The study appears online May 16, 2013 and will appear in the July 2013 print edition of the American Journal of Public Health.

Standards set by the American Association of State Highway and Transportation Officials (AASHTO) in its Guide for the Development of Bicycle Facilities generally serve vehicles well but overlook most bicyclists’ needs, according to lead author Anne Lusk, research scientist in the Department of Nutrition at HSPH, who has been studying bicycling patterns in the U.S. and abroad for many years. “In the U.S., the default remains the painted bike lane on the road,” she said, which is problematic since research has shown that women, seniors, and children prefer not to ride on roads with traffic.

According to the researchers, the AASHTO guidelines discouraged or did not include cycle tracks due to alleged safety concerns and did not cite research about crash rates on cycle tracks. This study analyzed five state-adopted U.S. bicycle guidelines published between 1972 and 1999 to understand how the guidelines have directed the building of bicycle facilities in the U.S. They also wanted to find out how crash rates on the cycle tracks that had been built compared with bicycle crash rates on roadways in the U.S. They identified 19 cycle tracks in 14 cities in the U.S. and found these cycle tracks had an overall crash rate of 2.3 per one million bicycle kilometers ridden, which is similar to crash rates found on Canadian cycle tracks and lower than published crash rates from cities in North America for bicycling in the road without any bicycle facilities.

Anne Lusk stressed the new overlap of transportation and public health. “Bicycling, even more than walking, helps control weight and we need to provide comfortable and separate bicycle environments on existing roads so everyone has a chance for good health.”

The authors concluded AASHTO bicycle guidelines should be based on more rigorous and up-to-date research. If policies could allow for easier construction of cycle tracks, studies have indicated that more individuals would be willing to bicycle. Encouraging more cycling would be helpful for weight control, heart function, and would boost physical fitness for children and adults in addition to helping to reduce traffic congestion and air pollution from vehicles, said the authors.

“We believe this research is a major step toward urban bicycle networks that are safer and more inviting for riders across all demographics,” said Steven Bercu of the Helen and William Mazer Foundation, which funded the study. “As cities promote bicycling, it is critical that planners, engineers and others have access to research that points to the safest options, rather than just repeating designs based on assumptions that were never properly studied.”

Additional support for the study included a Ruth L. Kirschstein National Research Service Award (F32 HL083639) from the National Institutes of Health. Luis Miranda-Moreno was supported by the Natural Sciences and Engineering Research Council of Canada.

“Bicycle Guidelines and Crash Rates on Cycle Tracks in the United States,” Anne C. Lusk, Patrick Morency, Luis F. Miranda-Moreno, Walter C. Willett, Jack T. Dennerlein. American Journal of Public Health, online May 16, 2013; July 2013 print edition.

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

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The study appears in the online May 7, 2013 issue of Cell Metabolism.

“Although it has long been recognized that a key event leading to development of type 2 diabetes is uncontrolled glucose production from the liver, underlying mechanisms have been elusive,” said senior author Gökhan S. Hotamisligil, chair of the Department of Genetics and Complex Diseases and J.S. Simmons Professor of Genetics and Metabolism at HSPH. “We now have identified aP2 as a novel hormone released from fat cells that controls this critical function.”

The ability of one organ—in this case, the adipose tissue—to so directly and profoundly control the actions of another—the liver —is in itself very exciting, said Hotamisligil. “We suspect this communication system between adipose tissue and liver may have evolved to help fat cells command the liver to supply the body with glucose in times of nutrient deprivation. However, when the engorged fat cells lose control over this signal in obesity, the blood levels of aP2 rise, glucose is poured into the bloodstream and cannot be cleared by other tissues. The result is high blood glucose levels and type 2 diabetes.

Type 2 diabetes is a metabolic disease that impacts at least 26 million Americans and is linked to heart disease, stroke, and other serious health complications. The disease is often linked to obesity and insulin resistance and a loss of control of glucose production in the liver and insulin production in the pancreas, resulting in too much glucose in the blood.

The majority of cases of type 2 diabetes are related to failure of insulin action in the body. However, for decades researchers and physicians have been faced with a conundrum: not all who are obese or resistant to insulin develop type 2 diabetes. In fact, many patients who are severely obese never develop the disease. As a result scientists have theorized that an unknown factor is involved in regulating glucose metabolism in the liver, and perhaps the presence or absence of this element might determine who gets the disease.

