HHS Secretary Sebelius Announces Cornerstone Funding of the $650 Million Recovery Act Community Prevention and Wellness Initiative

Creating ways for healthful lifestyle habits to be the natural first choice for Americans is the goal of a $650 million initiative of the U.S. Department of Health and Human Services (HHS). The funds from the American Recovery and Reinvestment Act will be used to increase physical
activity, improve nutrition, decrease obesity, and decrease smoking in U.S. communities.

HHS Secretary Kathleen Sebelius today announced a funding opportunity for communities and tribes to apply for $373 million in cooperative agreements for the comprehensive public health initiative, Communities Putting Prevention to Work, to be led by the Centers for Disease Control
and Prevention (CDC).

"This initiative will make disease prevention and health promotion top priorities in states and communities across the country," Secretary Sebelius said. "Preventing disease is vital as a strategy to improve our nation's health and reduce health care costs."

Communities Putting Prevention to Work will change systems and environments-for example, improving access to healthy foods and opportunities for physical activity-and putting into place policies, such as clean-indoor-air laws, that will promote the health of populations. Funded entities will have two years to complete their work.

The $373 million in cooperative agreements will be awarded to communities through a competitive selection process. The cooperative agreements will support evidence-based prevention strategies for youth and adults and will promote partnerships across communities and sectors.

The remainder of the funds for this initiative will be made available in the coming weeks to states, territories, and organizations to support, extend and evaluate the reach and impact of the community projects.

Funded projects will emphasize high-impact, broad-reaching policy, environmental, and systems changes in schools (K-12) and communities. For example, communities will work to make high-fat snack foods and sugar-sweetened beverages less available in schools and other community sites and to use media to promote healthy choices. In addition, funded communities will be encouraged to provide quality physical education in the nation's schools and enact comprehensive smoking bans.

"The CDC is excited to have this opportunity to help states and communities do more to deliver proven prevention strategies, in ways that reach whole communities and populations," said CDC Director, Thomas Frieden, M.D., M.P.H. "Chronic diseases linked to obesity, poor nutrition, physical inactivity, and tobacco use are the leading causes of death and disability in our nation. These additional resources will improve the quality of life for millions of Americans."

Communities interested in applying for Communities Putting Prevention to Work grants can find more information at www.grants.gov. The application deadline for the community projects is Dec. 1, 2009. Deadlines for state, territory, and other prevention projects that are part of the
Communities Putting Prevention to Work initiative will be announced soon.

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Annual CDC Report Finds High Burden of Sexually Transmitted Diseases, Especially Among Women and Racial Minorities

Reported cases of chlamydia and gonorrhea in the United States exceeded 1.4 million in 2007, according to an annual report (http://www.cdc.gov/std/stats07/) by the Centers for Disease Control and Prevention. These diseases continue to be the most commonly reported infectious diseases in the nation and pose persistent and preventable threats to fertility in the United States.

The report, Sexually Transmitted Disease Surveillance, 2007, shows persistent racial disparities across these and other sexually transmitted diseases (STD), and a particularly heavy burden of disease among women. The report also finds continued increases in syphilis. This disease, while once on the verge of elimination, began re-emerging as a threat in 2001 and increased 15.2 percent between 2006 and 2007.

"The widespread occurrence of these diseases should serve as a stark reminder that STDs remain a serious health threat in the United States, especially for women and racial and ethnic minorities," said John M. Douglas, Jr., M.D., director of CDC's Division of STD Prevention. "Left untreated, chlamydia and gonorrhea can cause infertility, affecting a woman's chance to bear children later in life. Such a severe consequence is entirely avoidable, if as a nation we work together to increase the use of proven prevention tools and make them widely available to those who need them."

Women Bear Heavy STD Burden, Including Risk of Infertility

Women continue to bear a disproportionate burden of the long-term health consequences of STDs. In 2007, the chlamydia rate among women was three times that of men (543.6 cases per 100,000 women, compared to 190 cases per 100,000 men). The gonorrhea rate was also higher among women (123.5 per 100,000 women, compared to 113.7 per 100,000 among men).

Although the two diseases can be easily diagnosed and treated, they often have no symptoms and go undetected. If left untreated, up to 40 percent of chlamydia and gonorrhea infections in women can result in pelvic inflammatory disease -- a condition that causes as many as 50,000 women to become infertile each year. Untreated chlamydia or gonorrhea can also cause ectopic pregnancy, chronic pelvic pain, and other serious health problems.

