wood Johnson Foundation and published in the American Journal of Public Health on sports-related traumatic brain injuries in youth sports, is generating deserved attention.

The study, by Hosea Harvey, JD, PhD, Assistant Professor of Law at the Temple University Beasley School of Law, found that while forty four states and Washington, D.C.,  passed youth sport TBI laws  between 2009 and 2012, none of the laws focus on preventing the injuries in the first place. The laws on the books deal primarily with increasing coaches’ and parents’ ability to identify and respond to traumatic brain injuries and reducing the immediate risk of multiple brain injuries.

>>Read more in a Q&A with the Babe Ruth League Inc. about how youth sports leagues are making strides to prevent injuries.

Harvey’s conclusion is that continued research and evaluation is needed to develop a more comprehensive reduction in youth sport traumatic brain injuries.

NewPublicHealth: What did your study address?

Hosea Harvey: I looked at traumatic brain injury (TBI) laws that were passed at the state level that purported to deal with the problem of youth TBIs in sports statewide. I looked at every related state law passed between 2009 through the end of 2012, though most states only had one law that they passed that dealt with youth sports TBIs during that period.

NPH: And your study found that no state that right now has a law that says this is what you have to do in order to prevent these concussions in the first place?

While a growing number of major league sports teams have policies on concussion assessment and return to play, many youth and school sports leagues and teams do not have similar rules, despite thousands of sports-related traumatic brain injuries (TBIs) reported in children and adolescents every year.

Hosea H. Harvey, PhD, JD, Assistant Professor of Law in Temple University’s Beasley School of Law, has just published an article in the American Journal of Public Health analyzing how this health issue is being addressed across the country. He found that there are laws dealing with concussions in youth sports in 44 states and D.C.—but none are focused on preventing the injuries. The laws only address detecting the injuries or preventing an additional injury after one has already occurred.

The study also revealed that many laws don’t draw on evidence around what works. For example, most state laws establish a minimum 24-hour period of youth athlete removal, but there is no scientific agreement about the optimal minimal time someone who has suffered a sports-related TBI should be removed from play. The study utilized an open source dataset from Robert Wood Johnson Foundation grantee Public Health Law Research called LawAtlas.

>>Read the full study.

NewPublicHealth previously spoke with Harvey and Kerri McGowan Lowrey, JD, MPH, Senior Staff Attorney with the Network for Public Health Law — Eastern Region, about legal and legislative approaches to addressing concussions in youth sports. The previous interview is included below:

One in Five Kids At Risk for Suicide Live in Homes with Guns
Nearly one in five children and teens found to be at risk for suicide report that there are guns in their homes and fifteen percent of those with guns in their home said they know how to access both the guns and the bullets, according to a study presented at the Pediatric Academic Societies annual meeting in Washington, D.C.

The study researchers recommend that emergency department doctors screen all children and teens for suicide risk. Suicide is the second leading cause of death among young people ages 10 to 24 years in the United States, according to Centers for Disease Control and Prevention. Nearly half of young people who die by suicide use a gun. Read more on injury prevention.

Teen Girls Who Exercise Are Less Likely to be Violent
A study from the Columbia University Mailman School of Public Health finds that high school girls who play sports or run have a lower risk of being in fights or in a gang. Researchers at the school reviewed results of a 2008 survey completed by 1,312 students at four inner-city high schools in New York to determine if there was an association between regular exercise and violence-related behaviors.

The survey results found that girls who had exercised more than 10 days in the last month had decreased odds of being in a gang, those who did more than 20 sit-ups in the past four weeks had decreased odds of carrying a weapon or being in a gang and those who reported running more than 20 minutes the last time they ran had lower odds of carrying a weapon. Girls who participated in team sports in the past year had decreased odds of carrying a weapon, being in a fight, or being in a gang.

Among boys, none of the exercise measures were linked to decrease in violence-related behaviors. But the researchers say that a connection may not have been found because a smaller percentage of boys than girls completed the survey and that more research is needed to see if exercise interventions can reduce youth violence. Read more on violence.

