Betty C. Jung logo

Blogging since 2000....

Blog Index

Search Betty C. Jung's Web site

Custom Search

Search the Entire Internet

Custom Search

Suggested Citation: Jung, B.C. (2010 - 2023). Betty C. Jung's 2010 Public Health Blog (January - June).
Web document:

    June 30, 2010 - Third Quarter 2010 Begins!

    Well, it is for someone on this big blue planet, but I am still working on EST. As I have been doing for years, I keep the Whats New page fresh by archiving every three months. So, everything on this page for March to June has been moved to its final resting place on my Web site. All March - June blog entries can be found on my Betty's Public Health Blog 2010. Oh, goody, a couple of tweets for the my Twitter page @bettycjung !

  • June 29, 2010 - Peak Heart Rate & Gender

    Just released today, peak heart rate differs by gender, according to new findings released from the St. James Women Take Heart Project. Researchers report, "Whereas the current standard formula for normal maximum heart rate is 220 minus the patient's age, subtracting age times 0.88 from 206 provides a more accurate norm for women." The calculations would be tricky but I am sure sites that provide online target heart rate calculators will be making changes to their tools in the coming months.

    Source: Gulati M, et al "Heart Rate Response to Exercise Stress Testing in Asymptomatic Women: The St. James Women Take Heart Project" Circulation 2010; DOI: 10.1161/CIRCULATIONAHA.110.939249, as reported in

  • June 29, 2010 - Epi Info and OpenEpi In Epidemiology and Clinical Medicine Health Applications of Free Software

    Andy Dean's Epibook

    Graphic Source: DownloadFiles/EpiBook.pdf

    Here's the latest from the "Father of Epi Info" himself, Andrew Dean, " Epi Info and OpenEpi In Epidemiology and Clinical Medicine - Health Applications of Free Software" It is the latest manual for using EpiInfo, the free statistical program that he worked on with colleagues when he was at the CDC.

    This is the best free statistical program around, and I still use it myself. It will do almost everything you need it to do for Public Health work.

    It is available for download here: EpiBook and on my Public Health Software Page, under Epi Info. I must warn that it's 364 pages long.

    Whle you are at it, you should check Andrew Dean's other brainchild which has many free software programs and resources that epidemiologists will appreciate.

  • June 28, 2010 - HbA1C & Race

    People with Type 2 diabetes have a hard time using the glucose in their bodies for energy, and the excessive amounts of circulating glucose end up damaging organs. There are many ways to measure glucose in the body, from fingersticks to blood specimens. Depending on the when the test is done, values can vary widely. Everyone's blood sugar goes up after eating and then gradually goes down as the body uses for energy the glucose from the food eaten. However, blood sugars for people with type 2 diabetes may not go down at all because the pancreas can no longer produce the insulin needed to metabolize the glucose.

    The latest blood test gaining popularity with those who help people manage diabetes is glycated hemoglobin (HbA1c). HbA1c reflects the average level of glucose in a person's body over a 3-month period and was originally used to gauge how well diabetes is being controlled by treatment. However, because its value was not affected by the wide fluctuations that can be seen in daily blood sugar readings, medical practitioners felt that HbA1c would make a good diagnostic measure. "In January 2010, ... the American Diabetes Association (ADA) published a statement that defined HbA1c >6.5% as diagnostic for diabetes and levels of 5.7% to 6.4% as "prediabetes" and a marker of elevated risk for both diabetes and cardiovascular disease."

    Because of the availability of standard measures for what makes for good medical management of disease, diabetes has become the focus of pay for performance initiatives. Such initiatives basically reward those practitioners who are doing a good job with helping their patients manage their diabetes, as evidenced by stellar HA1bc readings. Unfortunately, this may not be as cut and dry as it now seems.

    Researchers report that "HbA1c level may ... be influenced by ... physiologic, environmental, genetic, or socioeconomic factors, including race and ethnicity. For example, uremia, hyperbilirubinemia, hypertriglyceridemia, chronic alcoholism, chronic ingestion of salicylates, and opiate addiction can falsely increase HbA1c results, whereas vitamin C and vitamin E ingestion have also been reported to falsely lower HbA1c results."

    The June 22 Medscape article, "HbA1C Variation by Race Weakens Its Exclusive Diabetes Diagnostic Power" reported, "African Americans have higher levels of glycated hemoglobin (HbA1c) than whites given the same blood glucose concentrations, and the difference is greater as glucose levels go up--that is, there is a gap in mean HbA1c levels between blacks and whites who are normoglycemic by conventional blood glucose criteria, and it's wider among prediabetics and wider still among those with outright diabetes." Researchers suggest "...that physiologic or genetic factors may contribute to racial differences in HbA1c."

    What this basically means is Race will need to be taken into consideration when interpreting HbA1c results, and that such results may need to be adjusted to reflect racial differences. It also means that as much as we would like to have one number that covers it all we may not be there just yet. Check my Diabetes Resources on the Net Page to learn more about diabetes.

    Source: 723961?src=cmenews&uac=81167HX. Original source: Ziemer DC, Kolm P, Weintraub WS, et al. Glucose-independent, black-white differences in hemoglobin A1c levels: a cross-sectional analysis of 2 studies. Ann Intern Med 2010; 152:770-777.

  • June 25, 2010 - Health Literacy Online

    Graphic Source: Web_Guide_Health_Lit_Online.pdf

    If you want to be heard, you need a presence on the Web. That's why there are millions of Web sites. But, if you are interested in conveying a message than just having a presence then you have to think about your audience.

    The Office of Disease Prevention and Health Promotion (ODPHP) just released an online manual called Health Literacy Online - A guide to writing and designing easy-to-use health Web sites . This is a truly useful guide for anyone involved in developing Web sites to educate the public about health matters. Not only do you have to consider the literacy of potential visitors, but you really have to keep in mind that Internet use has changed the way people process information and data, especially as they appear on the Web.

    Right now I am reading The Dumbest Generation: How the Digital Age Stupefies Young Americans and Jeopardizes Our Future (Or, Don't Trust Anyone Under 30) , and it pretty much confirms the crisis in Education today, and why keeping things simple is the way to go. More about that when I finish the book and write up a brief review of the book (even though the title probably says it all).

  • June 24, 2010 - Stress Management - Key to Conquering Heart Disease?

    Graphic Source:

    Here is a stress management mind map that I thought was quite succinct in portraying the various strategies one can take to manage stress. Because stress affects us all differently, it would make sense that stress can be handled in different ways as well. If you think about it, many of the unhealthy behaviors people indulged in these days are in response to stress and are risk factors for heart disease (i.e., smoking, drinking, overeating, etc.), so why not learn to handle stress in healthy ways that prevents the development of heart disease? If you notice, unhealthy coping mechanisms are "one size fits all" approaches that do not address what's causing the anxiety, just the physiological expression of the anxiety, such as the uneasy feeling elicited by perceived stress situations.

  • June 23, 2010 - Anxiety and Heart Disease

    In January, 2008, Time reported on a new long-term study published in the Journal of the American College of Cardiology that found "Even after accounting for other mood problems, like depression or anger, and for a whole host of physiological and demographic indicators including age, body mass index, education, blood pressure, cholesterol levels and smoking and drinking habits the effect of chronic anxiety was clear. It was also a stronger risk factor for heart attack than any of the other psychological problems in the study. (Source: article/0,8599,1701335,00.html)

    To be published in the June 29, 2010 issue of the Journal of the American College of Cardiology, "Two new studies firmly establish anxiety as an independent predictor for subsequent coronary heart disease years down the line." Findings include:

    • "...anxiety was associated with the development of incident CHD in initially healthy persons"
    • "...anxious people had around a 25% greater risk of CHD and an almost 50% higher risk of cardiac death over a mean follow-up period of 11.2 years,"
    • "...those with anxiety disorders--as diagnosed by a psychiatrist--were twice as likely to suffer CHD or acute MI, even after adjustment for baseline confounders."
    • Original sources: Roest AM, Martens EJ, de Jone P, et al. Anxiety and risk of incident coronary heart disease. A meta-analysis. J Am Coll Cardiol 2010; 56:38-46.; 2.Janszky I, Ahnve S, Lundberg I, et al. Early-onset depression, anxiety and risk of subsequent coronary heart disease. 37-year follow-up of 49,321 young Swedish men. J Am Coll Cardiol 2010; 56: 31-37, as reported at:

    These findings are not necessarily surprising, but they do provide additional support for the role that mental health plays in the development of heart disease. It has been long known that stress affects the heart "because chronic stress exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of heart attack." (Source:

    Finally, if stress is the underlying culprit, then we really can do something about it. Learning to manage stress positively will probably help in reducing the development of heart disease, which will improve our quality of life.

  • June 18, 2010 - INTERSTROKE: Ten modifiable risk factors explain 90% of stroke risk

    Interstroke 2010

    Graphic adapted from:

    When looking at causes of disease, nothing makes Public Health practitioners more happier than to see the possibility of being able to do something about it. So, identifying modifiable risk factors of disease means opportunities exist for public health education as a means of intervening. In a recent conference, results of the INTERSTROKE study (a standardized, case-control study looking at the importance of established and emerging risk factors for the common stroke subtypes in different regions ) was presented.

    • "Overall, self-reported hypertension was the strongest risk factor for stroke and was stronger for intracerebral hemorrhage than for ischemic stroke. A history of hypertension was associated with a more than 2.5-fold increased risk of stroke. When a stricter definition of hypertension was used blood pressure >160/90 mm Hg the strength of the association increased."
    • "Along with hypertension, current smoking, abdominal obesity, diet, and physical activity accounted for 80% of the global risk of stroke, explaining 80% of the risk of ischemic stroke and 90% of the risk of hemorrhagic strokes. When additional risk factors were included in the model, including diabetes mellitus, alcohol intake, psychosocial factors, the ratio of apolipoprotein B to A1, and cardiac causes (atrial fibrillation or flutter, previous MI, and valve disease), these 10 risk factors accounted for 90% of the risk of stroke. Hypertension, smoking, abdominal obesity, diet, and alcohol intake were the most important risk factors for intracerebral hemorrhagic stroke."
    • " association with total and non-HDL cholesterol for ischemic stroke risk but did observe a strong association between apolipoprotein and HDL-cholesterol levels and the risk of ischemic stroke. Interestingly, the group observed that the reduction in risk of ischemic stroke associated with elevated apolipoprotein A1 and HDL cholesterol was larger than the increase in risk associated with increased levels of apolipoprotein B or non-HDL cholesterol."
    • Citation source:

    Now that you know, you can do something to reduce your risk for stroke. How about, for starters, quit smoking. If you don't smoke, don't start. And, start walking briskly walking (3 to 3.9 miles per hour clip) an hour a day, which will reduce your blood pressure.

    Researchers report "...walking 30 minutes at 50 percent effort was most effective, reducing blood pressure for at least four hours." (Source: CM/ContentDisplay.cfm&CONTENTID=10098 ) And, WebMD reports that "Women who walked at a pace of 3 miles per hour or faster had a 37% lower risk of suffering any type of stroke." (Source: 20100406/brisk-walking-reduces-stroke-risk)

  • June 17, 2010 - Using Observational Studies to Compare Medical Interventions

    AHRQ - Comparing Medical Interventions

    Graphic source: index.cfm/search-for-guides-reviews-and-reports/ ?pageaction=displayProduct&productID=454

    When it comes to looking at the effectiveness of medical interventions, randomized controlled trials (RCTs) are considered the gold standard. In such studies researchers control what happens to whom and when, in a controlled environment. This helps them to draw conclusions based on observations made as to whether or not an intervention works or not. Well, that's the theory. But in real life, people do not live in laboratories, and as much as we would like to think we can control everything, we can't. Think about the Placebo Effect.

    Many times such trials try to control so much that so many variables are excluded from the study that the final conclusions are not very meaningful for the clinicians who may be seeing patients that do not necessarily resemble the selected study population. Add to this that researchers should in theory be building a body of knowledge may not necessarily be interested in added to the work of others, but are interested in blazing a particular niche of their own. In the end there may be many studies but hardly comparable so that meta-analyses performed are viewed with skepticism regarding the statistical methods used to make sense of it all.

    After all, Public Health practitioners have had to make do with the mostly frowned upon research methods of observational studies for years, studies that are largely pooh-poohed by laboratory researchers. But, if observational studies are done well they can provide a wealth of information that can be used to make decisions and policies that affect millions. Let's not forget John Snow, who without the benefit of RCTs, managed to stem the rising deaths from the 1854 England cholera outbreak by removing a water pump, and James Lind, who, a century earlier (1753), made the connection between vitamin C deficiency and scurvy based on basic observations.

    On June 14th, the Agency for Healthcare Research and Quality released Selecting Observational Studies for Comparing Medical Interventions to inform Comparative Effectiveness Reviews (that) are systematic reviews of existing research on the effectiveness, comparative effectiveness, and harms of different health care interventions. I have to say that this is a step in the right direction that incorporates a much needed Public Health perspective to comparing medical interventions.

  • June 16, 2010 - Diabetes & Cancer

    As if it is not enough that about 68% of people with diabetes will eventually die from heart disease ( dm/pubs/statistics/), there is now new research that is suggesting that there might be a cancer link as well.

    In a consensus statement released today by the American Diabetes Association and the American Cancer Society based on expert reviews, "...emerging evidence ... suggests cancer incidence is associated with diabetes as well as certain diabetes risk factors and treatments....Epidemiologic evidence suggests that people with diabetes are at a significantly higher risk of many forms of cancer. Type 2 diabetes and cancer share many risk factors, but potential biologic links between the two diseases are not completely understood.... evidence from observational studies suggests that some medications used to treat hyperglycemia are associated with either an increased or reduced risk of cancer."

    Summary of findings include:

    • "Diabetes (primarily type 2) is associated with an increased risk of some cancers (liver, pancreas, endometrium, colon/rectum, breast, and bladder). Diabetes is associated with a reduced risk of prostate cancer. For some other cancer sites, there appears to be no association or the evidence is inconclusive.
    • The association between diabetes and some cancers may be due in part to shared risk factors between the two diseases such as aging, obesity, diet, and physical inactivity.
    • Possible mechanisms for a direct link between diabetes and cancer include hyperinsulinemia, hyperglycemia, and inflammation.
    • Healthy diet, physical activity, and weight management reduce the risk and improve outcomes of type 2 diabetes and some forms of cancer and should be promoted for all.
    • Patients with diabetes should be strongly encouraged by their health care professionals to undergo appropriate cancer screenings as recommended for all people of their age and sex.
    • The evidence for specific drugs affecting cancer risk is limited, and observed associations may have been confounded by indications for specific drugs, effects on other cancer risk factors such as body weight and hyperinsulinemia, and the complex progressive nature of hyperglycemia and pharmacotherapy in type 2 diabetes.
    • Although still limited, early evidence suggests that metformin is associated with a lower risk of cancer and that exogenous insulin is associated with an increased cancer risk. Further research is needed to clarify these issues and evaluate the possible association of insulin and other diabetes medications with the risk of cancer.
    • Cancer risk should not be a major factor when choosing between available diabetes therapies for the average patient. For selected patients with a very high risk of cancer occurrence (or for recurrence of specific cancer types), these issues may require more careful consideration."
    • Citation source:

    I believe the fundamental problems are poor diet and inactivity. Addressing these two lifestyle issues is the place to break the cycle of developing type 2 diabetes and the poor health outcomes that result - heart disease and cancer.

