AJPH September 2016 Highlights

Date: Sep 15 2016

AJPH Research: Blood lead levels in children, medical marijuana and opioids, e-cigarette advertising

CONTACT: For copies of articles or full table of contents of an issue, contact Mandi Yohn via email or 202-777-2509.

American Journal of Public Health highlights:

1. Children in federally assisted housing have lower blood lead levels than expected

2. States with operational medical marijuana laws show reductions in opioid use

3. Majority of e-cigarette advertisements imply products help consumers quit smoking

Children in federally assisted housing have lower blood lead levels than expected

According to a new study in the American Journal of Public Health, U.S. children living in federally assisted housing have lower blood lead levels than comparable children who did not receive housing assistance.

Researchers examined data for National Health and Nutrition Examination Survey respondents from 2005-2012 that were linked to 1999-2014 records from the Department of Housing and Urban Development. For households that fell within less than 2 times the national poverty threshold, they compared blood lead levels of children ages 1-5 living in assisted-housing with those of children who did not receive assisted-housing.

Results showed that in unadjusted analyses, blood lead levels for children living in federally assisted housing were not significantly different than children who did not receive housing assistance. However, after adjusting for potential confounding factors – including demographic, socioeconomic and family characteristics – children living in federally assisted housing had lower blood lead levels than their non-assisted housing counterparts.

“In a nationally representative sample of US children 1 to 5 years old in 2005 to 2012, children receiving federal housing assistance had lower blood lead levels than expected given their demographic, socioeconomic and family characteristics," the authors explain. "This study adds to the literature describing how factors related to housing conditions and stability are associated with health among U.S. children and can help inform future research.”

[“Housing Assistance and Blood Lead Levels in Children in the United States, 2005-2012.” Contact: Katherine Ahrens, Office of Population Affairs, Rockville, Maryland.]

States with operational medical marijuana laws show reductions in opioid use

According to a new study in the American Journal of Public Health, states with operational medical marijuana laws showed a reduction in opioid positivity among 21- to 40-year-old fatally injured drivers, indicating a potential reduction in opioid use and overdose.

Researchers analyzed 1999-2013 Fatality Analysis Reporting System data from 18 U.S. states that tested for alcohol and other drugs in at least 80 percent of drivers who died within one hour of crashing. They compared opioid positivity among drivers crashing in states with an operational medical marijuana law – such as allowances for home cultivation or active dispensaries – versus drivers crashing in states before those laws went into effect.

Results showed that among 21- to 40-year-old deceased drivers, crashing in states with an operational medical marijuana law was associated with lower odds of testing positive for opioids than crashing in these states before the laws were operational. Results also showed an overall reduction in opioid positivity for most states after implementation of an operational medical marijuana law.

“In theory, we would expect the adverse consequences of opioid use to decrease over time in states where medical marijuana use is legal, as individuals substitute marijuana for opioids in the treatment of severe or chronic pain,” the authors explain. “As states with these laws move toward legalizing marijuana more broadly for recreational purposes, future studies are needed to assess the impact these laws may have on opioid use.”

[“State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers.” Contact: June Kim, MPhil, MHS, Department of Epidemiology, Columbia University, New York, New York.]

Majority of e-cigarette advertisements imply products help consumers quit smoking

The majority of leading e-cigarette brands use cessation themes in their advertisements that imply the products help consumers quit smoking, according to new research in the American Journal of Public Health.

Researchers analyzed the content of advertising by e-cigarette brands on company-sponsored social media channels and blogs and user testimonials appearing within brand-sponsored websites. They then assessed claims of cessation efficacy as explicit – unambiguously stating that e-cigarettes help consumers quit smoking – or implicit – using euphemisms such as “it works.”   

Results showed that among 23 leading e-cigarette brands, 22 used cessation-themed advertisements. Overall, 23 percent of the total advertisements from those brands contained cessation claims, of which 18 percent were explicit and 82 were implicit.

“Given the lack of scientific evidence regarding cessation efficacy, there is no rational basis for e-cigarette brands to assert cessation efficacy when advertising their products,” the authors explain. “It is conceivable that future technical advances and chemical modifications may achieve nicotine delivery similar to combustible cigarettes. If and when a specific e-cigarette brand can present data supporting its efficacy as a cessation device, the product should be subject to FDA regulation as a drug, device, or combination product requiring prior approval.”

[“Leading-Brand Advertisement of Quitting Smoking Benefits for e-Cigarettes.” Contact: Robert Jackler, MD, Stanford University, School of Medicine, Stanford, California.]

Find a full list of research papers published online on Sept. 15, 2016, at 4 p.m. EDT below:

  • Lack of Cost-Effectiveness Analyses to Address Healthy People 2020 Priority Areas
  • Penn Center for Community Health Workers: Step-by-Step Approach to Sustain an Evidence-Based Community Health Worker Intervention at an Academic Medical Center
  • From Compassionate Conservatism to Obamacare: Funding for the Ryan White Program During the Obama Administration
  • Health Care Use and Spending for Medicaid Enrollees in Federally Qualified Health Centers Versus Other Primary Care Settings
  • Work-Related Depression in Primary Care Teams in Brazil
  • Roles of Health Care Providers and Patients in Initiation of Unnecessary Papanicolaou Testing After Total Hysterectomy
  • Harnessing the Question–Behavior Effect to Enhance Colorectal Cancer Screening in an mHealth Experiment
  • Pediatric Asthma Care Coordination in Underserved Communities: A Quasiexperimental Study
  • Trends in HIV Infection Among Persons Who Inject Drugs: United States and Puerto Rico, 2008–2013
  • Continuing Versus New Prescriptions for Sedative-Hypnotic Medications: United States, 2005–2012
  • Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers
  • Tuberculosis in Jails and Prisons: United States, 2002–2013
  • State Medical Marijuana Laws and the Prevalence of Opioids Detected Among Fatally Injured Drivers
  • A Prospective Study of Social Isolation, Loneliness, and Mortality in Finland
  • Housing Assistance and Blood Lead Levels: Children in the United States, 2005–2012
  • Leading-Brand Advertisement of Quitting Smoking Benefits for e-Cigarettes
  • Moderation of the Relation of County-Level Cost of Living to Nutrition by the Supplemental Nutrition Assistance Program
  • Quality of Care in a Safe-Abortion Hotline in Indonesia: Beyond Harm Reduction

The articles above were published online Sept. 15, 2016, at 4 p.m. EDT by the American Journal of Public Health under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Mandi Yohn at APHA, 202-777-2509, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions Department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30, and online single article access is $22 at www.ajph.org. For direct customer service, call 202-777-2516, or email us.

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities. We strengthen the public health profession. We speak out for public health issues and policies backed by science. We are the only organization that influences federal policy, has a 140-plus year perspective and brings together members from all fields of public health. Visit www.apha.org