USDA Announces New Rules to Fund Broadband Service in Underserved Rural Communities
The USDA has announced new rules that simplify the proposals to request funds for internet broadband access in rural areas. USDA broadband funds have provided internet access for nearly 65,000 rural households, businesses, and community organizations such as libraries, schools and first responders. Read more on preparedness.

While residential use of lead-based paint has been banned in the U.S. since 1978, millions of homes still have the paint, and the health dangers it brings with it, on their walls. Lead paint has been linked to cognitive and behavior issues as well as anemia and even death, especially in young children because their brains are still developing. But according to the Centers for Disease Control and Prevention, about half a million children ages 1 through 5 have potentially dangerous blood lead levels.

In Philadelphia, according to the 2009 American Housing Survey data, 91.6 percent of the housing units were built before 1978. Exacerbating the issue, close to 30 percent of families live in poverty, which can delay household maintenance and lead to peeling paint—a major lead risk to children in older homes. Studies also show that the number of children in Philadelphia with elevated blood levels is higher than the national average.

“This problem requires a public health solution since [preventing childhood] lead exposure…involves multiple stakeholders, including the child and parents, the property owner, and the local authorities who make and enforce laws, ordinances and codes,” says Carla Campbell an associate teaching professor in the School of Public Health at Drexel University. Campbell is the author of a new study on a lead court established in Philadelphia in 2003. The lead court is designed to speed the cleanup of lead hazards in apartments and rented homes. Campbell’s research was funded by the Public Health Law Research, a project of the Robert Wood Johnson Foundation, based at the Temple University School of Law. Campbell’s study appears in a special issue of the Journal of Health Politics, Policy and Law focused on public health law research.

NewPublicHealth recently spoke with Carla Campbell about Philadelphia’s lead court and the implications of its success for other public health issues.

NewPublicHealth: What did your study find?

Did you know that consumers are supposed to call a three-digit number, 811, before starting any digging on residential property? Many would-be diggers don’t, which is why the U.S. Department of Transportation’s Pipeline and Hazardous Materials Safety Administration (PHMSA) began an 811 public education campaign last month.

PHMSA has good reason for getting the word out. Striking buried lines is a leading cause of pipeline-related death and injury and can lead to service outages in whole neighborhoods. Over the last 20 years, property damage costs were over $500 million nationwide from such strikes.

PHMSA estimated that three out of ten households will begin residential construction or renovation projects this spring. A call to 811, which connects would-be diggers to a local utility’s call center, a few days before planned digging generates a visit from a local representative who will mark the approximate location of nearby underground lines, pipes and cables, so workers can dig safely.

 “We want 811 to become as well-known as 911, because digging without getting your utilities marked is not only dangerous, it can also cut off services to an entire neighborhood and cost you money[in fines],” said PHMSA Administrator Cynthia Quarterman.

Since 811 debuted six years ago, serious pipeline incidents from unsafe digging have decreased by more than 45 percent, according to PHMSA.

Study: Minor Injuries in Some Children May Indicate the Possibility of More Serious Child Abuse Later On
A study in Pediatrics finds that relatively minor abuse injuries often precede more serious abuse of children. The study refers to “sentinel” injuries—a previous injury reported in a child’s medical history that was suspicious or had an implausible explanation. Researchers examined records of infants seen by the child protection team at Children’s Hospital of Wisconsin between March 2001 and October 2011. Of the 200 children who were definitely abused, 55 (27 percent) had a sentinel injury. Of those, 80 percent had a bruise, 11 percent had an injury inside the mouth, and 7 percent had a fracture. Of 100 children where abuse was suspected but not confirmed, 8 had a sentinel injury. None of the infants in the control group—who had no history of abusive injuries—had a sentinel injury. The study authors say their findings suggest that in more than a quarter of cases of definite physical abuse, there may be escalating and repeated violence toward the infant instead of a single event of momentary loss of control by a frustrated or angry caregiver. Improved recognition of sentinel injuries and interventions would prevent additional cases of child abuse, according to the researchers. Read more on injury prevention.

