Mary Ellen Schneider

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and the private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. “Everything is in the computer,” Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physicians' notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. “Hands down, I would take the VA computer [system] anywhere,” Dr. Turner concluded.

VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight, said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. “We had to find ways to reduce redundancies and care for more patients.”

And the move to an electronic system was driven largely by clinicians who said they needed better tools. “We had clinicians actively saying, 'We need this, we need this, we need this,'” she said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not add value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. “We are definitely different because we have the alignment of the payer and provider within our own enterprise.”

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. “You've got to build it for the clinicians,” he said.

Automating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to “pave the cow path.” They must let clinicians know up front that the work flow is going to change.

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and the private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. “Everything is in the computer,” Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physicians' notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. “Hands down, I would take the VA computer [system] anywhere,” Dr. Turner concluded.

VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight, said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. “We had to find ways to reduce redundancies and care for more patients.”

And the move to an electronic system was driven largely by clinicians who said they needed better tools. “We had clinicians actively saying, 'We need this, we need this, we need this,'” she said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not add value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. “We are definitely different because we have the alignment of the payer and provider within our own enterprise.”

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. “You've got to build it for the clinicians,” he said.

Automating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to “pave the cow path.” They must let clinicians know up front that the work flow is going to change.

Over the last decade, health care within the Department of Veterans Affairs has transformed itself from a notorious near failure to a national model for quality improvement, leaving many asking how they can incorporate those lessons.

The answer may lie in part with the department's electronic health record system. Known as VistA (Veterans Health Information Systems and Technology Architecture), the system recently received the Innovations in American Government Award—a top honor from Harvard University's Kennedy School of Government.

The award was given to seven government programs that each took a unique approach to meeting community needs. All recipients were given a $100,000 grant to share the factors behind their success.

For Dr. Douglas J. Turner, it's clear that the VA is doing something right when it comes to health information technology (IT). Dr. Turner, who is chief of general surgery for the VA Maryland Health Care System at the Baltimore VA Medical Center and is on the surgery faculty at the University of Maryland, Baltimore, has a foot in both the VA system and the private sector.

At the University of Maryland Medical Center, he works with at least two different computer systems for reporting patient variables as well as consulting with several different electronic and paper sources to get the information he needs to see patients.

In contrast, at the VA, every clinic is connected in the VistA system with a single patient identifier. “Everything is in the computer,” Dr. Turner said.

The VA computerized patient record system, which sits atop the VistA platform, includes the physicians' notes, lab results, and results of consults and surgical procedures. It also generally includes information from visits made outside the system. A hard copy of the clinical record from an outside visit can be scanned into the VA system and made available within a day, Dr. Turner said.

Quality of care has improved since the implementation of VistA, Dr. Turner said. The system includes a check for drug-drug interactions plus several other alerts that let the physician know what's been going on with the patient since the last visit. “Hands down, I would take the VA computer [system] anywhere,” Dr. Turner concluded.

VA officials began building the first generation of the computerized patient record system in the late 1980s out of a need to deal with the increasing number of veterans coming into the system, while resources remained tight, said Linda Fischetti, R.N., acting chief health informatics officer at the Veterans Health Administration's Office of Information. “We had to find ways to reduce redundancies and care for more patients.”

And the move to an electronic system was driven largely by clinicians who said they needed better tools. “We had clinicians actively saying, 'We need this, we need this, we need this,'” she said.

The idea was to create a single system with robust functionality in every health care environment—the inpatient hospital, the outpatient hospital, the long-term care facility, and clinics within the community. The current system is the second generation and VA officials continue to modernize it, Ms. Fischetti said. Today the system allows VA clinicians access to complete historical information on their patients, as well as real-time clinical reminders and real-time decision support.

The No. 1 lesson from the VA experience is that the system must be driven by the needs of the clinician, Ms. Fischetti said. The system also needs to do more than just replace the paper chart. If the health IT product does not add value for physicians, she said, they might not adopt it.

She noted, however, that the VA, as both the payer and provider of health care services, distinguishes itself from most of the care providers in the United States. “We are definitely different because we have the alignment of the payer and provider within our own enterprise.”

While the VA is a unique system, there are lessons that can be applied in large hospital systems and even in solo physician practices, said Tom Leary, director of federal affairs at the Healthcare Information and Management Systems Society.

For example, successful adoption of a health IT system requires buy-in from clinician leadership. While clinician use of a system can be mandated to some extent in any organization, it does not produce the same results unless physicians and nurses want to use the technology, Mr. Leary said.

Other systems can also learn from the VA's approach to designing the system with the needs of its clinicians in mind, said Dr. Dennis Weaver, acting chief medical officer for the National Alliance for Health Information Technology. “You've got to build it for the clinicians,” he said.

Automating paper processes doesn't work. Physicians and administrators who are selecting an electronic health record system need to resist the urge to “pave the cow path.” They must let clinicians know up front that the work flow is going to change.

Translating Research Results

Officials at the National Institutes of Health are stepping up their efforts to bring research findings to clinicians faster through the launch of four new Centers of Research Translation: the Center for Translating Molecular Signal Pathways to Orthopedic Trauma Care; the Center for Lupus Research; the Center for X-Linked Hypophosphatemic Rickets Research; and the Center for Research Translation in Scleroderma. The scleroderma research effort will be led by Dr. Frank Arnett, professor of internal medicine in the division of rheumatology at the University of Texas Medical School in Houston. As part of the center's efforts, researchers will focus on the molecular basis of the disease. The centers were funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of NIH.

Lupus Researcher Honored

The Lupus Foundation of America recently honored Dr. Morris Reichlin of the Oklahoma Medical Research Foundation for a lifetime of achievement in the field of lupus research. Dr. Reichlin, director of the clinical immunology laboratory at the Oklahoma Medical Research Foundation in Oklahoma City, received the Evelyn V. Hess Research Award. Dr. Reichlin and his colleagues have been involved in studying autoimmune responses in patients with lupus. “Dr. Reichlin is clearly one of the leaders in research in lupus and has maintained that position over a number of years. His observations on autoantibodies and the tests he developed to detect them are critical components of the diagnosis of lupus that are used today,” Dr. Gary Gilkeson, chair of the Lupus Foundation of America Medical-Scientific Advisory Council, said in a statement.

Power Mobility Device Coverage

Medicare officials recently announced changes to the fee schedule for new power mobility devices (PMDs) in an effort to improve the accuracy of the prices. The “refinements” will increase the fees paid for complex rehabilitation power wheelchairs. The changes will also result in increases to the fees for standard geriatric mobility power wheelchairs. The price increases are intended to reflect the greater durability and performance of these chairs compared with others, according to officials from the Centers for Medicare and Medicaid Services. The fee schedule was originally released in October. More information on the code refinements is available online at

www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp

Part D Model Guidelines

The United States Pharmacopeia (USP) has released a draft of the third version of the Medicare Part D Model Guidelines. Each year, a USP expert panel updates the guidelines to be used by Medicare Part D drug plans when compiling their formularies. The guidelines themselves are not a formulary and instead list therapeutic categories, pharmacologic classes, and key formulary drug types from which drug plans should offer medications. About 80% of Part D drug plans based their formularies on the guidelines. The USP expert panel will submit a final version of the guidelines to Medicare officials by Feb. 5, 2007. The draft guidelines are available online at

www.usp.org

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. However, practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. Large practices may also have an advantage in health IT adoption because of more active physician leaders who are promoting IT and quality improvement, according to the report. The data in the report are from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available online at

www.hschange.org/CONTENT/891

Translating Research Results

Officials at the National Institutes of Health are stepping up their efforts to bring research findings to clinicians faster through the launch of four new Centers of Research Translation: the Center for Translating Molecular Signal Pathways to Orthopedic Trauma Care; the Center for Lupus Research; the Center for X-Linked Hypophosphatemic Rickets Research; and the Center for Research Translation in Scleroderma. The scleroderma research effort will be led by Dr. Frank Arnett, professor of internal medicine in the division of rheumatology at the University of Texas Medical School in Houston. As part of the center's efforts, researchers will focus on the molecular basis of the disease. The centers were funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of NIH.