“It was surprising to find that a critical hormone playing a pathological role in diabetes turned out to be the secreted form of aP2, which for decades has been considered a protein that resides inside the fat cells,” said Hotamisligil. In the new study, HSPH researchers first increased the levels of aP2 in normal, healthy mice to match the high blood aP2 levels seen in obese mice and humans. This resulted in impaired glucose metabolism. Next, they reduced the blood aP2 levels in obese and diabetic mice to low levels seen in lean healthy mice. This intervention restored glucose metabolism to its normal status. Therefore, the investigators reached the conclusion that the amount and action of aP2 in blood was critical for diabetes, opening up new avenues for potentially being able control or prevent type 2 diabetes. The researchers also identified a potential therapeutic role for a novel aP2 antibody that neutralizes aP2 activity and corrects type 2 diabetes in mice.

“The consequences of this discovery are profound, and the potential therapeutic applications by switching this protein off have the capability to reshape the way physicians treat diabetes,” said lead author Haiming Cao, postdoctoral fellow in the Department of Genetics and Complex Diseases at HSPH.

This research was funded in part by National Institutes of Health grant DK064360. Individual authors were supported by fellowships from the NIH Roadmap (DK71507-04) and the American Diabetes Association; the Roadmap Grant R90 DK071507 from NIH, and fellowships from the Manpei Suzuki Diabetes Foundation and the Japan Society for the Promotion of Science. The technology described in this study is licensed to the biopharmaceutical company UCB, Union Chimique Belge.

“Adipocyte Lipid Chaperone aP2 is a Secreted Adipokine Regulating Hepatic Glucose Production,” Haiming Cao, Motohiro Sekiya, Meric Erikci Ertunc, M. Furkan Burak, Jared R. Mayers, Ariel White, Karen Inouye, Lisa M. Rickey, Baris C. Ercal, Masato Furuhashi, Gurol Tuncman, and Gökhan S. Hotamisligil, Cell Metabolism, online May 7, 2013 —Vol. 17, 1-11

For more information:

Marge Dwyer
617.432.8416
mhdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

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For immediate release: Sunday, May 5, 2013

Boston, MA — A new study led by researchers from Harvard School of Public Health (HSPH) and the Wellcome Trust Sanger Institute in the UK has, for the first time, used genome sequencing technology to track the changes in a bacterial population following the introduction of a vaccine. The study follows how the population of pneumococcal bacteria changed following the introduction of the ‘Prevnar’ conjugate polysaccharide vaccine, which substantially reduced rates of pneumococcal disease across the U.S. The work demonstrates that the technology could be used in the future to monitor the effectiveness of vaccination or antibiotic use against different species of bacterial pathogens, and for characterizing new and emerging threats.

The study appears online May 5, 2013 in Nature Genetics.

“This gives an unprecedented insight into the bacteria living and transmitting among us,” said co-author William Hanage, associate professor of epidemiology at HSPH. “We can characterize these bugs to an almost unimaginable degree of detail, and in so doing understand better what helps them survive even in the presence of an effective vaccine.”

Pneumococcal disease is caused by a type of bacteria called Streptococcus pneumoniae, which is present in many people’s noses and throats and is spread by coughing, sneezing, or other contact with respiratory secretions. The circumstances that cause it to become pathogenic are not fully understood. Rates of pneumococcal disease—an infection that can lead to pneumonia, meningitis, and other illnesses—dropped in young children following the introduction of a vaccine in 2000. However, strains of the bacteria that are not targeted by the vaccine rapidly increased and drug resistance appears to be on the rise.

The research, led by HSPH co-senior authors Hanage; Marc Lipsitch, professor of epidemiology; and Stephen Bentley, senior scientist at the Wellcome Trust Sanger Institute, aimed to better understand the bacterial population’s response to vaccination. Whole genome sequencing—which reveals the DNA code for each bacterial strain to an unprecedented level of detail—was used to study a sample of 616 pneumococci collected in Massachusetts communities from 2001 to 2007.

This study confirmed that the parts of the bacterial population targeted by the vaccine have almost disappeared, and, surprisingly, revealed that they have been replaced by pre-existing rare types of bacteria. The genetic composition of the new population is very similar to the original one, except for a few genes that were directly affected by the vaccine. This small genetic alteration appears to be responsible for the large reduction in the rates of pneumococcal disease.