HUD Renews Grants for Local Communities’ Response to Homelessness
The U.S. Housing and Urban Development Department (HUD) is renewing funding for 7,000 local homeless housing and service programs across the country. The funding ensures the programs will remain open for at least the coming year, according to HUD, which has challenged local communities to review their response to homelessness and to emphasize proven strategies including “rapid re-housing” for homeless families and permanent supportive housing for people who experience chronic homelessness. The amount of renewed funding is $1.5 billion in grants that will support programs including street outreach, client assessment and direct housing assistance. HUD expects to award additional grants later this year. HUD recently announced its 2012 “point in time” estimate of the number of homeless persons in America. Approximately 3,000 cities and counties reported 633,782 homeless persons on a single night in January of 2012. Read more on housing.

Policy and Practice Changes Needed to Improve Survival in People who have Heart Attacks in the Hospital
Policy and practice changes by healthcare institutions, providers and others could greatly improve survival for people who have a have a heart attack in the hospital, according to an American Heart Association (AHA) consensus statement in its journal, Circulation. Each year, more than 200,000 adults and 6,000 children have in-hospital cardiac arrests, and survival has remained essentially unchanged for decades, according to the AHA. Only 24.2 percent of in-hospital cardiac arrest patients survive to hospital discharge.

Key recommendations include:

• Establishing competency of all hospital staff in recognizing a cardiac arrest, performing chest compressions and using an automated external defibrillator or AED.
• Ensuring that best practices are used in all stages of care for cardiac arrest.
• Requiring that all in-hospital cardiac arrests be reported, with survival data, using consistent definitions across hospitals. Definitions currently are not standardized, according to the researchers.
• Modifying billing codes to allow collection of more specific and accurate data for in-hospital cardiac arrest.
• Separate guidelines for in-hospital versus out-of-hospital cardiac arrests.

Read more on heart health.

Judge Strikes Down N.Y. City’s Sugary Drink Limit; Bloomberg to Appeal
“The loopholes in this rule effectively defeat the stated purpose of this rule,” wrote State Supreme Court Justice Milton Tingling when striking down New York City’s 16-ounce limit on sodas and other sugary drinks just hours before it was set to go into effect. He also called the law “arbitrary and capricious.” Still, Mayor Michael Bloomberg says he expects to win on appeal. “As far as we have come, there is one public health crisis that has grown worse and worse over the years, and that is obesity," he said at a news confernce. "Five thousand people will die of obesity this year in New York. The best science tells us that sugary drinks are a cause of obesity." Read more on obesity.

NFL, GE Partner in $60M Effort to Study and Prevent Brain Injuries
The National Football League and General Electric Co have announced a $60 million partnership to advance research into brain injuries while also developing new technologies to help limit injuries to athletes. It includes $40 million for research into imaging technologies and $20 million for researchers and businesses working on injury prevention, identification and management. The NFL has faced multiple lawsuits related to concussions, including a class action on behalf of 4,000 former players. "We're trying to do this with the best minds anywhere in the world," said GE Chairman and CEO Jeff Immelt at a news conference. Each year, U.S. emergency rooms see about 173,000 temporary brain injuries related to sports and recreation in people age 19 and under, according to the U.S. Centers for Disease Control and Prevention. Read more on injury prevention.

