Tim Church

The use of flexible sigmoidoscopy screening reduces deaths from colorectal cancer cases by more than 25 percent. That’s according to results from the first randomized clinical trial in the United States that looked at the effectiveness of sigmoidoscopy. The article was published in the New England Journal of Medicine.

Tim Church a University of Minnesota cancer prevention expert, said 155,000 people were involved in the study, including more than 29,000 people in Minnesota.

“There was a 21 percent reduction in the incidence of colorectal cancer in the screened group when we compared to the usual care group,” he said. “And that’s a big reduction – more than 1 out of 5 cancers were prevented. And, then, [there was] a 26 percent reduction in the deaths from colorectal cancer. “

Freedom of choice

Church says it’s important to be screened because colorectal cancer is the second-leading cause of cancer-related death in the United States. He said the results from this most recent study provide patients with freedom of choice when it comes to screening options for colorectal cancer. That’s important for public health because, he said, the options should should result in more people being screened.  

The options include fecal occult blood tests, colonoscopy, and flexible sigmoidoscopy. 

According to Church, of all the screening options, flexible sigmoidoscopy and colonoscopy are the most sensitive for detecting polyps that may lead to colorectal cancer. Removal of pre-cancerous polyps – which can be done during sigmoidoscopy or colonoscopy – reduces colorectal cancer risk.

A sigmoidoscopy, however, examines the lower colon using a thin, flexible tube-like instrument. The procedure has fewer side effects, requires less bowel preparation and poses a lower risk of bowel perforation than colonoscopy, which uses a similar but longer tube to view the entire colon.

“Each of the screening methods has its own strengths and weaknesses. And people have different preferences,” Church said. “So, the bottom line is: If you want to get screened for colorectal cancer, you have a wide variety of choices. You need to figure out what’s best for you, but you have no excuse not to be screened.”

Study results more than a decade in the making

To arrive at their results, researchers from 10 institutions worked for nearly two decades to track the health of more than 154,000 patients, as part of the Prostate Lung Colorectal and Ovarian (PLCO) cancer screening trial.

“The University of Minnesota saw almost a fifth of the trial participants,” said Church. “We worked closely with the nine other institutes to help promote and enroll patients within the other communities across the country.” 

Participants in the trial were randomly assigned to a flexible sigmoidoscopy screening group or a usual care group that only received screening if they asked for it or when their physician recommended it. The flexible sigmoidoscopy group participants were screened once when they entered the study and again three to five years later. 

The researchers compared overall colorectal cancer cases and deaths in the two groups, and analyzed incidence and mortality according to where the cancers developed. Although flexible sigmoidoscopy examines only the rectum and sigmoid colon, participants with a suspicious finding were referred for a follow-up colonoscopy, in which both the distal and proximal regions of the colon would be examined.

At the end of the 12 year trial, participants in the screening group had a 21 percent lower incidence of colorectal cancer overall as a result of catching precancerous trouble spots earlier and a 26 percent lower rate of colorectal cancer mortality than participants in the usual care group. 

The findings showed that over the course of 10 years, if 1,000 people had two sigmoidoscopy screenings, there would be approximately three fewer new cases and one less death from colorectal cancer than in a group the same size not receiving regular screenings. 

Traci Toomey

Alcohol abuse takes its toll on public health and our communities in many ways, including through higher rates of violent crime.

And a new University of Minnesota study has confirmed that neighborhoods with a higher density of alcohol establishments experience more violent crime. But the study also compared neighborhoods with on-premise alcohol sales – such as bars and restaurants – with neighborhoods containing off-site alcohol sales, such as liquor stores.

Traci Toomey, a professor of epidemiology at the University’s School of Public Health, led the study.

On-premise alcohol sales led to more violent crime than off-premise sales

“We found a stronger relationship between density of alcohol establishments and violent crime for on-premise – the bars and the restaurants – than we did for the off-premise establishments,” she said.  

“But that’s not to say that there wasn’t a connection between the number of, or the density of, off-premise establishments and violent crime. It’s just that it was higher, it was more magnified, for the on-premise establishments.”

Findings should influence policy

Toomey said that policy makers should consider these findings and previous studies when making decisions about the number of alcohol licenses to be granted in a given community.

“The recommendation is that we need to control the density of alcohol establishments in a neighborhood and in a community,” she said. “We need to make sure that we’re not flooding these communities with alcohol establishments and inadvertently increasing the problems that that neighborhood is experiencing.”

Toomey added that while elected officials may be tempted to increase the number of alcohol establishments as a way to raise revenue during tough economic times, she said that they need to weigh those benefits against the strong potential for increases in violent crime.

“An increase in violent crime will increase community costs in terms of law enforcement, court costs, health care costs, and contribute to a poorer quality of life for neighborhood residents.”

On-premise vs. off-premise

Toomey said that on-premise establishments like bars and restaurants sell alcohol to be consumed on site, while off-premise establishments like liquor stores and convenience stores sell alcohol to be consumed at a different location. As a result, these types of establishments could pose different problems for neighborhoods.  

On-premise establishments are more likely to attract larger crowds, and customers at these establishments may drink too much and get involved in problems like fights and vandalism, Toomey said. Meanwhile, “off-premise establishment customers typically do not hang out at the establishment and are more likely to get intoxicated and have problems at different locations, potentially outside of the neighborhoods where they purchased the alcohol.”

About the study

Toomey and her colleagues examined data from 83 neighborhoods in Minneapolis for 2009, including alcohol-outlet densities, neighborhood demographics, and four categories of crime: assault, rape, robbery, and total violent crime.

Results will be published in the August 2012 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

 Listen to Toomey on Public Health Moment

Virginia Quick, one of the researchers in the study, explains the results.

“What we found were that young adults who weighed themselves a few times a week or more were at increased risk or associated with more frequency of unhealthy weight-control behaviors,” Quick said. She added that it is also associated with healthy weight-control behaviors, “unhealthy muscle-enhancing substance use behaviors, and also poor psychological well being.”

Health care providers should take note

Quick said that before recommending self-weighing as a weight-monitoring tool, health care providers should screen young adults to ensure that they are not at risk of unhealthy weight behaviors.

“We really encourage health care providers to screen young adults for some of these unhealthy psychological behaviors that may be occurring. So, they could be weighing themselves more frequently and that could be associated with some of these poor health outcomes,” Quick said.

“I believe one of the most important messages, take-home messages, is really that your weight on the scale doesn’t measure your overall health and well being. There are other ways to measure your overall health and well being.”

About the Study

Data were drawn from Project EAT-III (Eating and Activity in Teens and Young Adults), the third wave of a population-based study. Participants included young adults (n = 2,287, mean age = 25.3 years) from the Minneapolis/St. Paul metropolitan area.

The study found that self-weighing a few times per week or more frequently was reported by 18 percent of young adult women and 12 percent of young adult men. Linear regression models, adjusted for body mass index and demographic characteristics, indicated that in both women and men, more frequent self-weighing was associated with a higher prevalence of dieting, both healthy and unhealthy WCBs, and muscle-enhancing behaviors. Additionally, young women who reported more frequent self-weighing were more likely to report binge eating. More frequent self-weighing was also associated with more depressive symptoms and lower self-esteem in women and lower body satisfaction in young men.

Listen to Quick on Public Health Moment

Nick Kelley

For weeks, scientific debate has focused on the publication of two studies that document the lab creation of H5N1 virus, or bird flu. The debate included varying opinions about the case-fatality rate — in other words, how deadly the virus might be if transferred to the human population.

But Nick Kelley, a researcher with the University of Minnesota Center for Infectious Disease Research and Policy, says that part of the debate misses the point.

“Is it 60 percent or is it 2 percent? [Either] is still dramatically above what we see for seasonal influenza,” Kelley said. “And as along as it’s anywhere near what we saw in 1918, we’re going to have a major problem in the world responding to it.”

Kelley added that the case-fatality rate for the 1918 pandemic was about 2 percent.

New vaccine technology needed

He said that it’s time to get serious about finding a modern vaccine to combat the bird flu before we experience a pandemic.

“We need to dramatically alter the way we do our flu vaccine work right now,” he said. “We’re using technology that was pioneered in the ‘40s and ‘50s and refined in the ‘60s. And that’s just not sufficient for a 21st century problem like this.”

Part of the issue is funding, but there are other factors, Kelley said. 

“We need more research direction,” he said. “And, we need a clear pathway from a regulatory perspective to get these new vaccines to market so that they are just as safe and more effective than what we currently have.”

Listen now to Kelley on Public Health Moment

Studies have shown that uninsured children have less access to health care services. But what about children with insurance that carries expensive out-of-pocket costs? 

That’s what University of Minnesota assistant professor Pinar Karaca-Mandic wanted to learn. She recently completed a study, published in the Journal of the American Medical Association, that looked at children with asthma.

“Of course insurance makes it easier for patients to access health care,” Karaca-Mandic said. “However, there has been a trend to increasing out-of-pocket payments that patients and families make. And studies of adults have shown that people often respond to this by forgoing necessary health care.”

Study results

Pinar Karaca-Mandic

Karaca-Mandic found that children of parents who pay more out-of-pocket costs use their asthma control medication less often and have more asthma-related hospitalizations. 

“We found that among children age 5 to 18 years, children whose families paid more out-of-pocket towards asthma-control medications used their medications less often,” she said. “And, at the same time, these children were more likely to get hospitalized for asthma. We didn’t find this effect for younger children, which perhaps reflects that parents are less sensitive to costs for these younger children whose asthma is typically more severe.”

Karaca-Mandic added that this impacts the overall health care system.

“The result is these children aren’t getting the medicine they need, which can spell serious long-term trouble for them,” she said. “The results signal one of the true impacts of rising insurance costs.” She added that children, families, and schools should be educated on the importance of asthma care and the potential life-long implications of medication under-use.”