  • June 15, 2010 - National Action Plan to Improve Health Literacy

    National Action Plan to Improve Health Literacy

    The U.S. Department of Health and Human Services (USDHHS) last month released its National Action Plan to Improve Health Literacy . Here is a little excerpt:

    "According to Healthy People 2010, everyday health promotion and disease prevention activities, along with effective navigation of today's health care system and response to public health alerts and recommendations, require Proficient health literacy. Adults with proficient health literacy skills can perform complex and challenging literacy activities such as integrating, synthesizing, and analyzing multiple pieces of information in a complex document. An example of health material that requires proficient skills is a table of information about health insurance costs based on income and family size. Materials are often written at a reading level too high for most readers, and many health care professionals use only some of the recommended strategies when working with patients with limited health literacy." (p. 7). Graphic & Citation Source: HLActionPlan/pdf/Health_Literacy_Action_Plan.pdf

    I am glad to see that a national action plan has been developed. Health illiteracy is a public health problem because people do not naturally communicate very well. Add to that the complexity of the health care system, the medical jargon and the explosive use of technology in all phases of medical care and you can see why a concerted effort needs to be made to make things as understandable and as simple as possible. Being health literate becomes essential when the average person must make decisions based on the information they receive that can impact life and death.

    I have to stress that "information literacy" is not just a problem of the health care sector alone, poor communication is apparent everywhere today. Not being able to speak in "plain English" (or in the language of the patient/client/customer) plagues most professionals, from lawyers to bankers, to name a few. All the "shortcuts" that professionals use may seem common sense among themselves but in most cases just go over of the top of most people's heads.

    I say this because people would rather nod in assent rather than appear stupid and that is too bad. This is probably one reason why so many people have financial problems because they sunk all their money in investments they did not understand. So, the onus really is on the professional to make an effort to convey clear messages without appearing condescending. This is one of the strengths of those educated in health promotion and health education methods - your audience should frame your message. You can find a link to this great plan on my Health Care Quality Issues Page, under Health Literacy.

  • June 14, 2010 - Gulf of Mexico Oil Disaster on June 12, 2010

    NASA Gulf of Mexico 6/14/2010

    Graphic source: NaturalHazards/view.php?id=44295&src=nha

  • June 14, 2010 - Social Determinants of Children's Health

    Reynolds Barton

    Graphic source:

    The importance of the social determinants of children's health is nicely summarized in this graphic that was included in the Health in Scotland 2006: Annual Report of the Chief Medical Officer. The message is relevant beyond Scotland's borders and probably holds true for most countries today.
    • "We must think of health and well-being holistically as not just the absence of disease, but the positive presence of physical, mental and emotional well-being, the capacity to function independently in society, form satisfying relationships, feel a purpose in life, cope with adversity and have hope and resilience. A child's potential can be represented diagrammatically (see graphic). Throughout life factors act to diminish that potential, whilst others act to promote and protect it. Some examples are illustrated - readers will be able to think of many more."
    • Publications/2007/11/15135302/3

  • June 11, 2010 - Poverty and Unhealthy Behaviors

    CDC - Poverty and Unhealthy Behaviors

    Prevalence of Selected Unhealthy Behavior-Related Characteristics Among Adults Aged ≥18 Years, by Poverty Status* --- National Health Interview Survey, United States, 2005--2007
    Graphic Source:

    Here are some new statistics that the CDC has just published in the MMWR.

    U.S. adults with the lowest family incomes were more likely than adults with the highest family incomes to be current cigarette smokers (28.3% versus 15.1%), to be physically inactive (57.5% versus 27.8%), to be obese (28.8% versus 22.1%), and to sleep ≤6 hours in a 24-hour period (31.7% versus 25.9%). Smoking and physical inactivity showed the steepest declines with increasing income. In contrast, the percentage of adults who had five or more alcoholic drinks in 1 day in the past year was lowest among adults with family incomes below (17.2%) or near the poverty level (17.3%) and highest among adults in the highest family income group (23.6%).
    Source: Schoenborn CA, Adams PF. Health behaviors of adults: United States 2005--2007. Vital Health Stat 2010;10(245).

    More data available at Health Behavior Statistics,

  • June 10, 2010 - Harris Poll; National Satisfaction

    May 2010 Harris Poll about American Life

    Graphic source:

    Here is the latest findings from a May 2010 Harris poll that asked what Americans considered to be positive aspects of American life.

    It's good to see that "quality of life" came in third, but when you think about it, it's quite an elusive concept that is variously defined.

    Nevertheless, it's somewhat sad to see that the health care system only got 33% of positive ratings, which is only slightly higher than for the economic system, which is at 28% (which can be expected, given the state of the economy these days).

  • June 10, 2010 - Why the World Has to be Smoke-Free

    EPA - ETS in the Home

    Graphic source:

    Looking at this graph from the EPA, which depicts data from 1994 to 2003, one would think that things are getting better - fewer children are being exposed to environmental tobacco smoke. Unfortunately, this is really not the case.

    In the June 7th Medpage Today report, "Smoke Exposure for Kids Lower Where Smoking Banned," based on 1999-2006 NHANES data, smoking bans do not benefit children who live with smokers.

    Here are some of the findings from the Pediatrics article:

    • "...smoke-free laws are an effective strategy for reducing cotinine in youth without home secondhand smoke exposure,..."
    • "About one-fifth (21%) of children came from a smoking home, and nearly all (98%) of these children had detectable levels of cotinine. Fewer than half (45.4%) of children from nonsmoking homes had detectable levels."
    • Source: Dove M, et al "Smoke-free air laws and secondhand smoke exposure among nonsmoking youth" Pediatrics 2010; DOI: 10.1542/peds.2009-3462, as reported in Medpage Today,

    According to the U.S. Surgeon General 2006 report, "There is no risk-free level of exposure to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent."
    A May 1997 Circulation article reported "constant exposure to environmental tobacco smoke in the workplace or home nearly doubled the risk of having a heart attack."
    And, in 1992, AHA's Council on Cardiopulmonary and Critical Care "urged that environmental smoke be treated as an environmental toxin, and that ways be found to protect workers and the public from this health hazard."

    So, while smoke bans at the workplace may be benefiting people in those environments, the most vulnerable citizens in our society, children, continue to be subjected to environmental tobacco smoke that will compromise their health for years to come. It's time to think about working towards a smoke-free world.

  • June 9, 2010 - Liquid Calories Add Up!

    From the "Eat This, Not That" archives, comes "Sip Your Way to a Flat Belly!" with some easy ideas for cutting calories on the liquid side (and how much weight you can lose, wow!)....

    • Step 1: Swear Off the Soda and Iced Tea
      (Annual Weight Loss: 18 Pounds!)
    • Step 2: Drink 8 Cups of Water Every Day
      (Annual Weight Loss: 26 Pounds!)
    • Step 3: Enjoy One, Two, or Even Three Yogurt-Based Smoothies a Day
      (Annual Weight Loss: 10 Pounds!)
    • Step 4: Avoid Juice Drinks
      (Annual Weight Loss: 19 Pounds!)
    • Step 5: Drink Coffee, Not Coffee Drinks
      (Annual Weight Loss: 18 Pounds!)
    • Source:
  • June 8, 2010 - BMI and Type 2 Diabetes

    BMI and Type 2 Diabetes

    Graphic source:

    Here is a graph that shows the impact of BMI on the development of type 2 diabetes.

    Basically, the more weight you put on the greater the risk for developing diabetes. However, note that for every BMI category, women are at a higher risk for developing diabetes than men.

    BMI (Body Mass Index) Categories

    • Underweight = <18.5
    • Normal weight = 18.5-24.9
    • Overweight = 25-29.9
    • Obesity = BMI of 30 or greater
    • Source:

    So, Ladies, losing the weight will really help in reducing your risk for developing type 2 diabetes.

  • June 6, 2010 - Pregnant Women's BMIs and Caesarean Sections

    6/6/2010 NY Times

    Graphic source:

    Today's New York Times article,"Growing Obesity Increases Perils of Childbearing" confirms what I just posted yesterday - obesity does impact our quality life. Here are some quotes from this report,
    • "About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies."
    • "Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth."
    • "Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows."
    • "Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health."
    • "
    • Citation source:

    After reading this, I am beginning to wonder how obesity will be affecting infant mortality rates, and what that says about the health status of countries that have to deal with the rising weights of their citizens.

  • June 5, 2010 - More Americans Are Becoming Obese and Extremely Obese...

    NCHS Data -

    Graphic source:

    NCHS Data -

    Graphic source:

    In the June 4th NCHS Health E-Stat: Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976-1980 Through 2007-2008, the news is not good. Analyzing two different national data sources, the National Center for Health Statistics (NCHS) has reported that more Americans are becoming obese and extremely obese than just being overweight.

    Of course, you don't need these graphs to tell us that, just look around you. Soon the norm for what's considered average will shift to those who are overweight, and chronic diseases will be just a part of living, and the health care system will still not be able to meet the needs of the growing numbers of people who will need services (at younger ages) because they have not been living healthy and taking care of themselves.

    If this scenario bothers you like the way it bothers me, and the world as depicted in the film Wall-E seems too plausible, then make the choice to change to improve your quality of life. I'm doing my part, and so can you! Change these disturbing trends. It is never too late to

    Eat healthy and exercise Stretching is good Stationary bike Even cats exercise!
  • June 4, 2010 - Kaiser Family Foundation's Conducting Research with Online Query Tools Video Tutorial

    Conducting Research with Online Query Tools
Video Tutorial

    Graphic adapted from:

    The Kaiser Family Foundation has just released a very helpful video tutorial that provides a nice overview of what it's like today to manage the overwhelming sources of data that are now available to you.

    If you want, you can download the slides and print out the notes that accompany the slides. The notes are comprehensive and do add to the content on the slides. You can find a link to this tutorial on my Research Resources on the Internet Page.

    Epidemiologists and research analysts today have it so easy, they really do. When I first started as an epidemiologist I had to learn a lot about database management, and pretty much spent the bulk of my time doing just that, which involved creating databases, cleaning the data, etc. It was like icing on the cake to actually get to analyze the data and make something of what was being collected.

    These days, thanks to the National Center for Health Statistics and many other federal agencies working on Public Health issues, public health data are freely available for analysis and distribution. Of course, new skills are necessary to make the most of such available data. Though the data may be freely available, they are in formats that require some knowledge of available online data query tools to retrieve the data that are there.

    When we used to have more control over the quality of the data (not that what is available is not of good quality, but how many people actually read the design and methods and other technical sections of the national statistical reports?), we were better able to understand the nuances of what was being collected and that informed our analyses and how to best interpret and represent what we were trying to study. Thus, the ease with which data can be had these days may have eliminated the mundane tasks associated with data management, but at the same time has somewhat dampen the appreciation one should have for what data are. It's like health services researchers using administrative databases to look at healthcare quality outcomes. Not exactly the best match or the most appropriate use of such data but the data are there.

    I believe that the danger of misinterpreting data will rise unless those who handle data take the time to learn the basics of research methodology and ethics, data management and data quality so they can analyze and interpret data intelligently. It's one thing to have to decide what data need to be collected, and another thing to have so much that one must choose carefully what is appropriate to use for the tasks at hand.

  • June 4, 2010 - Hurricane Season Again!

    Hurricane Katrina 2005

    Graphic source:

    June 1st heralds the start of another hurricane season, which will last for 6 months!

    The Agency for Healthcare Research and Quality developed a useful Webpage entitled, "Tools and Resources to Help Communities Prepare for Hurricane Season" that brings together all the resources currently available for communities that need to prepare for the possibility of dealing with this natural event, which could be disastrous.

    If we have learned anything from 2005's Hurricane Katrina, it is always better to plan for disaster than to stand by and let it take its toll. You can find a link to this page and other disaster preparedness information at Emergency Preparedness/Disaster Planning .

  • June 3, 2010 - Inflammation and Heart Disease

    HDL and LDL

    Graphic source:

    The good cholesterol/bad cholesterol dichotomy has asserted for many years that HDL is the good cholesterol and LDL the bad cholesterol. Most studies to date have found those with low HDL levels (men <40 mg/dL, women <50 mg/dL) had poorer cardiovascular outcomes than those with normal and higher HDL levels. To date, most medications that treated high cholesterol targeted LDL by lowering LDL levels.

    However, recent pharmaceutical advances to raise HDL with drugs have proven disappointing, as in the development of torcetrapib, an experimental drug designed to increase levels of HDL cholesterol. The study was halted in 2006 because of an excessive number of cardiovascular events and death.
    Here is a graphic that shows higher HDL levels do reduce cardiovascular events in those with high LDLs, but if you look closely, the relationship isn't so linear among those with LDLs greater than 100 mg/dL.

    CRP and HDL More recent research into the role of HDL may set the stage for a better understanding of how HDL works. A recent study has found:

    "Patients in the high-risk subgroup were characterized as having high levels of C-reactive protein (CRP), a well-known marker of inflammation, in addition to high HDL cholesterol. Study authors believe genetics and environmental factors, particularly inflammation, influence whether high levels of HDL cholesterol are protective or if they increase cardiovascular risk in individual patients. Given an inflammatory environment, an individual's unique set of genes helps determine whether HDL cholesterol transforms from a good actor to a bad actor in the heart disease process."

    Using a graphical data mapping tool known as "outcome event mapping" researchers can show how patients who had elevated levels of HDL cholesterol placed them in a high-risk category for coronary events, based on their CRP levels.

    I am sure that this is just a start of innovative research studies looking into the pathogenesis of cardiovascular disease. But, I have found in all my readings of the scientific literature regarding this issue, it really all comes down to inflammation and endothelial dysfunction.

    Graphic and citation source:

  • June 2, 2010 - Trying some Twitter apps...

    Because I have two Twitter accounts: @bettycjung and @pch201wellness, (my ongoing class project to populate the Net with health and wellness facts), I have decided to look into how to disseminate the tweets. Of course, brevity is key to Twitter's success, while at the same time, something is lost in the process (reflection, rumination, etc).

    Nevertheless, I am trying 2 new applications. One is from Twittermeme which allows people to retweet my blog entries, and the other is a code snippet that allows people to go directly to their Twitter account to share what they have read. Of course, these applications are based on the assumption that you have a Twitter account to begin with. Fortunately, you can create one for free. Oh, well, never hurts to try something new....

  • June 1, 2010 - May 26th's GAO Report on Herbal Dietary Supplements

    On May 26th, the General Accounting Office released its report, Herbal Dietary Supplements: Examples of Deceptive or Questionable Marketing Practices and Potentially Dangerous Advice. FINALLY, something is being done about the dietary supplement industry's practices.

    Here is the summary of this report, in its entirety...

    • "Recent studies have shown that use of herbal dietary supplements--chamomile, echinacea, garlic, ginkgo biloba, and ginseng--by the elderly within the United States has increased substantially. Sellers, such as retail stores, Web sites, and distributors, often claim these supplements help improve memory, circulation, and other bodily functions. GAO was asked to determine (1) whether sellers of herbal dietary supplements are using deceptive or questionable marketing practices and (2) whether selected herbal dietary supplements are contaminated with harmful substances. To conduct this investigation, GAO investigated a nonrepresentative selection of 22 storefront and mail-order retailers of herbal dietary supplements. Posing as elderly consumers, GAO investigators asked sales staff (by phone and in person) at each retailer a series of questions regarding herbal dietary supplements. GAO also reviewed written marketing language used on approximately 30 retail Web sites. Claims were evaluated against recognized scientific research published by the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). GAO also had an accredited lab test 40 unique popular single-ingredient herbal dietary supplements for the presence of lead, arsenic, mercury, cadmium, organichlorine pesticides, and organophosphorous pesticides.

