Howard County has been the healthiest in Maryland since the Country Health Rankings launched in 2010. NewPublicHealth recently spoke with the county’s executive, Ken Ulman, about how the Rankings have helped drive further progress in improving the health of Howard County. Health initiatives introduced by Howard County have included a program that certifies schools as “Healthy Schools,” if they meet criteria in several areas including nutrition and physical activity, and a smoking ban in all county parks. 

NewPublicHealth: Howard County has been consistently been ranked the healthiest county in Maryland. What key factors do you credit for that?

Ken Ulman: We start with some advantages. We have the blessings of a highly educated population that cares deeply about their community and have good jobs, and many, though not all, have [adequate financial] resources and access to care. We also have the advantage of having a nonprofit, the Horizon Foundation, based in Howard County that is dedicated to improving the health and wellbeing of people living and working in our county.

So it’s a combination of policy initiatives coupled with a public that really wants to make progress in these areas.

NPH: Have the County Health Rankings helped drive any of your public health and prevention initiatives?

Municipal mixed-use zoning is a public health strategy to create more walkable neighborhoods by creating integrated, un-siloed access to daily activities—such as going grocery shopping and traveling to school and work. A recent study in a special issue of the Journal of Health, Politics, Policy and Law funded by Public Health Law Research, a program of the Robert Wood Johnson Foundation, evaluated municipal zoning ordinances in 22 California cities to see whether the ordinances improved walkability in those communities. NewPublicHealth spoke with the study’s two authors, Sue Thomas, PhD, senior research scientist at the Pacific Institute for Research and Evaluation-Santa Cruz (PIRE) and Carol Cannon, PhD, formerly with PIRE and current associate research scientist at the CDM Group, Inc, a consulting firm in Bethesda, Md.

>>Read the full study.

NewPublicHealth: What was the scope of your study? 

Carol Cannon: We looked at ordinances that create municipal mixed use zoning, and whether these laws seem to have an impact on the potential for walking to destinations. 

NPH: In what ways were the study and findings innovative?

CDC: Only 20 Percent of U.S. Adults Meet Aerobic, Muscle-strengthening Requirements
Only about one in five U.S. adults meet the aerobic and muscle strengthening components of the federal government's Physical Activity Guidelines for Americans, according to a new report in the U.S. Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report. The guidelines call for a minimum of 2.5 hours of moderate-intensity aerobic activity each week, or 1.25 hours of vigorous-intensity aerobic activity, as well as at least two days of muscle-strengthening activities. About half of adults meet the aerobic minimums and 30 percent meet the muscle-strengthening requirements, which Carmen D. Harris, MPH, epidemiologist in CDC's physical activity and health branch, called “encouraging.” "This is a great foundation to build upon, but there is still much work to do,” she said. “Improving access to safe and convenient places where people can be physically active can help make the active choice the easy choice." Read more on physical activity.

Hospital Programs Find Success in Cutting Antibiotic Prescriptions, Drug-resistant Bacteria
Hospital programs designed to decrease the number of prescriptions for antibiotics also successfully cut the number of drug-resistant bacteria, according to a new study in the Cochrane Library. Such bacteria, as well as the possibility of secondary infections, can leave patients especially at risk. "Antibiotic resistance is recognized worldwide as a public health problem that's just getting worse. Really around the world people are worried that we'll end up with bacteria that are resistant to the antibiotics we've got," said Peter Davey, MD, of the University of Dundee in Scotland. Researchers found that while persuasion/education programs were effective, actually restricting prescriptions saw more improved outcomes early on, which persuasion/education’s effectiveness catching up later. "We got good evidence that restrictive interventions work faster in terms of changing prescribing and microbial outcomes," he said. Read more on preventing antibiotic resistance.

Suicide Rate Up Significantly for Middle-aged Americans
Attempts to explain the dramatic increase in suicides by middle-aged Americans over the past decade have left many public health experts “dumfounded,” according to Lanny Berman, executive director of the American Association of Suicidology. "The best we can come up with is maybe this is the group most likely to be affected by the recession and unemployment and [home] foreclosure," he said. "It affected suicide rates both nationally and internationally." A new report from the U.S. Centers for Disease Control and Prevention reveals that suicides for people aged 35-64 rose by 28 percent from 1999 to 2010. For comparison’s sake, more Americans died by suicide in 2010 (38,364) than in car crashes (33,687). According to an agency news release: "Suicide is a tragedy that is far too common. The stories we hear of those who are impacted by suicide are very difficult. This report highlights the need to expand our knowledge of risk factors so we can build on prevention programs that prevent suicide,” said CDC Director Tom Frieden, MD. Read more on mental health.