About the study

The study is a collaboration led by University of Minnesota health policy researcher Karaca-Mandic. She partnered with researchers from Massachusetts General Hospital and the University of Southern California. The researchers looked at 8,834 privately insured patients from across the United States who were prescribed medication for long-term asthma control. 

The research was funded by the National Institute of Child Health and Human Development, the National Institute on Aging and the Roybal Center for Health Policy Simulation. The study’s co-authors are Anupam B. Jena, M.D., Ph.D., Massachusetts General Hospital, and Geoffrey Joyce, Ph.D., and Dana Goldman, Ph.D., both from the Schaeffer Center for Health Policy and Economics at USC.

Katy Kozhimannil

A fourth of all reproductive-aged women are at risk of being uninsured or of having gaps in their health insurance coverage. That’s according to research from the University of Minnesota’s School of Public Health.

The study also found that private health insurance coverage has decreased among pregnant women, while more are relying on state Medicaid programs. Katy Kozhimannil, an assistant professor of health policy at the University of Minnesota, led the study.

“Our analysis revealed that reproductive-age women are increasingly at risk of uninsurance,” Kozhimannil said. “And this raises concerns about access to pre-natal and pre-conception care, which impacts birth outcomes and child health and wellbeing, as well.”

Kozhimannil added that that while Medicaid programs are doing a “fairly good job” of covering pregnant women, she noted that her analysis found that 10 percent of pregnant women reported having no health insurance.

Health reform will increase coverage but may limit access

Kozhimannil added that as health reform rolls out and new options become available, it’s possible that more people will move from one type of coverage to another, a process known as “churning.” This could limit access for many pregnant women, she said.

“There’s likely to be an increase in insurance coverage overall. [But] what is important to keep in mind is just because insurance coverage increases, coverage doesn’t always equal access to services,” she said. “And, so, as health care reform rolls out, and moves forward, we’ll need to pay particular attention to reproductive-age women and pregnant women to ensure that they’re getting appropriate access to services.”

About the study

To determine whether there had been changes in health insurance coverage among women of reproductive age, University of Minnesota researchers analyzed survey data collected by the Centers for Disease Control and Prevention on 207,968 female respondents ages 18 to 49 between 2000 to 2009.  The study included data from 3,204 women who reported being pregnant at the time of the survey.

The results are published in the March-April 2012 issue of “Women’s Health Issues.”

According to the latest study, 25 percent of reproductive-age women in the United States have gone without health insurance at some point over the past year, a number that has been increasing between 2000 and 2009.  Because nearly half of the pregnancies in America are unintended, this means that many women may not have access to the care they need to plan for a healthy pregnancy, because of a lack of insurance coverage. 

For the authors, the results from this study reveal important differences between health insurance coverage for reproductive-age women in general and pregnant women in particular, due in part to the availability of Medicaid coverage . Among pregnant women, 10 percent reported that they were uninsured, a number which remained steady over the decade.  From 2000 to 2009, the percentage of pregnant women with private health insurance dropped by 22 percent, and the number of pregnant women insured by Medicaid increased by 47 percent.  

Kathleen Call

The economy is recovering, but the percentage of Minnesotans without health insurance remains as high now as it did two years ago at the official end of the great recession. That’s according to findings from the Minnesota Department of Health and the University of Minnesota.

In 2011, 9.1 percent of Minnesotans were without health insurance, which is unchanged from 2009. The report states that Minnesota’s insurance rate did not improve in part because employer coverage did not recover from the erosion documented in 2009. 

But the 9.1 percent figure represents only the average. Minnesotans of color continue to have dramatically higher rates of uninsurance.

Kathleen Call, associate professor of health policy at the University of Minnesota, explains.

“The rate of uninsurance for the state as a whole is 9 percent, where it’s twice that for African Americans, almost twice that for American Indians and it’s 26 percent among Hispanic/Latino population in the state,” Call said. “So, that’s a significantly higher rate than is true for the state as a whole. The good news is it hasn’t been increasing. But the bad news is, that’s quite a disparity.”

Gains for young adults

On the bright side, a greater percentage of young adults had health insurance coverage in 2011 than in 2009. Call believes this is a result of state policy changes and federal health reform that extended the age under which young adults could continue to be covered by their parents’ health insurance.

“And we are seeing that they are gaining access to insurance through their parents and guardians,” she said. “So, there’s evidence that that law is actually making a difference for that age group. So, policies do work.”

More about the study findings

During the last decade, Minnesota’s uninsured rate has trended upward from 6.1 percent in 2001. Minnesota saw its uninsured rate jump from 7.2 percent in 2007 to 9 percent in 2009, largely because of the impact of an economic downturn. An estimated 490,000 Minnesotans were uninsured in 2011, compared to 480,000 Minnesotans in 2009, and 374,000 in 2007. Researchers estimate that approximately 70,000 children were without health coverage in 2011.

Coverage in public insurance programs, including Medicare and Minnesota’s state programs, such as Medical Assistance and MinnesotaCare, remained constant at 29.2 percent. It was 28.7 percent in 2009, compared to 25.2 percent in 2007. The share of the population that purchased individual coverage in the private market remained steady as well, at about 5 percent.

More information

• Read the full news release
• Download the study fact sheet (PDF)

Listen to Call on Public Health Moment

Roger Feldman

An increasing number of public health experts are calling for a soda pop tax as a way to combat obesity, diabetes, and heart disease, while reducing health care costs. Roger Feldman, a professor and health policy expert at the University of Minnesota, is a strong advocate for a pop tax.

He said that 34 percent of  Americans are overweight and another 34 percent are obese. “Obesity is linked to many diseases and shorter life expectancies. So, it is the number one public health problem in the country – becoming the number one public health problem in the world,” Feldman said. “We know what causes obesity. One of the factors is overeating – or in this case, over-drinking. And my recommendation came, simply, as a way to solve that problem.”

Pop consumption has increased as health outcomes declined

Feldman said that the consumption of soda pop has increased dramatically over time.

“For example, among children, it’s increased 500 percent in the recent period. Among adults, it’s the most responsible factor for our rising caloric intake,” he said.

Feldman added that the research is clear linking soda pop over-consumption to poor health.

“Women who consume at least one sugar-sweetened beverage every day have twice the risk of developing diabetes as women who do not drink pop,” he said. “Pop consumption has also been implicated in increasing the risk of pancreatic cancer, which is one of the most deadly types of cancer.”

Compares pop tax to success of cigarette tax

Feldman said he’s confident a pop tax would work, based on our history with cigarette taxes.

“The example of cigarette taxes gives me a lot of confidence that a pop tax would be a good idea,” he said. “In the United States, the rate of smoking has fallen dramatically in the last 10 years: From 25 percent of the adult population down to 20 percent of the adult population. The reason for the fall is that we have increased the taxes on cigarettes. And I think the same thing would happen if we increased the taxes on pop.”

Listen to Feldman on Public Health Moment

PAD is a circulatory disease caused by a buildup of fat and other materials in blood vessels outside of the heart — usually in the legs, feet, and arms. Left untreated, it can increase heart attack and stroke risk, severely limit walking ability, and lead to limb amputation.

University of Minnesota cardiologist, Dr. Alan Hirsch, says relatively few women are aware of PAD.

“Currently, the burden of peripheral artery disease is as high or higher for women than men,” he said. “Less than one in four women with or at risk of PAD are aware of it. And the risk of heart attack and stroke is as high as it would be if someone had already suffered a heart attack.”

Hirsch calls for more awareness, testing

Alan Hirsch

Hirsch provides advice for women and for providers.

“The first call to action is to assure that women at risk – in general women over the age of 50 or with heart disease risk factors – are tested for PAD,” he said. “One other call to action — to primary care clinicians and to women’s heart-health programs — is to recognize that the risk to women is not only the direct cardiac risk but the risk of PAD. This is a message to practice holistically and to recognize that arterial disease – whether in the brain, heart, or legs – is more or less equal.”

More about PAD

About 8 million people in the United States have peripheral artery disease, but only about 10 percent experience the warning sign of leg pain. Many people experience no symptoms at all. As a result, few sufferers receive prompt treatment. 

Major risk factors of peripheral artery disease include being 50 and older, smoking and diabetes. High blood pressure and high cholesterol, obesity, sedentary lifestyle, and a family history of PAD also may increase the risk.

Listen to Hirsch on Public Health Moment

Public Health Moment

[powerpress url="http://www.advances.umn.edu/audio/Grant_intended_to_reduce_cancer_disparities.mp3"]Listen to Jean Forster on Public Health Moment (1:30)

In an effort to reduce cancer-related health disparities, the National Cancer Institute is providing a $2.2 million training grant to the University of Minnesota’s Medical School and School of Public Health. The grant will be used to help researchers develop, test, and evaluate intervention strategies related to reducing these disparities.

Jean Forster, a professor of epidemiology and community health at the University of Minnesota, explains what we already know about these disparities.

Jean Forster

 “Racial ethnic minority groups are often more likely to get cancer and to die from cancer of various kinds than the general population,” she said. “For example, African American men have a 32-percent higher rate of cancer than white men. And African American women have a 16-percent higher rate of cancer compared to white women.”

About the training

The investigators will consist of three pre-doctoral and three post-doctoral fellows, all studying cancer-related health disparities who are members of the University’s Health Disparities Work Group.

“The Health Disparities Work Group grant provides a unique collaboration between the School of Public Health, the Medical School and our community,” said Forster.

The six fellows will work closely with their academic and community mentors, as well as psychologists, physicians, epidemiologists and community organizations to address community-identified problems that can exacerbate cancer-related health disparities. These problems can range from risk factors for cancer like obesity, smoking cessation and nutrition to health care access and immigrant health issues that affect cancer treatment.