“The widespread use of whole genome sequencing will allow better surveillance of bacterial populations — even those that are genetically diverse — and improve understanding of their evolution,” said Lipsitch. “In this study, we were even able to see how quickly these bacteria transmit between different regions within Massachusetts and identify genes associated with bacteria in children of different ages.”

“In the future, we will be able to monitor evolutionary changes in real-time. If we can more quickly and precisely trace the emergence of disease-causing bacteria, we may be able to better target interventions to limit the burden of disease,” said Bentley.

Support for the study was provided by the National Institutes of Health, the Wellcome Trust, and the AXA Foundation.

“Population Genomics of Post-Vaccine Changes in Pneumococcal Epidemiology,” Nicholas J. Croucher, Jonathan A. Finkelstein, Stephen I. Pelton, Patrick K. Mitchell, Grace M. Lee, Julian Parkhill, Stephen D. Bentley, William P. Hanage, Marc Lipsitch  Nature Genetics, online May 5, 2013

For more information:

Todd Datz
Harvard School of Public Health
tdatz@hsph.harvard.edu
617.432.8413

Mark Thomson
Wellcome Trust Sanger Institute
Press.office@sanger.ac.uk
Tel +44 (0)1223492384
Mobile +44 (0)7847302595

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Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health.

The Wellcome Trust Sanger Institute is one of the world’s leading genome centres. Through its ability to conduct research at scale, it is able to engage in bold and long-term exploratory projects that are designed to influence and empower medical science globally. Institute research findings, generated through its own research programmes and through its leading role in international consortia, are being used to develop new diagnostics and treatments for human disease.

The study, led by Katherine Baicker, professor of health economics at Harvard School of Public Health and Amy Finkelstein, Ford professor of economics at MIT, appears in the May 2 issue of the New England Journal of Medicine.

“This study represents a rare opportunity to evaluate the costs and benefits of expanding public insurance using the gold standard of scientific evidence—the randomized controlled trial.  Without a randomized evaluation, it’s difficult to disentangle the effects of Medicaid from confounding factors like income and health needs that also affect outcomes,” said Baicker, co-principal investigator of the study.

In 2008, Oregon held a lottery to give additional low-income, uninsured residents access to its Medicaid program; about 90,000 individuals signed up for the lottery for the 10,000 available openings. Approximately two years after the lottery, the researchers conducted more than 12,000 in-person interviews and health examinations of lottery participants in the Portland, Oregon metropolitan area, and compared outcomes between those randomly selected in the lottery and those not selected in order to determine the impact of Medicaid.

Some of the key findings:

Physical health

• Medicaid had no significant effect on measures of hypertension or high cholesterol, or on the rates of diagnosis or use of medication for these conditions.
• Medicaid increased the probability of being diagnosed with diabetes after the lottery by 3.8 percentage points (compared to the 1.1% of the control group who were diagnosed with diabetes) and increased the use of diabetes medication by 5.4 percentage points (compared to the 6.4% of the control group who used diabetes medication), but had no effect on glycated hemoglobin (a measure of diabetic blood sugar control).

Mental health

• Medicaid reduced rates of depression by 9 percentage points (compared to the 30% of the control group screening positive for depression) and increased self-reported mental health.

Financial hardship

• Medicaid virtually eliminated out-of-pocket catastrophic medical expenditures (defined as out-of-pocket medical expenditures in excess of 30% of household income) and reduced other measures of financial strain.

Utilization and access

• Medicaid increased health care use, including use of physician services, prescription drugs, and preventive care.

“The study highlights the important financial protections that Medicaid provides, as well as the substantial improvements in mental health, but does not provide evidence that Medicaid coverage translates to measurable improvements in physical health in the first two years,” said Finkelstein, co-principal investigator of the study.

The current study is part of an ongoing research program gathering a wide array of data sources to examine many different effects of Medicaid, and represents a collaboration between non-profit and academic researchers and state policy makers. A previous study looking at data collected about a year after the lottery found that Medicaid substantially increased health care use, increased self-reported health, and reduced financial strain. More information can be found at www.nber.org/oregon.

Support for the study was provided by the Office of the Assistant Secretary for Planning and Evaluation, Department of Health and Human Services; the California HealthCare Foundation; the John D. and Catherine T. MacArthur Foundation; the National Institute on Aging (P30AG012810, RC2AGO36631, and R01AG0345151); the Robert Wood Johnson Foundation; the Alfred P. Sloan Foundation; the Smith Richardson Foundation; and the Social Security Administration (5 RRC 08098400-03-00, to the National Bureau of Economic Research as part of the Retirement Research Consortium of the Social Security Administration); and by the Centers for Medicare and Medicaid Services.