Lupus Researcher Honored

The Lupus Foundation of America recently honored Dr. Morris Reichlin of the Oklahoma Medical Research Foundation for a lifetime of achievement in the field of lupus research. Dr. Reichlin, director of the clinical immunology laboratory at the Oklahoma Medical Research Foundation in Oklahoma City, received the Evelyn V. Hess Research Award. Dr. Reichlin and his colleagues have been involved in studying autoimmune responses in patients with lupus. “Dr. Reichlin is clearly one of the leaders in research in lupus and has maintained that position over a number of years. His observations on autoantibodies and the tests he developed to detect them are critical components of the diagnosis of lupus that are used today,” Dr. Gary Gilkeson, chair of the Lupus Foundation of America Medical-Scientific Advisory Council, said in a statement.

Power Mobility Device Coverage

Medicare officials recently announced changes to the fee schedule for new power mobility devices (PMDs) in an effort to improve the accuracy of the prices. The “refinements” will increase the fees paid for complex rehabilitation power wheelchairs. The changes will also result in increases to the fees for standard geriatric mobility power wheelchairs. The price increases are intended to reflect the greater durability and performance of these chairs compared with others, according to officials from the Centers for Medicare and Medicaid Services. The fee schedule was originally released in October. More information on the code refinements is available online at

www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp

Part D Model Guidelines

The United States Pharmacopeia (USP) has released a draft of the third version of the Medicare Part D Model Guidelines. Each year, a USP expert panel updates the guidelines to be used by Medicare Part D drug plans when compiling their formularies. The guidelines themselves are not a formulary and instead list therapeutic categories, pharmacologic classes, and key formulary drug types from which drug plans should offer medications. About 80% of Part D drug plans based their formularies on the guidelines. The USP expert panel will submit a final version of the guidelines to Medicare officials by Feb. 5, 2007. The draft guidelines are available online at

www.usp.org

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. However, practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. Large practices may also have an advantage in health IT adoption because of more active physician leaders who are promoting IT and quality improvement, according to the report. The data in the report are from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available online at

www.hschange.org/CONTENT/891

Translating Research Results

Officials at the National Institutes of Health are stepping up their efforts to bring research findings to clinicians faster through the launch of four new Centers of Research Translation: the Center for Translating Molecular Signal Pathways to Orthopedic Trauma Care; the Center for Lupus Research; the Center for X-Linked Hypophosphatemic Rickets Research; and the Center for Research Translation in Scleroderma. The scleroderma research effort will be led by Dr. Frank Arnett, professor of internal medicine in the division of rheumatology at the University of Texas Medical School in Houston. As part of the center's efforts, researchers will focus on the molecular basis of the disease. The centers were funded by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, part of NIH.

Lupus Researcher Honored

The Lupus Foundation of America recently honored Dr. Morris Reichlin of the Oklahoma Medical Research Foundation for a lifetime of achievement in the field of lupus research. Dr. Reichlin, director of the clinical immunology laboratory at the Oklahoma Medical Research Foundation in Oklahoma City, received the Evelyn V. Hess Research Award. Dr. Reichlin and his colleagues have been involved in studying autoimmune responses in patients with lupus. “Dr. Reichlin is clearly one of the leaders in research in lupus and has maintained that position over a number of years. His observations on autoantibodies and the tests he developed to detect them are critical components of the diagnosis of lupus that are used today,” Dr. Gary Gilkeson, chair of the Lupus Foundation of America Medical-Scientific Advisory Council, said in a statement.

Power Mobility Device Coverage

Medicare officials recently announced changes to the fee schedule for new power mobility devices (PMDs) in an effort to improve the accuracy of the prices. The “refinements” will increase the fees paid for complex rehabilitation power wheelchairs. The changes will also result in increases to the fees for standard geriatric mobility power wheelchairs. The price increases are intended to reflect the greater durability and performance of these chairs compared with others, according to officials from the Centers for Medicare and Medicaid Services. The fee schedule was originally released in October. More information on the code refinements is available online at

www.cms.hhs.gov/DMEPOSFeeSched/01a_Power_Mobility_Devices.asp

Part D Model Guidelines

The United States Pharmacopeia (USP) has released a draft of the third version of the Medicare Part D Model Guidelines. Each year, a USP expert panel updates the guidelines to be used by Medicare Part D drug plans when compiling their formularies. The guidelines themselves are not a formulary and instead list therapeutic categories, pharmacologic classes, and key formulary drug types from which drug plans should offer medications. About 80% of Part D drug plans based their formularies on the guidelines. The USP expert panel will submit a final version of the guidelines to Medicare officials by Feb. 5, 2007. The draft guidelines are available online at

www.usp.org

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. However, practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely due to the greater financial resources of larger practices along with more administrative resources and economies of scale. Large practices may also have an advantage in health IT adoption because of more active physician leaders who are promoting IT and quality improvement, according to the report. The data in the report are from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. “Larger practices appear to be gaining critical mass in adopting IT for patient care, but the smallest practices, which account for more than half of all practicing physicians, appear to be at risk of being left behind,” Joy M. Grossman, a coauthor of the report and a senior health researcher at HSC, said in a statement. The report is available online at

www.hschange.org/CONTENT/891

Medicare officials plan to expand their voluntary quality reporting program to include more subspecialty measures next year.

The Physician Voluntary Reporting Program was launched last January with a set of 16 core measures, representing 19 of the 39 Medicare physician specialty designations. For 2007, Medicare officials have developed a draft list that includes quality measures that cover 32 of the 39 medical specialties.

Officials at the Centers for Medicare and Medicaid Services recently released a list of 86 unique quality measures from which they plan to select a subset for use in the program. The final list is expected to be posted by Jan. 1, 2007, but the list may be updated throughout the coming year. At press time, the list included 21 measures for internal medicine and family medicine, 11 for geriatrics, 8 for cardiology, 9 for neurology, 1 for psychiatry, 3 for rheumatology, and 4 specific to endocrinology.

Under the program, physicians can use either G-codes or CPT Category II codes, when available, to report on the measures. Physicians who participated in 2006 can expect to receive confidential feedback reports from the CMS sometime this winter.

In assembling the draft list of measures for 2007, CMS officials gave preference to measures that had been adopted or endorsed by the AQA (formerly called the Ambulatory Care Quality Alliance) and the National Quality Forum (NQF). They also tried to first include measures for which electronic data collection could be used, instead of reporting on claims.

But some physician groups have cited concerns about the additional measures being considered by the CMS. Dr. Lynne M. Kirk, president of the American College of Physicians, said that some of the 86 measures listed by the CMS have not been fully vetted by either the AQA or the NQF.

But Dr. Kirk is hopeful that the CMS will listen to the group's concerns. Last year, CMS officials had proposed beginning the program with 36 measures, but after hearing feedback from medical specialty societies, pared that list to a starter set of 16 measures.

While the intent of the program is good and the measures have been well chosen, the program creates too large a burden on physicians, said Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists.The use of G-codes to report data means that physicians have to train their staff to use the codes, he said. And even physicians who have already adopted electronic health records don't have a clear path to submit data electronically. While the CMS allows the use of CPT-II codes, which can be transmitted electronically and more easily by paper, these codes are not available for all measures. The CMS should only use measures that have CPT-II codes available, Dr. Hellman said.

The other major issue is that physicians are not getting any additional money for participating in the program, Dr. Hellman said. Physicians take on additional costs to report the data and they should be given an incentive, he said.The American College of Cardiology does not have a formal position on the Physician Voluntary Reporting Program. ACC officials were involved in the development of the eight cardiology-specific measures that are being considered for inclusion by CMS and ACC supports their inclusion in the program. But more details are needed on what data collection methods physicians can use. “We feel that payment for quality or performance is a complex issue and more testing and evaluation of the measures and prospective data collection tools” are needed, according to an ACC statement.

Of the eight measures for cardiology, five were for treatment for coronary artery disease. They included the percentage of CAD patients with diabetes and/or left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or angiotensin receptor blocker (ARB) therapy, and the percentage of CAD patients who received antiplatelet therapy, at least one lipid profile or all component tests, and β-blocker therapy for prior MI.

The other three cardiology measures were for heart failure, and included the percentage of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitors, ARB therapy, and β-blocker therapy; and the percentage of heart failure patients with paroxysmal or chronic atrial fibrillation prescribed warfarin therapy.

