Public Health Advances

finding public health in unexpected places

CHA Director Dr. Fielding on Lowering Prices for Lifesaving Drugs

Center for Health Advancement Director, Dr. Jonathan Fielding, addresses the exorbitant increase in drug prices and suggests several solutions in a recent U.S. News & World Report. Americans pay more for common medicines than most other countries, forcing millions of U.S. consumers to forego filling a doctor’s prescription or to lower their dosage to make the medicine last longer. Failure to take a prescribed medicine or reducing the amount costs $300 billion in extra medical expenses and contributes to 125,000 deaths a year. Read on for Dr. Fielding’s common-sense fixes to make drugs affordable.

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Nothing Stops a Bullet Like a Job

The short-term benefit is money in their pockets. The long-term benefits are improved educational, employment and health outcomes and reduced drug/alcohol use, arrest rates for violent crime and incarceration. Summer jobs for youth do more than save kids from boredom during their time off from school.


After generally trending downward since 1989, the labor force participation rate for youth started to climb a bit in 2010 and has since been around about 60%. Despite recent increases in the number of summer jobs for young adults, the demand is still higher than the supply.. This past February, the Department of Labor announced $20 million in grants to expand the summer jobs programs into career pathways for youth. These efforts build on other programs meant for low-income at-risk youth, such as the My Brother’s Keeper initiative.


There are a number of summer jobs programs around the country, including in such cities as Chicago, New York City and Los Angeles. Programs are also available in rural areas as well, such as in Minnesota. These programs target youth between ages 14 to 24 years. Youth in L.A. are provided with work experience for 6 weeks, paid $10.50 an hour and work approximately a total of 120 hours (20 hours a week). The employers pay the teens their salary, but they are reimbursed with federal and state funding. But, summer job programs provide much more than a paycheck, especially for low-income, at-risk teens, who can benefit from the program in a myriad of ways.


The National Bureau of Economic Research researched the outcomes associated with the New York City Summer Youth Employment Program, which is the largest employment program in the country. The researchers looked at three years of program participant data, tax records, incarceration data and death records. They found that program participation results in increases in average earnings and the probability of employment in the year of program participation. Participation also decreased the probability of incarceration by a 10 percent reduction relative to the baseline incarceration rate and decreased the probability of mortality by a 20 percent reduction relative to the baseline mortality rate. That’s impressive for a relatively inexpensive program!


In Chicago, a randomized control trial from 2014 found that participation in a program called One Summer Plus reduced violent crime arrests by 43% over a 16-month period compared to the control group. Participants were high school students from disadvantaged neighborhoods in Chicago, worked for 8 weeks for 25 hours a week and were paid minimum wage of $8.25 per hour. The youth were assigned job mentors (about 10 mentees per mentor). Half the participants worked 15-hour weeks and received 10 hours of social-emotional learning. However, interestingly, there was not a difference between the group that received the therapy and those that didn’t, suggesting that students working longer hours also acquired some of the same social-emotional skills on the job or that the therapy was ineffective. However, we know from our own analysis that cognitive behavioral therapy for juveniles, which this study based its therapy off of, helps to reduce arrests. Regardless, the program had a lasting impact, reducing arrests for violent crimes even up to a year after the program ended. A notable theory from their findings was that prevention of violence, by offering summer jobs while teens were still in school, rather than remediation, when they’re already out of school and struggling in the labor market, can improve outcomes more effectively, with less intensive treatment.


These programs can also help with outcomes that are more difficult to quantify, but are still important, such as building self-confidence, communication skills to interact with strangers, and learning which aspects of a job they like and dislike to inform a future career.


Despite the many benefits, the documentation required for such programs can be enough to cause some teens to give up before they start. Especially for the most at-need ones, who may lack home stability and the support necessary to help locate and obtain their social security card, working papers, proof of family income and other necessary documents. If the summer jobs programs can work with these particular youth, the employment programs would be likely to reach a targeted niche of the most at-risk kids.


The summer youth employment programs that target at-risk kids not only helps them and their families financially, but extends beyond that to prevent arrests and improve educational and health outcomes. It’s one of those ‘Win-Win’ interventions that have benefits for multiple sectors and stakeholders.

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Using College Food Waste to Feed Food Insecure Students

Approximately 19% of University of California students go hungry at times due to limited resources and an additional 23% lack steady access to a variety of quality, nutritious food. Yet, college campuses are one of the biggest food wasters. College campuses throw away about 22 million pounds of uneaten food each year. That’s a lost opportunity to feed students that are food-insecure.


Food insecurity is not typically associated with college students, but with increased tuition and living costs, many students struggle to get by as they work toward a better future for themselves. About one in ten California State University college students are homeless and more than double that do not have a consistent source of nutritious food.


Food waste is a massive problem. Half of all food produce in America is thrown away because it doesn’t meet our standards of perfection. We want to see only blemish-free vegetables and fruits, but that’s not the way food naturally grows. Food also gets thrown away because it’s uneaten and our standards don’t allow food to be saved for the next day. Cafeterias especially struggle because they have to prepare enough food to feed everyone, but they can’t always predict the exact number of students that will stop in.