“The Oregon Experiment—Effects of Medicaid on Clinical Outcomes,” Katherine Baicker, Sarah L. Taubman, Heidi L. Allen, Mira Bernstein, Jonathan H. Gruber, Joseph P. Newhouse, Eric C. Schneider, Bill J. Wright, Alan M. Zaslavsky, Amy N. Finkelstein, NEJM, May 2, 2013, 368;18

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

MIT
Sarah McDonnell
617.253.8923
s_mcd@mit.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory and the classroom to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at HSPH teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s first professional training program in public health. For more information on the school visit: http://www.hsph.harvard.edu

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The study appears in the April 17, 2013 issue of the Journal of the American Medical Association (JAMA).

“We found clear evidence that reducing harm and improving quality is perversely penalized in our current health care system,” said Sunil Eappen, the lead author and chief medical officer of Massachusetts Eye and Ear Infirmary.

“It’s been known that hospitals are not rewarded for quality. But it hadn’t been recognized exactly how much more money they make when harm is done,” said senior author Atul Gawande, director of Ariadne Labs, professor in the Department of Health Policy and Management at HSPH and a surgeon at BWH.

An estimated $400 billion is spent on surgical procedures each year in the U.S. While effective methods to reduce complications have been identified, hospitals have been slow to implement them. Financial incentives may be a reason. The goal of the study was therefore to evaluate the hospital costs and revenues associated with having one or more major complications with surgical patients covered by four primary insurance types—private insurance, Medicare, Medicaid, and self-payment.

The researchers analyzed data from 34,256 surgical inpatients discharged in 2010 in a non-profit, 12-hospital system in the southern U.S. They looked at ten severe, preventable surgical complications and the contribution margin—revenue minus variable expenses—per patient. A total of 1,820 procedures were identified with at least one complication.

The results showed that, for privately insured patients, complications were associated with a $39,017 higher contribution margin per patient ($55,953 vs. $16,936). For Medicare patients, the contribution margin per patient was higher by $1,749 ($3,687 vs. $1,880). For Medicaid and self-payment, complications were associated with significantly lower contribution margins than those without complications.

What that means, say the researchers, is that who pays for patients’ care determines the financial implications of surgical complications. In this hospital system, private insurers covered 40% of patients, Medicare covered 45%, Medicaid covered 4% and 6% were self-pay, a breakdown that is comparable to the average U.S. hospital in 2010. Overall in this hospital system, complications were associated with a more than $8,000 higher contribution margin per patient.

At safety-net hospitals, which treat patients primarily covered by Medicaid or self-pay, reducing complications could improve financial performance. However, the study shows that at most U.S. hospitals, programs to reduce complications would worsen their financial performance.

“This is clear indication that health care payment reform is necessary,” said Gawande. “Hospitals should gain, not lose, financially from reducing harm.”

The research was funded through support from the Boston Consulting Group and from Texas Health Resources.

“The relationship between occurrence of surgical complications and hospital finances,” Sunil Eappen, Bennett Lane, Barry Rosenberg, Stu Lipsitz, David Sadoff, Dave Matheson, William Berry, Mark Lester, Atul Gawande, JAMA, April 17, 2013—Vol. 309, No. 15

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

photo: iStockphoto.com/Abel Mitja Varela

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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Boston, MA – Older adults who have higher blood levels of omega-3 fatty acids—found almost exclusively in fatty fish and seafood—may be able to lower their overall mortality risk by as much as 27% and their mortality risk from heart disease by about 35%, according to a new study from Harvard School of Public Health (HSPH) and the University of Washington. Researchers found that older adults who had the highest blood levels of the fatty acids found in fish lived, on average, 2.2 years longer than those with lower levels.

“Although eating fish has long been considered part of a healthy diet, few studies have assessed blood omega-3 levels and total deaths in older adults,” said lead author Dariush Mozaffarian, associate professor in the Department of Epidemiology at HSPH. “Our findings support the importance of adequate blood omega-3 levels for cardiovascular health, and suggest that later in life these benefits could actually extend the years of remaining life.”

The study—the first to look at how objectively measured blood biomarkers of fish consumption relate to total mortality and specific causes of mortality in a general population—appears online April 1, 2013 in Annals of Internal Medicine.