Information on the Physician Voluntary Reporting Program and the draft list of quality measures is available online at www.cms.hhs.gov/pvrp/01_overview.asp

Medicare officials plan to expand their voluntary quality reporting program to include more subspecialty measures next year.

The Physician Voluntary Reporting Program was launched last January with a set of 16 core measures, representing 19 of the 39 Medicare physician specialty designations. For 2007, Medicare officials have developed a draft list that includes quality measures that cover 32 of the 39 medical specialties.

Officials at the Centers for Medicare and Medicaid Services recently released a list of 86 unique quality measures from which they plan to select a subset for use in the program. The final list is expected to be posted by Jan. 1, 2007, but the list may be updated throughout the coming year. At press time, the list included 21 measures for internal medicine and family medicine, 11 for geriatrics, 8 for cardiology, 9 for neurology, 1 for psychiatry, 3 for rheumatology, and 4 specific to endocrinology.

Under the program, physicians can use either G-codes or CPT Category II codes, when available, to report on the measures. Physicians who participated in 2006 can expect to receive confidential feedback reports from the CMS sometime this winter.

In assembling the draft list of measures for 2007, CMS officials gave preference to measures that had been adopted or endorsed by the AQA (formerly called the Ambulatory Care Quality Alliance) and the National Quality Forum (NQF). They also tried to first include measures for which electronic data collection could be used, instead of reporting on claims.

But some physician groups have cited concerns about the additional measures being considered by the CMS. Dr. Lynne M. Kirk, president of the American College of Physicians, said that some of the 86 measures listed by the CMS have not been fully vetted by either the AQA or the NQF.

But Dr. Kirk is hopeful that the CMS will listen to the group's concerns. Last year, CMS officials had proposed beginning the program with 36 measures, but after hearing feedback from medical specialty societies, pared that list to a starter set of 16 measures.

While the intent of the program is good and the measures have been well chosen, the program creates too large a burden on physicians, said Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists.The use of G-codes to report data means that physicians have to train their staff to use the codes, he said. And even physicians who have already adopted electronic health records don't have a clear path to submit data electronically. While the CMS allows the use of CPT-II codes, which can be transmitted electronically and more easily by paper, these codes are not available for all measures. The CMS should only use measures that have CPT-II codes available, Dr. Hellman said.

The other major issue is that physicians are not getting any additional money for participating in the program, Dr. Hellman said. Physicians take on additional costs to report the data and they should be given an incentive, he said.The American College of Cardiology does not have a formal position on the Physician Voluntary Reporting Program. ACC officials were involved in the development of the eight cardiology-specific measures that are being considered for inclusion by CMS and ACC supports their inclusion in the program. But more details are needed on what data collection methods physicians can use. “We feel that payment for quality or performance is a complex issue and more testing and evaluation of the measures and prospective data collection tools” are needed, according to an ACC statement.

Of the eight measures for cardiology, five were for treatment for coronary artery disease. They included the percentage of CAD patients with diabetes and/or left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or angiotensin receptor blocker (ARB) therapy, and the percentage of CAD patients who received antiplatelet therapy, at least one lipid profile or all component tests, and β-blocker therapy for prior MI.

The other three cardiology measures were for heart failure, and included the percentage of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitors, ARB therapy, and β-blocker therapy; and the percentage of heart failure patients with paroxysmal or chronic atrial fibrillation prescribed warfarin therapy.

Information on the Physician Voluntary Reporting Program and the draft list of quality measures is available online at www.cms.hhs.gov/pvrp/01_overview.asp

Medicare officials plan to expand their voluntary quality reporting program to include more subspecialty measures next year.

The Physician Voluntary Reporting Program was launched last January with a set of 16 core measures, representing 19 of the 39 Medicare physician specialty designations. For 2007, Medicare officials have developed a draft list that includes quality measures that cover 32 of the 39 medical specialties.

Officials at the Centers for Medicare and Medicaid Services recently released a list of 86 unique quality measures from which they plan to select a subset for use in the program. The final list is expected to be posted by Jan. 1, 2007, but the list may be updated throughout the coming year. At press time, the list included 21 measures for internal medicine and family medicine, 11 for geriatrics, 8 for cardiology, 9 for neurology, 1 for psychiatry, 3 for rheumatology, and 4 specific to endocrinology.

Under the program, physicians can use either G-codes or CPT Category II codes, when available, to report on the measures. Physicians who participated in 2006 can expect to receive confidential feedback reports from the CMS sometime this winter.

In assembling the draft list of measures for 2007, CMS officials gave preference to measures that had been adopted or endorsed by the AQA (formerly called the Ambulatory Care Quality Alliance) and the National Quality Forum (NQF). They also tried to first include measures for which electronic data collection could be used, instead of reporting on claims.

But some physician groups have cited concerns about the additional measures being considered by the CMS. Dr. Lynne M. Kirk, president of the American College of Physicians, said that some of the 86 measures listed by the CMS have not been fully vetted by either the AQA or the NQF.

But Dr. Kirk is hopeful that the CMS will listen to the group's concerns. Last year, CMS officials had proposed beginning the program with 36 measures, but after hearing feedback from medical specialty societies, pared that list to a starter set of 16 measures.

While the intent of the program is good and the measures have been well chosen, the program creates too large a burden on physicians, said Dr. Richard Hellman, president-elect of the American Association of Clinical Endocrinologists.The use of G-codes to report data means that physicians have to train their staff to use the codes, he said. And even physicians who have already adopted electronic health records don't have a clear path to submit data electronically. While the CMS allows the use of CPT-II codes, which can be transmitted electronically and more easily by paper, these codes are not available for all measures. The CMS should only use measures that have CPT-II codes available, Dr. Hellman said.

The other major issue is that physicians are not getting any additional money for participating in the program, Dr. Hellman said. Physicians take on additional costs to report the data and they should be given an incentive, he said.The American College of Cardiology does not have a formal position on the Physician Voluntary Reporting Program. ACC officials were involved in the development of the eight cardiology-specific measures that are being considered for inclusion by CMS and ACC supports their inclusion in the program. But more details are needed on what data collection methods physicians can use. “We feel that payment for quality or performance is a complex issue and more testing and evaluation of the measures and prospective data collection tools” are needed, according to an ACC statement.

Of the eight measures for cardiology, five were for treatment for coronary artery disease. They included the percentage of CAD patients with diabetes and/or left ventricular systolic dysfunction (LVSD) who were prescribed ACE inhibitor or angiotensin receptor blocker (ARB) therapy, and the percentage of CAD patients who received antiplatelet therapy, at least one lipid profile or all component tests, and β-blocker therapy for prior MI.

The other three cardiology measures were for heart failure, and included the percentage of heart failure patients with left ventricular systolic dysfunction prescribed ACE inhibitors, ARB therapy, and β-blocker therapy; and the percentage of heart failure patients with paroxysmal or chronic atrial fibrillation prescribed warfarin therapy.

Information on the Physician Voluntary Reporting Program and the draft list of quality measures is available online at www.cms.hhs.gov/pvrp/01_overview.asp

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor child. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

New Children's Ad Guidelines

Advertisers have adopted an updated set of voluntary guidelines that spell out appropriate conduct in advertising to children under age 12. The guidelines were produced by the Children's Advertising Review Unit, which is administered by the Council of Better Business Bureaus and is funded by the children's advertising industry. The guidelines include directives on avoiding deceptive practices, avoiding misleading product representations and claims, and making disclaimers understandable, and also restrictions on celebrity endorsements, and prohibitions on blurring the line between advertising and program content, among others. For example, the guidelines prohibit the use of program personalities to advertise products or services adjacent to a TV program aimed at children under age 12 in which the same person or character appears. The guidelines also tackle the responsible advertising of food products. Under the guidelines, advertisers depicting food products must show the food in the context of a nutritionally balanced meal and snack foods should not be shown as substitutes for meals. The voluntary program applies to national advertising directed at children under age 12 years and online data collection targeting children under age 13 years. The guidelines are available at

www.caru.org/guidelines/guidelines.pdf

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. The figures on based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern,” said Eric Broderick, SAMHSA acting deputy administrator. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

Price Tag for Teen Births

The public cost of teenage births was more than $9 billion in 2004, according to an estimate of costs to federal, state, and local governments for all births to women aged 19 years and younger prepared by the National Campaign to Prevent Teen Pregnancy. The estimate includes increases in public sector health care costs for the baby, increased child welfare payments and other public assistance, increased costs to state prisons for the children of teen mothers, and lost revenue because of lower taxes paid by parents and the children over their adult lifetimes. The highest costs are for births to mothers 17 years and younger—about $8.6 billion in 2004. Overall, between 1991 and 2004, the researchers estimate that the public cost of teen births was about $161 billion.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement.