The program can be tailored to suit the individual’s training requirements with opportunities for teaching experience, clinical and community-based work, publication of research, collaborative grant writing experience, and independent grant submission.

“This is really about training the next generation of researchers to focus specifically on that issue of what can we do to reduce that disparity,” Forster said. She added that another goal is to “train individuals from vulnerable populations to do this research. They’re much more effective in working with their own communities. We really want to make the research workforce more diverse.”

About the Health Disparities Work Group

The Health Disparities Working Group mission is to give greater visibility to health disparities research at the University of Minnesota, School of Public Health (SPH) and nationally; develop collaborations with faculty and community partners; and ensure SPH students are well trained to work in a diverse society. 

Listen to Forster on Public Health Moment

Todd Rockwood

Our U.S. soldiers are trained to drive defensively and aggressively in combat zones in order to evade enemy fire and avoid roadway explosives.

Upon returning home, however, thousands of veterans are finding it difficult to adjust to normal driving behavior. This has resulted in higher accident rates for some veterans. That’s according to USAA, a leading insurance company for service members.

Part of the reason for the erratic driving likely is due to combat training, but it also might be caused by traumatic brain injury. But having a clearer understanding is important so that the issue can be better addressed. 

Minnesota researchers examining the issue

At the University of Minnesota, Erica Stern, an associate professor in the Program in Occupational Therapy, Center for Allied Health Programs; and Todd Rockwood, associate professor of health policy, School of Public Health, are teaming up on a national study involving combat veterans that will attempt to uncover why so many veterans are driving erratically.

“The issue that we’re attempting to address in this study is looking at the impact that being exposed to driving in combat situations has on service members once they return back,” Rockwood said. “Further, one of the goals is to look at the impact of mild TBI – traumatic brain injury – on these driving behaviors, given the nature of warfare and IEDs and concussive force, and the emergence of TBI.” 

Rockwood said that Stern has experience in this area, having conducted a 2007 study of Minnesota National Guard soldiers who had returned from Iraq. In that study about 25 percent of the soliders reported that within months of returning home they had driving through a stop sign. And close to a third said that others had witnessed them driving erratically.

Training is needed for returning soldiers

Rockwood said that one goal is to identify potential training for returning soldiers. 

“The underlying goal of this study is to use this data to inform the development of training programs – to facilitate the transition from driving in a combat situation to driving on civilian roads.”  

Listen to Rockwood on Public Health Moment

Listen to full interview

• [powerpress url="http://www.advances.umn.edu/audio/Food_Insecurity_Long.mp3"]Listen to full interview with Bruening (4:29)

On average, Twin Cities families, compared with families across the state and nation, have less access to healthy, affordable food. That’s according to new research from the University of Minnesota. 

The highest rates of what is called food insecurity were found in women, Asian Americans (primarily Hmong) and other non-white racial groups, and single parents. 

Meg Bruening, a U of M PhD student and research assistant involved in the study, explains why we should be concerned.   

“What we found is that food insecure parents had poorer nutritional outcomes. There’s less access to fruits and vegetables, parents were more likely to report skipping breakfast, or serving less healthy foods at meals,” Bruening said. “And, so, that relates to their overall health. We also found that food insecure parents had higher prevalences of overweight and obesity compared to food secure parents.”

More needs to be done for vulnerable families

For this study, researchers didn’t look at why the Twin Cities had higher rates of families lacking access to healthy and affordable food, but Bruening provides some possible reasons. 

“There are a lot more low-income people within the Twin Cities. The Twin Cities are known for health disparities,” she said. “There are employment disparities within the Twin Cities and that can relate to how much income somebody has to purchase food and oftentimes families have to choose between what’s called the phenomenon of heating or eating — whether or not they heat their home or they feed their family.”

She added that the findings provide additional evidence that policymakers need to maintain and build a stronger safety net for families struggling with poverty and food insecurity.

“More is needed to be done to protect vulnerable families so that everyone has access to affordable, healthy foods, which may result in improved nutrition-related outcomes.”

About the study

Data came from the study, Project F-EAT (Families and Eating and Activity in Teens), a population-based study of parents of adolescents aimed at learning more about food, physical activity, and home food environments. Dianne Neumark-Sztainer, a University of Minnesota professor of epidemiology, led the study. She, Bruening, and other U of M School of Public Health researchers collected survey data from 2,095 parents and caregivers in Minneapolis and St. Paul school districts over a 12-month period.

Study results revealed that 39 percent of the parents and caregivers surveyed experienced food insecurity, which was tied to a number of problematic measures, such as higher rates of obesity among parents and caregivers, fewer healthy foods served at meals and a higher rate of binge eating. Researchers also found that just over 13 percent of study participants reported very low food security.

Listen to Bruening on Public Health Moment

David Jacobs

Taking dietary supplements is supposed to improve health, but in a recent study involving more than 38,000 women, researchers have concluded that women who took supplements had, on average, a 2.4 percent increased risk of dying over the course of the 19-year study, compared with women who didn’t take supplements. 

David Jacobs, a University of Minnesota professor of epidemiology, led the observational study.  He recommends that people try to get their nutrients through a healthy diet rather than from supplements.

“Well, I would say to eat food. Eat a better diet,” he said. “And if you are really focused on particular nutrients you could look through lists of nutrients for foods and try to eat more of those foods.”

Half of all Americans use supplements

About half of Americans now use dietary supplements, according to the Centers for Disease Control and Prevention, pushing annual sales beyond $27 billion. Jacobs said that he believes there should be greater scrutiny of the industry. 

“If you are a person out there and you feel that these [supplements] are doing good things for you – they may very well be doing it, we only evaluated mortality,” Jacobs said. “These things might be doing some good things for you during your life. If you feel like you have more energy or whatever, more power to you. But as a general rule, for the whole population, a restructuring of this industry and less use [of supplements] would probably be advisable.”>

About the study

Researchers studied data from more than 38,000 women taking part in the Iowa Women’s Health Study, which is an ongoing study that started in 1986. The researchers collected data on the women’s supplement use in 1986, 1997 and 2004.

The study linked a number of common vitamins and minerals to the slight increase in mortality, including multivitamins, vitamin B6, folic acid, iron, magnesium, zinc, and copper.

For example, of the 12,769 women in the study who took a daily multivitamin, 40.8 percent had died by the end of 2008, whereas 39.8 percent of the 10,161 women who hadn’t taken a daily multivitamin had died.

Listen to Jacobs on Public Health Moment

Learn more

The Minnesota Department of Health provvides information about radon, including where to purchase test kits.

• Radon facts from the Minnesota Department of Health

Winter is a good time to think about testing your home for radon. Radon is a colorless, tasteless, and odorless radioactive gas that can cause lung cancer. In fact, radon kills more than 20,000 Americans each year.  

Peter Raynor, an associate professor of environmental health at the University of Minnesota, says high levels of radon are most commonly found in basements. 

“Radon is ultimately the product of the decay of uranium,” he said. “Radon can leak into the basement through cracks or pipe entries and get into the air of the basement. Radon is a concern because its products from radioactive decay can enter the lung and cause lung cancer.”

About 1 in 3 Minnesota homes have high radon levels

Peter Raynor

About one in three Minnesota homes have radon levels that pose a significant health risk, according to the Minnesota Department of Health. As a result, department officials and Raynor recommend that homeowners test for radon. Raynor added that winter months are ideal for testing.

“Probably the best thing to do is to purchase a short-term test kit that you can get from a city or county or at most home improvement stores. And these are kits that usually allow you to make a test over the course of maybe three days and send the sample to a company that will analyze the result — all for mostly less than $10 in most cases.“

If radon exceeds certain levels, Raynor said the Environmental Protection Agency recommends that mitigation be performed. 

“There are contractors who do that work that are certified by the National Environmental Health Association and work with the Minnesota Department of Health,” he said. 

“My own home required radon mitigation back in the early 2000s when I tested it and I had kind of a complicated system I needed to put in and the costs were somewhere a little less than $1,500 for that to be done. But my system was more complicated than most.”

Shalini Kulasingam

It’s cervical cancer awareness month and there’s news to report. Two sets of draft guidelines now recommend that women be screened only once every three years instead of annually.

The U.S. Preventive Services task force now and previously recommended screening every three years. What’s changed is that the other major group that writes guidelines, a coalition that includes the American Cancer Society, is now in agreement.

Shalini Kulasingam, an assistant professor of epidemiology at the University of Minnesota, worked on both sets of draft guidelines.

“What should be noted with these recommendations are that they recommend screening beginning at age 21, that it be conducted every three years if you are doing it with cytology  and that screening can end at age 65 [if screenings are normal and there’s been no increase in risk],” Kulasingam said.

Screening has resulted in fewer cases, fewer deaths

Cervical cancer once was the leading cause of cancer death for women in the United States. But over the last 40 years, the number of cases and the number of deaths from cervical cancer have declined signficantly — due to the success of screening, such as the Pap test, according to the Centers for Disease Control and Prevention.

Still, Kulasingam noted that both groups recommended against annual screening. 

“For a long time in this country — because of discrepancies between these different sets of recommendations — clinicians have continued to screen women every year,” she said. “But now with this set of recommendations, with both large groups coming out and recommending that women be screened every three years, hopefully, we will see a decrease in annual screening because this really represents over-screening in this group — especially in younger women.”

Kulasingam said that there are downsides to over-screening. 

“You can have false positives,” she said, adding that it can prompt complications from treatment, especially for women of child-bearing age. “And, it should be noted, the benefits of annual screening are marginal, in terms of the reduction of incidences.”

Final guidelines are expected to be released in mid-2012.

Listen now

Mark Pereira

A common New Year’s resolution is to live a healthier lifestyle by eating a balanced diet and exercising more. But despite our earnest intent, the follow through really is hard.