Previous studies have found that fish, which is rich in protein and heart-healthy fatty acids, reduces the risk of dying from heart disease. But the effect on other causes of death or on total mortality has been unclear. With this new study, the researchers sought to paint a clearer picture by examining biomarkers in the blood of adults not taking fish oil supplements, in order to provide the best assessments of the potential effects of dietary consumption of fish on multiple causes of death.

The researchers examined 16 years of data from about 2,700 U.S. adults aged 65 or older who participated in the Cardiovascular Health Study (CHS), a long-term study supported by the National Heart, Lung, and Blood Institute. Participants came from four U.S. communities in North Carolina, California, Maryland, and Pennsylvania; and all were generally healthy at baseline. At baseline and regularly during follow-up, participants had blood drawn, underwent physical examinations and diagnostic testing, and were questioned about their health status, medical history, and lifestyle.

The researchers analyzed the total proportion of blood omega-3 fatty acids, including three specific ones, in participants’ blood samples at baseline. After adjusting for demographic, cardiovascular, lifestyle, and dietary factors, they found that the three fatty acids—both individually and combined—were associated with a significantly lower risk of mortality. One type in particular—docosahexaenoic acid, or DHA—was most strongly related to lower risk of coronary heart disease (CHD) death (40% lower risk), especially CHD death due to arrhythmias (electrical disturbances of the heart rhythm) (45% lower risk). Of the other blood fatty acids measured—eicosapentaenoic acid (EPA) and docosapentaenoic acid (DPA)—DPA was most strongly associated with lower risk of stroke death, and EPA most strongly linked with lower risk of nonfatal heart attack. None of these fatty acids were strongly related to other, noncardiovascular causes of death.

Overall, study participants with the highest levels of all three types of fatty acids had a 27% lower risk of total mortality due to all causes.

When the researchers looked at how dietary intake of omega-3 fatty acids related to blood levels, the steepest rise in blood levels occurred when going from very low intake to about 400 mg per day; blood levels rose much more gradually thereafter. “The findings suggest that the biggest bang-for-your-buck is for going from no intake to modest intake, or about two servings of fatty fish per week,” said Mozaffarian.

Support for the study came from the National Heart, Lung, and Blood Institute (NHLBI) and the Office of Dietary Supplements of the National Institutes of Health (R01-HL-085710).

“Plasma Phospholipid Long-Chain Omega-3 Fatty Acids and Total and Cause-Specific Mortality in Older Adults,” Dariush Mozaffarian, Rozenn N. Lemaitre, Irena B. King, Xiaoling Song, Hongyan Huang, Molin Wang, Frank M. Sacks, Eric B. Rimm, and David S. Siscovick, Annals of Internal Medicine, online April 1, 2013

For more information:

Marge Dwyer
617.432.8416
mdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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Boston, MA — Women who experienced physical, emotional, or sexual abuse as children are more likely to have a child with autism than women who were not abused, according to a new study from Harvard School of Public Health (HSPH). Those who experienced the most serious abuse had the highest likelihood of having a child with autism — three-and-a-half times more than women who were not abused.

“Our study identifies a completely new risk factor for autism,” said lead author Andrea Roberts, research associate in the HSPH Department of Social and Behavioral Sciences. “Further research to understand how a woman’s experience of abuse is associated with autism in her children may help us better understand the causes of autism and identify preventable risk factors.”

The study appears online March 20, 2013 and in the May 2013 print issue of JAMA Psychiatry. It is the first to explore the relationship between a mother’s exposure to childhood abuse and risk of autism in her children.

The authors examined data from more than 50,000 women enrolled in the Nurses’ Health Study II. They found that it was not just women exposed to the most serious levels of abuse who had higher risk of having a child with autism, but also a large number of women who experienced moderate abuse. While about 2% of women reported the most serious abuse, even women in the top 25% of abuse severity—which included mostly women who experienced more moderate levels of abuse —were 60% more likely to have a child with autism compared with women who did not experience abuse. These results suggest that childhood abuse is not only very harmful for the person who directly experiences it, but may also increase risk for serious disabilities in the next generation, the authors said.

Delving further, the researchers looked at nine pregnancy-related risk factors to see if they were linked to higher risk of having a child with autism in women who were abused as children. These nine risk factors—including gestational diabetes, preeclampsia, and smoking—have been previously associated with an increased likelihood of having a child with autism.