There are a number of organizations that work to connect unused food to the people that need it to help decrease food waste and malnutrition. Imperfect, a service delivery start-up, provides customers with deeply discounted “ugly” produce that would otherwise be thrown away. A small box of 10-14 pounds of produce costs $12. The EatBy app helps households reduce their own waste and claims to save families an average of $700 a year. Food Loss & Waste Protocol has a mission to develop an internationally accepted standard to quantify the amount of food removed from the food supply chain. With more accurate information, they hope entities can take steps to decrease food waste.


A number of California campuses also have programs to reduce the amount of discarded food scraps. The Food Recovery Network is a student-run movement against food waste at college campuses. Started at University of Maryland-College Park in 2011, it now has 191 chapters nationwide and has recovered 1,418,630 pounds of food. In response to the recognized need for food for some students, the UCLA Food Closet was started to provide students who are experiencing financial hardship with food. What started as leftover food from on-campus events has morphed into a pantry with donations from staff and other students. The program has received national news coverage and is inspiring other college campuses to create similar programs. Today, about 40-50 students visit the food closet each day to get food and toiletries, which they can do anonymously. Fresno State similarly developed a ‘cupboard’ that provides leftover food from catered events. A mobile app immediately notifies students when food is available.


An innovative idea to reduce food waste among college cafeterias is to go trayless and offer smaller plate sizes. Students often load up their trays with more food than they end up eating. The remaining food goes in the trash. Without a tray, they are less likely to get additional plates of food that they won’t eat. A number of universities have opted to go trayless to reduce food and water waste. One study found that trayless dining reduced food waste by 25% to 30% per person. Additionally, 288,288 gallons of water were conserved, which together saved an estimated annual amount of $57,000. Reducing food waste also saves costs for college campuses. A study estimated that it costs the campus $1.60 for every pound of food removal. Perhaps more important than cost, connecting students with edible food waste allows these students to have access to consistent meals. Access helps them worry less about where they’ll get their next meal from, and concentrate more on their studies. Additionally, better nutrition helps them concentrate in and outside the classroom, which is likely to improve their success rate in college.


When food is wasted in college cafeterias that serve the very people who might need it, it’s a no brainer to develop food closets and other similar initiatives.

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Are e-cigarettes sending progress on tobacco control up in smoke?

Tobacco control has been viewed as a public health victory. Since the U.S. Surgeon General’s report on smoking and health more than 50 years ago, smoking rates in the U.S. are falling. However, with the introduction of e-cigarettes in 2007, public health experts may have a new hurdle to overcome.


E-cigarettes have been promoted as a low-nicotine option that provides smokers a substitute for cigarettes to help them quit. However, tobacco-control advocates, scientists and public health leaders debate the effects of using e-cigarettes on the user’s health and some argue that vaping, a term for smoking flavored e-cigarettes, has become the gateway to smoking for people who did not previously smoke. With flavors like raspberry, bubble gum, and vanilla mocha frappe, is it any wonder that kids are attracted to vaping? A study from England found that kids who were exposed to ads for candy-flavored e-cigarettes increased their interest in vaping. And indeed, while e-cigarettes may be helping some individuals quit, for youth, the rate of nicotine use has skyrocketed, according to a study published this month.


E-cigarette use by adolescents has increased rapidly in recent years. The CDC found that in one year, between 2013 and 2014, e-cigarette use tripled among middle and high school students. Similar smoking rates among 12th graders haven’t been seen since 1995. Using data from the Children’s Health Study, a longitudinal study of 12th grade cohorts, researchers found that while smoking rates of southern California adolescents has declined, adolescents who use e-cigarettes are not merely substituting for cigarettes. Instead, the data indicates that e-cigarette use is occurring in adolescents who would not otherwise have used tobacco products. Among 12th-grade students, the combined adjusted prevalence of current cigarette or e-cigarette use in 2014 was 13.7%. This was substantially greater than the 9.0% adjusted prevalence of current cigarette use in 2004, before e-cigarettes were available.


A pack of cigarettes typically contains anywhere from 8 mg to 20 mg of nicotine (along with many other chemicals) and your body absorbs about 1mg of that. In comparison, e-cigarettes can be purchased without nicotine or with as much as 48 mg/ml of nicotine. However, preliminary tests by the FDA found nicotine in all but one of the non-nicotine e-cigarettes that were tested. Also, the differences in devices and the rate at which you ‘vape’ lead to big differences in the amount of nicotine you absorb. Research suggests that experience also makes a difference. Current e-cigarette smokers achieved systemic nicotine and/or cotinine concentrations similar to those produced from traditional cigarettes, compared to inexperienced e-cigarette users who inhaled modest nicotine concentrations. However, exposure to any amount of nicotine at a young age is harmful to healthy brain development.


In a 2015 survey, 61% of males and females aged 19 years or older felt e-cigarettes should not be used in front of children. The FDA recently passed regulations to restrict the sale of e-cigarettes to minors and include warning labels on products. Hopefully the impact of the FDA’s regulation will help to halt the growing popularity of these products among youth. If not, further regulation may be required. Additional public health interventions also need to be designed that specifically target minors and discourage any use of e-cigarettes.

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