Mark Pereira, a University of Minnesota professor of epidemiology, suggests that we start by having a Holiday resolution.

“The average person experiences extra weight gain and increases in blood pressure and blood cholesterol during the holidays,” he said. “The solution for many is a New Year’s resolution. But a better approach might be to anticipate the holiday season and some of the challenges that it brings to lifestyle and get going earlier. Perhaps, a holiday season resolution, setting realistic goals, anticipating and being proactive to some of the challenges and having a plan and a schedule.”

Pereira suggests some options, such as walking to a party instead of driving.

“If you are hosting a party, you can be creative by having more variety of healthy foods and smaller portion sizes, he said. “And remember not to shop or go to parties when you’re very hungry.”

Play active video games

Pereira adds that playing active video games, like the Wii and Xbox Kinect, is actually good exercise — especially for snowbound Minnesotans during winter months.

“Think about active video games when the weather is bad outside,” Pereira said. “Research is now showing that some of the active video games actually do get people off the couch and they burn more calories and have some fun instead of just sitting.”

Listen to Pereira on Public Health Moment

Tim Church

Should any man of any age — absent symptoms — ever be screened for prostate cancer using the Prostate-Specific Antigen (PSA) test?

No, according to draft recommendations from the U.S. Preventive Services Task Force.

Public comment on the draft guidelines is open until Dec. 13, 2011.

Screening has caused more harm than good

University of Minnesota professor Tim Church, who has conducted clinical trials to measure the success of PSA screenings, said that research has shown that these tests have resulted in more harm than good.

“Not only is there cost involved, inconvenience, and the pain that might be involved with diagnostic workups, but some men — considerable numbers of men — end up impotent or incontinent and with chronic pain and with blood in their urine, due to the effects of the false-positive screening tests,” he said.

What about men with higher risk?

Some men do have a higher risk and Church says that men concerned about prostate cancer should consult with their doctor.

“Obviously, some groups need to be more concerned than others. It’s been well demonstrated that black men, for example, have much higher rates — not only of prostate cancer incidence but also of prostate cancer death,” Church said. “In addition, men who have a history of prostate cancer in their family, may also be of higher risk of prostate cancer.”

Listen to Church on Public Health Moment

Harry Lando

President Obama last week scolded tobacco companies for their opposition to the new graphical cigarette package warning labels. He said that the industry is fighting the requirement because it does not want to be honest about the consequences of smoking.

The Food & Drug Administration (FDA) approved new warning labels that companies would have to place on the top half of cigarette packs. Some include such images as a man exhaling cigarette smoke through a tracheotomy hole in his throat and a smoker wearing an oxygen mask. The warning labels were due to be implemented in September 2012. But five tobacco companies are suing and recently a federal judge granted a request by the companies to postpone the deadline, while the court is reviewing the constitutionality of the FDA requirement.

Meanwhile, graphic labels are already being used effectively in other countries in promoting the negative health consequences of smoking. That’s according to Harry Lando, a University of Minnesota public health professor.

“There have been studies done that have compared U.S. warnings with the rotating warnings that are still print versus the much bigger and graphic warnings in Canada, and the U.K., and Australia,” Lando said. “And the warnings in the other countries just had much more impact.”

Health consequences of smoking are clear

The risks and consequences of smoking are clear: About 90 percent of lung cancer deaths in men and almost 80 percent in women are due to smoking.

But Lando said that there are many other health risks associated with smoking beyond lung cancer. 

“The problem is that there are more than 60 known carcinogens in the burning cigarette. Not only is it lung cancer and other kinds of cancer, but the risk of heart disease goes up substantially,” Lando said. “We keep learning new things like macular degeneration. I had not heard that that was related to smoking, but it is, which [macular degeneration] is a cause of blindness. There’s evidence that impotence in men is even more likely in smokers than in non-smokers.”

Listen now to Lando on Public Health Moment

Determining the best method for training our military combat medics is the goal of an $11 million Department of Defense project. The project will be led by University of Minnesota health sciences researchers.

The U of M team will lead a consortium of partners that will analyze and compare traditional training methods with more modern methods, such as mannequin simulations. They’ll then develop and validate assessment tools to evaluate training, retention, and competence of medics in pre-hospital Tactical Combat Casualty Care.

According to Dr. Robert M. Sweet, a University of Minnesota urologic surgeon and the principal investigator on the grant, the team will examine the external and human factors that influence performance of battlefield medics’ life-saving skills and provide the Department of Defense with a roadmap for the development of novel simulation tools to facilitate and optimize training. 

“New training capabilities may potentially save the lives of service members as training shifts to state-of-the-art approaches to combat medicine,” said Sweet, a simulation expert who also directs the U of M Medical School’s Simulation Programs. 

The role of public health

Julie Jacko

Professor Julie Jacko from the U of M’s School of Public Health, is a key member of the team. 

“What we’re hoping to be able to do is streamline the training with new technological models, such as mannequin simulations, and at the same time try to mitigate some of the costs associated with the training,” Jacko said. “We’re looking at a population of individuals, namely combat-casualty medics, and we’re asking the question, ‘How can we help these individuals deliver the highest quality of care possible to our population of service members around the world.’”

Jacko and her colleagues from the U of M School of Public Health are leading three key areas of the project. Professor Francois Sainfort is leading the comparison team that will look at experimental design and analytics. Professor Bill Riley is the cost-analysis team lead and he is working closely with Associate Professor Sandy Potthoff. 

Jacko will lead the team looking at how human and environmental factors influence the quality of care in combat settings.

“We’re very interested in understanding how things like temperature and humidity and stress and olfaction and a whole variety of different environmental stressors affect performance,” she said. “And how, perhaps, some of those environmental factors can be mitigated, based upon the way that these combat medics are actually trained.”

Said Sweet: “With our military partners, we plan on providing means of skills assessment and recommendations on revising training curricula for some of the most critical injuries and trauma routinely seen on the battlefield: massive bleeding (hemorrhage) and airway management.”

Consortium partners

Consortium partners include: the American College of Surgeons, National Registry of Emergency Medical Technicians, The U.S. Army Medical Department, the Defense Medical Readiness Training Institute, Madigan Army Medical Center, the Uniformed Services University for Health Sciences, U.S. Army Research Development and Engineering Command, Applied Research Associates, Inc., and the Program Executive Office for Simulation Training and Instrumentation.

• Read more about the grant

Listen now to Jacko on Public Health Moment

Learn More

• Read news coverage about the research findings

The location and design of nutrition labels on food packages — first introduced 20 years ago — has come into question based on a new University of Minnesota study that used eye-tracking technology to objectively measure whether or not consumers read the labels.

Dan Graham

U of M researcher Dan Graham led the study. He said that the study results show room for improvement.

In the study, participants were provided product information on a computer screen and were asked to evaluate the product and decide whether or not they would purchase the product. The product information included nutrition information.

Graham and other researchers observed via the eye-tracking device what participants viewed and for how long.

“We found out that people in this task did tend to look at the nutrition facts panel more so if it was in the center of the screen than if it was on the sides,” he said. “And they tended to look more at nutrients nearer the top of the label compared to those closer to the bottom. The highest viewing was for calories and the lowest was for the vitamins and minerals.”

Graham said that when the Nutrition Facts label was presented in the center column, subjects read one or more sections of 61 percent of the labels compared with 37 percent and 34 percent of labels among participants randomly assigned to view labels on the left- and right hand sides of the screen, respectively. In addition, labels in the center column received 30-plus percent more view time than the same labels when located in a side column.

Moving labels front and center would be beneficial

Graham said the study results indicate that a change in location for the nutrition labels would be beneficial for consumers.

“Based on this study, that was just using a computer screen, if we could translate that to a package front, for instance, it seems that it would be beneficial to have the nutrition label front and center — at the top and the middle of a food package, where people tend to look most frequently,” Graham said.

“And if we could have the nutrients that are most relevant to public health in a similarly prominent place on that label, that seems like it could draw consumer attention. And, from there, perhaps we could make the leap to saying that perhaps they would eat more healthfully if they saw it.”

About the Study

In a simulated grocery shopping exercise, 203 participants observed 64 different grocery products displayed on a computer monitor. Each screen contained three elements, the well-known Nutrition Facts label, a picture and list of ingredients, and a description of the product with price and quantity information. These three elements were presented so that one third of the participants each saw the Nutrition Facts label on the left, right, and center. Each subject was asked whether they would consider buying the product. Participants were aware that their eye movements would be tracked, but unaware that the study focus was nutrition information.

Using a computer equipped with an eye-tracking device, investigators observed that most consumers view label components at the top more than those at the bottom. Further data suggest that the average consumer reads only the top five lines on a Nutrition Facts label.

Researchers found that consumers’ self-reported viewing of Nutrition Facts label components was higher than objectively measured viewing using an eye-tracking device.

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Lisa Harnack

Vitamin D is one of the few nutrients that people can pick up from sources other than food, says Lisa Harnack, director of the Nutrition Coordinating Center and a professor of epidemiology at the University of Minnesota.

“Our body can synthesize [vitamin D] when our skin is exposed to sunlight,” she said. “And, of course, in Minnesota, in the winter months, we don’t have much sun exposure.”

Why is vitamin D important

Vitamin D is essential for the developing and sustaining healthy bones and can help prevent osteoporosis.

But many Americans and Minnesotans fall short of the recommended intake of this vitamin, Harnack said. In fact, Harnack’s latest research — recently published by the Journal of the American Dietetic Association — shows vitamin D in the diet has been heading in the wrong direction.

“We recently looked at vitamin D intake in the Minneapolis-St. Paul Metropolitan area and found that vitamin D intake has been on the decline over the past 25 years,” she said. “And that’s probably because vitamin D is found in just a few foods and one of those is milk. And people are drinking less milk today than in the past.”