    • Certain dietary supplements commonly used by the elderly were deceptively or questionably marketed. FDA statutes and regulations do not permit sellers to make claims that their products can treat, prevent, or cure specific diseases. However, in several cases, written sales materials for products sold through online retailers claimed that herbal dietary supplements could treat, prevent, or cure conditions such as diabetes, cancer, or cardiovascular disease. When GAO shared these claims with FDA and the Federal Trade Commission (FTC), both agreed that the claims were improper and likely in violation of statutes and regulations. In addition, while posing as elderly customers, GAO investigators were often told by sales staff that a given supplement would prevent or cure conditions such as high cholesterol or Alzheimer's disease. To hear clips of undercover calls, see Perhaps more dangerously, GAO investigators were given potentially harmful medical advice. For example, a seller stated it was not a problem to take ginkgo biloba with aspirin to improve memory; however, FDA warns that combining aspirin and ginkgo biloba can increase a person's risk of bleeding. In another case, a seller stated that an herbal dietary supplement could be taken instead of a medication prescribed by a doctor. GAO referred these sellers to FDA and FTC for appropriate action. GAO also found trace amounts of at least one potentially hazardous contaminant in 37 of the 40 herbal dietary supplement products tested, though none in amounts considered to pose an acute toxicity hazard. All 37 supplements tested positive for trace amounts of lead; of those, 32 also contained mercury, 28 cadmium, 21 arsenic, and 18 residues from at least one pesticide. The levels of heavy metals found do not exceed any FDA or Environmental Protection Agency (EPA) regulations governing dietary supplements or their raw ingredients, and FDA and EPA officials did not express concern regarding any immediate negative health consequences from consuming these 40 supplements. While the manufacturers GAO spoke with were concerned about finding any contaminants in their supplements, they noted that the levels identified were too low to raise any issues internal product testing."
    • Citation Source:

    This issue of unregulated dietary supplements has been of particular interest to me since I spearheaded, as a toxic hazards epidemiologist for the State of Connecticut, a multi-state investigation into a folk remedy pill that was used for managing menstrual cramps. Eventually, these pills were found to be contaminated with lead. To read more about this, check the 1999 MMWR Koo Sar Pills Epidemiological Investigation Report and How Koo Sar Pills information was disseminated.

    I also wrote about the misuse of dietary supplements in my analysis of the FDA 2008 Health and Diet Survey - Table G1 results, in my March 4, 2010 Entry.

    Summary from that posting: In essence, survey results show that people think the government is testing supplements for their safety (and it is not, FDA only monitors safety AFTER they have been on the market), so people are using them to treat themselves. If that's the case, then how come almost 3/4s of the people responding don't feel that these products are safe? There is some disconnect here, and I would just have to re-emphasize that this should give cause for the FDA to look into regulating the dietary supplement industry. Once people start using supplements for treatment, then I think they are using supplements as medications, and as medications these products can be regulated by the FDA.

  • May 28, 2010 - Could it be the sodium rather than the sugar?

    A recent published study in Circulation , "Reducing Consumption of Sugar-Sweetened Beverages Is Associated With Reduced Blood Pressure. A Prospective Study Among United States Adults" that was reported in Medpage Today, researchers contend that "Cutting down on sugar-sweetened soft drinks was associated with a drop in blood pressure."

    Losing weight has been found to lower blood pressure ( ), as well as reducing salt intake( ).

    While cutting out sodas is beneficial to health, I am not so sure that it is the reduction in sugar intake, as these researchers contend, is the reason for the reduction in blood pressure, which could well be attributed to weight loss and/or reduced sodium intake. I do not agree with these researchers on their conclusions unless they can rule out the possibility of confounding associated with sodium intake. Because sodium is present in practically all sodas ( , this simple fact should have been accounted for in their sub-analyses.


  • May 27, 2010 - Trans Fats Are Bad For You!

    The war on trans fats is heating up, and not a moment too soon. Found in practically all processed foods and fast foods, trans fats damage the vascular system and contribute to heart disease. Watch this video and learn about trans fats.

    And, look at this!!

    Major Food Sources of Trans Fat for American Adults (Average Daily Trans Fat Intake is 5.8 Grams or 2.6 Percent of Calories)

    Pie chart of trans fats sources

    Graphic source:

    To learn more, check out Nutrition - Trans Fats

  • May 26, 2010 - Diet & Exercise and Cholesterol


    Graphic source: health/healthguide/choesterol_ess.html

    Hyperlipidemia is considered a common risk factor for the development of cardiovascular disease. American Family Physician's May 1st "Diet and Exercise in the Management of Hyperlipidemia" article presents a meta-analysis of what has been found to be effective in managing hyperlipidemia. Pertinent findings include:
    • "...dietary approaches tend to lower total cholesterol, LDL cholesterol, and triglyceride levels, and exercise tends to raise HDL cholesterol levels and lower triglyceride levels."
    • "Exercise plus a low-saturated fat diet reduced LDL cholesterol levels by 7 to 15 percent and triglyceride levels by 4 to 18 percent, while increasing HDL cholesterol levels by 5 to 14 percent."
    • "Exercise plus nutritional supplements (fish oil, oat bran, plant sterols) reduced LDL cholesterol levels by 8 to 30 percent and triglyceride levels by 12 to 39 percent, while increasing HDL cholesterol levels by 2 to 8 percent. Therefore, combining diet and exercise interventions seems additive, or at least synergistic."
    • "Decreased intake of saturated and trans fats, increased intake of poly- and monounsaturated fats, moderate alcohol intake, supplementation with plant sterols or stanols, and isocalorically increased consumption of tree nuts are likely to produce the most beneficial changes in lipid levels. The Portfolio Diet and Mediterranean Diet are worth recommending as alternatives to an unenhanced TLC diet. Aerobic exercise confers additional benefits if done on a regular basis."
    • Citation source: 2010/0501/p1097.html

    For more information about cholesterol, see Cholesterol .

  • May 23, 2010 - The Hazards of Visceral (Belly) Fat

    Belly Fat

    Graphic source: news/fullstory_99022.html

    Belly Fat

    Graphic source: Blueprint/Page.aspx?pageId= 221&tabindex=5

    Visceral fat, or belly fat, contributes to what is commonly known as abdominal obesity or central adiposity. Regardless of what it is called, it is now recognized as a risk factor for a growing number of diseases. As early as 2001,"Abdominal obesity is an independent risk factor for coronary heart disease in middle-aged men and even more important than overall obesity." ( content/23/9/706.short).

    In 2006, researchers reported "...intra-abdominal adiposity associated with abdominal obesity increases cardiometabolic risk directly, via altered secretion of adipokines, and indirectly, via promotion insulin resistance, diabetes and the cluster of cardiometabolic risk factors associated with the metabolic syndrome. ( content/8/suppl_B/B20.short)

    In 2008, researchers reported "The association between abdominal obesity and diabetes, which is well documented, has been mainly explained by the lower insulin sensitivity of subjects with excess visceral fat... (in which)several molecules released in greater or lower amount by visceral adipocytes can exert also a detrimental role on beta-cell function. Visceral obesity is also associated with an excessive depot of triglycerides and other lipid products (e.g., ceramide) within the key organs of glucose metabolism (liver, skeletal muscle, pancreatic islets). This phenomenon seems to contribute to both insulin resistance and beta-cell dysfunction, favoring abnormalities of glucose homeostasis." (

    And on May 20th, researchers reported that middle-age patients with lots of visceral fat was significantly associated lower brain volume and that obesity in midlife has been associated with an increased risk of dementia. A possible explanations for this association may be that "obesity is highly associated with inflammatory markers. Cytokines such as interleukin-6 and tumor necrosis factor alpha, for example, are produced in adipose tissue, and it also contains inflammatory monocytes and macrophages." (Debette S, et al "Visceral fat is associated with lower brain volume in healthy middle-aged adults" Ann Neurol 2010; DOI: 10.1002/ana.22062, as reported at: AlzheimersDisease/20201?utm_content=GroupCL&utm_medium=email& impressionId=1274420083796& utm_campaign=DailyHeadlines&utm_source=m Spoke&userid=36040)

    This research also suggests the "stronger connection between central obesity, particularly the visceral fat component of abdominal obesity, and risk of dementia and Alzheimer's disease." ( medlineplus/news/ fullstory_99022.html

    Thus, the evidence is growing that visceral fat is bad for your health. While losing visceral fat (through aerobic exercise) will improve your cardiovascular health and help with controlling diabetes, it is too soon to say that losing visceral fat would reduce your risk for Alzheimer's Disease. Nevertheless, losing the fat will definitely make you feel better by not having to carry around all that excess weight. To learn more about visceral fat, see my Obesity Page.

    Tweet This!

  • May 21, 2010 - Carbohydrates (Added Sugars) and Lipids

    Here's another study from the "Oh-no, not this, too" department, a recent JAMA study, based on National Health and Nutrition Examination Survey (NHANES) 1999 -2006, has found:

    • "...increased carbohydrate intake has been linked with dyslipidemia."
    • "...on average, participants obtained 15.8% of their energy intake from added sugars -- 21.4 teaspoons a day containing 359 kilocalories."
    • "...those with the highest consumption of added sugars were more than three times as likely to have LDL-C levels indicative of dyslipidemia.... They were also 20% more likely to have high triglycerides (more than 150 milligrams per deciliter) and 60% more likely to have a high ratio of triglycerides to HDL-C (greater than 3.8)."
    • "...a high intake of such sugars -- mainly sucrose from beets and cane and high fructose corn syrup -- is correlated with some key measures of dyslipidemia."
    • Citation source: Welsh JA, et al "Caloric sweetener consumption and dyslipidemia among US adults" JAMA 2010; 303(15): 1490-97. As reported in Medpage Today's April 20, 2010'a "Added Sugar Adds Up to Heart Risk."
  • May 20, 2010 - Processed Meats and Heart Disease and Diabetes

    Processed meats are bad for you!

    Graphic source: ens/mar2009/2009-03-25-02.asp

    In the "Oh-no, not this, too" department, processed meats are now being linked to coronary heart disease and diabetes. In the May 17th Circulation's "Red and Processed Meat Consumption and Risk of Incident Coronary Heart Disease, Stroke, and Diabetes Mellitus. A Systematic Review and Meta-Analysis," researchers report,
    • "...eating 50 g of processed meat per day--the equivalent of one typical hot dog in the US, or two slices of deli meat--was associated with a 42% higher risk of CHD and a 19% increased risk of diabetes."
    • "...processed meats had about four times the amount of sodium and 50% more preservatives, such as nitrates, than the unprocessed red meat."
    • "...processed and unprocessed meats have been associated with a higher risk of some cancers, especially colorectal."
    • "People should definitely give more emphasis to increasing consumption of foods that have been shown to be protective, such as fruits, vegetables, whole grains, fish, and nuts."

      Citation source: Processed Meat, Not Red Meat Per Se, Linked to CHD, Diabetes, from
      Original source: content/abstract/CIRCULATIONAHA.109.924977v1

      You can find a link to this research paper, and other heart disease information, on my Cardiovascular Disease - General Information Page

  • May 19, 2010 - Unemployment & Obesity: Is there a connection?

    CDC - US Obesity Rates, 2004
    CDC - US Obesity Rates, 2005
    CDC - US Obesity Rates, 2006
    CDC - US Obesity Rates, 2007
    CDC - US Obesity Rates, 2008
    Bureau of Labor and Statistics, 2004-2008 Unemployment

    Obesity maps source: obesity/data/trends.html; Unemployment map source: SVotD7fi0EI/AAAAAAAAAFc/ hXp5f4dgUrY/s400/2004+to+2008+ Increase+in+Unemployment+ Rate+by+County.gif

  • Here are the annual obesity trend maps from the CDC covering the same time period (2004-2008) as the "Change of Unemployment Rate" map from the Bureau of Labor and Statistics (2004 - 2008). Certainly, the CDC obesity trend maps do show that more and more states have higher obesity prevalence rates as the years go by. So, is there a connection between unemployment and stress? And, if there is, then what is it?

    An interesting 2007 working paper, WHY THE POOR GET FAT: WEIGHT GAIN AND ECONOMIC INSECURITY found ... over the 12-year period between 1988 and 2000, a one point (0.01) increase in the probability of becoming unemployed causes weight gain over this period to increase by about one pound, and each realized drop in annual income results in an increase of about 5.5 pounds. The mechanism also appears to work in reverse, with health insurance and government social safety net payments leading to smaller weight gains. Source: WorkingPapers/tsmith/Insecurity033007.pdf

    Keep in mind that this study looked at the outcome for "the probablity of becoming unemployed." However, if you look at the stress that comes with being unemployed, then there is plenty support regarding weight gain in response to stress. Who among us have not resorted to comfort foods during times of stress? Check out my Nutrition, Fitness, Obesity and Mental Health - Stress Pages for resources to avoid weight gain when the economy has been mean to you.

  • May 18, 2010 - "Here's the Skinny: Americans Getting Fatter"

    US Obesity Rates, 2008 - 2010 1st Quarter
    WebMD's 5/7 article, "Here's the Skinny: Americans Getting Fatter" summarizes the latest obesity statistics available, and it's not a pretty picture. The trend, for almost all groups is ever upward. I think this unfortunate trend may reflect and has been exacerbated by the state of the economy. I'll need to research this a little bit and maybe post something about what I find.

    Citation and Graphic Source: americans-getting-fatter?ecd=wnl_din_051710

  • May 17, 2010 - Be Healthy and Save $3,448 a Year!

    US Bureau of Labor and Statistics - How We Spend Our Money

    Graphic Source: how-the-average-us-consumer-spends-their-paycheck/

    I was so amazed at these numbers. Just think, the average American family (or, unit) spends $323 on tobacco and $457 on alcohol and $2,668 for food eaten outside the home. If you make a committment to living healthy, by giving up cigarettes and alcohol and cutting out fast foods you can save $3,448 a year!
  • May 16, 2010 - Liquid Calories: 1 pound a week/52 pounds a year!

  • May 16, 2010 - Health Effects of Smoking

    Health Effects of Smoking

    Graphic source:

  • May 15, 2010 - Women, Know the Signs and Symptoms of Stroke!'s Majority of U.S. Women Have Limited Knowledge of Stroke Symptoms, Risks reported on the results of its New HealthyWomen Survey that was conducted with the National Stroke Association and the American College of Emergency Physicians.

    Interesting findings:

    • "Despite the fact that every year more women suffer strokes than men, 68 percent in the survey said they are not aware of this;
    • "One in four women surveyed did not believe stroke can happen at any age;"
    • "Despite the growing prevalence of stroke in women, 71 percent of those surveyed said they are only somewhat or not at all knowledgeable about the risk factors for stroke;"
    • "Women are twice as likely to die from stroke as breast cancer, however women in the survey believed breast cancer is five times more prevalent than stroke and 40 percent of women said they were only somewhat or not at all concerned about experiencing a stroke in their life.
    • Women "... often underestimate their own risks and ignore warning signs of serious health problems like stroke."

    So, here are the six primary symptoms of a stroke :

    • Sudden numbness or weakness on one side of the face or facial drooping;
    • Sudden numbness or weakness in an arm or leg, especially on one side of the body;
    • Sudden confusion, trouble speaking or understanding speech;
    • Sudden trouble seeing in one or both eyes;
    • Sudden trouble walking, dizziness, loss of balance or coordination;
    • Sudden severe headache with no known cause.