The report found that there were more than 1.1 million chlamydia cases reported in 2007, up from about one million in 2006, making it the largest number of cases ever reported to CDC for any condition. Gonorrhea, the second most commonly reported infectious disease, had more than 350,000 cases reported in 2007. However, it is estimated that more than half of all new infections with chlamydia and gonorrhea continue to go undiagnosed, underscoring the importance of increased screening. CDC recommends annual chlamydia screening for all sexually active women under 26 years old, and supports U.S. Preventive Services Task Force recommendations to screen high-risk, sexually active women for gonorrhea.

STDs Take Heaviest Toll on Racial Minorities, Especially Black Women

CDC's 2007 STD surveillance report also indicates ongoing racial disparities in the three most common reportable STDs, with African-Americans bearing the greatest burden. While representing 12 percent of the U.S. population, blacks had about 70 percent of reported gonorrhea cases and almost half of all chlamydia and syphilis cases (48 percent and 46 percent respectively) in 2007.

STDs take an especially heavy toll on black women 15 to 19 years of age, who account for the highest rates of both chlamydia (9,646.7 per 100,000 population) and gonorrhea (2,955.7 per 100,000 population) of any group. STDs in this age group are of particular concern because of the potential threat of these two diseases to a woman's fertility.

Studies have shown that one of the most important social determinants of sexual health is socioeconomic status. Higher rates of poverty among blacks than whites, and socioeconomic barriers to quality healthcare and STD prevention and treatment services have been associated with higher prevalence and incidence of STDs among racial and ethnic minorities.

"The racial disparities in rates of STDs are among the worst health disparities in the nation for any health condition," stressed Douglas. "We must intensify efforts to reach these communities with needed screening and treatment services. Testing and the knowledge of infection is a critical first step toward reducing the continued consequences of these diseases."

Growing Threat of Syphilis

Syphilis, a disease close to being eliminated as a public health threat less than a decade ago, has increased each year since 2000 and remains a serious threat to the health of gay and bisexual men.

In 2007, men who have sex with men (MSM) continued to account for the majority of primary and secondary (P&S) syphilis cases, representing 65 percent of the 11,466 P&S syphilis cases reported. Increased transmission among MSM is believed to be the primary driver of increased rates of syphilis overall in the United States. Syphilis among MSM is of particular concern because it can facilitate HIV transmission and lead to irreversible complications such as strokes, especially in those who already have HIV. CDC recommends that all MSM be tested for syphilis at least annually.

Additionally, while P&S syphilis continues to occur at substantially lower levels among women than men (1.1 cases per 100,000 among females compared to 6.6 among males), syphilis rates have been increasing among women and infants in recent years, reversing years of decline in these populations. Syphilis rates among women have increased since 2004, and the rate of congenital syphilis increased for the second consecutive year in 2007. Because untreated syphilis can be transmitted from a pregnant woman to her infant and result in stillbirths, infant deaths, or severe complications in children who survive, CDC recommends that all women be screened for syphilis during the early stages of pregnancy.

Intensified Efforts Needed to Address Significant Gaps in STD Prevention

To reduce the toll of STDs and protect the health of millions of Americans, expanded prevention efforts are urgently needed. CDC estimates that almost 19 million new sexually transmitted infections occur each year, and almost half of those are among 15- to 24-year-olds. In addition to the threat of infertility, increased risk of HIV acquisition, and other health risks, STDs also have a substantial economic impact. CDC estimates STDs cost the U.S. health care system as much as $15.3 billion annually.

CDC supports a comprehensive approach to STD prevention through screening, treatment, and behavioral interventions, with a focus on reducing health disparities, especially those occurring among racial and ethnic groups. To further progress against the most widespread reportable STDs, CDC, along with the Partnership for Prevention and eight other leading STD organizations, recently established the National Chlamydia Coalition. CDC also has been working with partners and community leaders across the nation on syphilis elimination efforts since 1999, yet successes in some areas and populations continue to be offset by increases in others, as programs must continually shift efforts to address emerging needs. Ultimately, successful elimination of this disease will require intensified efforts at the federal, state and local level to reach the diverse and expanded populations now at risk.

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Low Vitamin D Levels Pose Large Threat to Health

Researchers at Johns Hopkins are reporting what is believed to be the most conclusive evidence to date that inadequate levels of vitamin D, obtained from milk, fortified cereals and exposure to sunlight, lead to substantially increased risk of death.

In a study set to appear in the Archives of Internal Medicine online Aug. 11, the Johns Hopkins team analyzed a diverse sample of 13,000 initially healthy men and women participating in an ongoing national health survey and compared the risk of death between those with the lowest blood levels of vitamin D to those with higher amounts. An unhealthy deficiency, experts say, is considered blood levels of 17.8 nanograms per milliliter or lower.

Of the 1,800 study participants known to have died by Dec. 31, 2000, nearly 700 died from some form of heart disease, with 400 of these being deficient in vitamin D. This translates overall to an estimated 26 percent increased risk of any death, though the number of deaths from heart disease alone was not large enough to meet scientific criteria to resolve that it was due to low vitamin D levels.