Tips for getting more vitamin D

Harnack explains how we can get more vitamin D through our diet.

“Dairy milk is required by federal law to be vitamin D fortified. But if you’re a soymilk drinker or a rice milk drinker, some of those products are fortified, you just need to read the label and look for one that in the nutrition facts panel indicates that it contains vitamin D,” Harnack said. “Some yogurts are fortified with vitamin D, some margarine, some orange juices are now fortified with vitamin D, and some of the breakfast cereals.”

But there are few foods that naturally contain vitamin D, Harnack said.

“There’s a limited number of foods that are naturally high in vitamin D: Oily fish, like salmon and tuna, mushrooms, liver. So, it’s hard to get the foods that are naturally high in vitamin D regularly in your diet.”

About the Nutrition Coordinating Center

The Nutrition Coordinating Center provides databases, software, training, and services for the collection and analysis of dietary data. The center distributes and supports dietary analysis software applications for the collection and coding of 24-hour dietary recalls and the analysis of food records, menus, and recipes. The center also maintains a comprehensive research-quality food and nutrient database, the only one of its kind nationally. The database of more than 18,000 foods has been in existence for 35 years.

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Julie Sonier

But the increased rate is even greater in Minnesota.

That’s according to a recent report by the University of Minnesota’s State Health Access Data Assistance Center — or SHADAC.

SHADAC’s Julie Sonier explains why Minnesota experienced such a drop.

“Minnesota was one of 12 states nationally that experienced a decline in employer-sponsored insurance of 10 percentage points or more. But in Minnesota we think that a key part of this story is really an economic story,” she said. “We had a pretty substantial shift in the last decade in the income distribution of our population. So, we have a lot more people who are earning in the low-wage category than we did at the beginning of the decade. People in low-wage jobs are much less likely to have access to employer insurance.”

Findings are concerning

SHADAC director Lynn Blewett, a University of Minnesota professor of public health,  said that, historically, employers have been the primary source for health insurance for most families in Minnesota.

“So it is concerning to see a decade-long significant drop in coverage rates in the state,” said Blewett. “It’s especially troubling to see that moderate- to low-income families are disproportionately affected by the drop in employer-sponsored coverage.”

Study can help state policymakers

Sonier said that the intent of the study was to provide states with information about the differences in coverage as state lawmakers consider changes in health policy.

“One of the things that we were really trying to shine a light on was all of this variation across states,” she said, “and to really encourage the continued measurement and tracking of these trends at the state level, so that state policymakers have the information that they need about what’s going on in their state when it comes time to make key decisions.”

• View customized reports for each state and national trend numbers

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Alvaro Alonso

September is atrial fibrillation month, a time to raise awareness about this condition, which causes an irregular and often rapid heart rate.

According to Alvaro Alonso, an associate professor of public health at the University of Minnesota, an irregular heartbeat can lead to stroke, heart failure, and an early death. Atrial fibrillation affects more than 2 million Americans.

Recent research by Alonso, however, has found that the condition is preventable by, among other things, improving diet and increasing exercise.

Key finding

“Our main finding was that avoiding cardiovascular risk factors like hypertension, obesity, diabetes, etc., we might be able to prevent between 50 and 60 percent of the atrial fibrillation cases occurring in the population,” Alonso said.

“Our recommendation to the public is to follow the existing guidelines for the prevention of cardiovascular diseases that focus on having a healthy diet, having an appropriate weight, [and] having an active lifestyle. Those recommendations that are applicable to other heart diseases might also be applicable to atrial fiblliration.”

Results back theory

Although the results were not surprising, Alonso said that this was the first time a large study was undertaken to show this relationship between an irregular heartbeat and cardiovascular risk factors.

“In the last few years there has been an increased interest in showing that atrial fibrillation is actually preventable,” Alonso said. “And our study puts numbers to those [theories].”

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John Connett

Good news for those who suffer from chronic obstructive pulmonary disease — or COPD: A clinical trial involving more than 1,100 people has found that a common antibiotic called azithromycin can reduce the occurrence and severity of COPD exacerbations or flareups.

Professor John Connett, a University of Minnesota biostatistican, led the study. He said it’s especially good news because until now there has not been a good treatment for people who suffer from COPD. COPD refers to a group of chronic lung diseases that block airflow. These include bronchitis and emphysema.

“The azithromycin group had fewer exacerbations. They had them later in the year, on average. And they generally benefitted from this treatment,” Connett said. “It was a positive study. And it does have implications for treatment for COPD because there are not a lot of good treatments available right now. There are other treatments that will treat symptoms — make the person feel better, breathe a little bit better. This one actually prevents some illnesses.”

Potential side effects

Connett’s study did identify some side effects to the use of azithromycin, including hearing loss for a few study participants. The average age of those in the study was 65, Connett said.

“There were a few people who had some deterioration in their hearing levels. There was maybe 2 percent or so that had some loss of hearing. [But] there will be hearing loss anyway (in people age 65 and older),” Connett said. “There was hearing loss in both groups, but there was a little bit more in the azithromycin group.”

Advice for people who suffer from COPD

Connett offers advice for those who suffer from COPD.

“If a person has impaired hearing, they should be sure to mention that to their doctor, and have their hearing tested before they actually start azithromycin.”

About this study

The study was published in the Aug. 25 issue of the New England Journal of Medicine.

Azithromycin, an antibiotic available in generic form, is already prescribed for a wide variety of bacterial infections. Previous research suggested that this antibiotic might work for COPD exacerbations, but this study was the first to enroll a large number of COPD patients.

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Jim Neaton

A major new clinical trial seeks to determine whether HIV-infected individuals with no symptoms have less risk of developing AIDS or related illnesses if they begin taking treatments sooner rather than later.

SPH professor Jim Neaton will lead the trial, which involves 4,000 HIV-infected participants at more than 250 clinical sites in 36 countries. Participants will be followed for up to five years.

The trial is the latest from the International Network for Strategic Initiatives in Global HIV Trials (INSIGHT), the world’s largest HIV/AIDS clinical trial network, funded by the NIH’s National Institute of Allergy and Infectious Diseases.

“There are different recommendations about when to treat HIV because the evidence is not robust,” says Neaton. “That’s why you need a very strong study design with randomization and a lot of people with long-term follow-up to really get the answer about risk versus benefit.”

INSIGHT investigator Keith Henry, director of HIV clinical research at the Hennepin County Medical Center, says that risks include side effects, which, in rare instances, can be deadly. He says that cost is another factor to consider.

“A year of antiretroviral treatment and monitoring [in the U.S.] averages about $25,000 for a patient who is doing well. Forty years of that adds up to one million dollars,” says Henry. “So having really good data about which groups of patients most benefit is crucial.”

Listen to Neaton, Keith Henry on Public Health Moment

Toben Nelson

Kids who play sports are more physically active than those who do not, but they are just as likely to be overweight. That’s according to Toben Nelson, a University of Minnesota epidemiologist who does research in this area.

“Youth who participate in sports are more likely to be physically active. But they’re not as active as some parents might think they are,” Nelson says. “In an hour’s worth of practice, kids are really only getting about 30 minutes of moderate to vigorous physical activity. The other part of that time, they’re really standing around.”

Food environment also a factor

Nelson says that the food environment surrounding youth sports is also a contributing factor in why these kids are just as likely to be overweight.

“The food environment in youth sport is one that promotes lots of the kind of foods that are more likely to make kids overweight.”

Nelson says that, for example, parents often rely on the convenience of fast food when rushing kids to after-school games and practices. And, he says, the youth sports climate includes unhealthy concession food and the use of treats as rewards.

What should parents do?

“Parents can plan ahead for when their children are participating in sports and bring along healthier snacks than ones that are available in youth sports settings,” Nelson says. “They can also work with parents and coaches to provide snacks following games that are more healthy for children.”

More information

For more information and resources on this topic, visit the Healthy Youth Sport website.

Listen to Nelson on Public Health Moment

Jamie Stang

A good place to start is the new dietary food plate. Jamie Stang, a nutrition expert at the University of Minnesota, says the “myplate” is a good model to use when deciding what to include in the lunch box.

“The new myplate is actually a good idea. You can use myplate on a plate or you can think of your lunch box as a plate,” she says. “So, typically, we want to see at least half of the plate being fruit and vegetable. So, if you think of the lunch box, filling half of your lunch box with carrot sticks or bananas or grapes – easy things that you can put in the lunch box.

“The other half of the plate should be the protein and the carbohydrates. And that could be anything from your tuna or your peanut butter and jelly sandwich, that could be crackers and cheese, it could be hummus and pita chips – but thinking about splitting the plate or lunch box half and half.”

As far as beverages, Stang says to drink water instead of sugary drinks and switch to fat-free or 1 percent milk.

School lunches are a good option

She adds that lunches served at school are a well-rounded, nutritious option.

“[School] lunches have come a long way,” Stang says. “Starting with some recent legislation, we’re now seeing half or more of the grain products must be whole grain. We also see that they are required to have fruit and vegetable with meals. And there’s a lot more focus on variety and providing specific fruits and vegetables that provide missing nutrients.”

Tips for grocery shopping

Stang says parents should always check food labels before purchasing. An item may look healthy but could have a lot of added sugar or be extremely high in sodium, which effectively cancels out most of its nutritional value.

Ready-made lunches are not cost effective either, she says.

“People will buy pre-made and processed foods because they think they’re cheap and quick, but you can make healthy alternatives for a similar or lower price.”

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His top priorities: Ensuring access and delivering excellence.

“It’s critically important that the barriers to the students who do not have the financial means to come to the University be as low as possible,” Kaler said. “The second element is a bigger element and that’s encapsulated in one word: which is excellence. And what that means to me is really focusing.”