The researchers did find that women who had experienced abuse as children had a higher risk for each of the pregnancy-related risk factors that were examined. Surprisingly, though, those risk factors accounted for only 7% of the increased likelihood of having a child with autism among women who were abused.

Given that these factors accounted for so little of the association between mother’s experience of abuse and risk of autism in her children, the authors speculated that other factors may be playing a role. One possibility, they said, is that long-lasting effects of abuse on women’s biological systems, such as the immune system and stress-response system, are responsible for increasing their likelihood of having a child with autism. More research is needed to tease out the mechanisms involved in the maternal childhood abuse-autism link, the authors said.

“Childhood abuse is associated with a wide array of health problems in the person who experiences it, including both mental health outcomes like depression and anxiety, and physical health outcomes like obesity and lung disease. Our research suggests that the effects of childhood abuse may also reach across generations,” said senior author Marc Weisskopf, associate professor of environmental and occupational epidemiology at HSPH.

Given the findings in this study, the authors suggest increasing efforts to prevent childhood abuse, and suggest that clinicians focus more strongly on limiting pregnancy-related autism risk factors, particularly among women who experienced abuse in childhood.

Other HSPH authors included Alberto Ascherio, professor of epidemiology and nutrition; and Kristen Lyall, visiting scientist in the HSPH Department of Nutrition.

Support for the study was provided by DOD W81XWH-08-1-0499 and W81XWH-08-1-0497, USAMRMC A-14917, NIH 5-T32MH073124-08 and Autism Speaks 1788. The Nurses’ Health Study II is funded in part by NIH CA50385.

“Association of maternal exposure to childhood abuse with elevated risk for autism in offspring,” Andrea L. Roberts, Kristen Lyall, Janet W. Rich-Edwards, Alberto Ascherio, Marc G. Weisskopf,” JAMA Psychiatry, online first March 20, 2013, in print May 2013

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

###

Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

HSPH on Twitter: http://twitter.com/HarvardHSPH
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The findings suggest that certain hospitals’ high rates of cesarean births have more to do with characteristics of the hospitals themselves than with characteristics of their patients.

“Even after taking into account factors that put women at risk of having a c-section, such as age,  and pre-existing health conditions, some hospitals still have higher rates of c-section delivery than others,” said senior author S V Subramanian, professor of population health and geography at HSPH. Put simply, for two women with a similar observed risk profile, one might have a c-section delivery and one might not, depending on which hospital they go to, he said.

The study appears in the March 18, 2013 online issue of the journal PLOS ONE. The article is available at this link: http://dx.plos.org/10.1371/journal.pone.0057817.

While c-sections can be a lifesaving procedure for an infant in distress, or when there are multiple births or other labor complications, c-sections that are not medically necessary can put mothers and babies at avoidable risk of infection, extend hospital stays and recoveries, and increase health costs. In spite of these risks, c-section rates have been increasing in the U.S. over the past 17 years. Mirroring the national trend, cesarean deliveries in Massachusetts have increased steadily since 1997. In 2009, about one-third of all births in Massachusetts were by c-section—up 61% from 1998.

In 2008, the Massachusetts Department of Public Health invited local clinicians and researchers to partner with state health officials in a study to better understand why c-section rates have been rising in Massachusetts. The HSPH, Boston University, Massachusetts General Hospital, and Massachusetts Department of Public Health team, using data from the Pregnancy to Early Life Longitudinal data system, analyzed 228,864 births in Massachusetts’ 49 hospitals with maternity services from 2004-2006—98% of all births during that period.

The researchers found that about 27% of first-time mothers in Massachusetts having single, vertex (head-first)  presentation, full-term infants from 2004-2006 had c-sections. C-section rates in Massachusetts hospitals varied from 14% to 38% even among this low-risk group.

Previous research had been unable to offer clear answers on whether variations in hospitals’ c-section rates had simply to do with hospitals’ different case mix. But the new research findings, say the authors, show with more certainty that a mother’s risk of c-section really is influenced by her choice of hospital. “This is the first time that anyone has shown this problem exists right here in Massachusetts, which is widely considered to be one of the world’s premier health care hubs,” said Mariana Arcaya, research scientist at the Harvard Center for Population and Development Studies and co-author of the study.