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor child. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

New Children's Ad Guidelines

Advertisers have adopted an updated set of voluntary guidelines that spell out appropriate conduct in advertising to children under age 12. The guidelines were produced by the Children's Advertising Review Unit, which is administered by the Council of Better Business Bureaus and is funded by the children's advertising industry. The guidelines include directives on avoiding deceptive practices, avoiding misleading product representations and claims, and making disclaimers understandable, and also restrictions on celebrity endorsements, and prohibitions on blurring the line between advertising and program content, among others. For example, the guidelines prohibit the use of program personalities to advertise products or services adjacent to a TV program aimed at children under age 12 in which the same person or character appears. The guidelines also tackle the responsible advertising of food products. Under the guidelines, advertisers depicting food products must show the food in the context of a nutritionally balanced meal and snack foods should not be shown as substitutes for meals. The voluntary program applies to national advertising directed at children under age 12 years and online data collection targeting children under age 13 years. The guidelines are available at

www.caru.org/guidelines/guidelines.pdf

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. The figures on based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern,” said Eric Broderick, SAMHSA acting deputy administrator. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

Price Tag for Teen Births

The public cost of teenage births was more than $9 billion in 2004, according to an estimate of costs to federal, state, and local governments for all births to women aged 19 years and younger prepared by the National Campaign to Prevent Teen Pregnancy. The estimate includes increases in public sector health care costs for the baby, increased child welfare payments and other public assistance, increased costs to state prisons for the children of teen mothers, and lost revenue because of lower taxes paid by parents and the children over their adult lifetimes. The highest costs are for births to mothers 17 years and younger—about $8.6 billion in 2004. Overall, between 1991 and 2004, the researchers estimate that the public cost of teen births was about $161 billion.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement.

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor child. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

New Children's Ad Guidelines

Advertisers have adopted an updated set of voluntary guidelines that spell out appropriate conduct in advertising to children under age 12. The guidelines were produced by the Children's Advertising Review Unit, which is administered by the Council of Better Business Bureaus and is funded by the children's advertising industry. The guidelines include directives on avoiding deceptive practices, avoiding misleading product representations and claims, and making disclaimers understandable, and also restrictions on celebrity endorsements, and prohibitions on blurring the line between advertising and program content, among others. For example, the guidelines prohibit the use of program personalities to advertise products or services adjacent to a TV program aimed at children under age 12 in which the same person or character appears. The guidelines also tackle the responsible advertising of food products. Under the guidelines, advertisers depicting food products must show the food in the context of a nutritionally balanced meal and snack foods should not be shown as substitutes for meals. The voluntary program applies to national advertising directed at children under age 12 years and online data collection targeting children under age 13 years. The guidelines are available at

www.caru.org/guidelines/guidelines.pdf

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. The figures on based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern,” said Eric Broderick, SAMHSA acting deputy administrator. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

Price Tag for Teen Births

The public cost of teenage births was more than $9 billion in 2004, according to an estimate of costs to federal, state, and local governments for all births to women aged 19 years and younger prepared by the National Campaign to Prevent Teen Pregnancy. The estimate includes increases in public sector health care costs for the baby, increased child welfare payments and other public assistance, increased costs to state prisons for the children of teen mothers, and lost revenue because of lower taxes paid by parents and the children over their adult lifetimes. The highest costs are for births to mothers 17 years and younger—about $8.6 billion in 2004. Overall, between 1991 and 2004, the researchers estimate that the public cost of teen births was about $161 billion.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement.

BOSTON — Voters in several states made their voices heard last month on public health issues ranging from smoking bans to restrictions on abortion to the minimum wage.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA). The following is a sample of the some of the issues that appeared on the ballot on Nov. 7:

Smoking Restrictions

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed statewide smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax increases while California and Missouri rejected them.

“I think the United States has made great progress,” said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University in Baltimore.

Social norms around smoking are starting to change but that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs. Despite the number of states moving toward smoking bans, Ms. Stillman does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country.

“They can't be everywhere at once,” she said.

If there is a single effort at the federal level, it should be for the Food and Drug Administration to regulate tobacco, said Dr. Georges Benjamin, executive director of the APHA.

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act, which prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The proposition also imposes an increase on cigarette taxes.

Arizona voters also passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products. The voters also rejected a ballot initiative that prohibited smoking in many public places but would have exempted bars and parts of restaurants that have a separate ventilation system.

Nevada voters passed a ballot question to ban smoking in a number of indoor areas including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants. Exceptions include stand-alone bars, casinos, strip clubs or brothels, and retail tobacco stores. This initiative allows cities and towns to adopt stricter laws.

Voters in Nevada rejected a similar-sounding initiative that would have prevented local counties and towns from passing stricter regulations related to smoking.

Ohio voters took similar action on two of their ballot questions. They passed a proposal to prohibit smoking in a number of public places and rejected a proposal that would have called for similar prohibitions on smoking but would have stricken from the books any stricter local laws on smoking.

Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to increase taxes on cigarettes and dedicate a portion of those funds to tobacco-prevention programs. In California and Missouri, initiatives that would have increased taxes on cigarettes failed.

Reproductive Health

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban that was passed by the South Dakota legislature earlier this year.

The controversial South Dakota law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where the abortion is necessary to preserve the woman's health or in cases of rape or incest.

After the law was signed by the governor earlier this year, opponents began a petition to force the issue onto the November ballot. If voters had approved the ballot measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by the voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the life or health of the woman.

In Oregon and California, voters rejected measures that would have required physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state's constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. This is not the first time that California voters have dealt with this issue. Last year they defeated the same measure in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

Minimum Wage

Minimum wage hikes passed in all six states where they were proposed, raising the minimum wage as high as $6.85 per hour in Ohio and Colorado.

The federal minimum wage is set at $5.15 per hour but about half the states have higher minimum wage laws. Washington state has the highest minimum wage among the states at $7.63 per hour, according to the National Conference of State Legislatures.

Voters raised the minimum wage to $6.50 in Missouri, $6.15 in Montana, $6.75 in Arizona, $6.85 in Ohio, and $6.85 in Colorado. In Nevada, voters approved a measure to make the minimum wage $5.15 per hour if the employer provides health insurance and $6.15 per hour if the employer does not. This measure was passed by voters in 2004 but under Nevada law must be passed in two consecutive elections since it amends the constitution.

BOSTON — Voters in several states made their voices heard last month on public health issues ranging from smoking bans to restrictions on abortion to the minimum wage.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA). The following is a sample of the some of the issues that appeared on the ballot on Nov. 7:

Smoking Restrictions

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed statewide smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax increases while California and Missouri rejected them.

“I think the United States has made great progress,” said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University in Baltimore.

Social norms around smoking are starting to change but that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs. Despite the number of states moving toward smoking bans, Ms. Stillman does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country.

“They can't be everywhere at once,” she said.

If there is a single effort at the federal level, it should be for the Food and Drug Administration to regulate tobacco, said Dr. Georges Benjamin, executive director of the APHA.

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act, which prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The proposition also imposes an increase on cigarette taxes.

Arizona voters also passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products. The voters also rejected a ballot initiative that prohibited smoking in many public places but would have exempted bars and parts of restaurants that have a separate ventilation system.

Nevada voters passed a ballot question to ban smoking in a number of indoor areas including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants. Exceptions include stand-alone bars, casinos, strip clubs or brothels, and retail tobacco stores. This initiative allows cities and towns to adopt stricter laws.

Voters in Nevada rejected a similar-sounding initiative that would have prevented local counties and towns from passing stricter regulations related to smoking.

Ohio voters took similar action on two of their ballot questions. They passed a proposal to prohibit smoking in a number of public places and rejected a proposal that would have called for similar prohibitions on smoking but would have stricken from the books any stricter local laws on smoking.

Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to increase taxes on cigarettes and dedicate a portion of those funds to tobacco-prevention programs. In California and Missouri, initiatives that would have increased taxes on cigarettes failed.