Study: Better Fitness Equals Better Grades for Kids
Getting kids more exercise may also make them more likely to get better grades, according to a new study in the Journal of Pediatrics. The study found that physically fit elementary and middle school students were 2.4 times more likely to pass math tests and about 2 times more likely to pass reading tests . The findings are especially significant at a time when schools across the country are cutting physical education programs. "Schools sacrificing physical education and physical activity time in search of more seat time for math and reading instruction could potentially be pursuing a counterproductive approach," said lead researcher Robert Rauner, MD, of Creighton University and Lincoln Public Schools in Lincoln, Neb. Read more on physical activity.

Personalized Risk Assessments Lead to Smarter Patient Decisions
Providing patients with personalized risk assessments instead of generalized assessments makes them more likely to make educated decisions about screening tests, according to a new review of 41 studies published in the Cochrane Library. The personalized evaluations include factors such as age, race, gender, weight, lifestyle and family history. "Knowing your individual risk for a particular health problem may help you make an informed choice about what screening services you might be interested in," said Michael LeFevre, MD, MSPH, co-vice chair of the government-backed U.S. Preventive Services Task Force. "Over time, what would be ideal is that we're able to make more specific, individualized recommendations and fewer population recommendations.” Read more on access to health care.

Study: ADHD, Autism, Depression May Share Genetic Link
Autism, attention-deficit/hyperactivity disorder (ADHD), major depression and other mental disorders may share genetic risk factors, according to a new study in The Lancet. Bipolar disorder and schizophrenia were also linked. Researchers do not yet understand the link between the gene variants and the disorders, but the knowledge may help improve prevention and treatment methods. "This is the first clue that specific genes and pathways may cause a broader susceptibility to a number of disorders,” said lead researcher Jordan Smoller, MD, a professor of psychiatry at Harvard Medical School in Boston. “Now the important work will be to figure out how this actually happens.” Read more on mental health.

Restaurant Chains Serving More Lower-Calorie Choices Do Better Financially
Restaurant chains that serve more lower-calorie foods and beverages have better business performance, according to a study released today by the Hudson Institute. Over five years, chains that increased the amount of lower-calorie options they served had better sales growth, larger increases in customer traffic, and stronger gains in total food and beverage servings than chains whose offerings of lower-calorie options declined.

The report, Lower-Calorie Foods: It’s Just Good Business, analyzed 21 of the nation’s largest restaurant chains, including quick-service chains such as McDonald’s, Wendy’s, Burger King, and Taco Bell, and sit-down chains such as Applebee’s, Olive Garden, Chili’s, and Outback Steakhouse.

“Consumers are hungry for restaurant meals that won’t expand their waist lines, and the chains that recognize this are doing better than those that don’t,” said Hank Cardello, lead author of the report, senior fellow at the Hudson Institute, and director of the Institute’s Obesity Solutions Initiative.

Read more on obesity.

New AMA Report Outlines Physician Responsibilities for Newly Discharged Hospital Patients
The American Medical Association (AMA) has released a new report, “There And Home Again, Safely” that outlines a list of five responsibilities for outpatient physicians to consider when caring for patients who have recently left the hospital. Developed by a panel of experts to improve safety and reduce the rate of hospital readmissions, responsibilities include: 

• assessment of the patient’s health;
• goal-setting to determine desired outcomes;
• supporting self-management to ensure access to resources patients need;
• medication management; and
• care coordination to bring together all members of the health care team.

Read more on safety.

An Active Lifestyle May be Just as Beneficial as Structured Exercise
A new study conducted by researchers at Oregon State University College of Public Health and Human Science suggests that small amounts of activity that adds up to 30 minutes per day can be just as beneficial as longer bouts of physical activity at the gym.  More than 6,000 American adults participated in the study by wearing accelerometers on a daily basis. Those who participated in the short bouts of activity could be moving as few as one or two minutes at a time by engaging in activities – such as taking the stairs instead of the elevator or walking while talking on the phone. The researchers found that more than 40 percent of adults in the study reach their 30 minutes of daily exercise by making movement a part of their everyday life. The researchers say such an active lifestyle approach may be just as beneficial as structured exercise to improve health, including preventing metabolic syndrome, high blood pressure, and high cholesterol.

Read more on physical activity.