Ovarian Cancer Patients Who Don’t Receive Recommended Treatment More Likely to Die in 5 Years
Ovarian cancer patients who do not received the treatment recommended by the National Comprehensive Cancer Network (NCCN) clinical practice guidelines—or as many as two-thirds of patients—have a 30 percent greater risk of dying within five years, according to new findings to be presented at the annual meeting of the Society of Gynecologic Oncology. The study found that low-volume hospitals that treat fewer ovarian cancer patients are less likely to follow the treatment guidelines. "The high-volume hospitals, which did 20 or more cases a year, and high-volume physicians, which did 10 or more a year, were significantly more likely to administer treatment that was adherent to NCCN guidelines," said Robert Bristow, MD, director of gynecologic oncology at the School of Medicine of the University of California, Irvine. According to the American Cancer Society, in the United States, approximately 22,000 new cases of ovarian cancer are diagnosed each year and 15,000 women die from the disease. Read more on cancer.

Obese Drivers at Greater Risk of Dying in a Car Crash
Obese drivers are up to 78 percent more likely to die in a car crash than normal-weight drivers, according to a recent study by researchers at the UC Berkeley’s Safe Transportation and Research Education Center. Researchers reviewed data on accidents recorded in the managed by the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System, and found that drivers with a Body Mass Index (BMI) in the obesity range (over 30) were more likely than other drivers to die in a car crash even if they were wearing a seat belt and an airbag deployed. The researchers say that other health problems the obese drivers had could have been a factor in their deaths, but say that cars may not be designed people who are overweight. The study was published in the Emergency Medicine Journal. Read more on injury prevention.

AHRQ Releases Patient Safety Strategies
The Agency for Healthcare Research and Quality recently released 10 patient safety strategies for hospital and other health care facilities that the agency says can save lives:

• Preoperative checklists and anesthesia checklists to prevent operative and postoperative events
• Checklists to prevent central line-associated bloodstream infections
• Interventions to reduce urinary catheter use, including catheter reminders, stop orders, or nurse-initiated removal protocols
• Interventions including head-of-bed elevation, to prevent ventilator-associated pneumonia
• Hand hygiene
• The do-not-use list for hazardous abbreviations
• Interventions to reduce pressure ulcers
• Barrier precautions to prevent healthcare-associated infections
• Use of real-time ultrasonography for central line placement
• Interventions to improve prevention of blood clots

Read more on safety.

Study Finds Soccer Programs Increase Exercise among Low-Income Kids
A study by researchers at the University of California, Berkeley School of Public Health finds that an after-school soccer program and literacy program has been successful in increasing physical activity among elementary school children. The researchers found that the program increased moderate-to-vigorous physical activity by an average of 3.4 minutes per weekday and 18.5 minutes on Saturdays among students with a body mass index at or above the 85th percentile, when compared with students at control schools who did not host the program. The program did not significantly increase physical activity among children who were not overweight or obese. Read more on obesity.

Better Nutrition Advice Comes From Doctors Who Cook
At the “Healthy Kitchens, Healthy Lives – Caring for our Patients and Ourselves” conference presented by Harvard University and the Culinary Institute of America, health care professionals have been learning about both nutritional science and how to cook. The program was influenced by the idea that healthcare professionals practicing healthful behaviors—such as healthy eating, exercising, or wearing a seat belt—may be more likely to pass these same behaviors onto their patients.

A 2010 survey of 219 conference participants before the conference and 192 participants three months after found:

• 58 percent of healthcare professionals cooked their meals before the conference; 64% afterwards with reports of eating more whole grains, nuts and vegetables
• 46 percent said they could successfully advise an overweight patient on nutrition and lifestyle before the conference; 81% said they could afterwards

The researchers believe they “need enhanced educational efforts aimed at translating decades of nutrition science into practical strategies whereby healthy, affordable, easily prepared and delicious foods become the predominant elements of a person’s dietary lifestyle.” Read more on nutrition.

Caffeine During Pregnancy Linked to Smaller, Later Newborns
Coffee and other caffeinated beverages consumed during pregnancy might increase the odds for low birth weight or an extended pregnancy, according to a new study in BMC Medicine. The study looked at about 60,000 pregnancies tracked by the Norwegian Institute of Public Health. Researchers found that caffeine from all sources was tied to a higher risk for reduced birth weight and that every 100 mg of caffeine consumed per day extended pregnancy by five hours. Caffeine from coffee extended pregnancy by eight hours. The World Health Organization advises women to limit their caffeine consumption to 300 mg a day during pregnancy, while the United States recommends a 200 mg daily limit. Read more on maternal and infant health.