Reproductive Health

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban that was passed by the South Dakota legislature earlier this year.

The controversial South Dakota law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where the abortion is necessary to preserve the woman's health or in cases of rape or incest.

After the law was signed by the governor earlier this year, opponents began a petition to force the issue onto the November ballot. If voters had approved the ballot measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by the voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the life or health of the woman.

In Oregon and California, voters rejected measures that would have required physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state's constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. This is not the first time that California voters have dealt with this issue. Last year they defeated the same measure in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

Minimum Wage

Minimum wage hikes passed in all six states where they were proposed, raising the minimum wage as high as $6.85 per hour in Ohio and Colorado.

The federal minimum wage is set at $5.15 per hour but about half the states have higher minimum wage laws. Washington state has the highest minimum wage among the states at $7.63 per hour, according to the National Conference of State Legislatures.

Voters raised the minimum wage to $6.50 in Missouri, $6.15 in Montana, $6.75 in Arizona, $6.85 in Ohio, and $6.85 in Colorado. In Nevada, voters approved a measure to make the minimum wage $5.15 per hour if the employer provides health insurance and $6.15 per hour if the employer does not. This measure was passed by voters in 2004 but under Nevada law must be passed in two consecutive elections since it amends the constitution.

BOSTON — Voters in several states made their voices heard last month on public health issues ranging from smoking bans to restrictions on abortion to the minimum wage.

Public health experts offered their views on the ballot initiatives at the annual meeting of the American Public Health Association (APHA). The following is a sample of the some of the issues that appeared on the ballot on Nov. 7:

Smoking Restrictions

Results were mixed on public health initiatives related to tobacco. Voters in Arizona, Nevada, and Ohio passed statewide smoking restrictions. But voters were split in their support for raising taxes on cigarettes and other tobacco products, with Arizona and South Dakota approving tax increases while California and Missouri rejected them.

“I think the United States has made great progress,” said Frances Stillman, codirector of the Institute for Global Tobacco Control at Johns Hopkins University in Baltimore.

Social norms around smoking are starting to change but that progress could be in jeopardy due to a lack of public funding in the states, said Ms. Stillman, immediate past chair of the APHA section on alcohol, tobacco, and other drugs. Despite the number of states moving toward smoking bans, Ms. Stillman does not foresee a federal ban on smoking anytime soon. And local action benefits antismoking advocates, she said, because it's harder for the tobacco industry to fight these efforts around the country.

“They can't be everywhere at once,” she said.

If there is a single effort at the federal level, it should be for the Food and Drug Administration to regulate tobacco, said Dr. Georges Benjamin, executive director of the APHA.

In Arizona, voters passed Proposition 201, the Smoke-Free Arizona Act, which prohibits smoking in all public places and places of employment except retail tobacco stores, veterans' and fraternal clubs, certain designated hotel rooms, and outdoor patios. The proposition also imposes an increase on cigarette taxes.

Arizona voters also passed an initiative to establish an early childhood development and health fund that would be supported in part by revenues from the increase in the state tax on tobacco products. The voters also rejected a ballot initiative that prohibited smoking in many public places but would have exempted bars and parts of restaurants that have a separate ventilation system.

Nevada voters passed a ballot question to ban smoking in a number of indoor areas including child care facilities, government buildings, public places, all bars with a food-handling license, and all indoor restaurants. Exceptions include stand-alone bars, casinos, strip clubs or brothels, and retail tobacco stores. This initiative allows cities and towns to adopt stricter laws.

Voters in Nevada rejected a similar-sounding initiative that would have prevented local counties and towns from passing stricter regulations related to smoking.

Ohio voters took similar action on two of their ballot questions. They passed a proposal to prohibit smoking in a number of public places and rejected a proposal that would have called for similar prohibitions on smoking but would have stricken from the books any stricter local laws on smoking.

Voters in Florida passed a constitutional amendment to use tobacco settlement money to fund a statewide tobacco education and prevention program. Voters in South Dakota passed a measure to increase taxes on cigarettes and dedicate a portion of those funds to tobacco-prevention programs. In California and Missouri, initiatives that would have increased taxes on cigarettes failed.

Reproductive Health

Voters in three states defeated restrictions on abortion last month, including the far-reaching ban that was passed by the South Dakota legislature earlier this year.

The controversial South Dakota law would have outlawed abortion in all cases except to save the life of the mother. The law did not include exceptions in cases where the abortion is necessary to preserve the woman's health or in cases of rape or incest.

After the law was signed by the governor earlier this year, opponents began a petition to force the issue onto the November ballot. If voters had approved the ballot measure, the issue would ultimately have been decided in the courts, resulting in a direct challenge to Roe v. Wade. With the legislation defeated by the voters, current South Dakota law allows a woman to obtain an abortion during the first 24 weeks of pregnancy. After that time, abortions can be performed only to preserve the life or health of the woman.

In Oregon and California, voters rejected measures that would have required physicians to notify a minor's parents before performing an abortion. California's proposition 85 would have amended the state's constitution to prohibit physicians from performing an abortion on an unemancipated minor until 48 hours after notifying a parent or legal guardian. This is not the first time that California voters have dealt with this issue. Last year they defeated the same measure in a special election.

Oregon's measure 43 would have required a physician to provide written notice to a parent of an unemancipated minor age 15 and older at least 48 hours before providing the abortion. Under current law, parental consent for an abortion is required for minors younger than 15.

Lois Uttley, director of the MergerWatch Project, a group that advocates for greater access to reproductive health services, told this news organization that in an ideal world, girls would seek parental advice, but mandating parental involvement can lead to abuse. Instead, age-appropriate sex education, which includes both abstinence education and birth control, are more appropriate answers, said Ms. Uttley, who is the chair of the APHA Action Board.

“Good family communication unfortunately cannot be imposed by the government,” she said.

Minimum Wage

Minimum wage hikes passed in all six states where they were proposed, raising the minimum wage as high as $6.85 per hour in Ohio and Colorado.

The federal minimum wage is set at $5.15 per hour but about half the states have higher minimum wage laws. Washington state has the highest minimum wage among the states at $7.63 per hour, according to the National Conference of State Legislatures.

Voters raised the minimum wage to $6.50 in Missouri, $6.15 in Montana, $6.75 in Arizona, $6.85 in Ohio, and $6.85 in Colorado. In Nevada, voters approved a measure to make the minimum wage $5.15 per hour if the employer provides health insurance and $6.15 per hour if the employer does not. This measure was passed by voters in 2004 but under Nevada law must be passed in two consecutive elections since it amends the constitution.

Telehealth Licensure

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database could also streamline the verification of physician credentials in times of disaster, according to the FSMB.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Tex.) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes in 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But, it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

Telehealth Licensure

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database could also streamline the verification of physician credentials in times of disaster, according to the FSMB.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Tex.) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes in 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But, it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

Telehealth Licensure

Officials at the Federation of State Medical Boards are tackling the issue of licensure for physicians engaged in telehealth and those involved in the multistate practice of medicine. FSMB recently received a grant from the federal government to test different ways to reduce licensure barriers and better share information across jurisdictions. “With telehealth playing an increasingly important role in meeting the needs of underserved patient populations, the ability of physicians to be able to quickly obtain licensure in multiple jurisdictions has never been more important,” Dr. James N. Thompson, FSMB president and CEO, said in a statement. “This grant will allow us to find ways to streamline the licensure process while maintaining appropriate standards for public protection.” A centralized database could also streamline the verification of physician credentials in times of disaster, according to the FSMB.

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee Chairman Joe Barton (R-Tex.) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003. “Some CDC employees have raised concerns that these changes will make CDC more cumbersome and bureaucratic, taking time and resources away from scientific programs directly benefiting the public,” Rep. Barton and Rep. Whitfield wrote in the letter.

Health IT Standardization

The Certification Commission for Healthcare Information Technology (CCHIT), founded in 2004 by three health IT industry organizations, has been designated officially as a Recognized Certification Body by the Health and Human Services Department. CCHIT has already given its seal of approval to 33 ambulatory electronic health record products. The organization will continue to work on certification criteria for inpatient and hospital systems and the architecture that allows information exchange between health care providers and institutions. “Broad adoption of health information technology that is interoperable is absolutely crucial to providing patients with better care, at lower cost, and with less hassle,” HHS Secretary Mike Leavitt said in a statement. “I applaud the CCHIT for meeting the requirements to become a Recognized Certification Body and for their efforts to help bring the benefits of health IT within reach of consumers.”