    The NSA recommends the F.A.S.T. test as a quick screening tool that can help you identify stroke symptoms:

    • Face - Ask the Person to Smile. Does One Side of the Face Droop?
    • Arms - Ask the Person to Raise Both Arms. Does One Arm Drift Downward?
    • Speech - Ask the Person to Repeat a Simple Sentence. Are the Words Slurred? Can They Repeat the Sentence Correctly?
    • Time If the Person shows Any of These Symptoms, Time Is Important. Call 911 or Get to the Hospital. Brain cells Are Dying.

    Source: majority-us-women-have-limited-knowledge-stroke-symptoms-risks default/files/StrokeSurveyFactSheet.pdf

  • May 15, 2010 - Adult Obesity Prevalence

    Prevalence of Obesity (Class I, II, and III

    Class I obesity defined as a body mass index (BMI: weight [kg] / height [m2]) ≥30 but <35. Class II obesity defined as a BMI ≥35 but <40. Class III obesity defined as a BMI ≥40.

    Graphic source: mmwrhtml/mm5917a9.htm?s_cid=mm5917a9_e

    The MMWR's May 7th "Prevalence of Obesity (Class I, II, and III)* Among Adults Aged ≥20 Years, by Age Group and Sex --- National Health and Nutrition Examination Survey, United States, 2007--2008" notes

    "During 2007--2008, men had a higher prevalence of class I obesity (21.5%) than women (17.8%). However, women had a higher prevalence of class II (10.5%) and class III (7.2%) obesity then men (6.5% and 4.2%). The prevalence of class I obesity significantly increased with age in men, but not in women. The prevalence of class II and class III obesity did not differ significantly by age for either men or women."

    Citation Source: Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults 1999--2008. JAMA 2010;303:235--41

    Check Obesity Statistics for more data sources.

  • May 14, 2010 - U.S. Mortality Statistics, by Race and Ethnicity

    United States Adult Mortality Rates for Cardiovascular Diseases, 2004-2006

    United States Adult Mortality Rates for Common Diseases, 2004-2006

    Here are two interesting bar charts I came across in the U.S. Department of Health and Human Services, Office of Minority Health's The National Plan for Action - Draft as of February 17, 2010. By looking at mortality statistics by race and ethnicity one can see that differences do exist.

    USHHS/OMH reports, "Disparities by geography and socioeconomic status (SES) are typical of both heart disease and stroke. People living in the southeastern U.S. are more likely to die of heart disease or suffer from stroke compared to the rest of the country. Furthermore, there are significant disparities related to SES for heart disease and stroke. For example, individuals who have less than a high school education are three times more likely to report having had a heart attack or stroke than those who are college graduates. Those who earn less than $15,000 per year are nearly four times more likely to report having had a heart attack and more than six times more likely to report having had a stroke than are those who earn more than $50,000 per year."

    "The number of Americans with diabetes tripled from 1980 to 2006, and it is now the sixth leading cause of death in the U.S. About 10 percent of the nation's adults, ages 20 and older, have diabetes, and 37 percent of those with diabetes are aged 65 and older. Racial and ethnic minorities are at high risk for diabetes. Exhibit 2-14 shows that diabetes mortality rates for Blacks were about twice that of Whites between 2004-2006. American Indians and Alaska Natives, as well as Hispanics, also had high mortality rates from diabetes compared to Whites-1.8-fold and 1.5-fold, respectively."

    "Diabetes is also associated with low SES. For example, individuals who have less than a high school education are 2.3 times more likely to report having had a diagnosis of diabetes than those who are college graduates. Those who earn less than $15,000 per year are nearly three times more likely to report having diabetes than those who earn more than $50,000 per year."

    Citation and Graphic Source: npa/images/plan/printplan.html

  • May 13, 2010 - Overweight Children and Teens

    Source: figures/15-Figure-1.gif

    Source: figures/15-Figure-2.gif is a great site if you are looking for data about children and teens. Here are two graphs from the Overweight Children and Youth" page.

    As you can see, over a twenty-five year period, the percentage of children ages 6 - 11 who are overweight TRIPLED; while the percentage more than tripled for teens during the same time periods. (1)

    And, in looking at the gender, race and ethnicity of overweight teens, you can see that African-African teen girls are affected the most. (2)

    Here are a few of their findings regarding overweight children...

    • Children who are overweight are at an increased risk of developing type 2 diabetes, cardiovascular problems, orthopedic abnormalities, gout, arthritis, and skin problems. Childhood obesity has been linked to the premature onset of puberty.
    • In addition, being overweight can negatively affect children's social and psychological development. A recent study found bullying and obesity in children to be positively correlated, with physical activity decreasing as victimization increased.
    • The health threats posed by being an overweight child can be long lasting. Children and adolescents who are overweight are at risk for becoming overweight adults. Overweight adults face many problems due to their weight, such as decreased productivity, social stigmatization, high health care costs, and premature death.
    • In addition, overweight adults are at increased risk for type 2 diabetes, coronary heart disease, elevated blood pressure, stroke, respiratory problems, gallbladder disease, osteoarthritis, sleep apnea, and some types of cancer.
    • Source:
  • May 8, 2010 - Youth Violence Statistics From the CDC

    My previous entry about the NCHS teen violence report was so disturbing that I decided to learn more about teen violence. The CDC has made such statistics readily available to those interested. Just click on this graphic and it will take you to the page with links to Leading Causes of Death; Homicide; Non-Fatal Assaults and Violent Crime Arrests.

    Youth Violence Data. View national and state trends and patterns. Visit for more information.

    This graphic link is also available on my Public Health Data Page, under Violence/Suicide.

    Perhaps, the most disturbing statistics were those for violent crime arrests. According to 2006 data, male youths 15-19 years of age had the highest rate for violent crime arrests that involved murder, non-negligent manslaughter, forcible rape, robbery and aggravated assault.

    2006 Violent Crime Arrests

    Graphic source: youthviolence/stats_at-a_glance/vca_age-sex-06.html

  • May 8, 2010 - What U.S. Teens Are Dying From

    Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006

    Graphic source:

    It is always tragic to look at mortality statistics, but it's heartbreaking when the causes of deaths among young people today are preventable.

    According to the just released May NCHS Data Brief, Mortality Among Teenagers Aged 12-19 Years: United States, 1999-2006, 72% of U.S. teen deaths was caused by unintentional injuries(48%), homicides (12%), and suicides (11%).

    Of the deaths from unintentional injuries, 73% was from motor vehicle accidents. Basically, this means if teens die, they are dying violent deaths. This is truly beyond sad.


  • May 7, 2010 - Women, Take Care of Yourselves!

    May 9 -15, 2010 - Women's Health Week

    Graphic source:

    How nice to see the Surgeon General, Dr. Regina M. Benjamin, stepping up for half of the U.S. population, namely, women! Here is an excerpt:
    • "Mother's Day, May 9, marks the start of National Women's Health Week, a weeklong observance coordinated by the U.S. Department of Health and Human Services Office on Women's Health. With the theme It's Your Time, the goal of National Women's Health Week is to empower women to make their health a top priority and encourage them to take small, manageable steps to improve their health and reduce their risk for many diseases. On Mother's Day, women across the country will celebrate with family and friends. This year, I also encourage women to celebrate themselves by focusing on their health and well-being.
    • The most important steps women can take to improve their health include eating a well balanced, nutritious diet; getting regular physical activity; avoiding unhealthy behaviors, like smoking; and paying attention to mental health. In addition, women should get regular checkups and preventive screenings. May 10 is National Women's Checkup Day, and I urge all women to make an appointment with their health care professional.
    • Source: May 6th E-mail

    So, there you have it. Putting others first is second nature for most women, but sometimes women have to take care of themselves before they can take care of others. You can find links to women's health information on my Women's Health Index Page.

  • May 5, 2010 - May is National Physical Fitness and Sports Month

    National Physical Fitness and Sports Month - Get moving!
    Happy Cinco De Mayo! It is beautiful outside! Now is the time to start getting that blood flowing with some exercise! This is one habit that is good to have and nurture. Fight obesity by getting rid of all that extra weight you've been carrying around that's damaging your heart and ruining your knees! Add years to your life by taking off that excess weight. Click on the graphic and get more information from the Web site.

  • May 4, 2010 - Green Exercise and Mental Health

    San Juan Islands, WA

    Graphic source: ss/visitbellingham_5.htm

    Green exercise (spending time in the great outdoors) is good for your mental health and has a positive impact on health behaviors! According Environmental Science & Technology's "What is the Best Dose of Nature and Green Exercise for Improving Mental Health? A Multi-Study Analysis",
    • "...Evidence shows that exposure to natural places can lead to positive mental health outcomes, whether a view of nature from a window, being within natural places, or exercising in these environments..."
    • ".... green space is important for mental health and regular engagement is linked with longevity and decreased risk of mental ill-health."
    • "...all green environments improved both self-esteem and mood; the presence of water generated greater improvements."
    • "Self-esteem is an evaluation of a person's sense of worth or value, and there are strong positive correlations between self-esteem and health."
    • High levels of self-esteem are associated with healthy behaviors, such as healthy eating, participating in physical activities, not smoking, and lower suicide risks."
    • "Greatest changes come from 5 min of activity, and thus suggest these psychological measures are immediately increased by green exercise."


  • May 3, 2010 - The Prevalence of Chronic Disease Comorbidity

    NCHS Data Brief Number 36, April 2010

    Graphic source:

    NCHS Data Brief
Number 36, April 2010

    Graphic source:

    In the April NCHS Data Brief (Number 36), Hypertension, High Serum Total Cholesterol, and Diabetes: Racial and Ethnic Prevalence Differences in U.S. Adults, 1999-2006 , analysis of the National Health and Nutrition Examination Survey (NHANES) data shows the unfortunate reality of the prevalence of chronic diseases among Americans. Each of the three chronic diseases studied puts an individual at greater risk for heart disease, but there is a growing number of Americans who have more than one of these conditions.

    Though the prevalence of chronic disease comorbidity varied by race and ethnicity, non-Hispanic African Americans have a higher prevalence of hypertension alone and the combination of hypertension and diabetes. Appropriate medical management AND self-management of these conditions are necessary to avoid poor health outcomes, such as heart disease, stroke, amputations, kidney disease, etc. You can find a link to this report on my Health Behavior Data Page and for more information about chronic diseases, check my Chronic Disease Information Page.


  • May 1, 2010 - Physical Inactivity - the Most Prevalent Unhealthy Behavior in the U.S.

    CDC's April 30, 2010 report

    Graphic source: mmwrhtml/mm5916a7.htm

    In MMWR's April 30th "Prevalence of Selected Unhealthy Behavior Characteristics Among Adults ≥ Aged 18 Years, by Race* --- National Health Interview Survey, United States, 2005--2007�" report, one can see that physical inactivity beats out all the other unhealthy behaviors studied, regardless of race and ethnicity.

    Not too surprising that these behaviors (except for obesity, which is not really a health behavior, per se, but what I consider to be the poor health outcome of negative health habits) have been identified by another study as deadly habits, which I talked about in my April 28th blog entry (see below) just 3 days ago. I suppose you know what I am going to say by now -


  • April 30, 2010 - Soda Consumption and Liver Disease

    Medpage Today 4/29/2010

    Graphic Source: Gastroenterology/GeneralHepatology/19825

    Here are additional reasons to give up sodas:
    • "Daily consumption of fructose -- the sugar commonly found in soft drinks -- significantly increased hepatic fibrosis in patients with nonalcoholic fatty liver disease (NAFLD)."
    • "In older patients, daily fructose consumption increased the risk of hepatic inflammation and hepatocyte ballooning."
    • "The rising prevalence of obesity in the U.S. has been accompanied by an increased prevalence of NAFLD."
    • "Several studies have linked both obesity and NAFLD to increased consumption of high-fructose corn syrup, particularly soft drinks. In animal models, fructose induces rapid development of fatty liver and associated leptin resistance, microvascular disease, and vascular inflammation,..."
    • "Excessive dietary consumption of fructose also has been linked to NAFLD in humans."

    To find out more information about high fructose corn syrup and other nutritional information, check out my Nutrition Resources on the Net page

    Original source: Abdelmalek MF, et al "Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease" Hepatology 2010; DOI:10.1002/hep.23535. Citations from at: Gastroenterology/GeneralHepatology/19825

  • April 29, 2010 - Don't Blame PowerPoint

    NY Times 4/26/2010

    Graphic Source:

    This graphic appeared in the April 26th New York Times to capture the complexity of the American military strategy, citing General McChrystal saying, �When we understand that slide, we�ll have won the war,� and General Mattis saying, "PowerPoint makes us stupid.�

    Though I never thought I would come to the defense of Microsoft, but blaming PowerPoint is like shooting the messenger. Can you imagine what kind of written document would result were you to try and explain this in words? I dread the thought of being assigned to edit such a document!

    I am all for the big picture perspective, and if this is too complex, then may it's time to simplify the picture, or talk to the genius behind the picture. Whoever came up with the PowerPoint probably understands the problems better than anyone else. I still expect my students to be able to express what they want to say in pictures because it adds clarity to the discussion at hand. And, I would much rather look at a chart (whether it is in PowerPoint or some other program) than a table of numbers anytime.

    Source: We Have Met the Enemy and He Is PowerPoint ttp://

  • April 28, 2010 - Four Deadly Habits

    The four horsemen

    Graphic Source: PrimaryCare/PreventiveCare/

    According to the 4/27 Medpage Today coverage of a recent Archives of Internal Medicine research paper, All-cause mortality risk rose 85% for individuals with any one of these risky health behaviors (poor diet, inactivity, smoking, and excessive drinking) and jumped nearly 3.5 times for those who engaged in all four vices....Piling up all four unhealthy behaviors prematurely aged a person 12 years in terms of death risk."

    The behaviors studied included:

    • Smoking
    • Eating less than three servings of fruits and vegetables a day
    • Getting less than two hours of leisure time physical activity per week
    • Drinking more than 14 eight-gram units of alcohol per week for women (the equivalent of seven 12-ounce cans of beer) or 21 units for men (about 10.5 beers)

    Source reference: Kvaavik E, et al "Influence of individual and combined health behaviors on total and cause-specific mortality in men and women: The United Kingdom Health and Lifestyle Survey" Arch Intern Med 2010; 170: 711-18, as report in Medpage Today.

  • April 26, 2010 - Health Literacy Universal Precautions Toolkit

    Health Literacy Universal Precautions Toolkit

    Graphic Source:

    Just released by the NC Program on Health Literacy, Health Literacy Universal Precautions Toolkit is a 227-page document about the importance of health literacy, and what public health and health care professionals can do to improve communication between professionals and their clients/patients, etc.

    The most unfortunate thing about this document is its title, which is misleading. It really isn't about "universal precautions" as most health care and public health professionals understand the term to be. "Universal precautions," as defined by CDC, are a set of precautions designed to prevent transmission of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other bloodborne pathogens. (Citation source: dhqp/bp_universal_precautions.html)

    Despite the title, this document is worth looking into by those who are actively involved with health education and health promotion. The real question is - are you getting the message you are conveying across the way it should be understood? You can find a link to this document on my Health Care Quality Issues Page, under "Health Literacy."

  • April 25, 2010 - CDC's Tobacco Control State Highlights 2010

    CDC Tobacco Control State Highlights 2010 report

    Graphic Source: data_statistics/state_data/state_highlights/2010/pdfs/highlights2010.pdf

    According to its 4/22 CDC E-mail announcement regarding its new report,"Tobacco Control State Highlight 2010," this new report not only gives a state-by-state snapshot of efforts to cut tobacco use, but also showcases strategies that are reducing smoking, lowering smoking-related disease, and saving lives. .