Yet, researchers say it does highlight a trend, with other studies linking shortages of vitamin D to increased rates of breast cancer and depression in the elderly. And earlier published findings by the team, from the same national study, have established a possible tie-in, showing an 80 percent increased risk of peripheral artery disease from vitamin D deficits.

Researchers note that other studies in the last year or so in animals and humans have identified a connection between low levels of vitamin D and heart disease. But these studies, they say, were weakened by small sample numbers, lack of diversity in the population studied and other factors that limited scientists’ ability to generalize the findings to the public at large.

“Our results make it much more clear that all men and women concerned about their overall health should more closely monitor their blood levels of vitamin D, and make sure they have enough,” says study co-lead investigator Erin Michos, M.D., M.H.S.

“We think we have additional evidence to consider adding vitamin D deficiency as a distinct and separate risk factor for death from cardiovascular disease, putting it alongside much better known and understood risk factors, such as age, gender, family history, smoking, high blood cholesterol levels, high blood pressure, lack of exercise, obesity and diabetes,” says Michos. Vitamin D is well known to play an essential role in cell growth, in boosting the body’s immune system and in strengthening bones.

“Now that we know vitamin D deficiency is a risk factor, we can better assess how aggressively to treat people at risk of heart disease or those who are already ill and undergoing treatment,” says Michos, who adds that test screening for nutrient levels is relatively simple. It can, she says, be made part of routine blood work and done while monitoring other known risk factors, including blood pressure, glucose and lipid levels.

Heart disease remains the nation’s leading cause of death, killing more than a million Americans each year. Nearly 10 percent of those with the condition have not one identifiable, traditional risk factor, which the experts say is why a considerable extent of the disease goes unexplained.

Michos, an assistant professor at the Johns Hopkins University School of Medicine and its Heart and Vascular Institute, recommends that people boost their vitamin D levels by eating diets rich in such fish as sardines and mackerel, consuming fortified dairy products, taking cod-liver oil and vitamin supplements, and in warmer weather briefly exposing skin to the sun’s vitamin-D producing ultraviolet light.

Aware of the cancer risks linked to too much time spent in the sun, she says as little as 10 to 15 minutes of daily exposure to the sun can produce sufficient amounts of vitamin D to sustain health. The hormone-like nutrient controls blood levels of calcium and phosphorus, essential chemicals in the body.

If vitamin supplements are used, Michos says there is no evidence that more than 2,000 international units per day do any good. Study results show that heart disease death rates flattened out in participants with the highest vitamin D levels (above 50 nanograms per milliliter of blood), signaling a possible loss of the vitamin’s protective effects at too-high doses.

The U.S. Institute of Medicine suggests that an adequate daily intake of vitamin D is between 200 and 400 international units (or blood levels nearing 30 nanograms per milliliter). Previous results from the same nationwide survey showed that 41 percent of men and 53 percent of women are technically deficient in the nutrient, with vitamin D levels below 28 nanograms per milliliter.

Michal Melamed, M.D., M.H.S., study co-lead investigator who started the research as a clinical fellow at Johns Hopkins, says no one knows yet why or how vitamin D’s hormone-like properties may protect the heart, but she adds that there are plenty of leads in the better known links the vitamin has to problems with muscle overgrowth and high blood pressure, in addition to its control of inflammation, which scientists are showing plays a stronger role in all kinds of heart disease. But more research is needed to determine the nutrient’s precise biological action.

Researchers say their next steps are to test various high doses of vitamin D to find out if the nutritional supplementation results in fewer deaths and lower incidence of heart disease, including heart attack or moments of prolonged and severe chest pain.

The team also plans to investigate what biological triggers, such as obesity or hypertension, might offset or worsen the action of vitamin D on heart muscle, or whether vitamin D sets off some other reaction in the heart.

Melamed says that because vitamin D levels are known to fluctuate in direct proportion with daily physical activity, the growing epidemic of obesity and indoor sedentary lifestyles lend more urgency to act on the vitamin D factor.

Funding for this study was provided by the National Institutes of Health, the P.J. Schafer Cardiovascular Research Fund and the Paul Beeson Physician Faculty Scholars in Aging Program. Michos has received previous consulting fees from vitamin D therapeutics manufacturer Abbott Pharmaceuticals. The terms of these arrangements are being managed by the Johns Hopkins University in accordance with its conflict of interest policies.

Besides Michos and Melamed, other Hopkins researchers involved in this study, conducted solely at Hopkins, were Wendy Post, M.D.; and Brad Astor, Ph.D. Melamed is now an assistant professor at the Albert Einstein College of Medicine of Yeshiva University in New York City.

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