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. They cited several factors contributing to the stall, including smaller increases in cigarette prices and a 27% reduction in funding for state tobacco control and prevention programs for 2002–2006. Smoking rates are highest among people with less education—43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes in 5–10 years. The strongest support came from 18- to 29-year-olds; 57% favored criminalization, reported the DPA, which advocates medical treatment for drug use and is about to launch a public service campaign on the potential unintended consequences of a cigarette ban.

Medicare Handbook Bias

A group of senior House and Senate Democrats have charged that the 2007 Medicare Handbook casts HMO plans in a more favorable light than fee-for-service plans. The Bush Administration favors Medicare Advantage, the HMO program, which had enrolled about 7.5 million out of 42 million beneficiaries as of mid-year. But, it's no secret that Democrats have been unhappy with the program. At the National Medicare Congress in Washington in mid-October, Rep. Pete Stark (D-Calif.) said the program is “overpaid” relative to fee-for-service and that “Medicare loses money on everyone who signs up.” Rep. Stark joined Rep. Charles Rangel (D-N.Y.), Rep. John Dingell (D-Mich.), and Rep. Sherrod Brown (D-Ohio), and Sen. Max Baucus (D-Mont.) and Sen. Jay Rockefeller (D-W.Va.) in writing HHS Secretary Mike Levitt charging that the 2007 handbook “presents a misleading and biased view of Medicare coverage and options.” Though no changes can be made to the 2007 book, the legislators urged CMS to ensure that other beneficiary materials take their concerns into account.

RENO, NEV. — Infants—especially breast-fed infants—at an increased risk for type 1 diabetes aren't getting the recommended levels of vitamin D in their diets, despite efforts to publicize the relationship between type 1 diabetes and insufficient vitamin D, according to a poster presented at the annual meeting of the American College of Nutrition.

Given the reported association between low intake of vitamin D and higher risk for type 1 diabetes, researchers with the Environmental Determinants of Diabetes in the Young (TEDDY) study decided to assess the vitamin D intake of children aged 3–12 months who possess a genetic predisposition to the autoimmunity associated with type 1 diabetes.

The dietary intake of the infants was compared with recommendations for vitamin D intake from the American Academy of Pediatrics (AAP).

The researchers analyzed vitamin D intake for 342 infants from the TEDDY centers in Colorado, Georgia, and Florida. Fewer than half of the children in the study (49%) met AAP guidelines for vitamin D intake at 3 months, and 56% met guidelines at 6 months. But compliance with the AAP recommendations increased over time. By 9 months of age, the percentage of infants meeting AAP recommendations for vitamin D intake increased to 73% and continued to rise to 79% by 12 months.

The current AAP recommendation calls for infants to receive 200 IU of vitamin D daily within the first 2 months of life. Infants and children who consume at least 500 mL per day of vitamin D-fortified formula or milk should meet the recommended intake, but vitamin D supplementation is necessary in breast-fed infants, according to the AAP (Pediatrics 2003;111:908–10).

The TEDDY researchers found that infants with very low intakes of vitamin D were generally those infants who were predominantly breast fed. Many infants who were primarily formula-fed had vitamin D intakes that were twofold higher than the AAP recommendations. And some formula-fed infants with very large energy intakes were receiving three- to fourfold more than the AAP's recommended daily intake of vitamin D, the researchers wrote.

These preliminary results are based on dietary intake data collected between September 2004 and July 2006. The researchers collected 24-hour diet recall and 3-day food diaries from the primary caretakers. The 3-day records were averaged to obtain daily intake, and nutrient values were calculated. The data collection is ongoing.

The TEDDY study is funded by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Juvenile Diabetes Research Foundation.

RENO, NEV. — Infants—especially breast-fed infants—at an increased risk for type 1 diabetes aren't getting the recommended levels of vitamin D in their diets, despite efforts to publicize the relationship between type 1 diabetes and insufficient vitamin D, according to a poster presented at the annual meeting of the American College of Nutrition.

Given the reported association between low intake of vitamin D and higher risk for type 1 diabetes, researchers with the Environmental Determinants of Diabetes in the Young (TEDDY) study decided to assess the vitamin D intake of children aged 3–12 months who possess a genetic predisposition to the autoimmunity associated with type 1 diabetes.

The dietary intake of the infants was compared with recommendations for vitamin D intake from the American Academy of Pediatrics (AAP).

The researchers analyzed vitamin D intake for 342 infants from the TEDDY centers in Colorado, Georgia, and Florida. Fewer than half of the children in the study (49%) met AAP guidelines for vitamin D intake at 3 months, and 56% met guidelines at 6 months. But compliance with the AAP recommendations increased over time. By 9 months of age, the percentage of infants meeting AAP recommendations for vitamin D intake increased to 73% and continued to rise to 79% by 12 months.

The current AAP recommendation calls for infants to receive 200 IU of vitamin D daily within the first 2 months of life. Infants and children who consume at least 500 mL per day of vitamin D-fortified formula or milk should meet the recommended intake, but vitamin D supplementation is necessary in breast-fed infants, according to the AAP (Pediatrics 2003;111:908–10).

The TEDDY researchers found that infants with very low intakes of vitamin D were generally those infants who were predominantly breast fed. Many infants who were primarily formula-fed had vitamin D intakes that were twofold higher than the AAP recommendations. And some formula-fed infants with very large energy intakes were receiving three- to fourfold more than the AAP's recommended daily intake of vitamin D, the researchers wrote.

These preliminary results are based on dietary intake data collected between September 2004 and July 2006. The researchers collected 24-hour diet recall and 3-day food diaries from the primary caretakers. The 3-day records were averaged to obtain daily intake, and nutrient values were calculated. The data collection is ongoing.

The TEDDY study is funded by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Juvenile Diabetes Research Foundation.

RENO, NEV. — Infants—especially breast-fed infants—at an increased risk for type 1 diabetes aren't getting the recommended levels of vitamin D in their diets, despite efforts to publicize the relationship between type 1 diabetes and insufficient vitamin D, according to a poster presented at the annual meeting of the American College of Nutrition.

Given the reported association between low intake of vitamin D and higher risk for type 1 diabetes, researchers with the Environmental Determinants of Diabetes in the Young (TEDDY) study decided to assess the vitamin D intake of children aged 3–12 months who possess a genetic predisposition to the autoimmunity associated with type 1 diabetes.

The dietary intake of the infants was compared with recommendations for vitamin D intake from the American Academy of Pediatrics (AAP).

The researchers analyzed vitamin D intake for 342 infants from the TEDDY centers in Colorado, Georgia, and Florida. Fewer than half of the children in the study (49%) met AAP guidelines for vitamin D intake at 3 months, and 56% met guidelines at 6 months. But compliance with the AAP recommendations increased over time. By 9 months of age, the percentage of infants meeting AAP recommendations for vitamin D intake increased to 73% and continued to rise to 79% by 12 months.

The current AAP recommendation calls for infants to receive 200 IU of vitamin D daily within the first 2 months of life. Infants and children who consume at least 500 mL per day of vitamin D-fortified formula or milk should meet the recommended intake, but vitamin D supplementation is necessary in breast-fed infants, according to the AAP (Pediatrics 2003;111:908–10).

The TEDDY researchers found that infants with very low intakes of vitamin D were generally those infants who were predominantly breast fed. Many infants who were primarily formula-fed had vitamin D intakes that were twofold higher than the AAP recommendations. And some formula-fed infants with very large energy intakes were receiving three- to fourfold more than the AAP's recommended daily intake of vitamin D, the researchers wrote.

These preliminary results are based on dietary intake data collected between September 2004 and July 2006. The researchers collected 24-hour diet recall and 3-day food diaries from the primary caretakers. The 3-day records were averaged to obtain daily intake, and nutrient values were calculated. The data collection is ongoing.

The TEDDY study is funded by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Juvenile Diabetes Research Foundation.

RENO, NEV. — Vitamin C supplementation may result in a small reduction in systolic blood pressure for hypertensive individuals and may help lower cholesterol in patients with hypercholesterolemia, according to the results of two meta-analyses presented at the annual meeting of the American College of Nutrition.