    Before you print, just be aware it is 245 pages long. You can find a link to this report on my Evaluation and Report Cards Page and Health Behavior Data Page.

  • April 22, 2010 - Earth Day 2010
    We are stewards of the Earth

    Graphic source:

  • April 22, 2010 - Salt Intake and Health

    In Medpage Today's April 20th report, "Regulate Salt, IOM Says," the Institute of Medicine (IOM) is asking the FDA to regulate the amount of salt added to foods and gradually decrease sodium content as American palates adjust to the change. "The goal is to slowly, over time, reduce the sodium content of the food supply in a way that goes unnoticed by most consumers as individuals' taste sensors adjust to the lower levels of sodium,"... The IOM wants the FDA to amend the level of salt consumption generally recognized as safe (GRAS) to a safer one. Currently, the agency recommends no more than 2,300 mg per day, which amounts to about a teaspoon. Most Americans, however, get 50% more than that, or about 3,400 mg per day."
    Citation source:

    According to the American Heart Association, High salt diets have been linked to an increase in blood pressure and an increased risk for a number of cardiovascular diseases including heart disease and stroke.
    Citation Source:

    In CSPINET's "Fast Food '05" fact sheet, you can see that most fast food products contain excessive amounts of sodium. You can easily exceed the 2,300 mg daily limit by eating Wendy's Classic Triple with Cheese, Great Biggie Fries, Biggie Cola (2,630 mg),or, Whopper with Cheese, large Fries, large Coke (2,330 mg); and close to exceeding with McDonald's McNuggets (20,111/2 oz.) (2,240 mg).

    Perhaps, more importantly, sodium consumption by children and adolescents has been studied in 2008 by researchers looking at soda consumption. They concluded: .... salt is a major determinant of fluid and sugar-sweetened soft drink consumption during childhood. If salt intake in children in the United Kingdom was reduced by half (mean decrease: 3 g/d), there would be an average reduction of 2.3 sugar-sweetened soft drinks per week per child. A reduction in salt intake could, therefore, play a role in helping to reduce childhood obesity through its effect on sugar-sweetened soft drink consumption. This would have a beneficial effect on preventing cardiovascular disease independent of and additive to the effect of salt reduction on blood pressure.
    Citation source: Salt Intake Is Related to Soft Drink Consumption in Children and Adolescents A Link to Obesity? (Hypertension. 2008;51:629.) 2008 American Heart Association, Inc.

    Giving up fast food and soda will definitely help you stay below the 2,300 mg salt limit as well as reduce intake of such bad stuff as saturated fats, high fructose corn syrup and refined carbs that contribute to abdominal obesity while saving you money. This is a doable strategy to preventing chronic disease and addressing the obesity epidemic. For more information about sodium intake, see my Nutrition Page .

  • April 21, 2010 - The Costliness of Bad Health Habits

    In the 4/19 Investopedia's article, 6 Things You're Doing to Delay Your Retirement (and, it's never too early to start thinking about retirement...), "Bad Habits" comes in second for delaying retirement. Here are some numbers to think about:

    • "The average price for a pack of cigarettes nationwide is currently $5.00.... Smoking a pack of cigarettes a day will cost you $1,825 per year. Over a 50-year time period, the cost would be $91,250! That figure is based on cigarette prices not rising, which we all know is highly unlikely. New York residents are already paying over $10 for a pack of cigarettes."
    • "While drinking a glass of wine a day may lengthen your life expectancy, imbibing too much alcohol may kill your finances. With the average price of beer running $4, just drinking two bottles of beer a day can cost you $56 a week. That's almost $3,000 a year that could have been used to fund your IRA."
    • Source:

    Of course, saving money is a good incentive to give up bad habits, but why not do it out of respect for yourself? Think of all the things you want to do in life that you can enjoy better as a healthy individual.

  • April 20, 2010 - The Eruption of Iceland's Eyjafjallaj�kull Volcano

    Eyjafjallaj�kull Volcano

    Graphic source: NaturalHazards/view.php?id=43690&src=nha

  • April 19, 2010 - Latest Tidbits About Happiness

    Beach Happy Face

    Graphic source:

    • 12 Activities to boost happiness:
      1. Express gratitude,
      2. Cultivate optimism,
      3. Avoid overthinking,
      4. Practice acts of kindness,
      5. Nurture social relationships,
      6. Develop coping stratgies,
      7. Learn to forgive,
      8. Increase 'flow' experiences - those activities that completely absorb you,
      9. Savor life's joys,
      10. Commit to goals,
      11. Get in touch with your spiritual self,
      12. Take care of yourself through meditation, physical activity and just acting happy.
      Did you know:

    • The US ranks 23rd in happiness among nations. Denmark is #1;
    • Any additional dollars over an annual income over $50,000 doesn't make us much happier;
    • At age 48, men become, on average, more happier than women, but both sexes report increased happiness as they age;
    • Two minutes of focused daily writing can improve physical and psychological health.

    Citation source: Count on Happiness, Arthritis Today, May, June 2010, p. 100

  • April 14, 2010 - Carbohydrates and Heart Disease in Women

    NYT 2004

    Graphic source:

    While this graphic is from 2004, it pretty much shows how carbohydrate consumption has increased over time. Carbohydrate consumption is being blamed for the current obesity epidemic. To be fair, we need carbohydrates because the brain uses only carbohydrates for energy. Perhaps, we need to start thinking smartly about good carbs and bad carbs.

    In BBC's 4/12 report on a recent Archive of Internal Medicine research article notes, "Women who eat diets heavy in certain carbohydrates may be at greater risk of coronary heart disease....women alone whose diets contained a lot of bread, pizza and rice doubled their heart disease risk. These foods have a high glycaemic index (GI), meaning they release energy and raise blood sugar quickly. Thus, a high consumption of carbohydrates from high-glycaemic index foods, rather than the overall quantity of carbohydrates consumed, appears to influence the risk of developing coronary heart disease."
    Citation source:

    So, basically, for women to reduce their risk for heart disease should avoid those carbs that raise sugar rapidly, namely all the white carbs high on the glycemic index. It also means that it wouldn't hurt to get your carbs from colorful fruits and vegetables that are nutrient dense and low in calories. Check out my Diabetes Page for more information about the glycemic index.

  • April 9, 2010 - Childhood Obesity and Type 2 Diabetes

    CDC 2006-2008 data

    Here is a map from the CDC depicting the prevalence of childhood obesity in the U.S. Using 1998−2008 Pediatric Nutrition Surveillance System (PedNSS) data, the CDC in its "Obesity Prevalence Among Low-Income, Preschool-Aged Children 1998-2008" concluded that "One of 7 low-income, preschool-aged children is obese, but the obesity epidemic may be stabilizing. The prevalence of obesity in low-income two to four year-olds increased from 12.4 percent in 1998 to 14.5 percent in 2003 but rose to only 14.6 percent in 2008." This conclusion seems a bit on the optimistic side to me without looking at what happens when obesity is not addressed with young children.

    Map and Citation Source:

    NIDDK Childhood Diabetes

    Using data from the SEARCH for Diabetes in Youth study, the NIDDK reported, "Based on 2002 to 2003 data, 15,000 youth in the United States were newly diagnosed with type 1 diabetes annually, and about 3,700 youth were newly diagnosed with type 2 diabetes annually. The rate of new cases among youth was 19 per 100,000 each year for type 1 diabetes and 5.3 per 100,000 for type 2 diabetes. Type 2 diabetes was extremely rare among youth younger than 10 years of age. While still infrequent, rates were greater among youth ages 10 to 19 years compared with younger children, with higher rates among U.S. minority populations compared with non-Hispanic whites."

    Thus, whether or not childhood obesity is truly being contained will reveal itself, I believe, in the incidence and prevalence of type 2 diabetes in adolescents in the coming years. Epidemiologists should trend type 2 diabetes in children and adolescents over time to see whether or not obesity prevention programs are working. However, I hope that obesity is being addressed among young children now rather than wait to have it manifest itself in the compromised health outcome of type 2 diabetes in adolescents, which should not ever show up at all in children and adolescents.

    Map and Citation Source:

  • April 8, 2010 - The Nielsen Health Segments

    Nielsen Health Segments


    This nifty graphic may prove their point that perhaps we are what we eat! Perhaps, Public Health practitioners looking to apply social marketing strategies to Health Education interventions can make use of this information. However, I do find it somewhat disturbing that regardless of which category you are in, that so much is spent on tobacco. People with a truly healthy outlook would definitely stay away from tobacco. Then again, this paradigm may not be specific enough to explained what Nielsen called a "statistical anomaly." Maybe a little tweaking is in order.

    What don't they know about you? In a recent article, "Healthy Customers are Healthy Spenders" that reported on the Nielsen analysis of National Marketing Institute (NMI) data, you will learn (and maybe shocked) that market researchers have categorized people into Health-related Consumer Segments according to people's health beliefs and practices that supposedly drive shopping and buying decisions.
    • Well Beings (19%): The most health-proactive group; market leaders and influencers whose actions are driven by values. They eat more organics, consume modest amounts of supplements and pursue many different health modalities.
    • Food Actives (18%): More mainstream in their health pursuits, this group strives for moderation in their lifestyle and prefers food that is inherently healthy, as opposed to organics or supplements. Seeking a life balance includes balancing the budget for this price-sensitive segment.
    • Magic Bullets (24%): Consumers who hope supplements, Rx and pills will help them reach health goals. More into health management than prevention. Least likely to cook at home or exercise.
    • Fence Sitters (17%): Stressed out, but seeking control. They dabble in the latest exercise kick and actively pursue weight loss goals. Receptive to eco-friendly appeals and reliant on social media.
    • Eat, Drink & Be Merries (22%): Younger shoppers who crave taste and pinch pennies. No concerns here about prevention, making them the least health-active group.
    • Source:
  • April 7, 2010 - Plate Tectonics


    (Map source:

    Nothing like waking up to a newscast about still another biggie, a 7.7 in northern Sumatra, Indonesia, coming only 2 days after the 7.2 in Baja California, Mexico. And, we shouldn't forget the 8.8 that hit Chile on February 27th, and the devastating 7.0 that hit Haiti on January 12th. I don't know, but 2010 may turn out to be the "year of the big ones" since it's only April 2010!!! I am sure the 2012 enthusiasts are in the "see, I told you so" mode.

    While I much prefer being grounded, our planet does not necessarily provide us with that kind of stability, according to Plate Tectonics. The ground beneath our feet is constantly shifting to accommodate the forces of nature churning away at the earth's core. I am not sure if this map, developed by the U.S. Geological Survey, is of any comfort, but it does map out all the danger zones to watch out for.

  • April 4, 2010 - Is the 7.2 California Quake Prelude to the "Big One"?

    4/4/10 Mexico Quake

    (Map source: strong-earthquake-rocks- mexico-20100405-rm0x.html)

  • April 3, 2010 - Getting on Track: Physical Activity and Healthy Eating for Men site for men This Web site is just for all you men out there who's looking to improve your quality of life!

    Cardiovascular disease is the leading health threat for men, followed by lung cancer, prostate cancer, depression, suicide, diabetes and erectile dysfunction (Source: . All of these dieases can be prevented by physical activity, healthy eating and positive health behaviors. You can find a link to this Webpage on my Fitness Page. Start doing something good for yourself and those who love you.

    (Graphic Source:

  • April 1, 2010 - Determinants of Health

    Determinants of Health

    (Graphic Source:

    Here is a super graphic from that summarizes the factors, or determinants of health. These are the factors that contribute to our health and quality of life.

    Macro-level determinants such as social, economic factors and environmental factors (which may be beyond our individual control) contribute to 50% of what impacts our health. At this level, policy and environmental changes would be necessary to correct whatever ails us.

    Clinical care, which contributes 20%, is a combination of macro-level and micro-level determinants. Current economic problems have deprived many of access to health care necessary to maintain our health. However, we need to know enough about when we need medical attention and then to get it, which is a personal health behavior.

    And, finally, 30% of what impacts our health and quality of life is well within our grasp - our health behaviors. This is nothing new, we need to take care of our bodies if we want our bodies to take care of us.

    While so many factors impact our health, it is really important to remember that even if we were to live in the Garden of Eden, it still wouldn't be paradise if we don't take care of ourselves.

    Check out Social Determinants of Health Links to learn more about the various factors that affect our health and well-being.

  • March 30, 2010 - Salvaging the Culture of Childhood

    In the March 26 New York Times editorial, "Playtime Is Over," guest editorialist, David Elkind mourns the loss of innocence that was once the purview of Childhood, that "unstructured imagination time" that somehow lost its purpose in today's world. A cited "University of Michigan study found that from 1979 to 1999, children on the whole lost 12 hours of free time a week, including eight hours of unstructured play and outdoor activities."

    As a result of these changes, what is called by child-development experts as "the culture of childhood" has disappeared.

    • "This culture, which is to be found all over the world, was best documented in its English-language form by the British folklorists Peter and Iona Opie in the 1950s. They cataloged the songs, riddles, jibes and incantations ("step on a crack, break your mother's back") that were passed on by oral tradition. Games like marbles, hopscotch and hide and seek date back hundreds of years. The children of each generation adapted these games to their own circumstances.
    • For children in past eras, participating in the culture of childhood was a socializing process. They learned to settle their own quarrels, to make and break their own rules, and to respect the rights of others. They learned that friends could be mean as well as kind, and that life was not always fair."
    • (Citation Source:

    Elkind posits that this lack of socialization has resulted in the rise of bullying, teasing and discrimination. I tend to agree, and it can only get worse. Much of what we call Communication today would hardly be called "face-to-face." Every form of communication is electronically mediated so that many nonverbal cues are no longer available to inform our responses. Miscommunication can easily occur and misunderstanding ensues. I suppose we can no longer recapture the childhood of yesteryear, but at least I still remember what that childhood was like.

  • March 23, 2010 - Opioid Poisoning on the Rise

    Opioid Poisoning

    You can find a link to this issue brief on my Public Health Data Page .

    In the recent brief, " Unintentional Drug Poisoning in the United States, the CDC reports that drug overdoses have been steadily rising since the 1970s, and
    • "Drug overdose deaths were second only to motor vehicle crash deaths among leading causes of unintentional injury death in 2006 in the United States."
    • Among deaths attributed to drugs, the most common drug categories are cocaine, heroin, and a type of prescription drug called opioid painkillers.
    • Opioids are synthetic versions of opium. They have the ability to reduce pain but can also suppress breathing to a fatal degree when taken in excess. Examples of opioids are oxycodone (OxyContin), hydrocodone (Vicodin), and methadone.
    • In 2006, 17,740 drug overdose deaths occurred among males and 8,660 among females. Male rates exceed female rates in every age group. Men have historically had higher rates of substance abuse than women.
    • For both sexes, the highest rates were in the 45-54 years old age group. Rates increase dramatically between the 15- 19 and 20-24 years age groups as teenagers attend college or move away from home."


  • March 18, 2010 - The Status of Chronic Diseases - Hypertension is #1

    Chronic Care: Making the Case for Ongoing Care

    Graphic source:

    In the recently updated chartbook, "Chronic Care: Making the Case for Ongoing Care," from the Robert Wood Johnson Foundation (RWJF), the case is being made that the U.S. health care system is failing to meet the needs of people with chronic conditions. So, what else is new?