Breadth, depth of U of M programs a strength

Kaler said that Minnesota’s many quality programs provide the University with a unique opportunity to engage in meaningful multidisciplinary efforts spanning such programs as agriculture, veterinary medicine, public health, human health, and more.

“I think there are very few institutions that have the scope and span of the University of Minnesota across disciplines with the quality that we have,” Kaler said. That means that we can be very impactful in the world in ways that very few other institutions have that opportunity to be.”

U of M needs health sciences excellence to succeed

Kaler added that overall excellence at the U of M is dependent on strong health sciences programs.

“There is no top-flight public institution that doesn’t have a strong leadership position in academic health,” he said. “We can’t succeed without the Academic Health Center being excellent.”

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Lyn Steffen

Minnesotans are less likely than the average American to die of heart disease. The reason? Likely because, compared to national averages, Minnesotans smoke less and fewer have high blood pressure.

That’s according to a recent study, led by Lyn Steffen, an associate professor of epidemiology at the University of Minnesota.

“We know that the cardiovascular mortality rate in Minnesota is lower than for the general populations,” Steffen said. “We think that from these study findings that it truly is the cardiovascular risk factor levels that are lower in Minnesotans that explain this difference in the cardiovascular mortality rate.”

But Minnesotans are consuming more calories now

The bad news? Calorie intake is increasing

But Steffen adds that Minnesotans can do better, simply by improving their diets and consuming fewer calories.

“We do want to do better and I must say that one of the major public health problems right now is the fact that 69 percent of the population is overweight or obese,” she said. “Calorie intake has increased since we started the survey back in 1980. Calories have increased in both Minnesotans and in the general population.

“It is interesting that even though we have so many overweight and obese people, we still have other cardiovascular risk factors that are still so good in the Minnesota population.”

Listen to Steffen

Beth Virnig

That’s according to a RAND Corp. study that looked at 994 women with pre-invasive breast cancer. Researchers found significant treatment variations from surgeon to surgeon that may account for up to 30 percent of cancer recurrences.

“The study found that not all surgeons are equal,” says SPH professor Beth Virnig, who co-wrote an editorial to accompany findings in the Journal of the National Cancer Institute.

“For instance, in spite of the finding that mastectomy has lower risk of recurrence, a woman still might be better off having a more skilled surgeon doing breastconserving surgery plus radiation than a less-skilled surgeon doing a mastectomy.” That means women need to consider not just what treatment they get, but who gives them the treatment.

However, the study does not provide guidance on finding good surgeons. One solution, Virnig says in her editorial, is to develop a scoring system for breast cancer surgeons. But she acknowledges this may not be feasible.

Meanwhile, she suggests women get their doctors’ views on radiation therapy after breast-conserving surgery and the importance of negative margins, both of which are associated with a lower risk of recurrence.

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Kelly Brownell

Is there the political will to change the American diet?

That was the question posed by Yale University professor Kelly Brownell at the school’s annual Gaylord Anderson lecture.

Brownell noted that the Robert Wood Johnson Foundation has committed $100 million a year over five years to combat childhood obesity. Yet the food industry spends more than that per week, marketing junk food to children.

Brownell called for a penny-per-ounce tax on sugar-sweetened drinks as a way to combat obesity, cut health care costs, and raise revenue for debt-burdened government agencies. “Economists estimate that this would decrease consumption of sugar-sweetened beverages by up to 23 percent,” he said.

“The Congressional Budget Office estimates that such a decrease could reduce health care costs by $50 million over 10 years, and it would generate an awful lot of money.”

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Leslie Lytle

A new clinical trial aims to combat obesity by capitalizing on technology and social media’s influence on young adults.

In the new CHOICES trial (Choosing Healthy Options in College Environments and Settings), an SPH team will test a forcredit course and web-based social networking as a way to prevent unhealthy weight gain in 440 student participants attending three community colleges in Minnesota.

The trial is one of seven nationwide to test the role of technologybased weight management approaches—such as cell phone applications, text messaging, web-based social networking, and Bluetooth-enabled weight monitors—targeted to at-risk young adults.

SPH professor Leslie Lytle chairs the steering committee of the trials and is the principal investigator for CHOICES.

All will be supported by $36 million in funding over five years by the NIH’s National Heart, Lung, and Blood Institute, with support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Listen to Leslie Lytle on Public Health Moment

Kelvin Choi

Too many Americans are ignoring the dangers of indoor tanning, or they are unaware of the dangers, finds SPH researcher Kelvin Choi.

In a nationwide study of nearly 2,900 people, Choi found that 18 percent of women use indoor tanning facilities, yet only 13 percent believe people should avoid tanning salons to prevent skin cancer. About 6 percent of men reported tanning indoors.

Age was a significant factor, with 36 percent of women and 12 percent of men between the ages of 18 and 24 tanning indoors.

“There’s a knowledge gap out there,” says Choi. “People are still not recognizing that tanning beds actually cause cancer. We found that, alarmingly, the use of indoor tanning among young women is actually higher than smoking.”

The research showed that women who tanned indoors were more likely to be from the Midwest and the South. They were also more likely to use spray-tan products.

“Avoiding indoor tanning booths and beds is the simplest way to reduce the risk of getting skin cancer,” says Choi.

Listen to Kelvin Choi on Public Health Moment

Brian Davis and his clients love to talk about sports at the North Minneapolis barbershop he owns: Brian D’s Old School Barbers.

But lately, they’ve been talking a lot about men’s health, as part of “Barbershop Conversations,” a University of Minnesota study that encourages African American men to talk about their health and ultimately hopes to get more of them to become organ donors.

Davis volunteered for the study because he truly believes it can improve the health of his friends and clients.

“These guys brought a good project here and I just like to get the information out to my people,” Davis said.

Barbershops are community-gathering places

“Barbershops are an interesting venue, because there are actually very few spots that you can try to tap into African American men. And this happens to be one of them,” said David Radosevich, an adjunct assistant professor in the University of Minnesota School of Public Health. He added that Davis’ barbershop “is very much a community gathering place.”

Radosevich was the lead investigator on the three-year project, which was funded by the U.S. Department of Health and Human Services. Along with increasing organ donation among African American men, another primary goal was to increase awareness of potential risk factors for renal failure, dialysis, and kidney transplant.

Radosevich said that currently only about 35 percent of African American men list themselves as organ donors on their driver’s license, compared to nearly 50 percent of white men.

Part of that is likely due to the fact that, historically, many African American men have viewed the U.S. health care system with some skepticism. That was one reason to use community barbers to initiate health discussions. Radosevich said that the Barbershop Conversations project served to reduce some of that mistrust.

Project increased discussions about health

Radosevich views the recently completed project as a success, even though it’s too early to tell if more African American men have or will become organ donors, he said.

More than 370 African American men participated in the project. Nearly 6 percent of those not currently an organ donor indicated that they were likely to become one because of their involvement in the project. But the only time to do so is when one renews their driver’s license, Radosevich said.

“We did increase the salience of organ donation, at least among the men in the community,” Radosevich said. “And before people can actually make changes in health behaviors, it has to be a salient issue to them. In other words it has to be something that they think about, talk about with their friends, talk about with their family members.”

He said that the study results did show that discussion about organ donation and related health issues with family and friends increased by 14.5 percent because of the participants’ involvement in the project.

“So, hopefully, the next time they renew their driver’s license,” Radosevich said, “they’ll actually check off organ donation on their driver’s license.

Davis will continue dialogue

Twenty-five Twin Cities barbers, including Davis, participated in the project and received training in communications to facilitate discussions. Davis said he expects to continue to discuss health – and sports – with his clients now that the project is complete

“I’m sure we’ll continue to have this dialogue,” Davis said. “It’s just something that happens in good conversation.”

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Mary Story

Rates of childhood obesity have tripled over the last 30 years, with one-third of American children currently overweight or obese. Many factors contribute to this problem. But a key one is food marketing.

Nutrition expert Mary Story, a professor at the University of Minnesota, says that the food and beverage industry spends $2 billion a year marketing foods to kids.

“Most of this is for foods and beverages that are high in calories, fats, and added sugars. And there are very few ads for fruits, vegetables, and other healthy foods,” she said.

“The Institute of Medicine, in 2006, released a report on food marketing for children. And they concluded that marketing practices are out of balance with a healthful diet — and create an environment that puts our children’s health at risk.”

Briefing to Congress

Recently, Story briefed members of Congress on this topic. She and others call for industry to make changes and also for the creation of federal, state, and local policies to curb these marketing practices.

“What needs to happen is that we need to reduce unhealthy food marketing to children,” Story said. “We need to protect our children from unhealthy food marketing and help them improve their overall diets.”

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Henry Blackburn

May is Mediterranean Diet Month. But what is the Mediterranean Diet? And why is it good for you?

Who better to ask than Dr. Henry Blackburn, professor emeritus at the University of Minnesota. Blackburn worked with Ancel Keys, the famed U of M scientist best known as the man who linked a high-fat diet to cholesterol and heart disease. Blackburn assisted Keys on the Seven Countries Study, which was the first study to “examine systematically the relation among lifestyle, diet, and the rates of heart attack and stroke in contrasting populations.”

Keys was a proponent of the Mediterranean diet and together with his wife, Margaret, wrote several books, including: “Eat Well” and “Stay Well the Mediterranean Way.”

What is the Mediterranean Diet?

“Actually it’s many eating patterns in the traditional cultures around the Mediterranean Sea,” Blackburn said. “It’s characterized by a predominance of plant foods, far greater focus on the vegetables and fruits and grains and it has certain other commonalities in terms of wine and olive oil being important parts — and wild weeds, wild greens, in other words. And a focus on legumes, peas and beans, with lesser emphasis on meat and dairy.”