The findings suggest that hospital practices and culture are important determinants of a hospital’s c-section rate, said lead author Isabel A. Cáceres, who was an epidemiologist at the Massachusetts Department of Public Health at the time of the study and now at the Center for Health Information and Analysis, Commonwealth of Massachusetts. Though this study did not pinpoint which hospital factors were at play, the authors highlighted previous studies suggesting that liability and insurance, being a teaching hospital, hospital admission practices, and the presence of midwives may influence c-section rates. Lack of clinical guidelines or standards on when a cesarean should be performed also may help explain why hospital rates are so variable.

The researchers said that hospitals should re-examine their procedures for deciding when to perform c-sections to make sure that medical need—not other factors such as doctor preferences or fear of liability—determine how babies are delivered.

There was no direct funding for this study.

“Hospital differences in cesarean deliveries in Massachusetts (US) 2004-2006: the case against case-mix artifact,” Isabel A Cáceres, Mariana Arcaya, Eugene Declercq, Candice M. Belanoff, Vanitha Janakiraman, Bruce Cohen, Jeffrey Ecker, Lauren A. Smith, S V Subramanian, PLOS ONE: March 18, 2013.

For more information:

Marge Dwyer
617.432.8416
mhdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

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Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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In addition, the companies failed to apply for applications to have these products approved as “new products” as called for by the law.

The study was published online March 13, 2013 in Tobacco Control.

“The tobacco industry was found guilty by a federal court in 2006 for deceptively promoting ‘light’ cigarettes as safer after countless smokers who switched to lights died prematurely, thinking they had reduced their health risks. After a new federal law was passed in 2009 to end the tobacco industry’s deceptive marketing practices, the industry has apparently circumvented it by using new and sophisticated ways to deceive consumers and has not sought Food and Drug Administration approval for these products as required by law,” said study co-author Gregory N. Connolly, director of the Center for Global Tobacco Control at HSPH and professor of the practice of public health in the Department of Social and Behavioral Sciences.The new study focuses only on the use of color-term descriptors, which have evaded the “lights” ban, and does not address the choice of colors.

After the U.S. Surgeon General’s 1964 report found that cigarette smoking causes disease, tobacco companies began marketing “light” cigarettes with ventilation holes that allowed air to mix with smoke, which the companies said would limit the amount of smoke a person would inhale. However, a 2001 National Cancer Institute (NCI) report found that smokers compensate for the lower smoke yield in “light” cigarettes—and thus ingest as much tar and nicotine as “regular” cigarettes—by smoking more intensely, more often, or by blocking the ventilation holes with their fingers or lips.

In 2006, a U.S. federal court ruled that tobacco companies should be banned from any future use of descriptive words that convey a false health message. The FDA—given the authority to regulate tobacco products in 2009 as part of the Family Smoking Prevention and Tobacco Control Act—subsequently issued its ban.

To see whether the tobacco companies were complying with or circumventing the ban, the HSPH researchers examined retailer manuals from the tobacco company Philip Morris; manufacturers’ annual reports filed with the Massachusetts Department of Public Health; national cigarette sales data; and the results of a 2011 national public opinion survey that included questions about smokers’ perceptions of their brands being “light” or regular.

The study describes how Philip Morris removed the terms “light,” “ultra-light,” and “mild” from cigarette packs and substituted new brand names and colors. For example, the “Marlboro Light” brand was renamed “Marlboro Gold,” “Marlboro Mild” was renamed “Marlboro Blue,” and Marlboro Ultra-light” was renamed “Marlboro Silver.” Other tobacco companies made similar changes. The cigarettes themselves remained unchanged, however; the percentage of ventilation in each category of “light” sub-brands was the same after being renamed and given a new color descriptor. Ventilation is the principle determinant of whether a cigarette is called “light.”

In addition, the study notes that a Philip Morris brochure for retailers stated, “Some cigarette and smokeless packaging is changing, but the product remains the same. For trade use only: not to be shown or distributed to consumers.”

In the public opinion survey, more than 90% of the smoker respondents said that, one year after the FDA ban, they found it either “somewhat easy” (10%) or “very easy” (82%) to identify their usual brand of cigarettes—in other words, they still thought of certain brands as “light” even though the packages did not use the “light” descriptors.

“This study demonstrates the continued attempts of the industry to avoid reasonable regulation of tobacco products. Scrutiny is needed by the FDA and courts to ensure that tobacco manufacturers comply with the law and that their products no longer convey false impressions of reduced risk,” said study co-author Hillel Alpert, research scientist in the Department of Social and Behavioral Sciences.

The results will be presented at the annual meeting of the Society of Nicotine and Tobacco research on March 14, 2013 in Boston.