But vitamin C does not appear to be effective in lowering diastolic blood pressure among patients with hypertension, said Marc McRae of the department of nutrition and biochemical therapeutics at the National University of Health Sciences in Lombard, Ill., who presented the findings.

Mr. McRae and his colleagues performed a Medline search of randomized, double-blind controlled trials on the impact of daily vitamin C supplementation on systolic and diastolic blood pressure among hypertensive individuals. The researchers searched for studies published before January 2006.

A total of nine studies met the inclusion criteria, and the data were then extracted and analyzed. The pooled population of the studies included 297 subjects with a weighted mean baseline systolic blood pressure of 151.0 mm Hg and a weighted mean baseline diastolic pressure of 83.6 mm Hg. Study participants had taken a median daily dose of 500 mg of vitamin C over a 6-week median duration.

Overall, there was a small effect of vitamin C supplementation on systolic blood pressure, with an effect size of −2.4 mm Hg, which was statistically significant. The effect size for diastolic pressure was less than −0.5 mm Hg, which was not statistically significant.

Although the effect size for systolic blood pressure was small, previous studies have estimated that a sustained reduction of 2–3 mm Hg in systolic blood pressure can result in a 6% drop in the risk for stroke and a 4% reduction in the risk for heart disease, Mr. McRae said.

The results indicate that supplementation with at least 500 mg/day of vitamin C for approximately 6 weeks can lead to a small reduction in systolic blood pressure, he said.

In the second meta-analysis, Mr. McRae and his colleagues completed a similar evaluation of the impact of daily vitamin C intake among individuals with borderline-high and high cholesterol levels.

The researchers conducted another Medline search of studies published before January 2006, and included 16 studies that were randomized controlled trials of individuals with cholesterol levels greater than 200 mg/dL and a daily vitamin C intake of at least 500 mg.

The researchers divided the trials according to the baseline total serum cholesterol levels of the study participants. A total of 444 pooled subjects had borderline-high total cholesterol levels between 200 mg/dL and 240 mg/dL. Among those subjects, the median daily vitamin C intake was 1,000 mg over a median 6-week duration. This borderline-high cholesterol group had an effect size of −7.6 mg/dL, which was not significant.

A total of 307 pooled subjects had hypercholesterolemia with baseline total serum cholesterol levels greater than 240 mg/dL.

Study participants in that group had a median daily vitamin C intake of 1,000 mg over an 8-week median duration. The hypercholesterolemia group had an overall effect size of −17.2 mg/dL, which was statistically significant.

Although the decrease in cholesterol was not large in the hypercholesterolemia group, some studies have shown that even a drop of 20 mg/dL in total serum cholesterol can reduce the incidence of heart disease by 10%–12%, Mr. McRae said.

The results indicate that supplementation with at least 500 mg of vitamin C daily for at least 8 weeks can moderately reduce total serum cholesterol for those with hypercholesterolemia, he said.

RENO, NEV. — Vitamin C supplementation may result in a small reduction in systolic blood pressure for hypertensive individuals and may help lower cholesterol in patients with hypercholesterolemia, according to the results of two meta-analyses presented at the annual meeting of the American College of Nutrition.

But vitamin C does not appear to be effective in lowering diastolic blood pressure among patients with hypertension, said Marc McRae of the department of nutrition and biochemical therapeutics at the National University of Health Sciences in Lombard, Ill., who presented the findings.

Mr. McRae and his colleagues performed a Medline search of randomized, double-blind controlled trials on the impact of daily vitamin C supplementation on systolic and diastolic blood pressure among hypertensive individuals. The researchers searched for studies published before January 2006.

A total of nine studies met the inclusion criteria, and the data were then extracted and analyzed. The pooled population of the studies included 297 subjects with a weighted mean baseline systolic blood pressure of 151.0 mm Hg and a weighted mean baseline diastolic pressure of 83.6 mm Hg. Study participants had taken a median daily dose of 500 mg of vitamin C over a 6-week median duration.

Overall, there was a small effect of vitamin C supplementation on systolic blood pressure, with an effect size of −2.4 mm Hg, which was statistically significant. The effect size for diastolic pressure was less than −0.5 mm Hg, which was not statistically significant.

Although the effect size for systolic blood pressure was small, previous studies have estimated that a sustained reduction of 2–3 mm Hg in systolic blood pressure can result in a 6% drop in the risk for stroke and a 4% reduction in the risk for heart disease, Mr. McRae said.

The results indicate that supplementation with at least 500 mg/day of vitamin C for approximately 6 weeks can lead to a small reduction in systolic blood pressure, he said.

In the second meta-analysis, Mr. McRae and his colleagues completed a similar evaluation of the impact of daily vitamin C intake among individuals with borderline-high and high cholesterol levels.

The researchers conducted another Medline search of studies published before January 2006, and included 16 studies that were randomized controlled trials of individuals with cholesterol levels greater than 200 mg/dL and a daily vitamin C intake of at least 500 mg.

The researchers divided the trials according to the baseline total serum cholesterol levels of the study participants. A total of 444 pooled subjects had borderline-high total cholesterol levels between 200 mg/dL and 240 mg/dL. Among those subjects, the median daily vitamin C intake was 1,000 mg over a median 6-week duration. This borderline-high cholesterol group had an effect size of −7.6 mg/dL, which was not significant.

A total of 307 pooled subjects had hypercholesterolemia with baseline total serum cholesterol levels greater than 240 mg/dL.

Study participants in that group had a median daily vitamin C intake of 1,000 mg over an 8-week median duration. The hypercholesterolemia group had an overall effect size of −17.2 mg/dL, which was statistically significant.

Although the decrease in cholesterol was not large in the hypercholesterolemia group, some studies have shown that even a drop of 20 mg/dL in total serum cholesterol can reduce the incidence of heart disease by 10%–12%, Mr. McRae said.

The results indicate that supplementation with at least 500 mg of vitamin C daily for at least 8 weeks can moderately reduce total serum cholesterol for those with hypercholesterolemia, he said.

RENO, NEV. — Vitamin C supplementation may result in a small reduction in systolic blood pressure for hypertensive individuals and may help lower cholesterol in patients with hypercholesterolemia, according to the results of two meta-analyses presented at the annual meeting of the American College of Nutrition.

But vitamin C does not appear to be effective in lowering diastolic blood pressure among patients with hypertension, said Marc McRae of the department of nutrition and biochemical therapeutics at the National University of Health Sciences in Lombard, Ill., who presented the findings.

Mr. McRae and his colleagues performed a Medline search of randomized, double-blind controlled trials on the impact of daily vitamin C supplementation on systolic and diastolic blood pressure among hypertensive individuals. The researchers searched for studies published before January 2006.

A total of nine studies met the inclusion criteria, and the data were then extracted and analyzed. The pooled population of the studies included 297 subjects with a weighted mean baseline systolic blood pressure of 151.0 mm Hg and a weighted mean baseline diastolic pressure of 83.6 mm Hg. Study participants had taken a median daily dose of 500 mg of vitamin C over a 6-week median duration.

Overall, there was a small effect of vitamin C supplementation on systolic blood pressure, with an effect size of −2.4 mm Hg, which was statistically significant. The effect size for diastolic pressure was less than −0.5 mm Hg, which was not statistically significant.

Although the effect size for systolic blood pressure was small, previous studies have estimated that a sustained reduction of 2–3 mm Hg in systolic blood pressure can result in a 6% drop in the risk for stroke and a 4% reduction in the risk for heart disease, Mr. McRae said.

The results indicate that supplementation with at least 500 mg/day of vitamin C for approximately 6 weeks can lead to a small reduction in systolic blood pressure, he said.

In the second meta-analysis, Mr. McRae and his colleagues completed a similar evaluation of the impact of daily vitamin C intake among individuals with borderline-high and high cholesterol levels.

The researchers conducted another Medline search of studies published before January 2006, and included 16 studies that were randomized controlled trials of individuals with cholesterol levels greater than 200 mg/dL and a daily vitamin C intake of at least 500 mg.

The researchers divided the trials according to the baseline total serum cholesterol levels of the study participants. A total of 444 pooled subjects had borderline-high total cholesterol levels between 200 mg/dL and 240 mg/dL. Among those subjects, the median daily vitamin C intake was 1,000 mg over a median 6-week duration. This borderline-high cholesterol group had an effect size of −7.6 mg/dL, which was not significant.