    Here is the one I found to be the most important, and that is 1/3 of Americans have high blood pressure.

    This chartbook is available as a pdf and powerpoint and provides a wealth of data that unfortunately shows that having multiple chronic conditions is not unusual, especially as a person grows older. You can find links to these documents on my Cardiovascular & Chronic Disease Page.

    HBP prevalence, by age

    Graphic source: slides2/slide01.cfm?tk=22&dpg=2 )

    While it may be true that as we get older our blood pressure tends to creep up naturally, there really is no excuse for anyone under 75 to have high blood pressure. Many contributory factors to the development of high blood pressure are under our control, like smoking, eating unhealthy foods and lack of exercise.

    In the recent article,"Weight Loss Important in BP Management: ENCORE Published", researchers reported "The ENCORE study... weight loss and exercise, compared with DASH diet, produce additional BP lowering beyond the DASH diet alone." (Source:

    In a 2007 study, researchers found "30 minutes of walking three times a week -- even if it was broken into 10-minute walks throughout the day -- was enough to have a healthy effect on blood pressure as well as measurements around the waist and hip....Systolic blood pressure dropped by 5 points among those who exercised three days a week and by 6 points among those who exercised five days a week." (Source:

    You know the drill: Quit smoking, eat healthy &

  • March 15, 2010 - Diet and Exercise Still The Best for Primary and Secondary Prevention

    The Medpage Today 3/13's "ACC: NAVIGATOR Confirms Diet and Exercise Still Best" summarizes the findings from the "Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR)" studies reported in New England Journal of Medicine (NEJM). It notes, "the study did confirm the value of weight loss, diet, and exercise. Lifestyle intervention,..., appears to be the best option for primary and secondary prevention." ( Source: )

    In the accompanying March 14, 2010 NEJM editorial, DM Nathan states, "The global epidemic of type 2 diabetes has prompted a large number of clinical trials aimed at reducing its incidence.1 Not surprisingly, addressing the underlying lifestyle behaviors overeating and inactivity that result in obesity, the primary cause of the epidemic, has had a major and consistent effect in reducing the cumulative incidence of diabetes. In addition, lifestyle interventions have reduced the cardiovascular risk factors that typically accompany the prediabetic and diabetic states." ( Source: )

    This is great news for Public Health professionals, which confirms that therapeutic lifestyle modification is the way to go for addressing cardiovascular disease and preventing the development of type 2 diabetes. It is obvious that popping a pill is the not the answer to reducing the cardiovascular complications that come with uncontrolled type 2 diabetes. It is a reminder that being pro-active about health and wellness is a sensible philosophy for ensuring quality of life.

  • March 10, 2010 - To Sleep, Perchance to Dream (Hamlet) - Pre-Sleep Activities
    Statistics from a telephone survey of 1,000 Americans about what people do before they go to sleep, by race and ethnicity, was posted 3/8 on Findings included:
    • "There's enough research out there to suggest there may be ethnic differences in sleep disorders, such as insomnia and sleep apnea, differences in the amount and quality of sleep, and the health consequences of sleep disorders,... All groups reported getting an average of between six and seven hours of sleep a night on workdays or weekdays. The Mayo Clinic recommends adults and seniors get between seven and eight hours of shut-eye a night. Adequate amounts of sleep can boost your immune system, and too little can lead to drowsiness, difficulty concentrating, poor physical performance, and other effects,... about 75 percent in all groups believed sleep was related to health and daily functioning,...."

    Yes, sleep is absolutely essential, but it is the one activity we deprive ourselves of all the time. For more more information about sleep, check my Sleep Resources .

    Graphic and story source:

  • March 8, 2010 - Soda Consumption, Obesity and Diabetes

    #1 Soda Consumption (Darkest = Highest [81-89 gallons per capita])

    USDA Food Atlas - Soda Consumption

    #2 Obesity Prevalence (Darkest = Highest [35.1-43.5%])

    USDA Obesity Prevalence

    #3 Diabetes Prevalence (Darkest = Highest [12.1-17.4%])

    USDA Diabetes Prevalence

    Mapping can show there is a relationship between soda consumption, obesity and diabetes. Here are 3 maps I generated using the online mapping resources on USDA Food Atlas (4/17/14 - No longer available).

    What I have done is just give you the highest statistic for each category, which is represented by the darkest shade on each map.

    If you just concentrate on the darkest color on each map, you can see that they pretty much mirror one another - areas with highest soda consumption also have higher rates of obesity and diabetes. Though soda consumption is not the only factor that contributes to obesity and diabetes, it is a hugh factor. Time to give up the sodas.

  • March 8, 2010 12:05 AM - Hurt Locker and Kathryn Bigelow Win the Oscars (Congrats! Well-deserved)

    The Hurt Locker, 2009 Best Picture

    (Graphic source: )

  • March 6, 2010 - Mapping Fatal Injuries with WISQARS

    CDC's Wisqars Mapping

    Graphic source: 3/4/2010 CDC E-mail: Generate Data Maps with WISQARS Fatal Injury Mapping Module: News from CDC's Injury Center

    Here is a new mapping tool from the CDC's Wisqars System. In its announcement it provided an example of the kinds of maps you can interactively generate online.

    "This map shows geospatially smoothed, age-adjusted motor vehicle traffic death rates by county (highest rates are shown in brown). Motor vehicle traffic death rates were generally higher in rural areas in the United States from 2000 to 2006."

    You can find a link to on my Public Health Software and Mapping Page

  • March 5, 2010 - Twitter Predicts Oscar Upset

    Twitter says Hurt Locker Will Win Best Picture

    (Graphic source: )

    Can analyzing tweet trends predict the future? Well, the Waggener Edstrom Worldwide, a communications company, is trying to do just that with the Oscars. They say "Hurt Locker" will win Oscar's Best Picture. That would be nice because I think that film should win Best Picture, from a film aesthetic standpoint. Kathryn Bigelow should win Best Director as well. As it now stands, I am guessing Avatar will win Best Picture, and Kathryn Bigelow will for Best Director. Traditionally, the Golden Globes have been used to predict Oscar outcomes for years, and they have been pretty accurate for major categories, except for the year "Brokeback Mountain" won Golden Globe's Best Picture and "Crash" won the Oscar's Best Picture in 2006. Go figure.

    So, it will be interesting to see if Twitter can be used as a predictive tool. The potential for Public Health application is enormous (I think). After all, Google Flu trends have been found useful for monitoring flu outbreaks around the world, and this can be done faster than the traditional methods of compiling reports from existing epidemic surveillance systems. ( Source: google/google-flu-trends-predicts-epidemics )

    PS - I bet you were thinking how I could possibly find a Public Health angle to the Oscars. Never fear, I think "Public Health" all the time...

  • March 3, 2010 - Fish Oil Contamination

    Fish Oil

    Graphic Source:

    Fish oil pills are probably the most recommended dietary supplement for improving cardiovascular health, among a host of other health benefits. But, in a March 2nd report, there is a California lawsuit that contends these supplements have been found to have serious chemical contamination.

    "The lawsuit names eight makers and sellers of fish oil, shark oil, fish liver oil and shark liver oil supplements that have PCB contamination above the so-called "safe harbor" limits set for human PCB consumption under California's Proposition 65." (Source: )

    This has not come a moment too soon. I have always found that the dietary supplement industry is not regulated enough. There is no guarantee that what is on the label would be found inside the bottle, or the label discloses "everything" in the product. The health fraud advocacy group,, considers The Dietary Supplement Health and Education Act of 1994 (DSHEA) as basically weakening the authority of the FDA to regulate this industry. (Source: ) The most recent ruling from the FDA regarding dietary supplements can be found at Federal Register 65 FR 999 January 6, 1999 -- Regulations on Statements Made for Dietary Supplements Concerning the Effect of the Product on the Structure or Function of the Body; Final Rule ( GuidanceComplianceRegulatoryInformation/ucm107336.htm

    In 2007, Americans spent $34 billion on alternative remedies, many of which have not been scientifically proven to be effective, and half of those who use alternative medicine cannnot afford conventional care. (Source: )

    Regulating dietary supplements would fundamentally improve our quality of life by ensuring that the money we spend on what supposedly is healthy for us really works and will not compromise our health with contaminated products. The FDA needs to step up and do their part to ensure the safety of dietary supplements.

  • March 2, 2010 - Lower Gestational Diabetes Cutoffs

    Diagnosing gestational diabetes will become easier should the proposed consensus criteria get accepted by such organizations as the American Congress of Obstetricians and Gynecologists and the American Diabetes Association. Current U.S. guidelines diagnose only 5% to 8% of women with this condition and require women to make two medical visits for the glucose tolerance test.

    The proposed "new criteria require only a single measurement of fasting plasma glucose of 92 mg/dl or higher or a glucose tolerance test level of at least 180 mg/dl at one hour or 153 mg/dl at two hours. In high-prevalence countries like the U.S., all pregnant women should undergo diagnostic 75-g oral glucose tolerance testing,..."

    This will not only improve compliance with the blood testing necessary for diagnosis, but will increase the number of women who can be treated for this condition to prevent not only perinatal harm to the fetus but also prevent &/or delay the development of type 2 diabetes in the mother. For an overview of gestational diabetes, check out: The Connecticut Gestational Diabetes Mellitus Issue Brief . More information about diabetes can be found on the Diabetes Resources on the Net Page.

    Source: Metzger BE, et al "International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy" Diabetes Care 2010; 33: 676-82. as reported in Medpage Today (

  • March 1, 2010 - Follow the Public Health Blog Updates on Twitter!

    Hi! After some deliberation, I have decided to keep those interested in following my Public Health Blog with Twitter! As I post new items on my blog, I will tweet the topic. Every day is a new experience!

    This will be the graphic I will use to reach my Blog Updates Twitter page.

    Also, if you love to tweet, then check out the Twitter page I have developed for my Wellness classes at: Pch 201 Wellness Twitter Page. My students are sharing what they have found while developing their fact sheets.

  • February 28, 2010 - Blog Update

    Thanks for your interest in the Public Health Blog. I love keeping it up-to-date! Since there have been so many entries since January 1st, I have decided to move the January & February entries to the 2010 Blog Page now instead of waiting till the end of March.

  • February 27, 2010 - Movie Ratings By Betty

    Ratings by Betty

    In recent years I was posting movie ratings on my Oscars Page, which I have discontinued because it's easier to have the Internet Movie Database store the ratings for me. It also allows me to share my ratings, so here they are!

    Right now there are over 1,300 ratings, and I will be adding more as I continue to watch movies. Just click on the graphic and enjoy! You can also find a link to these ratings on my Movies Page .

  • February 25, 2010 - The Economy and Health Today's New York Times article, At Closing Plant, Ordeal Included Heart Attacks talks about the unsettling realities of how the economy affects our health. Being laid off from a job can result in the adoption of health-compromising behaviors, such as smoking and drinking, or relapse of these poor health behaviors to deal with stress ( articles/PMC1351253/pdf/nihms6176.pdf) and even in such negative outcomes as fatal heart attacks. Another negative change reported was the onset or relapse of depression, which has been associated with the development of heart disease. And, an unfortunate side effect of dealing with job loss was less exercise, when more exercise would probably be a healthier strategy for dealing with acute stress.

    One study found "...a person who lost a job had an 83 percent greater chance of developing a stress-related health problem, like diabetes, arthritis or psychiatric issues." ( and another found that layoffs affected life expectancy, as a "...worker who lost his job at age 40 had his life expectancy cut by a year to a year and half."

    For more information about mental health issues, check my Public Health Sites - Mental Health Section

    Citation source:

  • February 23, 2010 - 24 Ways to Lose Weight Without Dieting

    This is no gimmicky weight loss program, but some really common sense approaches to diet and exercise that will help you control your weight. For example, just by walking a mile in 20 minutes can help you burn off 100 calories. Or, sleep an extra hour a night and lose 14 pounds in one year! Check out WebMD's 24 Ways to Lose Weight Without Dieting Slideshow for simple ways to fight the bulge.

  • February 22, 2010 - County-Health Rankings

    USA Today's graphic
    The Robert Wood Johnson Foundation recently released its County Health Rankings which provides county-by-county snapshots of health in each state. Each county is ranked within the state on how healthy people are and how long they live, and along key factors that affect health such as: smoking, obesity, binge drinking, access to primary care providers, rates of high school graduation, rates of violent crime, air pollution levels, liquor store density, unemployment rates and number of children living in poverty. What makes these rankings different from previous state rankings is the examination of multiple factors that affect health in each county in all 50 states. You can find a link to the County Health Rankings on my Evaluation Page, under "State Report Cards [Health] (Non-government)."

    Here is a rendering of the statistics for USA Today.


  • February 21, 2010 - Self-Explanatory Economic Statistics

    NY Times 2/2/2010


  • February 19, 2010 - Going Generic

    Harris Poll

    Graphic source:

    In a Harris Poll conducted online within the United States January 18 to 25, 2010 among 2,576 adults (aged 18 and over), Americans are adapting to the current economic downtown by cutting back on little luxuries.

    In this particular graphic that looks across generations, the most common cost-saving method being used by most people is going generic. It is the first time I have seen the term, "Echo Boomers" used for what we used to call the "twenty-somethings." (which may be too generic for some...).

    I guess young people are beginning to realize they can live without the morning lattes and manicures, and that brownbagging and refillable water bottles maybe okay after all....

    Source: source=mc&utm_medium=textlink

  • February 18, 2010 - The Power of Positive Affect, or The Happiness and Heart Connection

    Beach Happy Face

    Graphic source:

    Just released by the European Heart Journal,
    • "Individuals who find joy, excitement, and contentment in their daily lives may be protected from cardiovascular disease,.... Higher levels of positive affect, a measure of happiness, were associated with a significantly lower risk of having a cardiovascular event over a 10-year period."
    • "Positive affect -- defined as the experience of pleasurable emotions such as joy, happiness, excitement, enthusiasm, and contentment -- has been shown in previous studies to be associated with increased survival, improved immune function, and lower risks of diabetes and hypertension. Negative emotions, including depression, have been linked to a greater risk of heart disease.... positive affect is thought to be predictive of cardiovascular health independent of negative emotions."
    • Researchers also report that positive affect..."has also been associated with lower blood pressure, norepinephrine reactivity, and cortisol levels,... may also protect against heart disease by improving sleep habits and the ability to quit smoking,..."

    Source: Davidson K, et al "Don't worry, be happy: positive affect and reduced 10-year incident coronary heart disease: the Canadian Nova Scotia Health Survey" Eur Heart J 2010; DOI: 10.1093/eurheartj/ehp603. Reported in 2/17 Medpage Today

  • February 17, 2010 - The Importance of Recess, Healthy Schools and Fidgeting

    The State of Play

    Graphic adapted from "State of Play" cover page at research/stateofplayrecessreportgallup.pdf

    "The State of Play" is the latest report from the Robert Wood Johnson Foundation that looks at the importance of recess to academic achievement. Based on a survey of 1,951 elementary school principals, RWFJ found, ...recess has a strong positive impact on academic achievement. Students listened better and were more focused after recess. And principals widely agreed that recess positively impacts social development and well-being." (Source: stateofplayrecessreportgallup.pdf)

    This report contnues in the vein of January 2010's Surgeon General�s Vision for a Healthy and Fit Nation 2010 that advocates Creating Healthy Schools. Schools play a pivotal role in preventing obesity among children and teenagers. Each school day provides multiple opportunities for students to learn about health and practice healthy behaviors that affect weight, including physical activity and good nutrition. Well-designed school programs can promote physical activity and healthy eating, reduce the rate of overweight and obesity among children and teenagers, and improve academic achievement." (Source: obesityvision/obesityvision2010.pdf p. 11)

    Yet, any parent of school age children will tell you that recess is hardly a priority in most schools. In the lives of young children, what is more important than play? If they don't play when they are young, will they play when they get older? A human body was not made to sit all day in the classroom and then at home in front of the TV or computer. Yet, this is the way most children spend their daily lives today. This is one of the reasons why there is an obesity epidemic.