Why is it good for us?

Said Blackburn: “What makes it healthy is apparently the plant emphasis and predominantly a low intake of saturated fats, which are usually animal fats.”

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Pat McGovern

Pat McGovern is a mother, stepmom, and, recently, she became a grandmother. The University of Minnesota professor of environmental health is also the mother of the local study center for the National Children’s Study — the largest long-term study of children’s health ever in the United States.

With Mother’s Day just around the corner, how does McGovern feel about her motherly responsibilities?

“Being a mom, a stepmom, and a grandmom are three of the most important roles in my life,” she said. “And being the mother of the National Children’s Study center here at the University of Minnesota is really a privilege and probably the most exciting thing I’ve done in my academic career at the University of Minnesota.”

Study has potential to make ‘huge difference’

Why is this study so important? Why should people care?

“I think the study has the potential to make a huge difference in the health and development of kids and grandkids and future generations,” McGovern said. “There’s nothing we care more about than the health of our kids and our grandkids. If people want to care about the children in Ramsey County, in the children in the country, hopefully, they too will want to contribute to the science that is leading this study and that will be produced by this study and help contribute to the health of future generations.”

For more information about the study, call 612-626-KIDS or visit the NCS Ramsey Kids website.

• Listen to McGovern on Public Health Moment (Long – 6:40)
• Listen ton McGovern (Short – 1:30)

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DeAnn Lazovich

Last year, more than 100,000 Americans were diagnosed with melanoma. About 75 percent of all skin cancer deaths are from melanoma, with nearly 9,000 in 2010. But melanoma is very curable, if detected early, according to the American Academy of Dermatology.

“Dermatologists recommend that people check their skin on a monthly basis for any changes in spots on the skin,” says DeAnn Lazovich, a cancer epidemiologist at the University of Minnesota. “Dermatologists also recommend that people have an annual skin test, conducted by a physician.”

Risk factors

Lazovich explains who the risk factors for melanoma.

“The risk factors for melanoma can be divided into two groups: Those that are non-modifiable — the ones that you inherit, such as your skin color, hair color, eye color, whether or not you have a tendency to develop freckles and moles, or if you have a family history of melanoma,” she said.

“The modifiable risk factors all have to do with exposure to ultra-violet radiation — either from the sun or from artificial devices, like indoor tanning.”

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The added sugars are at the least a contributing factor in the weight gain, says Huifen Wang, a University of Minnesota research assistant. Wang led the study, which involved people aged 25 to 74 and living in the Twin Cities Metropolitan area.

But what is added sugar? Wang explains.

“By definition, added sugars are sugars and syrup added to food during processing, preparation or added at the table. And actually, nowadays, people are consuming much more added sugars than they did four decades ago,” Wang said. “The primary food sources of added sugars in Americans’ diets are sugar-sweetened beverages, like sodas, energy sports and fruit drinks.”

Advice on sugar intake

Wang recommends limiting your intake of added sugars.

“Drink water instead of sugar-sweetened beverages,” she said. “Don’t add too much sugar to the foods at the table. Actually, according to the recommendation from the American Heart Association, most American women should not consume more than 100 calories from added sugars per day. And for men there should be no more than 150 calories.”

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Robert Kane

A few years ago, Robert Kane, a professor and expert on aging at the University of Minnesota, suddenly found himself in the role of caregiver for his mother. The problems he encountered with our nation’s long-term care system prompted him to write a book, titled: “It Shouldn’t Be This Way: The Failure of Long-Term Care.”

Now, Kane has written a second book, “The Good Caregiver.”

“Basically, this book is written as a survival guide for caregivers,” Kane said. “People are thrust into the position of having to give care for a frail relative, and come into it totally unprepared, they don’t know what their options are, they don’t know really where to begin. So, this is designed to help them and make their lives a little bit easier.”

Kane provides advice to other caregivers

Kane offers four pieces of advice for caregivers.

“Number one is to know that you’re in it for the long haul. So, you want to pace yourself and be a marathoner not a sprinter,” Kane said.

“Number two, there are a lot of options available that you may not know about. And it would be a mistake to be catapulted into a nursing home, for example, without considering other forms of long-term care.

“And the third is, you have a number of rights that institutions may not necessarily tell you about because it’s not in their best interest.

“And then, finally, you need to be very organized. You can’t count on the network of professionals who are going to be caring for your parent to know what’s going on and to avoid duplications in medications — even to know all of the diagnoses.”

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Kim Robien

More than 12 million Americans are considered cancer survivors. And because cancer survivors die of non-cancer-related causes at a much higher rate than the general public, researchers are calling for greater emphasis on improving nutrition as a way to improve the health of cancer survivors, while lowering overall health care costs.

Kim Robien, an assistant professor of epidemiology at the University of Minnesota, says that nutrition recommendations are generally the same for cancer survivors as they are for the general public.

“But the one thing to keep in mind is that cancer survivors are often at even higher risk of developing chronic diseases — such as cardiovascular disease, diabetes, osteoporosis — so you could say that it’s more important that cancer survivors follow these recommendations,” she said.

Nutritional advice for cancer survivors

And what specifically should cancer survivors focus on?

“Making sure that they maintain a healthy body weight, that they remain physically active, that they eat plenty of fruits and vegetables, drink alcohol in moderation,” Robien said. “We also recommend that cancer survivors try to obtain their nutrients from foods rather than supplements. There have been several studies that have linked supplement intake with higher cancer-specific and all-cause mortality among cancer survivors. But we don’t see that same effect when people are eating good amounts of these nutrients from foods.”

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Michael Osterholm

The United States has made little progress on preventing food-borne illness, despite what Americans have been told in recent months.

That’s according to infectious disease expert Michael Osterholm, a professor in the University of Minnesota School of Public Health.

“Over the past six weeks there have been two major news stories about food safety that have come out that have suggested that in fact the food supply is getting safer — and it will even get safer in the future, based on recent legislation,” Osterholm said.

“First of all, it is a fact that the study that the Centers for Disease Control and Prevention released in December, suggesting that there were big differences in the numbers of food-borne disease cases — including deaths, between 1999 and now — actually is not the case,” he said. “But really for the last 11 years, the numbers have been flat — that basically there haven’t been any major changes.

“The bottom line message is that food-borne disease still is an important problem in this country, that it hasn’t gotten much worse, but it also hasn’t gotten much better.”

Congress passed bill with no funding

Another problem in addressing food-borne illness, Osterholm says, is that Congress passed the federal food modernization act earlier this year, but with no funding attached.

“And when people say, ‘well, but in this very cash-strapped, kind of, budget-tight world, why do that,’ the cost-benefit of doing this is huge,” Osterholm said. “The cost of food-borne disease far, far outstrips the investment of trying to prevent it.”

• Read Osterholm’s editorial

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That’s according to research led by Katy Backes Kozhimannil, an assistant professor of health policy at the University of Minnesota School of Public Health.

The law requires postpartum depression screening for new mothers and was coupled with an aggressive awareness campaign.

“Postpartum depression is a serious illness that affects up to 19 percent of new mothers in the first three months following birth,” said Kozhimannil. “The good news is that when postpartum depression is identified, it is treatable, using psychotherapies and anti-depressant medications. But, left untreated, postpartum depression can have severe debilitating affects, both for the mother and her baby, and long-term impacts on the child and the family as a whole.”

Need to improve state screening policies

Kozhimannil says there are three ways to improve policies to improve treatment.

“One is to include in legislative and policy efforts, explicit efforts to address known barriers to care. Secondly, it’s important to think about payment for postpartum depression screening–whether that comes through an insurance coverage requirement or other types of mechanisms for payment for the services that clinicians provide,” she said. “And, thirdly, the issues of monitoring and enforcement are incredibly important. We need to make sure that we’re measuring the outcomes that we care about and are able to enforce the policies that are in place.”

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That last part can be a bit dangerous. A recent University of Minnesota study found that about 8 percent of fans watching games at sports stadiums are legally drunk when they leave.

Can that behavior translate to Super Bowl parties?

Darin Erickson, a University of Minnesota epidemiologist who led the study, thinks it can.

Sporting events, drinking “go hand-in-hand”

“The idea of viewing sporting events and consuming alcohol certainly go hand-in-hand. And I think there is the possibility of translating some of that around this notion of viewing sports at home,” he says. “There have been other studies, for instance, that have looked at Super Bowl Sunday and the increased likelihood of traffic crashes. What they found was that there was a statistically significant increase in the number of fatal car accidents on Super Bowl Sunday.

“Now, my guess is that is not due to the 80,000 people who are actually in the Super Bowl stadium. It’s because of all these Super Bowl parties that are happening.”

Plan ahead, Erickson says

Erickson recommends planning ahead.

“Limit how much you drink, obviously,” he says. “Second, if you eat something, that’s going to help. And having some kind of transportation plan would be perfect — whether that’s a designated driver, or whether that’s public transportation, etc.”

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Jean Abraham

Three out of every four employers that provide health insurance also provide a wellness program. The programs are designed to improve health and reduce overall health care costs.

But do they work? Is there a return on investment?

That’s what researchers at the University of Minnesota aimed to find out when they looked in-house, evaluating the U of M’s wellness program over the last few years.

One of the researchers, Assistant Professor Jean Abraham, a health policy expert, says the U of M’s program is working and saving money.

“Here at the University, we examined the effectiveness of the disease management program, as well as the lifestyle management program, and the fitness rewards program, which was recently launched in 2008,” Abraham says. “And our evaluation work is showing that not only do these programs save money, but they really are improving the health of employees. And that’s really the overall objective of these initiatives.”

More research needed

Abraham adds that more research is needed.