HHS Launches Year-Long National Dialogue on Mental Illness
As part of the effort toward helping to reduce gun violence in the country, the U.S. Department of Health and Human Services (HHS) has announced some new initiatives. HHS Secretary Sebelius says the agency will join with private and public partners to launch a year-long national dialogue on youth and mental illness, engaging parents, peers and teachers to reduce negative attitudes toward people with mental illness, to recognize warning signs and to improve access to treatment. Read more on mental health.

IOM Committee Says Current Childhood Immunization Schedule Is Safe
An Institute of Medicine report released yesterday supports the safety of the federal childhood immunization schedule, but recommends that it be monitored. The current schedule calls for 24 immunizations by age 2 which results in some parents delaying vaccines, sometimes out of fear that too many simultaneous vaccines may pose a safety risk. The IOM panel said there is no evidence that a different schedule would be safer. Read more on vaccines.

Take a Night to Count — and Help — the Homeless
During the last ten days of January, tens of thousands of volunteers in more than 3,000 U.S. cities and counties will join in Make Everyone Count, a national effort to count the number of homeless adults and youth in shelters and on the streets. The counts provide local planners with both the number and characteristics of people who are homeless to help them develop targeted responses. According to the U.S. Department of Housing and Urban Development, which provides grants for the counts, being able to determine how many people are homeless and why is critical to helping to end homelessness. Volunteer by contacting homeless organizations in your area. Listen to a public service announcement on counting the homeless “Make Everyone Count," by musician Cyndi Lauper.

Study Finds PE Requirement at Universities at All-time Low
A new study from the Oregon State University College of Public Health and Human Sciences finds that the number of college students required to take physical education and exercise requirements is at an all-time low of 39 percent. The researchers looked at data from 354 randomly chosen four-year universities and colleges going back to 1920, a year when 97 percent of students were required to take physical education. Oregon State still requires physical education courses and lead researcher Brad Cardinal says requiring PE sets the tone for students to understand that being active and healthy is as important as their academic courses. Cardinal says he thinks budget cuts and an increased focus on purely academic courses are factors behind the reduction in college PE. And Cardinal says that campus fitness centers don’t take the place of required courses because they can be intimidating for many students. Read more on physical activity.

Yes, today is Wednesday. But as a new year dawns and New Year's resolutions kick in (learning Zumba and building yoga into our weekly schedule are high on the list for NewPublicHealth staffers) let's call today an honorary Monday—a day to embrace a new plan for health.  The Monday Campaigns are here to help.

With the slogan "The day all health breaks loose," Monday Campaigns are a public health initiative of the Columbia University Mailman School of Public Health, the Johns Hopkins Bloomberg School of Public Health and the Lerner Center for Public Health Promotion at Syracuse University. The goal is to help prevent chronic disease by offering a weekly prompt that can support people in starting and sustaining healthy behaviors.

Why Monday?

Research at Johns Hopkins found that a week is a critical unit of time in planning lives and Monday has special significance as the beginning of the week. People view Monday as a day for a fresh start and a chance to set healthy intentions for the next 6 days. They’re more likely to start diets, exercise regimes, quit smoking and schedule doctor’s appointments on Monday than any other day. And, according to the Hopkins researchers, they’re looking for help in setting and carrying out their healthy intentions for the week.

The campaigns have grown to include government and non-profit organizations, businesses, media outlets and communities. The three schools provide research, case studies, health-related content, marketing concepts and programs ready for individuals, communities and public health departments. Specific campaigns include:

• Meatless Monday 
• Quit & Stay Quit Monday 
• Kids Cook Monday 
• Move It Monday 
• Man Up Monday 
• Caregiver Monday
  

The 2013 campaigns began last Monday, with a weekly series that offers tips for 2013. First up: set some long and short term goals:

A long-term goal can be something to work towards, like getting 2 ½ hours of activity each week or eating 5 servings of produce each day. Short-term goals are the smaller actions you take to build up to your objective.  

>>Weigh in: Which Monday campaigns will your community try this year?

AAP Calls for Schools to Maintain Daily Recess and Breaks
A new policy statement from the American Academy of Pediatrics (AAP) calls on all schools to have daily recess and breaks in order to promote activity and a healthy lifestyle. According to the AAP, “safe and properly supervised recess offers children cognitive, physical, emotional and social benefits. It should be used as a complement to physical education classes, not a substitute, and whether it’s spent indoors or outdoors, recess should provide free, unstructured play or activity.” The AAP also says that recess should never be withheld as a punishment and the statement authors add that “minimizing or eliminating recess can negatively affect academic achievement, as growing evidence links recess to improved physical health, social skills and cognitive development.” Read more on physical activity.