CDC: Reductions in Some Types of Health Care-Associated Infections
Progress in the fight against certain bloodstream and surgical-site infections continues in hospitals in the United States, according to a U.S. Centers for Disease Control and Prevention (CDC) report. The report looked at data submitted to the National Healthcare Safety Network (NHSN), CDC’s infection tracking system. CDC reported a 41 percent reduction in central line-associated bloodstream infections since 2008 and a 17 percent reduction in surgical site infections since 2008. “The significant decrease in central line and surgical site infections means that thousands of patients avoid prolonged hospitalizations and the risk of dying in the hospital,” said Patrick Conway, chief medical officer of the Center for Medicare & Medicaid Services (CMS). The data indicates hospitals are making progress toward the goals established in 2008: 50 percent cut in central line-associated bloodstream infections and a 25 percent cut in surgical site infections in five years. Read more on injury prevention.

U.S. Preventive Services Task Force Recommends Physicians Ask All Women about Intimate Partner Violence
Physicians should screen all women of childbearing age for signs of domestic violence and refer them for treatment if necessary, according to a new recommendation from the U.S. Preventive Services Task Force. In the United States, according to the U.S. Centers for Disease Control and Prevention, nearly one-third of women and more than 25 percent of men have been victims of domestic violence. In addition to the risks of injury and death, people who experience domestic violence may also develop sexually transmitted diseases, pelvic inflammatory disease, unintended pregnancies, chronic pain, neurological disorders, gastrointestinal disorders, depression, anxiety, post-traumatic stress disorder, substance abuse and suicidal behavior. Domestic violence in women is also linked to preterm birth and low-birth weight babies. The panel found that women who were screened for domestic violence were far more likely to discuss the issue with their doctor than women who were not screened. Read more on violence.

AAP: Playgrounds Need Yearly Safety and Quality Check
A new study of close to 500 Chicago playgrounds published in Pediatrics finds that the quality and safety of playgrounds can vary by neighborhood. Researchers looked at the playgrounds between 2009 and 2011 and assessed four categories: age-appropriate design, ground surfacing, equipment maintenance and physical environment. While most of the playgrounds met the criteria for age-appropriate design and physical environment, failing grades were often given for problems with ground surfacing, such as not enough wood chips to cushion falls, or equipment maintenance problems. The authors also found that neighborhoods with a higher percentage of low-income individuals had both fewer overall sites and more failing-grade playgrounds. The researchers reported failing grades to local authorities, which led to more passing grades at the end of the study. The researchers say strengthening community partnerships and training appropriate staff for yearly playground checks can result in a safer urban play environment for children. Read more on pediatrics.

Tenth Annual Traffic Law Report Card Finds Fewer Laws and More Deaths
The tenth annual report card on traffic safety by the group Advocates for Highway and Auto Safety finds that several states have repealed traffic safety laws and others have not moved to enact new ones. Last year only 10 state highway safety laws were enacted, while 16 laws were passed in 2011 and 22 were passed in 2010. According to the group, preliminary National Highway Traffic Safety Administration (NHTSA) data show the largest jump in traffic fatalities since 1975, a 7.1 percent increase in crash deaths during the first nine months of 2012 compared to the first nine months of 2011. The report card also found that:

• 18 states still need a primary enforcement seat belt law;
• 31 states still need an all-rider motorcycle helmet law;
• 19 states still need an booster seat law;
• No state meets all the criteria of Advocates’ recommended Graduated Driver’s License program;
• 40 states and Washington, D.C. are missing one or more critical impaired driving laws and;
• 15 states still need an all-driver text messaging restriction.

Read more on injury prevention.