    The body was meant to . And, if kids get enough exercise they wouldn't be fidgeting all the time. In fact, fidgeting can be viewed as the body's built-in mechanism to be active. Unfortunately, not everyone is born to fidget. Some fidget more than others.

    Mayo Clinic researchers have found that fidgeting is a good thing and can help with weight control. They have coined the term NEAT (non-exercise activity thermogenesis) for what we commonly call fidgeting, and found NEAT � more powerful than formal exercise � determines who is lean, and who is obese. Obese persons sit, on average, 150 minutes more each day than their naturally lean counterparts. This means obese people burn 350 fewer calories a day than do lean people.
    Source: "Fidgeting: Key to Who is Lean or Obese"

    So, people concerned about the growing obesity epidemic should advocate for recess during the school day, and they should encourage kids to do more than just sit around house getting fat. Spend quality time that is "activity-driven" and reap the benefits of better health. For more information, check my Fitness Page. For links to the reports mentioned in this blog entry, check my Health Behavior Data Sites.

  • February 14, 2010 - Happy Valentine's Day & Happy Chinese New Year! SCSU homepage year of the tiger graphic

  • February 11, 2010 - APA Style Information

    I have just updated all the links on my APA Information Page to reflect the new 6th edition of the APA writing style manual. It is not the easiest or most intuitive writing style but it is the most commonly used style for Public Health and the social sciences, which probably explains why this page is the most popular academic page on my Web site.

  • February 10, 2010 - Climate Change

    Shrinking glaciers

    Graphic Source:

    I know that 3+ feet of snow burying the mid-Atlantic states doesn't look promising for a global warming discussion, but how about climate change?

    After all the flip-flopping in the scientific community about whether or not global warming is really happening, it looks like the consensus is - yes, it is happening. So, I have added a new section to my Public Health Sites pages called "Global Warming" with links to credible sites providing the most up-to-date information of what is being done about the problem. Probably the most heartbreaking image of this Public Health issue is:

    Poor Polar Bear!

    Graphic source:

    Check Global Warming for more information.

  • February 9, 2010 - Pluto & its moon Charon - celestial beauty at its best

    Pluto and its moon Charon

    Graphic Source: Dr. R. Albrecht, ESA/ ESO Space Telescope European Coordinating Facility; NASA; 2346-1035_11-390103-6.html?tag=content;leftCol

  • February 8, 2010 - Time to give up sodas (The Soda and Cancer Connection)

    Just released today online... according to a report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research:

    "Consuming two or more soft drinks per week increased the risk of developing pancreatic cancer by nearly twofold compared to individuals who did not consume soft drinks."

    This is just one of the growing number of studies that show soda is bad for you, and a major contributor to the obesity epidemic. For more information about the negative consequences of drinking soda, check my Nutrition Page. Nothing beats water - zero calories, yet includes everything your body needs.


  • February 7, 2010 - Disability Statistics

    New York Times 2/5/2010

    Graphic source:

    The February 5th New York Times article, "The Odds of a Disability Are Themselves Odd" contends that disability statistics are unreliable, as they can vary anywhere from 30% to 52%. As with any kind of statistics, it really is important to know what's in the denominator and what's in the numerator.

    This graphic presents a rendition of disability for white collar workers, by gender (excluding physicians). While it may appear that women experience more disability than men in the workplace, it is only because pregnancy is considered a disability. From an employer's perspective that is how pregnancy is viewed.

    It does make you wonder why reproduction, a natural process, has to be viewed in such a negative light when talking about "productivity", and what pregnancy "complications" are they talking about? Like spending time to take care of a little baby? Obviously, this does not explain why the percentages are higher for women in the 45 to 65 age groups.

    A more useful analysis would be to eliminate "pregnancy" from disability statistics, which would help in identifying the health issues that are causing workplace disabilities. Based on such statistics, employers can then develop workplace wellness programs to address those lifestyle factors that are protective for and destructive to workplace productivity. I believe that once this is done, these graphics will be very different.


  • February 6, 2010 - The Human Genome and Aerobic Exercise

    Currently, researchers believe "that one of the best predictors of health and longevity is our body's ability to take in and use oxygen during maximum exercise. The more blood our heart can pump and the more oxygen our muscles can use, the less our risk of early disease and death." This means aerobic exercise is really important because the higher our VO2 max (maximum volume of oxygen used during exercise), the more resistant we are to getting sick.

    However, the Pennington Biomedical Research Center (PBRC) has found that genes may modulate the increase in VO2 max from aerobic exercise and notes that "low maximal oxygen consumption is a strong risk factor for premature illness and death." Basically, not everyone may benefit the same way from aerobic exercise. They have identified a set of about 30 genes that predicted the increase in VO2 max. And for those that do not have these genes, alternative prevention programs may be needed to reduce the risks of cardiovascular disease or diabetes. This may be the start of what researchers are calling,"personalized, genomic-based medicine."


  • February 4, 2010 - Spending our lives online

    2009 Harris Poll
    2009 Harris Poll

    Graphic and story source: interactive/internet-users-now-spend-13-hoursweek-online-11471/ ?utm_campaign=newsletter&utm_source=mc&utm_medium=textlink

    According to a recent Harris poll, U.S. adult Internet users spend an average of 13 hours a week online. Even when they looked at users by age groups, it's surprising to see that a fifth of those over 65 spend 8 to 15 hours online. Researchers found that the age groups spending the most time online are those ages 30-39 (18 hours) and those aged 25-29 (17 hours) and 40-49 (17 hours).

    Just yesterday, Medpage Today reported findings from the first National Health Interview Survey to collect data on health information technology that was conducted by the CDC and the National Center for Health Statistics.

    "The study found 51% of adults 18 to 64 used the Internet to look up health information at some point over a 12-month period. Previous research had shown that over 60% of all adults in the U.S. had, at some point, used the Internet to search for health or medical information. Not surprisingly, 18- to 49-year-olds were more likely than older adults to use health information technology."

    "Women were more likely than men to use the Internet for health information in all surveyed categories, including: Chatting online about health topics (2.5% of men versus 4.1% of women); Researching health information (43.4% versus 58%); Communicating with healthcare providers (4.2% versus 5.6%), or scheduling an appointment (1.8% versus 3.5%) by e-mail Refilling prescriptions online (5.3% versus 6.6%)"
    Source: PublicHealthPolicy/ GeneralProfessionalIssues/18281?utm_content =GroupCL&utm_medium=email& impressionId=1265264580293&utm_campaign= DailyHeadlines&utm_source= mSpoke&userid=36040#rate

    Think about this. What did we do before there was the Internet?? Also, it is now more important than ever that we be discriminating about what we find online and that those who post health information should do so with the best intentions, ensuring that it be credible and cite their sources.

  • February 2, 2010 - Internet Immortality's Our Digitally Undying Memories

    Graphic source:

    Siva Vaidhyanathan's "Our Digitally Undying Memories" offers a meta-review of books dealing with our presence on the Internet and a wary perspective of our cyber lives ( that is well worth reading.

    My thoughts? We all can achieve immortality - on the Internet. Unfortunately, what people were probably pursuing was just their 15 minutes of fame. We have lost our sense of boundaries on many levels. Privacy has become more important because Big Brother is the people with the cameras. How many times have you been forced to listen to conversations, in a public place, that should be private and not for everyone within listening distance?

    Many young people think nothing of posting their whole lives on Facebook and other social networks and then wonder how their identity got stolen. A sad example of the Net potential to ruin lives was when I came across a series of Youtube videos of college women who were fall-down drunks (I was looking for some educational videos about the hazards of alcohol abuse for my class). Obviously, these women did not post these videos, and, whoever did were no friend, nor should these be viewed as "just a joke" shenanigans. How will these women ever be able to explain themselves to some potential employer of these episodes of indiscretion? They can never be removed and will live on forever for anyone with Internet access. Is this the Immortality the Greek philosophers debated about? I think not.

  • January 30, 2010 - An Explanation for the Obesity Paradox

    Mayo Clinic Proceedings, 2/2010

    This graph shows that as weight rises, so does cardiovascular mortality (death).

    In May 2009, the Journal of the American College of Cardiology reported, "Obese patients with heart disease do better and live longer than leaner patients with the same severity of disease ( 090526-obesity-heart.html ). This became known as the "Obesity Paradox." However, this is not an excuse to put on weight just to better survive a heart attack, nor is it an excuse to smoke to control weight. Excess weight and smoking are known risk factors for heart disease.

    Coming out in February 2010's Mayo Clinic Proceedings, there is a study that attempts to explain the Obesity Paradox. Their conclusion? "Fitness altered the obesity paradox. Overweight and obese men had increased longevity only if they registered high fitness." ( content/85/2/115)

    In the accompanying editorial, The Obesity Paradox: Perception vs Knowledge, the authors propose "...the power of cardiorespiratory fitness as a covariate of its effect on the obesity-mortality association. A compelling rationale as to the importance of fitness vis-a-vis the obesity paradox is that many individuals within a given weight strata with a below average exercise capacity can be considered "unwell" compared with individuals with a higher exercise capacity. If indeed, after adjusting the analysis for fitness (or wellness), the paradoxical association between low body weight and mortality is blunted...."

    So, in plain English, what does this mean? Regardless of what weight category you are in, you should strive for maximum cardiorespiratory fitness. But, if you really work on your cardiorespiratory fitness you will lose weight. Sixty minutes of brisk walking every day will do the trick.

    You've got to Move it! and Too many pounds? Go run!

    Check out my Fitness Page for exercise links.

    Source for graphic and quotes:

  • January 27, 2010 - Global Warming Trends

    NASA/GISS global warming stats
    With all the technology we have these days, controversy still surrounds the reality of global warming. In the January 23rd report, "Past Decade the Warmest Since 1880," GISS Director James Hansen stated, "There's substantial year-to-year variability of global temperature caused by the tropical El Nino-La Nina cycle. But when we average temperature over five or ten years to minimize that variability, we find that global warming is continuing unabated."

    Graphic interpretation: " Except for a leveling off between the 1940s and 1970s, Earth's surface temperatures have increased since 1880. The last decade has brought the temperatures to the highest levels ever recorded. The graph shows global annual surface temperatures relative to 1951-1980 mean temperatures. As shown by the red line, long-term trends are more apparent when temperatures are averaged over a five year period." Credit: NASA/GISS


  • January 26, 2010 - Ideal Heart Health

    The American Heart Association (AHA) has recently released what they considered to be "ideal" heart health candidates, which include individuals without clinical cardiovascular disease who:

    • Never smoked or quit more than one year ago
    • Maintain a body mass index under 25 kg/m2
    • Stay physically active for at least 150 minutes at moderate intensity or 75 minutes at vigorous intensity each week
    • Eat a healthy diet, matching at least four to five of the key dietary components recommended by AHA guidelines, such as low sodium, low sugar-sweetened beverage, high fiber, and fruit and vegetable intake
    • Keep total cholesterol under 200 mg/dL
    • Maintain blood pressure below 120/80 mm Hg
    • Keep fasting blood glucose less than 100 mg/dL

    According to the AHA, only about 5% of Americans currently meet these criteria. Use these as guidelines for a healthier life. Most importantly, know what your numbers are and keep them in a healthy range.


  • January 23, 2010 - Get up!!!

    Keep moving!!!
    We are much too sedentary. If we're not sitting at work, we are sitting around somewhere. According to the 1/19 Medscape's Prolonged Sitting Boosts Bad Health," "sitting in front of the TV for hours on end can raise your risk of early death from heart disease. A woman's risk of metabolic syndrome, a precursor to diabetes and heart disease, jumps 26% for every extra hour she sits in front of the TV."

    You've got to . Here's one simple way I found to increase my daily steps, I never take a phone call sitting down. While I am on the phone, I am walking around. You'll be amazed at how many steps you can take while talking on the phone. By the way, pedometers are very useful motivators. If you are sedentary, you will get in only about 400-500 steps a day. You should aim for 10,000. If this sounds formidable, then start from a baseline and make an effort, on a daily basis, to add a few more steps. If you do this consistently, you will be able to rack up thousands of steps in no time! As they say in Quality Improvement, you don't know how you are doing unless you keep track of what you are doing.


  • January 22, 2010 - Start Fifth Grade with a Normal BMI

    RWJ Active Education: Physical Education, Physical Activity and Academic Performance (9/2009)
    I decided to re-post this graphic from my September 27, 2009 blog entry to show that research has shown that a student's physical fitness has an impact on academic performance. It would seem to me that the current obesity epidemic affecting youths today is going to impact their ability to function well in the workplace. Since the impact can be measured in middle school students, then we should intervene sooner, like in elementary school.

    Think about this. How hard would be to make it a school health goal that no child should finish fourth grade without a normal BMI? Or, all children should start fifth grade with a normal BMI. Good health habits should be nurtured early on to make the most of these formative years. Finally, I simply cannot bear the thought of having children on statins when adults suffer from side effects when using this class of drugs.

  • January 21, 2010 - Lipid Levels of U.S. Youths (1999-2006)

    In the just released 1/22/2010 MMWR Report, Prevalence of Abnormal Lipid Levels Among Youths --- United States, 1999--2006 , the CDC reports that "...32% of all youths were in a population recommended for lipid screening based solely on their weight status. The results also indicate that, during 1999--2006, an estimated one fifth of all youths had at least one lipid abnormality, and among obese youths, the prevalence was 43%."

    Other findings include: "Among all youths, 20.3% had at least one abnormal lipid level based on cutoff points for high LDL-C (≥130 mg/dL), low HDL-C (≤35 mg/dL), and high triglyceride levels (≥150 mg/dL) Compared with youths who were normal weight, overweight and obese youths were significantly more likely to have at least one abnormal lipid level (PR = 1.6 and PR = 3.0, respectively). A greater proportion of boys had low HDL-C compared with girls (11.0% versus 4.0%), and youths aged 18--19 years were more likely to have low HDL-C (10.4%) or high triglycerides (16.4%) compared with youths aged 12--13 years (4.7% and 9.5%, respectively). Youths aged 14--15 years also were more likely to have low HDL-C (8.7%) compared with youths aged 12--13 years (4.7%). High LDL-C levels differed little across age groups among the youths. The percentage of non-Hispanic white youths with low HDL-C (8.5%) or high triglycerides (12.1%) was higher compared with levels for non-Hispanic black youths (4.7% and 3.7%, respectively)."

    The report further states, "Although therapeutic lifestyle counseling is the first course of action in reducing abnormal lipid levels among youths, AAP recommends considering pharmacologic interventions to treat children whose LDL remains persistently high even after therapeutic lifestyle counseling."

    This is a pretty sad health picture of American youths today. I really don't like the idea of putting young kids on drugs to address a health issue that can be taken care of with better diet and more exercise. What are we teaching kids when we ask them to pop pills?? What does that say about how we, as a society, view the value of Health? Something is very wrong with this picture.