“The first generation of wellness program research has really been completed. But there is so much more that we don’t yet know,” she says. “For example, what factors influence employee participation, how should these programs be designed to be most cost effective, and how should these programs be organized as they relate to health insurance that is offered to employees.”

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Sarah Gollust

People are less likely to support laws requiring the human papillomavirus (HPV) vaccine for young girls when they learn that there is controversy over such laws, finds SPH research.

While the vaccine that protects against the potentially cancer-causing virus is widely supported in the medical and public health communities, state laws requiring girls to be vaccinated for middle-school attendance have caused controversy among parents, politicians, and even medical and public health experts disagreeing about whether such laws are appropriate. News coverage about the vaccine requirements likely amplifies the controversy.

Study among first to look at media’s role in health policy

SPH assistant professor Sarah Gollust finds that the controversy, in turn, leads to diminished public support for legally mandating the HPV vaccine. The study is among the first to examine the direct tie between controversy about a piece of health policy portrayed in the news media and public support for the policy.

“This research raises important questions about how the news media’s tendency to report on controversy shapes public opinion about health policy,” says Gollust.

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Tim Church

A large-scale study suggests that annual CT scans of current and former heavy smokers could reduce deaths from lung cancer by 20 percent.

Screening with the high-tech images has proved so successful that researchers stopped the trial six months early. The University of Minnesota played a major role in the National Lung Screening Trial, recruiting, screening, and tracking 6,600 participants.

Total nationwide participation in the study was 53,000. Participants received screening at enrollment and at the end of their first and second years in the trial. They were then followed for up to another five years.

In that period there were 354 deaths from lung cancer among participants in the CT arm of the study and 442 lung cancer deaths among the chest X-ray group.

The study marks the first time researchers have seen clear evidence of a screening method that could reduce deaths from lung cancer, the leading cause of cancer-related deaths in the United States and one that is often diagnosed once it’s too late for treatment.

“The idea is that we can discover the cancer before it becomes inoperable,” says SPH professor Timothy Church, principal investigator.

More analysis needed before screening is recommended

But Church warns against making any blanket recommendations at this point, stressing that more analysis is needed on the harms and benefits of CT screening. That process could result in a change in professional guidelines for lung cancer screening.

“We have to make sure that we’re not doing more harm than good,” Church says. “Once that analysis is done, recommendations can be formulated about who to screen, how often to screen, at what ages to screen, and how long to screen them.”

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Alan Hirsch

PAD, or Peripheral Artery Disease, is a common and often debilitating condition in which blood flow to the legs is obstructed by plaque that blocks heart or brain arteries. It affects at least 8 million Americans and is considered a major, but less known, risk factor for heart attacks and stroke.

As baby boomers age, rates of PAD are expected to spike.New research, led by SPH epidemiologist and Medical School cardiologist Alan Hirsch, shows that each year the U.S. spends roughly $21 billion on PAD-related hospitalizations.

The researchers also found that hospitalizations and treatment costs for what some refer to as “heart attacks below the belt” increase substantially as the disease progresses, and that many patients experience repeat hospitalizations.

Study registry includes 24,000 people

For the study, researchers used data from the Reduction of Atherothrombosis for Continued Health (REACH) registry. The registry includes more than 24,000 individuals with atherothrombosis, the hardening or narrowing of the arteries due to plaque buildup.

“My co-investigators and I are concerned that this nation may no longer be able to sustain the high costs associated with treating a very common and preventable disease such as PAD, especially when the many invasive treatments are not always durable,” says Hirsch.

Hirsch and colleagues are working to lower PAD costs and improve treatments through a national multicenter clinical study called CLEVER (Claudication: Exercise vs. Endoluminal Revascularization), sponsored by the National Heart, Lung, and Blood Institute and managed by the University of Minnesota and Brown University.

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Lisa Harnack, director of the Nutrition Coordinating Center at the University of Minnesota School of Public Health, says many of the traditional Thanksgiving foods are actually good for us – of course in moderation.

“Turkey’s really not a bad option. Turkey’s naturally a fairly lean meat, and, you know, a lot of the vegetables we have – squash and the green beans and things — are good choices,” she said. “And it’s really amazing that a lot of the foods that we eat around Thanksgiving are just packed with vitamin A, like the squash and the sweet potatoes. So, we get a lot of good nutrients along with our Thanksgiving meal.”

Harnack offers advice on how to avoiding eating and drinking too much.

“Beverages really add up so it’s good maybe after drinking the egg nog to switch over to water and satisfying your thirst with calorie-free beverages like diet sodas, tea, coffee or some other good choices,” Harnack said. “We tend to make food the focus of our get-togethers and it’s important that great food can be part of it but then it’s the point where it’s time to push away from the table and do something else – play a board game with your family, go for a walk with the kids, take them to the park to play – do something other than sit around that table where the food is there, tempting you to eat it.”

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Tim Church

Heavy smokers who receive annual CT scans, instead of standard X-rays, reduce their risk of dying from lung cancer by 20 percent.

That’s according to a study of 53,000 smokers. Tim Church, a University of Minnesota expert on cancer screenings, led the study in Minnesota.

“This finding is terribly important because it’s the first time that we’ve been able to demonstrate that you can in fact lower mortality from lung cancer among heavy smokers,” Church said. “And that’s something we can build on for preventing death from this disease. There are a number of things we might do to improve on the method that was used in the study. One way we can improve on it is by better targeting the screening, by better being able to assess the risk of lung cancer in smoking populations.”

• Listen to Church on Public Health Moment

More research needed

Despite the good news, Church says additional research needs to be done before CT scans can be recommended as a standard. That’s because a positive screening now requires additional testing to ensure that the positive finding is indeed cancer. This could range from additional radiological testing to surgery to remove parts of a lung.

“It’s not without costs, either dollar costs or human costs,” he said. “And so, there’s still some research to be done before we can recommend this as a general screening method for heavy smokers.”

Why do a large clinical trial?

Church said there was some controversy early on about doing the randomized clinical trial because some said that the use of CT scans had already been proven to reduce lung cancer deaths in an observational trial.

“It’s important to remember that the people saying that believed that it would reduce mortality by 90 percent. And this was based on observational studies that only looked at people being screened, had no comparison group of anyone being screened by a different method or not being screened at all,” Church said. He added that some observers said that CT scans wouldn’t save any lives.

“The only way to settle those kinds of controversies is by doing a large randomized clinical trial. … We found out that the answer was somewhere in the middle. There was an effect. It wasn’t 90 percent; it was only 20 percent.”

About the study

The National Lung Screening Trial (NLST), a randomized national trial involving more than 53,000 current and former heavy smokers aged 55 to 74, compared the effects of two screening procedures for lung cancer — low-dose helical computed tomography (CT) and standard chest X-ray — on lung cancer mortality and found 20 percent fewer lung cancer deaths among trial participants screened with low-dose helical CT. The NLST was sponsored by the NCI, a part of the National Institutes of Health, and conducted by the American College of Radiology Imaging Network (ACRIN) and the Lung Screening Study group.

The University of Minnesota School of Public Health is by far the largest of the study sites, with about 6,600 participants who have been screened and followed up for the past eight years.

A fuller analysis, with more detailed results, will be prepared for publication in a peer-reviewed journal within the next few months. Participants at the University of Minnesota site are being notified individually of the findings by the study’s investigators.

Starting in August 2002, the NLST enrolled about 53,500 men and women who were 55 to 74 years old at the time. Participants were required to have a smoking history of at least 30 pack-years and were either current or former smokers without signs, symptoms, or history of lung cancer. Pack-years are calculated by multiplying the average number of packs of cigarettes smoked per day by the number of years a person has smoked.

Participants were randomly assigned to receive three annual screens with either low-dose helical CT (often referred to as spiral CT) or standard chest X-ray. Helical CT uses X-rays to obtain a multiple-image scan of the entire chest during a 7 to 15 second breath-hold. A standard chest X-ray requires only a sub-second breath-hold but produces a single image of the whole chest in which anatomic structures overlie one another. Previous efforts to demonstrate that standard chest X-ray examinations can reduce lung cancer mortality have been unsuccessful.

The trial participants received their screening tests at enrollment and at the end of their first and second years on the trial. The participants were then followed for up to another five years; all deaths were documented, with special attention given to the verification of lung cancer as a cause of death. There were 354 deaths from lung cancer among participants in the CT arm of the study, whereas 442 lung cancer deaths occurred among those in the chest X-ray group.

An ancillary finding, which was not the main endpoint of the trial’s design, showed that all-cause mortality (deaths due to any factor, including lung cancer) was 7 percent lower in those screened with low-dose helical CT than in those screened with chest X-ray. Approximately 25 percent of deaths in the NLST were due to lung cancer, while other deaths were due to factors such as cardiovascular disease. Further analysis will be required to understand this aspect of the findings more fully.

The NCI and its partners, including the University of Minnesota, conducted this trial to obtain the most reliable results possible regarding the benefits of lung cancer screening. Researchers at the University, at NCI, and elsewhere will begin to use the extensive data from this trial to conduct further analyses and propose clinical guidelines and policy recommendations for lung cancer screening.

The possible disadvantages of helical CT include the cumulative effects of radiation from multiple CT scans; surgical and medical complications in patients who prove not to have lung cancer but who need additional testing to make that determination; and risks from additional diagnostic work-up for findings unrelated to potential lung cancer, such as liver or kidney disease.

In addition, the screening process itself can generate suspicious findings that turn out not to be cancer in the vast majority of cases, producing significant anxiety and expense. These problems must, of course, be weighed against the advantage of a significant reduction in lung cancer mortality.

It should also be noted that the population enrolled in this study, while ethnically representative of the high-risk U.S. population of smokers, was a highly motivated and primarily urban group that was screened at major medical centers. Thus the results may not accurately predict the effects of recommending low-dose helical CT scanning for other populations.

More information

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