A total of 307 pooled subjects had hypercholesterolemia with baseline total serum cholesterol levels greater than 240 mg/dL.

Study participants in that group had a median daily vitamin C intake of 1,000 mg over an 8-week median duration. The hypercholesterolemia group had an overall effect size of −17.2 mg/dL, which was statistically significant.

Although the decrease in cholesterol was not large in the hypercholesterolemia group, some studies have shown that even a drop of 20 mg/dL in total serum cholesterol can reduce the incidence of heart disease by 10%–12%, Mr. McRae said.

The results indicate that supplementation with at least 500 mg of vitamin C daily for at least 8 weeks can moderately reduce total serum cholesterol for those with hypercholesterolemia, he said.

Two major Medicare Part D drug plans have stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.

RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.

With these announcements, SilverScript, a subsidiary of Caremark, becomes the only one of the nine national or near-national Part D drug plan sponsors that still requires prior authorization, according to the Alzheimer's Association. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.

Earlier this year, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.

“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association, said in the letter.

Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association.

Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.

Two major Medicare Part D drug plans have stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.

RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.

With these announcements, SilverScript, a subsidiary of Caremark, becomes the only one of the nine national or near-national Part D drug plan sponsors that still requires prior authorization, according to the Alzheimer's Association. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.

Earlier this year, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.

“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association, said in the letter.

Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association.

Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.

Two major Medicare Part D drug plans have stopped requiring prior authorization for coverage of Alzheimer's medications, according to officials at the Alzheimer's Association.

RxAmerica and Medco no longer will require physicians to go through the prior authorization process before they prescribe Aricept (donepezil), Exelon (rivastigmine), Razadyne (galantamine), and Namenda (memantine) for Medicare Part D beneficiaries over age 65.

With these announcements, SilverScript, a subsidiary of Caremark, becomes the only one of the nine national or near-national Part D drug plan sponsors that still requires prior authorization, according to the Alzheimer's Association. Caremark spokesman Dale Thomas said the company is in contact with officials at the Centers for Medicare and Medicaid Services and the Alzheimer's Association but had no further comment at press time.

Earlier this year, officials with the Alzheimer's Association wrote to CMS citing problems that beneficiaries had getting access to Alzheimer's drugs after the end of the initial Medicare Part D transition period. The group also noted in its letter that it was “unrealistic and unreasonable” for prior authorization denials to be addressed through the appeals process.

“Neither frail patients nor their physicians can be expected to navigate the plan system and file additional documentation in order to obtain these medications that are on the plan's formulary,” Stephen McConnell, vice president of advocacy and public policy at the Alzheimer's Association, said in the letter.

Officials at the Alzheimer's Association sent copies of the letter to the three Part D drug plans and received quick responses from RxAmerica and Medco about plans to change their policies, according to Leslie B. Fried, director of the Medicare Advocacy Project of the Alzheimer's Association.

Removing prior authorization is vital, according to Dr. Marc Nuwer, professor of neurology at the University of California in Los Angeles. For every prior authorization request, the physician has to go back over the patient records looking for dates and other treatment information. “It's a hassle,” he said.

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor children. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement. “They may lead to new tools that will help us screen for those who are most vulnerable.”

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. These figures are based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern that requires action from multiple segments of our society,” Eric Broderick, SAMHSA acting deputy administrator, said in a statement. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how the CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003.

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. Smoking rates are highest among people with less education–43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely attributable to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report come from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. The report is available online at

www.hschange.org/CONTENT/891/

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor children. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement. “They may lead to new tools that will help us screen for those who are most vulnerable.”

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. These figures are based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern that requires action from multiple segments of our society,” Eric Broderick, SAMHSA acting deputy administrator, said in a statement. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how the CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003.

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. Smoking rates are highest among people with less education–43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely attributable to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report come from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. The report is available online at

www.hschange.org/CONTENT/891/

Paxil Settlement

The pharmaceutical giant GlaxoSmithKline has agreed to settle a class action lawsuit that alleged that the company inappropriately promoted the antidepressant Paxil to children. The $63.8 million settlement will include any individuals in the United States who bought Paxil or Paxil CR for their minor children. GlaxoSmithKline agreed to settle the case in order to avoid “protracted litigation” but officials there believe they acted appropriately, company spokeswoman Mary Anne Rhyne said. The settlement agreement is expected to receive final court approval in March 2007.

Investigating SSRIs and Suicide

Officials at the National Institute of Mental Health, part of the National Institutes of Health, are funding new research to help answer questions about the association between selective serotonin reuptake inhibitors (SSRIs) and suicidality. The projects, which will be conducted at academic medical centers across the country, will draw on data from the Food and Drug Administration, the Department of Veterans Affairs, Medicare, and the National Death Index. In one study being conducted at the University of Florida, researchers will examine whether an “activation syndrome” exists among certain young people that is brought on by SSRIs and can lead to suicidality. “These new, multiyear projects will clarify the connection between SSRI use and suicidality,” Dr. Thomas Insel, director of the National Institute of Mental Health, said in a statement. “They may lead to new tools that will help us screen for those who are most vulnerable.”

Misusing Rx Pain Relievers

More people are misusing prescription pain relievers for the first time than are trying marijuana, according to a report from the Substance Abuse and Mental Health Services Administration. About 2.7 million individuals aged 12 years and older reported misuse of prescription pain relievers in the past year, compared with 2.1 million who said they started using marijuana in the last year. These figures are based on the combined results of the 2002 and 2004 National Survey on Drug Use and Health. Overall, marijuana users are still outpacing prescription drug abusers. An annual average of about 11.3 million individuals aged 12 years and older reported using prescription pain medications nonmedically in the past year, compared with an average of 25.5 million individuals who had used marijuana in the past year. “While marijuana continues to be the most commonly used illicit drug, the misuse of prescription drugs is clearly a growing national concern that requires action from multiple segments of our society,” Eric Broderick, SAMHSA acting deputy administrator, said in a statement. The report is available online at

http://oas.samhsa.gov/prescription/toc.htm

House Investigates CDC Finances

Members of Congress are looking into alleged financial problems at the Centers for Disease Control and Prevention. In a letter, members of the House Energy and Commerce Committee requested that CDC officials provide an analysis done by Deloitte Consulting L.L.C. detailing “inefficiency and ineffective leadership” in the agency's finance office. Committee chairman Joe Barton (R-Texas) and chairman of the committee's subcommittee on oversight and investigations, Rep. Ed Whitfield (R-Ky.), also requested information on how the CDC manages human tissue samples and laboratory equipment. The congressmen also asked to be briefed on the status of CDC's reorganization, ongoing since June 2003.

Smoking Rates Level Off

An 8-year decline in adult smoking rates may be flattening, according to the CDC. The agency analyzed self-reported data from the 2005 National Health Interview Survey and found that the nation is falling behind in efforts to reduce cigar and cigarette smoking, use of smokeless tobacco, and adult quit attempts. In 2005, 21% of adults, or 45 million Americans, were smokers; of those, 43% had tried to quit. About 2% were cigar or smokeless tobacco users. All the rates were unchanged from 2004, the authors said in the Oct. 27 Morbidity and Mortality Weekly Report. Smoking rates are highest among people with less education–43% of those with a General Educational Development diploma; the rate is 30% among those living at or below the poverty level. Meanwhile, a Zogby International poll of 1,200 registered voters commissioned by the Drug Policy Alliance found that 45% were in favor of banning cigarettes within 5–10 years.

Health IT Gaps

The adoption gap in health information technology continues to widen, with physicians in smaller practices being left behind, according to a report from the Center for Studying Health System Change (HSC). Between 2000–2001 and 2004–2005, physicians in all types of practices increased their use of health IT for accessing patient notes, generating preventive care reminders, exchanging clinical data, obtaining treatment guidelines, and writing prescriptions. But practices with two or fewer physicians increased their use of health IT for writing prescriptions by 5%, compared with 28% among practices with more than 50 physicians. The gaps are likely attributable to the greater financial resources of larger practices along with more administrative resources and economies of scale. The data in the report come from the HSC Community Tracking Study Physician survey, a nationally representative telephone survey of physicians involved in direct patient care in the United States. The report is available online at

www.hschange.org/CONTENT/891/