    You can find a link to this report and other health behavior statistics on my Health Behavior Data Page


  • January 19, 2010 - Presenting Data


    Graphic Source:

    Because information has become a marketable commodity, data have become very important. But when it comes to sharing the data, presentation counts. An important skill for public health professionals is making the most of data, from assessing needs to evaluating program interventions.

    Reporting on these activities always includes presenting the data that were used for program development and evaluation. And, that is nothing more effective than visualizing the data with easy-to-understand graphs, charts and even maps. If given the choice, what would you rather look at, a table of numbers or a chart?

    Idealware's "A Consumers Guide to Low-Cost Data Visualization Tools" is an excellent resource about presenting data and the software you can use to do it in style. You can find a link to this useful guide on my Charting & Graphing Data; Data Presentation Page

  • January 15, 2010 - Are You Pouring on the Pounds?

    Is this visually stunning enough to get the point across that sodas are bad for you?
  • January 14, 2010 - 2009 Web site Stats, for the curious

    Hours Spent on the Web site
    Top 10 Pages for 2009
  • January 13, 2010 - Bisphenol A (BPA) & Cardiovascular Disease

    Bisphenol A sources; Environmental Working Group

    Graphic Source:

    In 2007, the Environmental Working Group (EWG) found that BPA is at unsafe levels in one of every 10 servings of canned foods (11%) and one of every 3 cans of infant formula (33%). (Source: )

    Today, Medpage Today reports that researchers analyzing NHANES data have confirmed that BPA, an endocrine disruptor, increases the risk of cardiovascular disease.

    BPA is found in numerous household products -- from drink containers and food packaging to the lining of canned goods. It is estimated that over 90% of the U.S. population is exposed to BPA, which is now considered the 4th toxic chemical risk factor for cardioavascular disease along with fine particulate air pollution, dioxins, and PCBs. The metabolism of BPA may induce oxidative stress and endothelial cell damage. (Source: Melzer D, et al "Association of urinary bisphenol A concentration with heart disease: Evidence from NHANES 2003/2006" PLoS ONE 2010. )

  • January 13, 2010 - New ADA recommendations regarding gestational diabetes mellitus (GDM)

    Recently released ADA recommendations pertaining to gestational diabetes mellitus include: "All pregnant women, except those at low risk for gestational diabetes, should be screened with an oral glucose tolerance test at 24 to 28 weeks of gestation. Low-risk status is defined by age younger than 25 years, normal prepregnancy weight, ethnicity in a group with a low overall prevalence of diabetes, and no family or personal risk factors for diabetes. Women with gestational diabetes should be screened for type 2 diabetes at the postpartum visit 6 to 12 weeks after delivery and then intermittently from that visit forward." (Source:

    This is really great since it is unfortunate that the US Preventive Task Force has not been able to recommend universal screening for GDM in recent years. From a Public Health perspective, I have always considered women who have gestational diabetes to be the ideal priority population for the prevention of type 2 diabetes. Research has consistently shown that these women are at a higher risk for developing type 2 diabetes than those who never had GDM while pregnant. Perhaps, the most startling statistic I came across was that women who have had 3 pregnancies with GDM are at a 100% risk for developing type 2 diabetes! ( Source: Postpartum Follow-up Crucial in Women With Gestational Diabetes content/3/5/8.full) The best news is that type 2 diabetes in these women is preventable through lifestyle modification. In a way these women are fortunate that they are being warned of the possibility of developing type 2 diabetes and hopefully will be motivated to do something about it.

    If you would like to read the issue brief I developed about GDM when I worked as the cardiovascular and diabetes epidemiologist for the State of Connecticut, check out Gestational Diabetes Mellitus Surveillance in Connecticut Issue Brief . You can also find more information about GDM and diabetes in general on my Diabetes Resources Page.

  • January 12, 2010 - Hemoglobin A1C to diagnose type 2 diabetes

    The American Diabetes Association published new recommendations on December 29 in the January supplement of Diabetes Care, one of which is "promoting hemoglobin A1c (A1c) as a faster, easier diagnostic test that could help reduce the number of undiagnosed patients and better identify patients with prediabetes."

    "The A1c test, which measures average blood glucose levels for a period of up to 3 months, was previously used only to evaluate diabetic control with time. An A1c level of approximately 5% indicates the absence of diabetes, and according to the revised evidence-based guidelines, an A1c score of 5.7% to 6.4% indicates prediabetes, and an A1c level of 6.5% or higher indicates the presence of diabetes. For optimal diabetic control, the recommended ADA target for most people with diabetes is an A1c level no greater than 7%." (Source: )

    The sooner people who have problems managing glucose metabolism, the earlier people can do something about it. If you have a family history of type 2 diabetes, carry extra weight, especially around the abdomen, have high blood pressure and/or high cholesterol, you should probably see your doctor and get an A1C done. Of course, if you don't know your numbers at all (blood pressure, cholesterol level) you should find out and see if you need treatment. Untreated high blood pressure can result in strokes and excessively high levels of bad cholesterol can put at risk for heart disease. For more information about diabetes, check my Diabetes Resources Page.

  • January 11, 2010 - An Hour a Day of Play Keeps the Fat Away

    60 minutes a day

    Now you can go and play with your kids every day and not feel guilty about it. New physical activity guidelines for children and adolescents say they should have an hour or more physical activity daily. An hour a day running around with the kids will also help you to lose weight as well, so it's a win-win situation all around. Be a role model, go out and pound the pavement with them!!!

    Youth Physical Activity Guidelines

    • Children and adolescents should have 60 minutes (1 hour) or more of physical activity daily.
    • Aerobic: Most of the 60 or more minutes a day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity at least 3 days a week.
    • Muscle-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days of the week.
    • Bone-strengthening: As part of their 60 or more minutes of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days of the week.
    • It is important to encourage young people to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety.

    Graphic and Guidelines source:

  • January 9, 2010 - How to Sleep

    NIH's Your Guide to Healthy Sleep

    Graphic source: public/sleep/healthy_sleep.pdf

    Though this activity is supposed to take up one third of our lives, it is one thing we don't do enough, and that's getting adequate sleep. In fact, lack of sleep is being blamed for the growing obesity epidemic from disrupting hormones in our body.

    "When you don't get enough sleep, it drives leptin levels down, which means you don't feel as satisfied after you eat. Lack of sleep also causes ghrelin levels to rise, which means your appetite is stimulated, so you want more food.... "Those who slept less than eight hours a night not only had lower levels of leptin and higher levels of ghrelin, but they also had a higher level of body fat. What's more, that level of body fat seemed to correlate with their sleep patterns. Specifically, those who slept the fewest hours per night weighed the most.
    (Source: The Dream Diet: Losing Weight While You Sleep )

    The NIH recently released Your Guide to Healthy Sleep which covers everything you ever want to know about sleep. You can find a link at Sleep Resources along with links to more information about sleep.

    Sweet dreams, my friend, and may you lose weight overnight and remember: CDC Sleep Graphic

  • January 8, 2010 - Herbals Are Not Good for Pregnant Women

    Herbal Medicines

    Graphic source:

    Can you believe that 10.9% of U.S. mothers reported use of an herbal product 3 months before or during pregnancy? This is what researchers found. They also reported, "During pregnancy, the overall prevalence was 9.4% and was highest during the first trimester (6.9%). A substantial proportion of women took herbal products during the second (5.1%) and third (5.2%) trimesters."

    Because so little is known about the effects these products may have on the fetus, researchers are urging women not to use these products to avoid potential harm to fetal organ development, which occurs early on during pregnancy. They also caution, "it is difficult to ascertain the ingredients in herbal products with any degree of reliability because of the nature of the herbal product industry, which may label ingredients inaccurately or change the blend of their ingredients. Finally, despite their widespread use, many pregnant women who use herbals do not tell their physicians... (and) the fact that a substance is natural does not necessarily mean that it is safe for the fetus."

    For more information about nutraceuticals, see my Nutrition Page.

    Source: Herbal Product Use Common in Pregnancy, May Pose Risks to Fetus. From Am J Obstet Gynecol. Published online December 28, 2009.( 714461?src=mp&spon=16&uac=81167HX)

  • January 7, 2010 - EPA's Strict New Health Standards for Smog

    Today the EPA proposed stricter health standards for smog. We can all breathe better now.

    According to the EPA,

    • "The tighter standards will cost tens of billions of dollars to implement, but will ultimately save billions in avoided emergency room visits, premature deaths, and missed work and school days."
    • "Smog is a respiratory irritant that has been linked to asthma attacks and other respiratory illnesses. It is formed when emissions from burning gasoline, power and chemical plants, refineries and other factories mix in sunlight."
    • (Source: )

    When I was in 11th grade (and this was decades ago), I wrote my first practice term paper (in preparation for college) on the subject of air pollution. So I guess I was into Public Health even then. The issue, however, remains pertinent as more research is beginning to show the health effects of environmental exposure to second-hand smoke and toxic chemicals, as what happened post-9/11.

    If you are wondering how your environment is treating you, check out the information for geography of choice with these two widgets from the EPA. You can also find these two widgets, along with 8 others and links to other environmental health resources on my Environmental Health Page.

  • January 6, 2010 - Obesity's Impact on Morbidity

    According to today's "Obesity Disease Burden Similar to Smoking" Medpage Today article, obesity is now surpassing tobacco's impact on our quality of life. Analyzing 1993 to 2008 BRFSS quality-adjusted life years (QALYs) data, researchers conclude that:

    • " a result of the increasing prevalence of obesity, the contribution of obesity-related QALYs lost had increased by 127% in 2008. At that time, obesity resulted in 0.0464 QALYs lost, slightly surpassing smoking."
    • "While smoking has bigger impact on mortality, smokers die at a much younger age,"..."For an obese person, although they [are at an increased risk to] die, they die at an older age," often with high medical bills for chronic medications and expensive treatments.

    We need to take better care of ourselves. Plus, do you really want to spend all your money on medical bills and medications to get through the day? Quit smoking, and lose the weight. Just 60 minutes a day of brisk walking will do the trick for most people, along with better eating habits. Check out my Fitness and Nutrition and Obesity Pages for helpful links.

    Source: Jia H, Lubetkin EI "Trends in quality-adjusted life-years lost contributed by smoking and obesity" Am J Prev Med 2010; DOI: 10.1016/j.amepre.2009.09.043, as reported at: PrimaryCare/Obesity/17810?pfc=111&spc=269

  • January 6, 2010 - Belly Fat & Women

    Mayo Clinic Belly Fat

    Graphic source:

    According to Mayo Clinic's "Belly fat in women: How to keep it off",

    • "... many women notice an increase in belly fat as they grow older and especially after menopause. Gaining fat in your abdomen is particularly unhealthy when compared with other locations in your body. Excess belly fat increases your risk of cardiovascular disease, diabetes and certain types of cancers."
    • "As you age and your metabolism slows down, the amount of fat in your body slowly increases. Women experience an even greater fat percentage increase than men do. Then after menopause, your body fat distribution tends to shift less in your arms, legs and hips, and more in your abdomen."
    • "Too much belly fat increases your risk of:
      • Heart disease
      • Breast cancer
      • Diabetes
      • Metabolic syndrome
      • Gallbladder problems
      • High blood pressure
      • Colorectal cancer"
    • "Researchers also have found that abdominal fat cells aren't just dormant energy waiting to be burned up. The cells are active, producing hormones and other substances that can affect your health. For example, some fat-cell-produced hormones can promote insulin resistance, a precursor to type 2 diabetes; others can produce estrogen after menopause, which may increase your breast cancer risk. Researchers are still sorting out how the excess hormones affect overall health, but they do know that too much visceral fat can disrupt the body's normal hormonal balance."


  • January 5, 2010 - Fat Studies

    According to The Chronicle Review's "No Fear of Fat" a new interdisciplinary field of scholarship is being developed around the study of fat. It seeks to explore the perceptions of fat, critiquing the negative assumptions, stereotypes, and stigmas placed on fat and the fat body.

    Advocates for fat studies define such research by what it is not:

    • "if you believe that fat people could (and should) lose weight, then you are not doing fat studies you are part of the $58.6-billion per year weight-loss industry or its vast customer base. If you believe that being fat is a disease and that fat people cannot possibly enjoy good health or long life, then you are not doing fat studies. Instead, your approach is aligned with 'obesity' researchers, bariatric surgeons, public-health officials who declare 'war on obesity,' and the medico-pharmaceutical-industrial complex that profits from dangerous attempts to 'cure' people of bodily difference."
    • "If you believe that thin is inherently beautiful and fat is obviously ugly, then you are not doing fat-studies work either. You are instead in the realm of advertising, popular media, or the more derivative types of visual art in other words, propaganda."
    • Source:

    If these studies are meant to help people who carry extra weight to feel better about themselves, then what health benefit is there to that? Currently, two thirds of Americans are either overweight or obese, which means population-based studies are probably more useful for defining the issues regarding "fat" than fat studies. Of course, economic-based studies may end up defining the burden of fat, whether we like it or not.

    Thus, the struggle to lose weight is a common struggle, but a worthwhile endeavor, for the sake of good health and improving quality of life. Here are two studies for your consideration:

    • "Weight loss induced by increased daily physical activity without caloric restriction substantially reduces obesity (particularly abdominal obesity) and insulin resistance in men. Exercise without weight loss reduces abdominal fat and prevents further weight gain."
    • Source: Reduction in obesity and related comorbid conditions after diet-induced weight loss or exercise-induced weight loss in men. A randomized, controlled trial. (Ann Intern Med. 2000 Jul 18;133(2):92-103).
    • "Achieving high levels of physical activity, normal weight, and never smoking, are effective ways to prevent cardiovascular disease and to extend total life expectancy and the number of years lived free of CVD. Increasing the prevalence of normal weight could further reduce the time spent with CVD in the population."
    • Source: Living healthier for longer: Comparative effects of three heart-healthy behaviors on life expectancy with and without cardiovascular disease. (BMC Public Health. 2009 Dec 24;9(1):487). ResultsPanel.Pubmed_RVDocSum&ordinalpos=4

    Check out the Quality of Life Quotes for more research findings.

  • January 2, 2010 - Losing Weight & Eating Better

    2009 and 2010 New Year Resolutions

    Graphic source: topics/behavioral-marketing/ top-new-years-resolutions- put-fiscal- above-physical-fitness-11522/ franklin-covey-top-10-new- years-resolutions-2009jpg/

    According to a new survey conducted by FranklinCovey Products, researchers found that the top three 2010 New Year resolutions to be similar to the top 3 for 2009. However, I thought it was great to see that losing weight stayed at second place, eating better at third place and that breaking a bad habit rose from 9th to 6th place. Maybe the health promotion messages are making a dent!

    While financial management is taking precedence, an Allianz Life Insurance Company survey found, "...when asked what resolution for 2010 they are most likely to keep, more people (40.2%) say diet and exercise, vs. managing their money better (38.7%)."

    (Source: topics/behavioral-marketing/ top-new-years-resolutions- put-fiscal-above-physical-fitness-11522/ ?utm_campaign=newsletter &utm_source=mc&utm_medium=textlink)

    Of course, 40% is better than nothing, but making any change does require some planning and committment to succeed. Resolving to not drag around extra weight on a daily basis is always a good thing.

  • January 1, 2010 - Happy 2010!!!

    Happy 2010!!!

  • Links

    Betty's Home Page Site Map

    Back to Top

    Published on the Web: March 22, 2016
    Updated: 12/11/2022 R178
    Comments, suggestions, dead link reports:

    © Copyright 2016 - 2023 Betty C. Jung
    All rights reserved.