Support and Solidarity Build Resilience Following Community Disasters
Community solidarity and support have remarkable benefits for communities coping with traumatic mass shootings, according to an American-Finnish research study recently published by the University of Turku. The researchers looked at the responses of four communities that suffered from similar tragedies in the United States and Finland. People in all four communities expressed their need for belonging after the shootings. According to the researchers, after each of the four incidents the communities held events including mass gatherings, communal vigils and spontaneously erected monuments to the victims. The researchers say that all these efforts demonstrated that the community was in shock, yet united, and able to focus attention on their collective loss and on each other. Read more on community health.

FDA Approved Most Drugs in 16 Years
Reuters is reporting that the U.S. Food and Drug Administration (FDA) approved 39 drugs in 2012, the largest number in the past 16 years. Important new drugs approved this year include two weight loss medicines, drugs to treat resistant cystic fibrosis and tuberculosis and a drug to reduce the risk of stroke in people with irregular heartbeats. Read more on the U.S. Food and Drug Administration.

New York City’s new schedule app for several of the city’s subway lines joins similar apps and online schedules introduced in cities around the U.S. that can help people more accurately plan their travel timetables --and maybe even get in some exercise. Transportation planners say that giving easily accessible and real time bus and subway schedules can increase public transportation use because it allows a traveler to accurately plan the time it takes for a trip.

San Francisco has had an app similar to the one just introduced in New York since 2008, according to a recent story in the Wall Street Journal. And other cities provide travel information online and accessible by smartphone. According to the American Public Transportation Association, real time information is one reason for a growth of almost 3 percent in public transportation use in the U.S. during 2012. Cost savings is another reason people are switching to public transportation, according to APTA, which calculated that public transit users saved about $800 during the month of December compared to the cost of owning and using a car. APTA calculated full year savings for the last year at close to $10,000.

And unless there’s a bus or subway stop right in front of the house, public transportation often adds physical exercise for its users. The closest public transportation stop for many NewPublicHealth staffers, for example, can add 1,000 steps of walking each day.

Bonus Link: Read a NewPublicHealth interview with Wendy Spencer, CEO of the Corporation for National and Community Service. Spencer gave up her car when she took the job at CNCS and moved from Florida to Washington, D.C. and now walks to work and meetings.

FDA Approves Drug to Treat Inhalational Anthrax
The U.S. Food and Drug Administration has approved a monoclonal antibody to treat inhalational anthrax, a form of the infectious disease caused by breathing in the spores of the bacterium Bacillus anthraces. “In addition to antibiotics, raxibacumab will be a useful treatment to have available should an anthrax bioterrorism event occur,” said Edward Cox, MD, MPH, director of the Office of Antimicrobial Products in FDA’s Center for Drug Evaluation and Research. “Although antibiotics are approved to prevent and treat anthrax infection, raxibacumab is the first approved agent that acts by neutralizing the toxins produced by B. anthracis.” The safety of raxibacumab was evaluated in 326 healthy human volunteers. Common side effects included rash, extremity pain, itching and drowsiness. Read more on bacteria.

Men More Likely than Women to Die in Car Crashes
A new study in the online journal Injury Prevention finds that male pedestrians hit by cars are more than twice as likely to die as women hit by vehicles. The researchers studied U.S. travel and traffic data for 2008 and 2009 for people over the age of 5. According to researchers, more study is needed to determine why men die at higher rates than women in pedestrian crashes. Reasons may include drunken male walkers and men walking along highways and other roads that carry cars at high speeds. Read more on injury prevention.

Concerns about Hair May Keep African-American Women from Exercising
New research finds that about a third of African-American women say concern over hair care is the reason they don’t exercise or exercise less than they should, according to Amy J. McMichael, MD, the lead author of the study published online today in the Archives of Dermatology, a JAMA network publication. For the study, 103 African-American women ranging in age from 21 to 60 filled out a 40-question survey that asked about physical activity; hair care and maintenance; and hair and scalp concerns. While all of the respondents thought it was important to exercise, 40 percent reported avoiding exercise at times due to hair-related issues. Half said they had modified their hairstyle to accommodate exercise. The researchers say that many African American women with coarser hair use either heat straighteners or chemical products to straighten their hair, which is a time-consuming process that doesn’t allow them to simply wash their hair after exercise. According to the lead researcher, a professor of dermatology at the Wake Forest University School of Medicine, over-washing fragile hair can make it break off easily. Read more on physical activity.