Support for the study came from National Cancer Institute grants 3R01 CA125224-03s1rev++ and 2R01 CA087477-09A2.

“Has the tobacco industry evaded the FDA’s ban on ‘Light’ cigarette descriptors?” by Gregory N. Connolly and Hillel R. Alpert, Tobacco Control, online March 13, 2013

For more information:
Marge Dwyer
617.432.8413
mhdwyer@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

Photo: ©vario images GmbH & Co.KG/Alamy

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Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu.

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Boston, MA — The public is very supportive of government action aimed at changing lifestyle choices that can lead to obesity, diabetes, and other noncommunicable diseases—but they’re less likely to support such interventions if they’re viewed as intrusive or coercive, according to a new Harvard School of Public Health (HSPH) study. The study also found that support was higher for interventions that help people make more healthful choices, such as menu labeling requirements, than for interventions that penalize certain choices or health conditions, such as charging higher insurance premiums for obese individuals.

“Policymakers everywhere are looking for ways to use legal and policy levers to stem the rising tide of health care costs related to obesity and chronic disease,” said Stephanie Morain, a doctoral candidate in health policy at Harvard University, who led the study. “They should be heartened by these findings—the public does see this as an appropriate role for government.” That public support is important, the study authors wrote, because it may affect people’s willingness to comply with the law.

The study appears in the March 2013 issue of Health Affairs.

In recent years, lifestyle choices such as overeating, physical inactivity, and alcohol and tobacco use have led to troubling increases in chronic ailments in the U.S. In response, health departments and legislative bodies have adopted policies aimed at combating the behavioral risk factors that lead to ill health, such as banning trans fats in restaurants, raising taxes on cigarettes, and screening schoolchildren for high body mass index.

But some have criticized such interventions, saying that they impinge on personal choice and exceed the scope of governmental authority. So the HSPH researchers decided to examine which factors play into public support for so-called “new-frontier” public health initiatives.

For the study, co-authors Morain and Michelle Mello, professor of law and public health in the HSPH Department of Health Policy and Management, analyzed the results of an online survey of 1,817 American adults conducted in October 2011 by Knowledge Networks (now part of GfK), a professional survey organization. In the survey, respondents were asked about their support for various types of public health policies, as well as the factors that influenced their support. There were questions about seven noncommunicable health conditions and 14 specific strategies to address them.

The researchers found a high level of support—between 70% and 90%—for government action on each of seven areas: preventing cancer, heart disease, childhood and adult obesity, and tobacco use; helping people control their diabetes; and reducing alcohol consumption.

Support was quite high for interventions that facilitate healthy choices, such as increasing the affordability of fruits and vegetables or requiring more instruction in public schools about the health risks of obesity. However, support waned when government actions were viewed as focusing on penalties or on limiting choices—such as adding insurance surcharges for obese individuals or making it illegal to smoke in private spaces.

The researchers also found that African-Americans and, to a lesser extent, Hispanics, are significantly more likely than whites to support government action to address noncommunicable diseases.

In addition, the survey indicated that people are much more supportive of government public health initiatives if they believe that “people like me” can influence public health priorities and if they think that public health officials understand the public’s values.

“The message for public health officials and legislators is, if you want the public to buy into these legal interventions, you’ve got to engage them early on,” said Mello. “You’ve also got to communicate about policies in a way that resonates with the public’s values.  For example, how does the intervention support healthy choices? Why is it fair?”

The study was supported by a grant from the Greenwall Foundation.

“Survey Finds Public Support for Legal Interventions Directed at Health Behavior to Fight Noncommunicable Disease,” Stephanie Morain and Michelle M. Mello, Health Affairs, March 2013

For more information:

Todd Datz
617.432.8413
tdatz@hsph.harvard.edu

Visit the HSPH website for the latest news, press releases and multimedia offerings.

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Harvard School of Public Health (http://www.hsph.harvard.edu) is dedicated to advancing the public’s health through learning, discovery, and communication. More than 400 faculty members are engaged in teaching and training the 1,000-plus student body in a broad spectrum of disciplines crucial to the health and well being of individuals and populations around the world. Programs and projects range from the molecular biology of AIDS vaccines to the epidemiology of cancer; from risk analysis to violence prevention; from maternal and children’s health to quality of care measurement; from health care management to international health and human rights. For more information on the school visit: http://www.hsph.harvard.edu

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HSPH home page: http://www.hsph.harvard.edu